1) You have been called to the home of a one-week-old infant whose parents called EMS because the baby had a seizure. On your arrival, the infant is pale, has poor muscle tone, is lethargic, and has a high-pitched cry. The parents state that the infant has not been feeding well for the past 24 hours. Based on these findings, which of the following should be included in your continued assessment and treatment of this patient? 1. Checking the blood sugar 2. Assessing the fontanelles 3. Contacting child protective services 4. Administering 0.3 mg of naloxone, IM 5. Administering an appropriate mL bolus of normal saline IV A) 3 and 4 B) 1 and 2 C) 2 and 3 D) 1, 2, and 5 2) You are caring for a newly born infant delivered approximately 8 minutes ago. The infant had a 1-minute APGAR score of 6, which improved to 7 at 5 minutes. Despite drying, warming, suctioning, and stimulating the infant, you note he continues to have central cyanosis. His heart rate is 132, and his ventilations are 50. Which of the following is the best action in this situation? A) Administer “blow-by” oxygen. B) Begin chest compressions. C) Administer 0.01 mg/kg of epinephrine subcutaneously. D) Assist ventilations with a bag-valve-mask device. 3) You have arrived at a residence just as a 30-year-old woman has delivered her first baby six weeks before her due date. Assessment of the newborn reveals central cyanosis, apnea, and absence of the brachial pulse. Which of the following should you do next? A) Suction the newborn’s mouth and nose with a bulb syringe and stimulate him by drying him off with a towel from the OB kit. B) Tell the mother that her newborn is not viable, wrap him in a receiving blanket, and allow her to hold the baby. C) Begin chest compressions at a rate of 120 per minute and reassess after 1 minute. D) Intubate the trachea and instill 0.04 mg of epinephrine diluted in saline into the tube. 4) You have been dispatched with the neonatal resuscitation team to an outlying hospital to stabilize and then transport a 30-week-gestation newborn to a neonatal intensive care unit. Which of the following methods should you use to maintain this newborn’s body temperature? A) Dress the newborn lightly in a T-shirt and diaper and cover loosely with a light blanket. B) Activate two or three chemical hot packs, place them against the newborn’s body, and secure them by wrapping him in a receiving blanket. C) Wrap the newborn in a receiving blanket, covering the body and head but leaving the face exposed, and hold him securely against your body for warmth. D) Wrap the newborn in receiving blankets, covering the body and head but leaving the face exposed, and place 104°F hot water bottles next to him. 5) In which of the following situations would the administration of epinephrine be indicated in a newborn? A) Heart rate of 60 with no response to ventilations after 30 seconds B) Heart rate of 80 to 100 with no response from ventilations and chest compressions C) Heart rate of 60 to 80 with no response to blow-by oxygen D) Heart rate less than 60 after ventilations and chest compressions 6) Which of the following is NOT an appropriate route of administration for naloxone in the newborn?   A) Intramuscular B) Intravenous C) Intraosseous D) Endotracheal 7) You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action? A) Prepare a report for the child protective agency regarding your suspicions that the parents cannot care for the child properly. B) Undress the infant to his diaper and sponge him with tepid water. C) Reassure the parents that the infant’s sleep patterns and temperature are normal. D) Contact medical control to order acetaminophen. 8) After ventilating a newly born infant by bag-valve-mask device, you note significant gastric distention that is beginning to interfere with ventilation. On attempting to pass a nasogastric tube to decompress the stomach, you find that there is an obstruction bilaterally at the level of the posterior nasopharynx. Which of the following choices indicates the likely problem and the action that should be taken? A) Choanal atresia; rotate the nasogastric tube back and forth between your fingers as you apply steady pressure in a posterior direction B) Cleft palate; rotate the nasogastric tube back and forth between your fingers as you apply steady pressure in a posterior direction C) Cleft palate; intubate the trachea and pass an orogastric tube D) Choanal atresia; intubate the trachea and pass an orogastric tube 9) You are assessing a newborn who presents with respiratory distress; heart sounds auscultated over the right chest; and a small, flat abdomen. Which of the following is appropriate in his care? A) Insertion of a gastric tube B) Needle chest decompression C) Elevation of the head and chest, endotracheal intubation D) Ventilation via an automatic transport ventilator 10) Which of the following is NOT an antepartum or intrapartum risk factor for newborn distress?   A) Multiple gestation B) Post-term gestation C) The maternal use of narcotics within 2 hours before delivery D) Maternal age between 16 and 35 years