Question 1

A 7 year old child is brought to hospital with complaint of excessive thirst. Her mother tells that she usually drinks more than 60 regular glass of water daily but still feels thirsty and has to urinate frequently almost more than 20 times/day. Her appetite is normal and weight is normal for her age. She was irradiated for craniopharyngioma at the age of 5 years. Which of the following is best medication to control her symptoms?

Accepted Answer

Vasopressin is best treatment option to control her symptoms of polydipsia and polyuria as she is most likely suffering from diabetes insipidus.Vasopressin causes release of antidiuretic hormone or ADH from endothelium which is deficient in diabetes insipidus.

Question 2

A 4 year old boy presents with the complaints of fatigue, low grade fever and generalized lymphadenopathy. Which of following is most common type of blood cancer in this age group?

Accepted Answer

Acute lymphocytic leukemia or ALL is most common type blood cancer in 2-5 years age group. ALL is caused by a defect in the stem cells that differentiate into lymphocytes.
Overall survival rates with adequate treatment are about 80%.

Question 3

A 6 year old girl is brought to emergency department after having a deep stab wound on left side of her lower abdomen. On her neurological examination she has left leg paralysis and loss of pain and thermal sensation of right leg and right lower abdomen below injury. Which of following is most likely diagnosis?

Accepted Answer

Lateral cord syndrome is most likely injury. It is characterized by ipsilateral (same side) paralysis and contra lateral (opposite side) loss of pain and thermal sensation below injury. It is usually caused by hemi section of spinal cord by knife injury or fracture dislocations.

Question 4

A 4 week old child is brought to hospital by his mother after he started vomiting whatever he eats. After vomiting he becomes hungry. Vomiting is projectile in nature and contains the food particles. On examination a palpable mass is felt in upper abdomen and signs of dehydration are present. Which of the following diagnostic modalities will most likely help to confirm the diagnosis?

Accepted Answer

Abdominal ultrasound will most likely help to confirm the diagnosis of hypertrophic pyloric stenosis. It is more common in boys > 3 weeks old. Vomiting is projectile and non-bilious. Onset of symptoms is usually >3weeks: Surgical pyloromyotomy is definitive treatment.

Question 5

A 1 year old child is brought to emergency department by his mother with the complaints of lethargy, drowsiness and altered level of consciousness. He is suffering from severe diarrhea for last 3 days and is not eating or drinking well. He is most likely having electrolyte imbalance. Which of following is primary action in ECF to maintain ECF levels for tissue perfusion?

Accepted Answer

Sodium is the primary action in ECF to maintain ECF levels for tissue perfusion. Sodium (Na) regulates fluid volume, osmolality, acid-base balance, and activity in the muscles, nerves and myocardium. Normal value: 135-145 mEq/L.

Question 6

A 39 week pregnant mother is on the labour and delivery ward and is asking the nurse on duty to explain some things about fetal circulation. She specifically asks that if not, any function in the lungs while in the womb where does the majority of the blood go? What should the nurse on duty respond?

Accepted Answer

With non-functioning lungs, most blood bypasses the right ventricle, and the blood shunts directly from the right to the left atrium through the foramen ovale, a small opening with a valve, the septum primum, to prevent backflow, and to the ascending aorta and cranial arteries.

Question 7

In a neonate whom was just born 4 hours previously, when does Atrioventicular Node conduction of impulse occur?

Accepted Answer

Atrioventricular node conduction of impulse: This occurs when the impulses from the SA node reach the AV node in the right atrial wall near the tricuspid valve.

Question 8

A 28 hour old infant is diagnosed with a mitral valve defect on auscultation by the neonatalogost. What is the mitral valve called?

Accepted Answer

The mitral valve (left atrioventricular valve). It is a bicuspid valve in that is comprised of two leaflets, which are circled by a fibrotic ring called the mitral valve annulus.

Question 9

A 3 week premature infant in the neonatal intensive care unit is showing signs of being in pain. The neonatal nurse on duty is responsible for doing a pain assessment on the infant. What scale or system will the neonatal nurse on duty use to determine the level of pain the infant is displaying?

Accepted Answer

The scale the neonatal nurse on duty will use to determine the level of pain the infant is displaying is the BIPP. The BIPP stands for Behavioral Indicators of Infant Pain and includes monitoring facial actions, sleep patterns, wake patterns, and hand movements.

Question 10

A neonate was admitted to the nursery for observation 48 hours after birth for showing signs of not wanting to eat, lethargic, apnea, irritable crying, and the mother suspected the neonate may have had a seizure. However, the neonatal nurse on duty disagrees with the mother. What is this neonate most likely suffering from?

Accepted Answer

The neonate is most likely suffering from acute hypertension as demonstrated by the signs and symptoms. If the neonate was suffering from severe acute hypertension the neonate would be presenting with more severe symptoms such as those in cardiogenic shock or congestive heart failure.

