Lesson 1: Overview and Principles of Resuscitation

Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
A full-term newborn is apneic after birth and fails to respond to tactile stimulation.
Newborns in secondary apnea usually respond with an increase in heart rate after which intervention?
Answers
Administration of free-flow 100% oxygen
Increasingly vigorous tactile stimulation
Chest compressions at a rate of 30 per minute
Effective positive-pressure ventilation
Next
Question 2 of 12
A caregiver states that he can always predict which babies will need help at birth.
You disagree because you know that ____% of newborns require initial assessment to determine whether resuscitation is required.
Answers
10%
1%
50%
100%
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Question 3 of 12
After the initial steps in resuscitation, a newborn is apneic with a heart rate less than 100 beats per minute.
What is the most important and effective action to take in the resuscitation of this baby?
Answers
Provide supplemental oxygen.
Ventilate the lungs.
Give epinephrine.
Perform chest compressions.
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Question 4 of 12
A newborn requires resuscitation, and you have begun positive-pressure ventilation and chest compressions.
Which 3 signs are used to evaluate the effectiveness of your actions and the need to continue some aspect of support?
Answers
Respirations, heart rate, assessment of oxygenation
Blood pressure, assessment of oxygenation, heart rate
Respirations, blood pressure, assessment of oxygenation
Respirations, muscle tone, and heart rate
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Question 5 of 12

A prenatal class is learning about labor and birth.

Approximately ________% of newborns require some assistance to begin breathing at birth?
Answers
30%
10%
5%
1%
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Question 6 of 12
Your hospital is planning Neonatal Resuscitation Program training and trying to decide who should be included.
For every delivery, who should be available?
Answers
Someone should be identified at every delivery as the person to call for help with the baby
Someone capable of initiating resuscitation should be present at every delivery and available to care for the baby
Someone skilled in neonatal resuscitation should be available in the hospital to be called for deliveries
Someone capable of initiating resuscitation should be present if risk factors are identified
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Question 7 of 12
You have determined that a baby needs resuscitation at birth.
What are the initial steps of resuscitation?
Answers
Provide warmth, position head to open airway, evaluate heart rate.
Provide warmth, position head to open the airway, dry and stimulate.
Provide warmth, evaluate color and respirations, evaluate heart rate.
Position head to open the airway, dry and stimulate, evaluate heart rate.
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Question 8 of 12
You are called to attend to a newborn at birth.
Which 3 questions should you ask to help assess the need for resuscitation?
Answers
Is the baby of term gestation? Is the baby breathing or crying? Does the baby have good tone?
Is the amniotic fluid clear? Is the baby breathing or crying? Is the baby of low birth weight?
Is the baby warm? Does the baby have good tone? Is the of baby full-term gestation?
Is the baby pink? Is the baby breathing or crying? Is the amniotic fluid clear?
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Question 9 of 12
A baby is born at 34 weeks gestation. Despite initial steps being taken, the baby is apneic and the heart rate is 70 beats per minute.
What steps should be taken next?
Answers
Begin positive-pressure ventilation, place an oximeter probe on the right hand or wrist, reevaluate in 30 seconds.
Administer free-flow oxygen, place oximeter probe on right hand or wrist, reevaluate in 30 seconds.
Administer continuous positive airway pressure (CPAP), place an oximeter probe on the right hand or wrist, evaluate color and tone.
Provide additional tactile stimulation, evaluate color and tone, reevaluate in 30 seconds.
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Question 10 of 12
You are called to a vacuum-assisted vaginal delivery that follows a period of non-reassuring fetal heart rate tracing. The baby emerges without a cry.

What physiologic response would support your assessment that the baby is in primary apnea, but not secondary apnea?
Answers
Respirations begin only after positive-pressure ventilation.
Blood pressure falls over several minutes.
Respirations begin in response to tactile stimulation.
Heart rate increases only after epinephrine administration.
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Question 11 of 12
Your hospital is staffed by several people skilled in neonatal resuscitation. Most of them have additional responsibilities away from the delivery room, a
While extra people may be useful, when should you first start to recruit additional help?
Answers
When, after birth, the obstetrician or labor nurse suggests that you need additional help
When, after birth, you determine that the baby requires intubation or other procedures
When you learn it is the birth of a multiple gestation, to care for the additional babies
When you anticipate the likely need for more advanced resuscitation based on the presence of any of the known perinatal risk factors
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Question 12 of 12
After several hours of labor with failure to progress, a baby is born via cesarean section. The baby cries at birth and is vigorous, but appears slightly dus
How long may it take for this normal baby to achieve an oxygen saturation of 90% or greater?
Answers
1 minute
2 minutes
5 minutes
10 minutes
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Lesson 2: Initial Steps of Resuscitation

Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
What is the best technique for removing secretions from the mouth and nose of a newborn who requires resuscitation?
Answers
Suction the nose before the mouth.
Suction the mouth or nose first.
Suction vigorously and deeply to clear secretions.
Suction the mouth before the nose.
Next
Question 2 of 12
Which statement best describes normal transitional physiology at the time of birth?
Answers

The oxygen saturation normally rises to at least 90% by 2 minutes of age.

