CCRN-NEONATAL sample questions

Question 1

A full-term infant delivered via emergent cesarean section for non-reassuring fetal heart tones presents at 3 hours of life with marked central cyanosis, tachypnea, and grunting. The infant is placed on an oxygen hood with 100% FiO2.

Simultaneous arterial blood gas analysis reveals a pre-ductal (right radial) PaO2 of 88 mmHg and a post-ductal (umbilical arterial catheter) PaO2 of 44 mmHg. Pre-ductal pulse oximetry shows 94% on the right wrist, while post-ductal pulse oximetry displays 81% on the left foot. An echocardiogram is urgently ordered to rule out congenital heart defects.

Which physiological diagnosis is most consistently supported by this pre- and post-ductal oxygenation gradient?

Accepted Answer

Right-to-left ductal shunting secondary to persistent pulmonary hypertension of the newborn (PPHN)

Answer

Tetralogy of Fallot with critical pulmonary stenosis and dynamic infundibular spasm

Answer

Total anomalous pulmonary venous return with severe infradiaphragmatic obstruction

Answer

Transposition of the great arteries with intact ventricular septum

Question 2

A 2-day-old term infant with unrecognized critical aortic coarctation undergoes acute spontaneous functional closure of the ductus arteriosus. Which TWO clinical findings indicate systemic hypoperfusion resulting from this ductal closure? (Select TWO)

Accepted Answer

Marked upper-to-lower extremity systolic blood pressure gradient with absent or diminished femoral pulses

Accepted Answer

Profound metabolic acidosis accompanied by acute oliguria and delayed capillary refill

Answer

Significantly elevated right-to-left shunting across a large ventricular septal defect

Answer

Bounding dorsalis pedis pulses with wide pulse pressure in the lower extremities

Answer

Isolated bounding neck veins with acute hepatomegaly in the absence of metabolic debt

Question 3

A neonate is delivered at 38 weeks' gestation with prenatal ultrasound findings concerning for a left-sided congenital diaphragmatic hernia (CDH). Immediately following delivery, the infant is apneic with a scaphoid abdomen and heart sounds displaced toward the right hemithorax. What is the immediate priority nursing intervention in the delivery room?

```mermaid
flowchart TD
Delivery([Delivery of CDH Infant]) --> CheckResp{Respiratory Distress?}
CheckResp -->|Yes| Intubate[Immediate Endotracheal Intubation]
CheckResp -->|Avoid| BagMask[Bag-Mask Ventilation CONTRAINDICATED]
Intubate --> Decompress[Insert Replogle/OG Tube to Low Continuous Suction]
```

Accepted Answer

Perform emergent endotracheal intubation and place an orogastric decompression tube

Answer

Apply high-flow nasal cannula at 6 L/min with heated humidified room air

Answer

Administer empirical intratracheal exogenous surfactant via a thin laryngeal catheter

Answer

Initiate bag-mask ventilation with positive end-expiratory pressure of 5 cmH2O

Question 4

A term newborn shortly after birth exhibits excessive, frothy oral secretions that bubble from the mouth and nose. When the nurse attempts to pass an 8-French orogastric tube to decompress the stomach prior to the initial feeding, the catheter meets firm resistance and curls back in the upper esophagus at approximately 10 cm. Which congenital anomaly should the critical care nurse immediately suspect?

Accepted Answer

Esophageal atresia with or without tracheoesophageal fistula (TEF-EA)

Answer

Bilateral bony choanal atresia with posterior nasopharyngeal stenosis

Answer

Congenital pulmonary airway malformation of the left lower bronchial tree

Answer

Congenital high airway obstruction syndrome secondary to laryngeal webs

Question 5

A multidisciplinary NICU quality improvement committee is reviewing evidence-based respiratory management protocols for spontaneously breathing preterm infants born between 26 and 29 weeks' gestation. Based on randomized clinical trials and neonatal resuscitation guidelines, what is the primary clinical benefit of initiating respiratory stabilization with continuous positive airway pressure (CPAP) compared to routine prophylactic endotracheal intubation?

Accepted Answer

Significant reduction in the combined outcome of death and bronchopulmonary dysplasia (BPD)

Answer

Complete elimination of pulmonary air leak syndromes including tension pneumothoraces

Answer

Immediate elevation in surfactant synthesis and functional residual capacity stabilization within 10 minutes

Answer

Total prevention of severe grade III and IV intraventricular hemorrhages

Question 6

The resuscitation team attends the precipitous vaginal birth of an infant born at 31 weeks' gestation. The newborn is apneic and limp with a heart rate of 80 bpm. In accordance with neonatal resuscitation guidelines, what initial fraction of inspired oxygen (FiO2) should the nurse ensure is dialed on the gas blender when positive-pressure ventilation (PPV) is initiated?

Accepted Answer

21% to 30% FiO2 (0.21 to 0.30)

Answer

40% to 50% FiO2 (0.40 to 0.50)

Answer

100% FiO2 (1.00)

Answer

60% to 75% FiO2 (0.60 to 0.75)

Free CCRN-NEONATAL sample questions

A 2-day-old term infant with unrecognized critical aortic coarctation undergoes acute spontaneous functional closure of the ductus arteriosus. Which TWO clinical findings indicate systemic hypoperfusion resulting from this ductal closure? (Select TWO)

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