Walsh: Perinatal and Pediatric Respiratory Care, 3rd Edition

Chapter 05: Examination and Assessment of the Neonatal Patient

Answers to Assessment Questions and Clinical Scenarios

1.	C
Rationale: Ideally, gestational age assessment is performed before the neonate is 12 hours old, to allow the greatest reliability for infants less than 26 weeks of gestational age.
2.	D
Rationale: Evaluating gestational age requires consideration of gestational duration based on the last menstrual cycle, prenatal ultrasound evaluation, and postnatal findings based on physical and neurological examinations. Postnatal examinations for determining gestational age include the Ballard score, which is based on external physical findings, and neurologic criteria (see Figure 5-1).
3.	C
Rationale: Normal values for temperature are 97.6  1 °F (axillary) and 99.6  1 °F (rectal).
4.	B
Rationale: The infant’s skin is an indicator of intravascular volume, perfusion status, or both. Both perfusion and underlying skin color affect the appearance of the skin. Capillary refill time should be less than 3 seconds. Assess refill by pressing the sole of the infant’s foot or the palm of its hand with a finger. Perfusion should be good and skin color pink.
5.	A
Rationale: The yellow color associated with mild to moderate jaundice is common among newborns after the first day of life. Jaundice on the first day of life, however, is always an indication for immediate evaluation.
6.	B
Rationale: Apnea is a pathologic condition in which breathing ceases for longer than 20 seconds. Apnea may be associated with cyanosis, bradycardia, pallor, and hypotonia (abnormally low muscle tone). Frequently, apnea is associated with nonspecific symptoms of diseases seen with many neonatal conditions.
7.	A
Rationale: Signs of distress include nasal flaring, expiratory grunting, tachypnea, and retractions. Vesicular breath sounds are not typically associated with infants with distress.
8.	C
Rationale: Brachial and femoral pulses should be equal in intensity and felt simultaneously. A delayed or weak femoral pulse in relation to the brachial pulse can indicate coarctation of the aorta. Blood vessels that supply the brachial circulation usually originate before the coarctation (aortic restriction) and blood flow is not compromised; however, the femoral arteries are located after the coarctation and may receive less blood flow, and hence present lower blood pressure and pulses.
9.	B
Rationale: In the absence of data, calculate an adequate target for normal mean blood pressure (MBP) as follows: adequate MBP = gestational age (weeks) + 5.
10.	D
Rationale: Placing pulse oximeters on preductal and postductal sites allows for assessing right-to-left ductal level shunting through a patent ductus arteriosus, as seen with persistent pulmonary hypertension of the newborn. In this case the right arm, or preductal site, will have a higher saturation, while the postductal site, or left arm and lower extremities, will have a lower saturation due to venous admixture occurring postductally.
11.	A
Rationale: A scaphoid, hollowed, or unusually flattened abdomen may be associated with congenital diaphragmatic hernia, in which abdominal contents are displaced into the chest through a defect in the muscular diaphragm.
12.	D
Rationale: The umbilical cord is yellowish white with three blood vessels. The two small and thick-walled arteries and one large and thin-walled vein are easily visible at the end of a freshly cut cord.