Babies may take as long as 10 minutes after birth to increase their oxygen saturation to greater than 90%.
Oxygen saturation is unreliable, and 100% oxygen is often needed immediately after birth.
Evaluation of skin color is a reliable indicator of the babys transition.
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Question 3 of 12
During a resuscitation of a newborn, what is the ideal head position?
Answers
The neck should be slightly flexed.
The baby should be prone, with the head turned to the left.
The baby should be prone, with the head turned to the right.
The neck should be mildly extended.
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Question 4 of 12
Which statement accurately describes the role of oxygen in newborn resuscitation?
Answers
Free-flow oxygen may be administered using an oxygen mask held close to the babys face.
Most newborn resuscitations should begin with 100% oxygen.
A newborn in secondary apnea can be expected to resume normal respirations with the application of free-flow oxygen.
It is reasonable to expect most babies have a pre-ductal saturation (Spo 2) of >90% by 3 minutes of age.
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Question 5 of 12
What is the most effective maneuver to establish normal breathing in a baby with secondary apnea?
Answers
Application of positive-pressure ventilation
Gentle rubbing of the back
Administration of free-flow oxygen
Flicking of the soles of the feet
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Question 6 of 12
A baby is born with meconium-stained amniotic fluid. The baby has normal muscle tone and respiratory effort and a heart rate of 120 beats per minute.
What is the appropriate action?
Answers
Application of supplemental oxygen
Administration of mild chest physiotherapy
Intubation and suctioning of the trachea
Clearance of secretions from the mouth and nose with a bulb syringe
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Question 7 of 12
What is the best way to determine if a baby requires supplemental oxygen in the delivery room?
Answers
Send an arterial blood gas, and evaluate the partial pressure of oxygen.
Place an oximeter on the babys right hand or wrist.
Determine the color of the babys chest and abdomen, and monitor for central cyanosis.
Determine the color of the babys hands and feet.
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Question 8 of 12
You are at the resuscitation of a newborn who is gasping and has a heart rate of 90 beats per minute.

What is the most important action you can take?

Answers
Assist ventilation.
Provide chest compressions.
Apply mild chest physiotherapy.
Provide free-flow oxygen.
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Question 9 of 12
Which statement describes best practice when using a pulse oximeter?
Answers
The combination of an appropriately placed oximeter and knowledge of minute-by-minute normal oxygen targets should guide resuscitation.
The probe should be attached to the instrument prior to attaching it to the baby, to ensure the most rapid acquisition of a signal.
The probe should be placed in a reliable post-ductal location to guide the application of supplemental oxygen in the newborn.
Once the oximeter is placed in a pre-ductal location, begin resuscitation with 100% oxygen and titrate downward.
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Question 10 of 12
What is the appropriate technique to stimulate a baby to breathe?
Answers
Holding the baby upside down and gently patting the buttocks
Vigorously rubbing the back
Slapping or flicking the soles of the feet
Application of mild ocular pressure
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Question 11 of 12
During the resuscitation of a newborn, you palpate the umbilical cord and count 10 beats over a 6-second period. What heart rate do you report to your t
Answers
30 beats per minute
60 beats per minute
100 beats per minute
120 beats per minute
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Question 12 of 12
You are at a delivery of a baby born through meconium-stained amniotic fluid.
What is the correct indication for intubating and suctioning the trachea at birth?
Answers
The baby is not pink by 1 minute of life.
The baby has wet-sounding lungs.
The baby has poor tone and respiratory effort.
The meconium is thick.
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Lesson 3: Use of Resuscitation Devices for Positive-Pressure Ventilation

Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.

Use Next/Previous rather than the scroll bar.

Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
You attend the birth of a neonate at 30 weeks gestation who needs respiratory support.
What concentration of oxygen should be used in the resuscitation of this preterm baby?
Answers
Start with room air and adjust to keep oxygen saturations in target range.
Start with 100% oxygen and adjust to keep oxygen saturations in target range.
Start with a concentration somewhat higher than room air and adjust to keep oxygen saturations in target range.
Start with 100% oxygen and adjust concentration based on color.
Next

Question 2 of 12
A preterm newborn has respiratory distress after birth. Her heart rate is above 100 beats per minute, but she appears dusky. A team member has placed a
What level of oxygen saturation should you try to achieve?
Answers
Adjust your oxygen to keep the saturation at the level at which the baby appears pink to the team.
Adjust the oxygen level to achieve the target levels for oxygen saturation according to the babys age in minutes.
Adjust the oxygen level to keep the saturation levels between 85% to 95%.
Adjust the oxygen level to ensure that the saturation level is always 90% or greater.
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Question 3 of 12
You attend the birth of a newborn with another caretaker. The baby is born limp and apneic. Despite initial steps, you are required to provide the newbo
Answers
Listen for breath sounds, begin chest compressions, and prepare for intubation and medications.
Apply the pulse oximeter probe to any extremity, increase the oxygen concentration to 100%, and call for additional help.
Apply the pulse oximeter probe to the right hand or wrist, take over ventilations, and increase the heat on the radiant warmer.
Apply the pulse oximeter probe to the right hand or wrist, listen for a rising heart rate, and watch for rising oxygen saturations.
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Question 4 of 12
You are giving positive-pressure ventilation to a premature newborn in your delivery room; both a flow-inflating bag and a T-piece resuscitator are avail
What features of these two devices differ, making you consider using the T-piece resuscitator instead of the flow-inflating bag?
Answers
Only the T-piece resuscitator reliably delivers 100% oxygen.
Only the T-piece resuscitator delivers consistent, reliable pressure with each breath.
Only the T-piece resuscitator has an adjustable valve to regulate the amount of continuous positive airway pressure or positive end-expiratory pressure.
Only the T-piece resuscitator can be used to deliver continuous positive airway pressure.
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Question 5 of 12
You are part of a team resuscitating a premature newborn. Shortly after birth, the baby developed apnea, followed by bradycardia. Positive-pressure ven
remember potential corrective steps, using the acronym MR SOPA. Despite taking the first 4 corrective steps, M-R-S-O, there is still no chest rise. You
What are the final 2 corrective steps in the acronym MR SOPA?
Answers
P: Push chest (compressions) A: Airway alternative.
P: Pressure increase, A: Add drugs (epinephrine).
P: Pressure increase, A: Airway alternative.