Question 11

Baby Dennis is diagnosed by echocardiogram with an atrial septal defect. The specific defect that baby Dennis suffers from is as the result of a reabsorption of the septum primum and/or the septum secundum being undeveloped. What specific type of atrial septal defect is baby Dennis most likely suffering from?

Accepted Answer

The specific type of atrial septal defect that baby Dennis is likely suffering from is ostium secundrum defect. This is the least worrisome of all the atrial septal defects and also the one most often diagnosed. The defect is detected in the fossa ovalis area.

Question 12

A 26 hour old infant is showing signs of cyanosis, metabolic acidosis and is entering into respiratory distress. A clinical cardiac assessment is started by the neonatologist and there is indication that there is filling in the right ventricular. In addition to this there is a very distinct second heart sound detected. It is suspected that the diagnosis is hypoplastic left heart syndrome (HLHS). The circulation in the infant diagnosed with HLHS differs in what way?

Accepted Answer

The circulation in the infant diagnosed with HLHS differs in that there is a larger quantity of flow across the ductus arteriosis. Because of this the level of PO2 is increased in infants with HLHS.

Question 13

A 25 year old diabetic mother gives birth to a 9.5 lb. infant who after 3 hours of birth begins to exhibit symptoms of hypoglycemia and a blood glucose level is drawn that is 6.5 mg/dL. Which of the following is this infant at risk of developing?

Accepted Answer

An infant born to a diabetic mother who begins to exhibit symptoms of hypoglycaemia 3 hours after birth is at risk of developing cardiovascular anomalies. Statistics show that 30% of infants born of diabetic mothers can suffer from cardiac hypertrophy which is the most common cardiac anomaly.

Question 14

In the neonatal intensive care unit, the neonatal nurse on duty notes that one of the neonates is experiencing breathing difficulties. The neonatal nurse also notices that the neonate's upper extremities appear pink while the lower extremities appear blue. What should be the next immediate management for the neonatal nurse on duty?

Accepted Answer

In a neonate whose upper extremities appear pink while their lower extremities appear blue; the next immediate management for the neonatal nurse on duty should be to check the blood pressure in the upper and lower extremities. The presenting signs may be an indication of coarctation of the aorta.

Question 15

A one month old baby Derek was brought into the emergency department presenting with general malaise. His mother noted that baby Derek didn't want to waken for feedings and seemed generally listless and irritable. She also noticed that he didn't seem to be urinating very much. The triage nurse is concerned that the baby Derek may be in shock and immediately checks baby Derek's blood pressure. What would be the normal systolic blood pressure for baby Derek?

Accepted Answer

The normal systolic blood pressure for baby Derek, who is one month old is 70 mm Hg. If the systolic blood pressure was below this, baby Derek may indeed be going into shock.

Question 16

The emergency neonatal nurse who is looking after an infant presenting with shock must determine if they are dealing with cardiac or noncardiogenic shock. This can best be accomplished by doing what?

Accepted Answer

For an infant presenting in potential shock it is important to determine if they are in cardiac and noncardiogenic shock; this can best be accomplished by checking the infant for hepatomegaly. This is more reliable than trying to determine if the jugular venous pressure is distended as it is not as easily recognized in infants.

Question 17

An intravenous fluid treatment of 0.9 % normal saline has been ordered for an infant that presented to the emergency department with slight tachycardia, significant decrease in urination, absence of tears when crying and dry mucous membranes. The emergency room physician has diagnosed the infant with hypovolemic shock. In order to correct the problem over a 24 hour period, how much of the lost fluids can be replaced in the first 8 hours?

Accepted Answer

In an infant in hypovolemic shock whom requires intravenous fluid treatment over a 24 hour period ½ of the lost fluid can be replaced in the first 8 hours. This is because sodium levels should only rise by 0.5meq/L/hr to prevent seizures.

Question 18

Baby Diane is being assessed for potential cardiac problems after a murmur was detected on initial physical examination. What is the most common heart condition found in infants at birth?

Accepted Answer

The most common heart condition found in infants at birth is congenital heart disease. It is estimated that there are approximately 13 infants born with congenital heart disease out of every one thousand births.

Question 19

When teaching a mother how to prevent accidents while caring for her 6-month-old, the nurse should emphasize that this age child can usually:

Accepted Answer

Muscular coordination and perception are developed enough at 6 months so that infant can roll over. If unaware of this ability of the infant, the mother could leave the child unattended for a moment to reach for something and the child could roll off the crib.

Question 20

The response that would be unusual in infants subjected to prolonged hospitalization would be:

Accepted Answer

Excessive crying and clinging are the usual responses of an infant who expects to be comforted, not one who has experienced prolonged separation from a parent because of illness.

Quiz 2: Neonatal