NRP Lesson 9 – NRP 7th Ed

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.

ANSWER :  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.

Which statement describes the ethical principle(s) that guide the resuscitation of a newborn?

ANSWER :  The approach to decisions in the newborn should be guided by the same principles used for 

adults and older children.

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 parents agree. Other team members think this decision 

might jeopardize them personally.

ANSWER :  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.

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 concerning options for resuscitation?

ANSWER :  The option of only providing comfort care can be considered.

You are part of a team called to an emergency cesarean delivery done for apparent acute placental 

abruption at 41 weeks’ gestation. The newborn emerged without respirations or heart rate and has had 

no detectable heart rate (by palpation or by oximetry monitoring) from the time the baby was first 

assessed. You and the team are convinced that resuscitation has been adequate (good chest movement 

with positive-pressure ventilation; timely and correct placement of umbilical catheter and administration 

of medications; fluids; and performance of chest compressions).

ANSWER :  After 10 minutes of no detectable heart rate (Asystole)

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

ANSWER :  The parents

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 next few hours with an estimated weight of 750 g. The care 

team offers the parents counseling.

ANSWER :  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 of Child Health & Human Development 

estimator for national data.

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 early death and nearly universal rate of severe 

morbidity among the rare survivors.

ANSWER :  Attempts at resuscitation are not indicated under these circumstances; care should focus on 

comfort alone.

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 in the event of survival, the likelihood of severe 

long-term morbidity is high. The parents firmly request that everything be done, starting with 

resuscitation at birth.

ANSWER :  You assure them that as the parents, they are the appropriate voice for their baby and you 

will support their wishes.

Good decisions are based on good data. Which statement about obstetric dating and assessment is 

correct?

ANSWER :  Techniques for obstetric dating are accurate to within 3 to 5 days, when assessed during the 

first trimester.

A laboring woman received a narcotic medication for pain relief 1 hour before delivery.The baby does not 

have spontaneous respirations and does not improve with stimulation.Your first priority is to

ANSWER :  Start positive-pressure ventilation

During resuscitation, a baby is responding to positive-pressure ventilation with a rapidly increasing heart 

rate. Her heart rate and oxygen saturation suddenly worsen.She has decreased breath sounds on the left 

side and transillumination also reveals a bright glow on the left side.What is the most likely cause of this 

distress?

ANSWER :  Left-sided pneumothorax

Which of the following is true about the preparation and resources needed for a very preterm birth?

ANSWER :  Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a 

hat.

Which of the following may be associated with delayed cord clamping in vigorous preterm newborns?

ANSWER :  Decreased need for blood transfusions

For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous 

epinephrine is indicated?

ANSWER :  0.1 mL

A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the 

electronic cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action?

ANSWER :  Stop chest compressions; continue positive-pressure ventilation.

How soon after administration of intravenous epinephrine should you pause compressions and reassess 

the baby’s heart rate?

ANSWER :  1 minute

What is the preferred method for assessing heart rate during chest compressions?

ANSWER :  Electronic cardiac (ECG) monitoring

A baby’s heart rate does not increase after intubation and the breath sounds are louder on the right side 

than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in 

an intubated baby?

ANSWER :  Endotracheal tube inserted too deep

If a preterm birth is anticipated, at what temperature should the room be set?

ANSWER :  23ºC to 25ºC (74° F – 77° F)

After chest compressions with coordinated ventilations are started, the heart rate should be assessed:

ANSWER :  After 60 seconds

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

ANSWER :  The newborn’s parents

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. The baby is 5 minutes 

old and breathing spontaneously. The baby’s heart rate is 120 beats per minute and the oxygen 

saturation is 90% in room air. The baby’s respirations are labored. Which of the following is an 

appropriate action?

ANSWER :  Administer CPAP at 5 cm H20 pressure

You are in the delivery room caring for a preterm newborn at 27 weeks’ gestation. Resuscitation has 

been completed and the baby is ready to be transported to the neonatal intensive care unit. Which of 

the following is a true statement about the baby’s subsequent care?

ANSWER :  Monitor blood glucose levels because of the risk of hypoglycemia after birth.

What time frame should be used to administer intravenous epinephrine?

ANSWER :  Rapid push, as quickly as possible

When are chest compressions indicated?

ANSWER :  When the heart rate remains less than 60 beats per minute after 30 seconds of 

positive-pressure ventilation that moves the chest, preferably through an alternative airway.

Which statement best describes the ethical principle(s) that guide the resuscitation of a newborn?

ANSWER :  The approach to decisions in the newborn should be guided by the same principles used for 

adults and older children.

A baby born at 36 weeks’ gestation was apneic after birth and required positive-pressure ventilation and 

oxygen supplementation in the delivery room. He continues to require supplemental oxygen after birth. 

Which of the following statements is true?

ANSWER :  His blood glucose level should be checked soon after resuscitation and then at regular 

intervals until stable and normal.

What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal 

administration to a baby weighing 3 kg?

ANSWER :  1.5 mL

When coordinating positive-pressure ventilation with chest compressions, how many events are 

performed each minute?

ANSWER :  30 breaths, 90 compressions

A newborn requires complex resuscitation. You have intubated and are administering positive-pressure 

ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, 

and the need to continue one or both of these measures?

ANSWER :  Respirations, heart rate, oxygen saturation

Which of the following statements is true about resuscitating and stabilizing extremely premature 

newborns?

ANSWER :  They have more difficulty achieving effective spontaneous ventilation than term newborns

Which of the following is the best indication for volume expansion after resuscitative efforts that 

included intubation, chest compressions, and IV epinephrine?

ANSWER :  The baby’s heart rate remains 50 beats per minute after resuscitative efforts and pulses are 

weak.

A mother had an emergency cesarean birth at 39 weeks’ gestational because of sudden fetal bradycardia 

and a suspected placental abruption. After birth, the baby required extensive resuscitation including 

positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, 

the baby has poor tone, lethargy, and apnea. Which of the following statements is true?

ANSWER :  Promptly evaluate her for possible therapeutic hypothermia (cooling) treatment and contact 

the nearest cooling center.

When a newborn has a high risk of mortality and there is a significant burden of morbidity among 

survivors, what should be included in your discussion with the parents concerning options for 

resuscitation?

ANSWER :  The option of providing comfort care can be considered.

If severe Bradycardia persists despite assisted ventilation and coordinated compressions what drug is 

administered?

ANSWER :  Epinephrine

If severe Bradycardia persists despite assisted ventilation then circulation is supported with what?

ANSWER :  Chest Compressions

Before birth, the alveoli in the fetal lungs are expanded and filled with what?

ANSWER :  Fluid

Before birth, oxygen is supplied to the fetus by the what?

ANSWER :  placenta

If 2 risk factors are present how many qualified people should be present solely to manage the baby?

ANSWER :  two