P: Provide more oxygen, A: Ask for help.

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Question 6 of 12
You are giving positive-pressure ventilation to a baby, but there is no improvement.
What are the first steps you should take to correct possible problems?
Answers
M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: give more Oxygen.
M: Mask readjustment, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly.
M: Mask readjustment, R: Reposition the baby on his/her side, S: Suction the mouth and nose, O: Open the mouth slightly.
M: Move the baby to a firm surface, R: Reposition the airway, S: Suction the mouth and nose, O: Open the mouth slightly.
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Question 7 of 12
A baby is apneic, and has a heart rate less than 100 beats per minute. You have provided positive pressure-ventilation for 30 seconds.
What are the signs that positive-pressure ventilation has been effective and may be discontinued?
Answers
The heart rate is above 60 beats per minute, and the baby is making some respiratory effort.
The heart rate has increased to greater than 100 beats per minute, and the baby is making some respiratory effort.
The heart rate has increased to greater than 100 beats per minute, and the oxygen saturation is in the target range.
The heart rate has increased to greater than 100 beats per minute, and the baby has sustained spontaneous breathing.
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Question 8 of 12
A full-term baby is born following an emergency cesarean delivery for non-reassuring fetal heart rate patterns. The baby is apneic at birth, despite tacti
What is the single most important and effective step in resuscitation of this newborn?
Answers
Administration of supplemental oxygen
Providing additional tactile stimulation
Chest compressions
Ventilating the lungs
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Question 9 of 12
You are giving positive-pressure ventilation to a baby because he is apneic and bradycardic.
What is the most important indicator of successful positive-pressure ventilation?
Answers
Improvement in tone and movement
A rising heart rate
Audible and bilateral breath sounds
Chest rise with each breath
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Question 10 of 12
A full term newborn is apneic at birth and requires positive-pressure ventilation.

What concentration of oxygen should be used during resuscitation?

Answers
Room air may be used to start resuscitation of full-term newborns, with concentration adjusted based on the target oxygen saturation for the age in minu
40% to 60% oxygen should be used for resuscitation of full-term newborns, independent of color or oxygen saturation.
Room air should be used for resuscitation of full-term newborns, independent of color or oxygen saturation.
100 % oxygen should be used if the baby is a full-term newborn, independent of color or oxygen saturation.

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Question 11 of 12
A baby is born in the hospital lobby as his mother waited for admission. He is apneic, despite tactile stimulation, drying, and bulb suctioning. You have
What should your next step be?
Answers
Start positive-pressure ventilation using room air, and transport the baby to a care area.
Call for someone to bring a 100% oxygen tank and oximeter to the patient before starting positive-pressure ventilation.
Quickly transport the baby to a care area, and start positive-pressure ventilation with blended oxygen and monitor with an oximeter.
Monitor the heart rate; if it slows, begin positive-pressure ventilation with room air.
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Question 12 of 12
A baby is noticed to have unusual breathing after birth.
Which finding is an indication for using positive-pressure ventilation?
Answers
Chest asymmetry
Marked tachypnea
Apnea or gasping
Grunting and retractions
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Lesson 4: Chest Compressions

Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
Which is the appropriate position on this baby to apply chest compressions?
Answers
A
C
B
D
Next

Question 2 of 12
A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute.
What is your next action?
Answers
Stop both chest compressions and positive-pressure ventilation.
Continue chest compressions and positive-pressure ventilation.
Stop chest compressions; continue positive-pressure ventilation.

Administer epinephrine while continuing chest compressions and positive-pressure ventilation.

PreviousNext
Question 3 of 12
What is the preferred technique for chest compressions?
Answers
2-thumb technique
2-finger technique
Fist technique
Heel-of-hand technique
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Question 4 of 12
When are chest compressions indicated?
Answers
Whenever the heart rate is less than 60 beats per minute
When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation
When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation
Whenever the heart rate is less that 100 beats per minute
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Question 5 of 12
Your team begins administering chest compressions to a newborn.
Correct technique includes which of the following?
Answers
Thumbs or fingers remain in contact with the chest at all times.
Ventilate whenever possible.
2:1 ratio of compressions to breaths is being used.
Compression depth is one fourth the diameter of the chest.
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Question 6 of 12
A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos
seconds.
What should the next step in the resuscitation process should be?
Answers
Provide free-flow oxygen, and begin initiating chest compressions.
Continue stimulating the baby for an additional 30 seconds.
Provide positive-pressure ventilation for at least 30 seconds.
Initiate chest compressions using the 2-thumb technique.
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Question 7 of 12
Which of the following is a potential danger of administering chest compressions?
Answers
Gaseous distension of the stomach and intestinal tract
Traumatizing the spinal column
Providing excessive blood flow to vital organs
Fracturing ribs or injuring the liver
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Question 8 of 12
Your team begins administering chest compressions to a newborn.

