NRP 7th edition part 1 Section 1

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A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated?

Insert a laryngeal mask

You are at the resuscitation of a newborn who is gasping and has a heart rate of 60 beats per minute. What is the most important action you can take?

Provide positive-pressure ventilation

What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)?

2.5 mm

Your team attends an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation?

Start positive-pressure ventilation and check heart rate response after 15 seconds

During the resuscitation of a newborn, you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team?

100 beats per minute

You are part of a team preparing for the birth of a baby who has meconium-stained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be

Present at the birth.

You are at a delivery of a baby born through meconium-stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth?

The baby should be brought to the radiant warmer for initial steps of newborn care.

What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial steps?

Administration of positive-pressure ventilation that inflates the lungs

A newborn of 34 weeks’ gestation is not breathing (apneic) at birth, does not respond to initial steps and requires positive-pressure ventilation. What concentration of oxygen should be used as you begin positive-pressure ventilation?

21 – 30% oxygen

You have started positive-pressure ventilation for a newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation?

A rising heart rate

A baby requires positive-pressure ventilation because she is not breathing (apneic), but she soon establishes spontaneous respirations and a heart rate over 100 beats per minute. Her oxygen saturation is lower than the target level when in room air, so you provide free-flow oxygen. Which of the following devices cannot reliably deliver free-flow oxygen?

Mask of self-inflating bag

Which statement best describes normal transitional physiology at the time of birth?

Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.

A baby is born at 34 weeks’ gestation. After the initial steps of resuscitation, the baby is not breathing (apneic). What are the next steps?

Initiative positive-pressure ventilation, place a pulse oximeter sensor on the right hand or wrist, evaluate heart rate.

A full-term baby is born by emergency cesarean delivery because of fetal bradycardia (Category III fetal heart rate tracing). The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process?

Initiate positive-pressure ventilation and check for increasing heart rate

What is the appropriate technique to stimulate a baby to breathe?

Gently rub the baby’s back or extremities

You are called to attend to a newborn at birth. At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with his mother or be moved to the radiant warmer for further assessment?

Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying?

What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room?

Place an oximeter sensor on the baby’s right hand or wrist and assess oxygen saturation.

You have determined a baby needs resuscitation at birth. What are the initial steps of newborn care?

Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate

The steps of intubation should ideally be completed within which duration?

30 seconds

Effective team functioning is critical in ensuring the best performance. Which of these characteristics is critical in team leaders?

They should be able to maintain situational awareness.

You have been called to attend a birth and are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help?

Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.

After the initial steps of newborn care, a baby is apneic. What is the most important and effective action to take in the resuscitation of this baby?

Provide positive-pressure ventilation.

Which statement describes recommended practice when using a pulse oximeter in the delivery room?

Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation.

Which of the following is an indication for endotracheal intubation?

The need for positive-pressure ventilation lasting more than a few minutes

Your hospital is planning Neonatal Resuscitation Program® training and trying to decide who should be included.
For every delivery, what is the minimum requirement for care of the newborn at birth?

Someone capable of initiating neonatal resuscitation should be present at every delivery whose only responsibility is management of the newborn.

A premature newborn is born apneic and requires ongoing respiratory support and chest compressions. You and 3 colleagues provide care immediately following birth. What behavioral skills are critical to ensure successful and optimal care during resuscitation?

Teamwork, leadership, communication

A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of positive-pressure ventilation that moves the chest. Your team plans to intubate. Which of the following is a true statement regarding the procedure?

The baby should be positioned on a flat surface with the neck slightly extended.

Remembering MR. SOPA helps your team correct problems with ventilation. Which of the following steps are included in MR. SOPA?

Adjust Mask and Reposition head and neck; Suction mouth then nose and Open the mouth; increase Pressure; insert Alternative airway

What is the preferred technique for removing secretions from the mouth and nose of a newborn who requires resuscitation?

Suction the mouth before the nose.

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