Correct technique includes which of the following?

Answers
Thumbs or fingers are lifted off the chest during the relaxation phase.
Compression depth is one-fourth the diameter of the chest.
Chest compressions and ventilation are well coordinated.
A 2:1 ratio of compressions to breaths is being used.
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Question 9 of 12
A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch
What do you do next?
Answers
Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate.
Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes.
Increase oxygen concentration to ensure that the baby is well oxygenated.
Decrease oxygen concentration and discontinue pulse oximetry monitoring.
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Question 10 of 12
When chest compressions are indicated, you should also consider:
Answers
Immediately administering epinephrine
Increasing the temperature setting of the radiant warmer
Endotracheal intubation, if not already done
Repositioning the babys head
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Question 11 of 12
When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?
Answers
30 breaths, 90 compressions
60 breaths, 120 compressions
60 breaths, 60 compressions
40 breaths, 80 compressions
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Question 12 of 12
What is the ideal depth of chest compressions for a newborn?
Answers
One fourth the antero-posterior diameter of the chest
Half the antero-posterior diameter of the chest
One third the antero-posterior diameter of the chest
Two thirds the antero-posterior diameter of the chest.
Previous
Lesson 4: Chest Compressions
Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.

Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
Which is the appropriate position on this baby to apply chest compressions?
Answers
A
C
B
D
Next

Question 2 of 12
A baby required ventilation and chest compressions. After 45 seconds of chest compressions, the oximeter indicates a heart rate of 70 beats per minute.
What is your next action?
Answers
Stop both chest compressions and positive-pressure ventilation.
Continue chest compressions and positive-pressure ventilation.
Stop chest compressions; continue positive-pressure ventilation.
Administer epinephrine while continuing chest compressions and positive-pressure ventilation.
PreviousNext
Question 3 of 12
What is the preferred technique for chest compressions?
Answers
2-thumb technique
2-finger technique
Fist technique
Heel-of-hand technique
PreviousNext
Question 4 of 12
When are chest compressions indicated?
Answers
Whenever the heart rate is less than 60 beats per minute
When the heart rate remains less than 90 beats per minute after 30 seconds of effective positive-pressure ventilation
When the heart rate remains less that 60 beats per minute after 30 seconds of effective positive-pressure ventilation
Whenever the heart rate is less that 100 beats per minute
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Question 5 of 12
Your team begins administering chest compressions to a newborn.
Correct technique includes which of the following?
Answers
Thumbs or fingers remain in contact with the chest at all times.
Ventilate whenever possible.
2:1 ratio of compressions to breaths is being used.
Compression depth is one fourth the diameter of the chest.
PreviousNext

Question 6 of 12
A full-term baby is born by emergency cesarean delivery secondary to fetal bradycardia. The baby is limp and not breathing. The initial steps of dry, pos
seconds.

What should the next step in the resuscitation process should be?
Answers
Provide free-flow oxygen, and begin initiating chest compressions.
Continue stimulating the baby for an additional 30 seconds.
Provide positive-pressure ventilation for at least 30 seconds.
Initiate chest compressions using the 2-thumb technique.
PreviousNext
Question 7 of 12
Which of the following is a potential danger of administering chest compressions?
Answers
Gaseous distension of the stomach and intestinal tract
Traumatizing the spinal column
Providing excessive blood flow to vital organs
Fracturing ribs or injuring the liver
PreviousNext
Question 8 of 12
Your team begins administering chest compressions to a newborn.
Correct technique includes which of the following?
Answers
Thumbs or fingers are lifted off the chest during the relaxation phase.
Compression depth is one-fourth the diameter of the chest.
Chest compressions and ventilation are well coordinated.
A 2:1 ratio of compressions to breaths is being used.
PreviousNext

Question 9 of 12
A baby has been receiving positive-pressure ventilation and chest compressions. Her heart rate is now 110 beats per minute. Your team discontinues ch
What do you do next?
Answers
Gradually discontinue positive-pressure ventilation, while monitoring breathing and heart rate.
Continue positive-pressure ventilation at a rate of 40 to 60 breaths per minute for several more minutes.
Increase oxygen concentration to ensure that the baby is well oxygenated.
Decrease oxygen concentration and discontinue pulse oximetry monitoring.
PreviousNext
Question 10 of 12
When chest compressions are indicated, you should also consider:
Answers
Immediately administering epinephrine
Increasing the temperature setting of the radiant warmer
Endotracheal intubation, if not already done
Repositioning the babys head
PreviousNext
Question 11 of 12
When coordinating positive-pressure ventilation with chest compressions, how many events are performed each minute?
Answers
30 breaths, 90 compressions
60 breaths, 120 compressions
60 breaths, 60 compressions
40 breaths, 80 compressions

PreviousNext
Question 12 of 12
What is the ideal depth of chest compressions for a newborn?
Answers
One fourth the antero-posterior diameter of the chest
Half the antero-posterior diameter of the chest
One third the antero-posterior diameter of the chest
Two thirds the antero-posterior diameter of the chest.
Previous
Lesson 5: Endotracheal Intubation and Laryngeal Mask Airway Insertion
Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth we
Answers
2.5 mm
3.0 mm
2.0 mm
3.5 mm
Next
Question 2 of 12
You are uncertain whether you have successfully intubated a newborn.
Which of the following is an indication that the endotracheal tube is correctly placed in the trachea, and not in the esophagus?
Answers
Continued cyanosis and bradycardia.
Air is heard entering the stomach.
No vapor (mist) is detected in the endotracheal tube.
Carbon dioxide detector indicates the presence of expired carbon dioxide.
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Question 3 of 12
A full-term newborn has a heart rate less than 60 beats per minute despite 30 seconds of bag-and-mask ventilation. Your team plans to intubate. Which

Question 5 of 12
You are part of a team resuscitating a baby who has meconium-stained fluid. A person experienced in endotracheal intubation should be
Answers
Called in from home when a baby is born and requires intubation.
Immediately available to join the resuscitation team to assist at every delivery.

Not necessary if another team member knows how to place a laryngeal mask airway.
Called from an office near the hospital.
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Question 6 of 12
What is the approximate period within which one should ideally be able to intubate a newborn?
Answers
60 seconds
30 seconds
40 seconds
20 seconds
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Question 7 of 12
You have successfully intubated a newborn with an estimated 35-week gestational age newborn and an estimated birth weight of 2 kg.
What is the correct tip-to-lip depth of tube insertion for correct placement in the mid-trachea?
Answers
6 cm
7 cm
9 cm
8 cm
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Question 8 of 12
Which of the following is an indication for intubation?
Answers
The presence of thick meconium in a vigorous newborn who must be suctioned
The need to administer continuous positive airway pressure
The need for positive-pressure ventilation lasting beyond a few minutes
An estimated gestational age of less than 28 weeks
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Question 9 of 12
What size (internal diameter) endotracheal tube should you use when intubating a newborn of 30 weeks gestation with a birth weight of 1,200 g?
Answers
3.0 mm
2.5 mm
4.0 mm
3.5 mm
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Question 10 of 12
What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 30 weeks (estimated birth weight of 1,200 g)?
Answers
2
00
0
1
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Question 11 of 12
You are practicing the use of an algorithm to direct the sequence of interventions to correct ventilation.
In which situation will the placement of a laryngeal mask airway be useful?

Answers
When a term newborn with thick meconium has respiratory depression at birth
When positive-pressure ventilation with a face mask fails to achieve effective ventilation and intubation is not possible
When a newborn has facial or upper airway malformations and is breathing comfortably
When a 30-week preterm newborn requires surfactant in the delivery room
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Question 12 of 12
What size laryngoscope blade should be used to intubate a newborn with an estimated gestational age of 38 weeks and an estimated birth weight of 3200
Answers
1
00
0
2
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Lesson 6: Medications
Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
During resuscitation, one of your team members suggests that the baby might benefit from a bolus of fluid.
Which of the following is an indication for volume expansion during resuscitation?
Answers
The babys heart rate is 110 after resuscitative efforts and there is a history of extensive vaginal bleeding during labor
The babys heart rate is 120 after resuscitative efforts but she is very pale
The babys heart rate remains 70 after resuscitative efforts and pulses are weak
The babys heart rate is increasing with resuscitative efforts but his pulses seem weak
Next

Question 2 of 12
You are called to an emergency cesarean delivery of a 28-week gestational age baby because of prolonged rupture of membranes, chorioamnionitis, and
the baby is non-vigorous with apnea, very poor tone, and a gray color. The baby appears to be about 1 kg. You place the newborn in plastic wrap, cover
stimulate, but the baby remains apneic with a heart rate of 30 beats per minute. You initiate ventilation but have no improvement in heart rate or chest m
pressure (MR SOPA). You quickly intubate, confirm appropriate endotracheal tube placement, and secure the tube. The heart rate continues to be 30 bea
improvement in heart rate. You decide to administer epinephrine and a team member places an umbilical venous catheter.
What dose of 1:10,000 concentration epinephrine will best result in return of spontaneous circulation?
Answers
0.1 ml epinephrine via intravenous administration
0.5 ml epinephrine via endotracheal tube administration
0.5 ml epiephrine via intravenous administration
0.1 ml epinephrine via endotracheal tube administration
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Question 3 of 12
A 32-week gestational age baby is delivered following 50% abruption and has not responded to the initial steps of resuscitation, 30 seconds of positive-p
positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is administered. The epinephrine should be administered over the following timeframe

Answers
Over 1 to 2 minutes
Over 5 to 10 minutes
Rapid push as quickly as possible
Over 3 to 5 minutes
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Question 4 of 12
Which fluid is not a reasonable choice for volume expansion?
Answers
Ringers lactate
Normal saline
Placental blood drawn through umbilical vein
O Rh-negative blood
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Question 5 of 12
A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to
60 seconds of cardiac compressions coordinated with positive pressure ventilation in a 3:1 ratio. You decide to administer intravenous epinephrine.
Which vessel in the drawing should be used?
Answers
C
B
A
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Question 6 of 12
You are called to an emergency cesarean delivery of a term baby due to a Category 3 fetal heart rate monitoring strip. At your request, additional help ha
Despite repositioning, drying and stimulation, the newborn remains apneic with a heart rate of 30 beats per minute. You initiate ventilation and achieve
and secure the tube. The heart rate is now 30 beats per minute, and a team member begins chest compressions. Together you provide 45 to 60 seconds o
epinephrine via the endotracheal tube while another team member obtains IV access.
What is the appropriate dose of 1:10,000 concentration of epinephrine for endotracheal delivery to a 3 kg baby?
Answers
0.5 ml epinephrine via endotracheal tube
1.5 ml epinephrine via endotracheal tube
0.3 ml epinephrine via endotracheal tube
0.9 ml epinephrine via endotracheal tube
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Question 7 of 12
Which of the following medications may be used during the first several minutes of neonatal resuscitation?
Answers
Calcium
Epinephrine
Atropine
Sodium bicarbonate
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Question 8 of 12
A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to
seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. An emergency umbilical venous catheter is placed.
The catheter should be inserted

Answers
Just as far as the length of the umbilical stump
Two thirds of the shoulder-to-umbilical distance
Just far enough to get blood return
to a depth of 10 to 11 cm
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Question 9 of 12
You are called to an emergency cesarean delivery of a term baby because of chorioamnionitis, meconium-stained amniotic fluid, and late decelerations t
meconium staining, and a gray color. You quickly intubate and suction for meconium; none is obtained below the cords. You then reposition the baby, dr
What is the most appropriate next step of resuscitation?
Answers
Intubate and administer 0.05 mg/kg of endotracheal epinephrine.
Start cardiac compressions coordinated 3:1 with ventilation.
Initiate effective positive-pressure ventilation for 30 seconds and reassess the heart rate.
Continue rubbing the back of the baby with a towel to increase stimulation.
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Question 10 of 12
How soon after delivery of epinephrine should you recheck the babys heart rate?
Answers
1 minute
30 seconds
5 minutes
10 to 15 seconds
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Question 11 of 12
A 34-week gestational age baby is delivered following prolonged premature rupture of membranes and cord prolapse. The newborn has not responded to
60 seconds of cardiac compressions coordinated with positive-pressure ventilation in a 3:1 ratio. A dose of epinephrine is administered.
What is the most important effect of epinephrine?
Answers
Increase heart rate via improved coronary perfusion pressure via its peripheral vasoconstrictive effects.
Increase heart rate via increased chronotropy.
Increase heart rate via increased inotropy.
Increase heart rate via increased pulmonary vasoconstriction.
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Question 12 of 12
If a newborns heart rate remains less than 60 beats per minute after positive-pressure ventilation and chest compressions, you should do all of the follow
Answers
Establish intravenous access for administration of epinephrine.
Check to ensure that ventilation is producing adequate lung inflation, and cardiac compressions are being done correctly.
Administer sodium bicarbonate.
Administer subsequent epinephrine doses (if needed) in 3- to 5-minute intervals.
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Lesson 7: Special Considerations
Examination Summary
This examination contains 12 question(s).

You must answer 80% correctly or 10 out of 12 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.

Do NOT click the X on the upper right-hand corner of the window.

Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 12
While resuscitating a term newborn, you observe that the baby has severe respiratory distress and an unusually flat abdomen, with no air entry on the lef
Which of the following is the most likely diagnosis?
Answers
Pierre Robin syndrome
Pulmonary hypoplasia
Left choanal atresia
Congenital diaphragmatic hernia
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Question 2 of 12
During positive-pressure ventilation of a newborn, the breath sounds suddenly become inaudible on one side of the chest.
Which of the following statements is true?
Answers
Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed superior
In the delivery room, a pneumothorax should only be evacuated from the 4th intercostal space in the midclavicular line
In the delivery room, a pneumothorax should only be evacuated from the 2nd intercostal space in the anterior axillary line
Prior to evacuating a pneumothorax, the baby should be positioned with the affected side (with the pneumothorax) placed inferior
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Question 3 of 12
Which of the following are special steps necessary in the resuscitation of a newborn with suspected congenital diaphragmatic hernia?
Answers
Support with continuous positive airway pressure and a high oxygen concentration
Endotracheal intubation and placement of an orogastric tube
Bag-and-mask ventilation at a high rate with no end-expiratory pressure
Bag-and-mask ventilation with high peak inspiratory pressure and high positive end-expiratory pressure
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Question 4 of 12
Which of the following is true about pneumothoraces in the newborn?
Answers
A chest radiograph must always be obtained prior to evacuating a pneumothorax
The risk of pneumothorax is increased if positive-pressure ventilation is provided
Pneumothoraces rarely complicate congenital diaphragmatic hernia
Every pneumothorax requires immediate evacuation
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Question 5 of 12
A baby does not appear to be improving after intubation.
Which of the following is a common cause of asymmetric breath sounds in an intubated baby?
Answers
Laryngeal web
Congenital goiter
Pierre Robin syndrome
Malpositioned endotracheal tube
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Question 6 of 12
A baby under your care has severe respiratory distress after birth, but can be easily ventilated with positive-pressure ventilation by mask.
How can you test for choanal atresia?
Answers
Place a carbon dioxide detector over each of the nares.
Attempt to pass an endotracheal tube through each naris into the posterior pharynx.
Obtain lateral skull radiographs to determine patency of the nares.
Attempt to pass a suction catheter through each naris into the posterior pharynx.
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Question 7 of 12
A 10-day-old, mechanically ventilated newborn suddenly develops bradycardia and low oxygen saturation, despite the oxygen concentration being incre
What is the first and the most important step in the resuscitation of this newborn?
Answers
Begin chest compressions at a rate of 90 events per minute.
Assess and establish adequate ventilation.
Administer 10 mL/kg normal saline bolus over 5 to 10 minutes.
Obtain a 12-lead electrocardiogram.
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Question 8 of 12
Which of the following statements is true about the use of therapeutic hypothermia in a baby with hypoxic-ischemic encephalopathy?
Answers
The improvement in outcome from this therapy is directly related to the degree of hypothermia.
Therapeutic hypothermia has been demonstrated to improve neurologic outcomes in newborns of all gestational ages.
Therapeutic hypothermia is effective if initiated at any time within the first 24 hours.
Therapeutic hypothermia requires specialized equipment, and should only be used according to well defined protocols.
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Question 9 of 12
A baby is unable to breath adequately after birth. Which of the following statements is true?
Answers
Severe pulmonary hypoplasia usually is incompatible with survival.
Pulmonary hypoplasia is rarely associated with pneumothoraces.
Pulmonary hypoplasia may result from any cause of polyhydramnios.
Hypoplastic lungs are easily ventilated with low inflation pressures.
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Question 10 of 12
Your team is resuscitating a preterm newborn. Positive-pressure ventilation with bag and mask has resulted in good bilateral air entry, normal heart rate,
Which of the following is the most likely cause of ineffective respirations in this newborn?
Answers
Maternal treatment with terbutaline
Maternal treatment with magnesium sulfate
Pulmonary hypoplasia
Congenital heart disease
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Question 11 of 12
Remembering the MR SOPA acronym helps your team correct problems with ventilation.
Which of the following steps are included in MR SOPA?
Answers

Mask seal ensured, Reposition head of baby, Suction the airway

Mask seal ensured, Repeat stimulation, Suction the airway
Mouth opened, Repeat stimulation, Saturation check
Mouth opened, Reposition head, Saturation check
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Question 12 of 12
You have established a team to help care for a newborn with a known congenital heart defect.
Which of the following statements is true for babies with major congenital heart disease?
Answers
These babies will have poor respiratory drive as a result of the heart disease.
These babies will always have a heart murmur on exam at birth.
These babies are rarely critically ill immediately following birth.
The diagnosis of congenital heart disease in these babies can almost always be established in the delivery room.
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Lesson 8: Resuscitation of Babies Born Preterm

Examination Summary
This examination contains 7 question(s).

You must answer 80% correctly or 6 out of 7 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 7
You are in the delivery room caring for a preterm newborn at 27 weeks gestation. The babys mother had a fever and chorioamnionitis. Resuscitation ha
Which of the following is a true statement about the babys subsequent care?
Answers
Supplemental oxygen should be provided to maintain the babys oxygen saturation equal to or above 98%.
Enteral feedings should be started immediately and advanced rapidly to ensure adequate nutrition.
Antibiotics are not indicated because the risk of infection is low following preterm birth.
Blood glucose levels should be monitored because glycogen stores may be rapidly depleted after resuscitation.
Next

Question 2 of 7
You are in the delivery room caring for a preterm newborn at 27 weeks gestation. The baby is 5 minutes old and breathing spontaneously. Heart rate is
becoming labored.
Which of the following is an appropriate action?
Answers
Administer positive-pressure ventilation with an initial inflation pressure of 30 to 35 cm H 2O.
Provide supplemental oxygen to rapidly increase the babys oxygen saturation above 95%.
Provide vigorous stimulation on the back, trunk, and extremities.
Administer 5 to 6 cm H2O continuous positive airway pressure.
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Question 3 of 7
You have been called to attend the birth of a baby at 25 weeks gestation, with an estimated fetal weight of 750 g.

Which of the following is a true statement about the preparation and resources needed for this preterm birth?
Answers
A compressed air source, oxygen blender, and pulse oximeter should be in the room and available for immediate use.
The delivery room temperature should be decreased to approximately 65F to 66F (18.3C to 18.8C) to avoid hyperthermia.
A size 1 laryngoscope and size 3.5-mm endotracheal tube should be prepared for the initial intubation attempt, in the event that the baby has respiratory
Personnel skilled in intubation and umbilical catheter placement may be on call at home or in another area of the hospital.
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Question 4 of 7
You have been called to attend the birth of a baby at 25 weeks gestation, with an estimated fetal weight of 750 g.
Which of the following is a true statement about the complications that may occur in this extremely premature baby compared to a term newborn?
Answers
The babys body-surface area decreases heat loss and increases the risk of developing hyperthermia.
The babys muscles and surfactant deficiency make effective spontaneous ventilation more difficult to achieve.
The babys underdeveloped lungs are less likely to be injured by positive-pressure ventilation and high concentrations of oxygen.
The lack of blood vessel development in the babys brain decreases the risk of developing intracranial bleeding.
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Question 5 of 7
What resources are needed to prepare for a preterm birth?
Answers
Additional means to maintain body temperature should be prepared, such as reclosable polyethylene bags and a portable warming pad.
All of these.
Additional trained personnel should be requested, including someone with expertise performing endotracheal intubation.
A pulse oximeter and an oxygen blender should be available in the delivery room.
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Question 6 of 7
You are in the delivery room caring for a preterm newborn at 28 weeks gestation. The baby was intubated for poor respiratory effort, and you are provid
oximeter on the right wrist; after 10 minutes, oxygen saturation is 80% and not rising.
Which of the following is an appropriate action?
Answers
Increase the oxygen concentration.
Ventilate without positive end-expiratory pressure.
Move the pulse oximeter to the babys left wrist.
Insert an orogastric tube.
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Question 7 of 7
You recognize that premature newborns are vulnerable to hyperoxia and you have an oximeter and blender in your delivery room.
What action is appropriate with this equipment during and immediately following resuscitation of babies born preterm?
Answers
Adjusting the inspired oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 5 to 10 minutes after birth.
Relying on the oximeter saturation reading when the heart rate displayed on the oximeter is different from the heart rate you hear with a stethoscope.
Turning up the inspired oxygen concentration if you note saturations of 70% to 80% during the first 2 minutes of life.
Always initiating ventilation with 21% oxygen (0.21 FiO2) in such babies.
Previous
HhLesson 9: Ethics and Care at the End of Life
Examination Summary
This examination contains 10 question(s).

You must answer 80% correctly or 8 out of 10 question(s) in order to pass this examination.
Use Next/Previous rather than the scroll bar.
Do NOT click the X on the upper right-hand corner of the window.
Please answer all questions below, then click the SUBMIT button at the bottom of the page to have your examination scored.
This assessment is not timed.

Question 1 of 10
A woman is admitted at 24 weeks gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born within the ne

What is likely to be helpful in this process?

Answers
It is worth obtaining up-to-date outcome data for your institution or region, or using the Neonatal Resuscitation Program Web site and National Instutite
It is best to wait until the mother has received some medications, such as magnesium sulfate or analgesics, as these often help relieve her anxiety and the
The obstetrician and neonatologist should ideally meet separately with the parents, so the full range of perspectives and possibilities is most clear.
Make sure you cover all material in one session because repeated discussions tend to increase anxiety and limit understanding.
Next
Question 2 of 10
You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability and whose birth is imminent.

What should you tell the parents when they ask you how decisions about resuscitation are made?
Answers
You offer to bring an ultrasonographer to the birth so that the baby can be immediately assessed for the presence of an intracranial hemorrhage, to guide
The decision agreed to before birth may need to be modified based on the condition of the baby after birth and the postnatal gestational age assessment.
You will categorically honor and follow whatever decision - to initiate or withhold resuscitation - you reach together prior to birth.
While the parents are important people, only you and the other caregivers have the knowledge and ultimate responsibility to make decisions on resuscita
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Question 3 of 10
In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?
Answers
The members of the resuscitation team
The delivering obstetrician
The hospital chaplain
The parents
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Question 4 of 10
You are called to the birth of a newborn weighing 385 g and gestational age of just under 23 weeks, a birth weight that is associated with almost certain
Which action is appropriate?
Answers
Attempts at resuscitation are not indicated under these circumstances; care should focus on comfort alone.
Attempts at resuscitation are indicated and expected if your team is called to a birth.
Attempts at resuscitation can be delayed for up to five minutes to allow time to determine whether the baby might respond.
Attempts at resuscitation should only be done after consultation with the hospital ethics committee.
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Question 5 of 10
Good decisions are based on good data. Which statement about obstetric dating and assessment is correct?
Answers
Fetal weight can not be estimated if there is intrauterine growth restriction.
Dating can be reliably based on the ultrasound calculations of fetal weight.
Techniques for dating are accurate to within 1 to 2 days, when they are performed in the second half of pregnancy.
Techniques for obstetric dating are accurate to within 3 to 5 days, when assessed during the first trimester.

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Question 6 of 10
Which statement describes the ethical principle(s) that guide the resuscitation of a newborn?
Answers
The approach to decisions in the newborn should be guided by the same principles used for adults and older children.
The decisions are the responsibility of the parent(s) and cannot be challenged by caregivers.
The baby is a minor and any decisions on performing or discontinuing resuscitation should be made during an emergency meeting of the hospital ethics
The ethical principles of beneficence, nonmaleficence, autonomy, and justice are used for adults and older children, but do not apply to newborns.
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Question 7 of 10
You are counseling a set of 17-year-old parents, whose baby is about to be born at 23 weeks gestation. You have explained that survival is unlikely and
that everything be done, starting with resuscitation at birth.
How might you answer them?
Answers
You explain that your first obligation is to do no harm and given the statistics, you will not begin resuscitation.
You tell them you are glad they made this choice because federal law requires you to do this anyway.
You assure them that as the parents, they are the appropriate voice for their baby and you will support their wishes.
You tell them that because they are younger than the legal voting age, they are not able to make final decisions and you will take that responsibility.
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Question 8 of 10
You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks gestation. The newborn emerg
monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with
medications; fluids; and performance of chest compressions).
After what duration of time might it be appropriate to discontinue resuscitative efforts?
Answers
After 10 minutes of no detectable heart rate (Asystole)
After 5 minutes of no detectable heart rate (Asystole)
After 20 minutes of no detectable heart rate (Asystole)
After 30 minutes of no detectable heart rate (Asystole)
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Question 9 of 10
In the course of planning care for a newborn with a known genetic disorder, one of your team members suggests that no resuscitation be offered. The pa
Which of the following statements is true?
Answers
Withdrawal or non-initiation of support may be acceptable if there is agreement between parents and the treating team that this support will be futile.
It is better to withhold resuscitation because once you start, you are obligated to continue life support.
If the parents request no resuscitation, there is no situation in which a caregiver can legally go against their wishes
United States federal law mandates resuscitation of all newborns regardless of underlying conditions
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Question 10 of 10
When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents
Answers
The resuscitation team alone will make the appropriate decision after birth.
The hospital ethics committee must be consulted in order to make a decision.
The option of only providing comfort care can be considered.
No resuscitation will be started under any circumstances.