ATS Medical Education
4,000 Neonatal Intensive Care Nursing Questions
HOME PAGE               TRY NOW               FREE SAMPLE QUESTIONS               CONTACT US
Sample Neonatal Intensive Care Questions


  1. It is important to differentiate conjunctivitis from orbital cellulitis associated with underlying ethmoiditis or maxillary osteomyelitis requiring urgent systemic treatment. A chronic watery discharge is usually due to congenital nasolacrimal duct obstruction The main need is:


A.    gentamicin and ceftazidime

B.     lose about 30 ml/kg of water

C.     cardiovascular effects

  1. to exclude congenital glaucoma,




Explanation: The main need is to exclude congenital glaucoma, keratitis, or uveitis. Pain, photophobia, corneal clouding, and conjunctival injection are warning signs. Probing is called for only if problems persist for more than 1 year.


  1. References Continuous infusions cause tolerance to develop.A higher plasma level becomes necessary, and a higher dose has to be given. Serious withdrawal symptoms can then occur when:


A.    infiltrate deep tissues

  1. the drug is stopped,
  2. several adrenal gland hormones

D.    metabolised to a range                                                                                                                                

Answer: B

Explanation: A higher dose has to be given. Serious withdrawal symptoms can then occur when the drug is stopped, with extreme irritability, tremor, myoclonus, ataxia, and choreoathetosis.





  1. Fentanyl is widely used to provide perioperative pain relief. A continuous infusion causes tolerance to develop and exposes babies to symptoms of opiate withdrawal. Morphine (q.v.) is better in this regard.Compatibility Fentanyl can be added (terminally) to a line containing:


  1. Clinical problems midazolam,

B.     reduce intestinal absorption

C.     Tetracaine

  1. midazolam,



Explanation: Compatibility Fentanyl can be added (terminally) to a line containing midazolam, milrinone, or standard TPN.



  1. Filgrastim (and lenograstim) enhance the production and release of white blood cells from bone marrow.Subcutaneous rather than IV use doubles the elimination half life to about 3 hours, increases therapeutic efficacy, and minimises the risk of toxicity associated with high peak blood levels. Adverse effects, including:


  1. Hydration  and fever,
  2. fever,

C.     blood tobramycin as blood gentamicin

D.    a suspension of killed



Explanation: Subcutaneous rather than IV use doubles the elimination half life to about 3 hours, increases therapeutic efficacy, and minimises the risk of toxicity associated with high peak blood levels. Adverse effects, including fever, dyspnoea, nausea, and vomiting, seem to have been uncommon with neonatal use.


  1. Teratogenic effects have been reported with high dose treatment in laboratory animals; the relevance of this to the drug’s use in early pregnancy remains to be established. The drug causes:


A.    Bordetella pertussis organisms

B.     simultaneous administration

  1. slowing of atrial,

D.    thrombocytopenia



Answer: C

Explanation: The drug causes slowing of atrial,AV nodal, and infranodal conduction, increasing the atrial and ventricular muscle’s refractory period. The drug exerts little effect on sinus node function, but it increases the PR interval and the duration of the QRS complex.


  1. Flucloxacillin is a non-toxic, semisynthetic, acid resistant, isoxazolyl penicillin similar to methicillin that was first developed in 1970. It has a side chain that protects the lactam ring from attack by staphylococcal (and some other) penicillinases. Flucloxacillin is closely related to:


  1. Exfoliative dermatitis

B.     anaesthetise the urethra   

C.     limits of neonatal homeostasis

  1. cloxacillin,



Explanation: Flucloxacillin is closely related to cloxacillin, nafcillin, and oxacillin, which are the products most often used in the USA. None is as well absorbed by mouth, but the dose when given IV or IM is the same as for flucloxacillin.


  1. Flucloxacillin is usually the drug of choice for penicillinase resistant staphylococcal infection.Treatment Dose: A dose of 100 mg/kg IV or IM is the one usually recommended when:


A.    endotracheal intubation

B.     anaesthesia after less than 1 min

C.     thrombophlebitis

  1. treating staphylococcal osteitis,




Explanation: A dose of 100 mg/kg IV or IM is the one usually recommended when treating staphylococcal osteitis, meningitis, or a cerebral abscess, but 50 mg/kg is adequate for most other purposes.





  1. A range of commercial and volunteer donor products are now available in vials and prefilled syringes containing from 250 units to 1500 units of anti-D immunoglobulin. Most should be stored at 4C, but lyophilized powders are safe at room temperature for


A.    1 month

B.     3months

C.     5months

D.    7months



The amount of anti-D (Rho) immunoglobulin actually required is proportional to the size of the fetomaternal bleed. Forevents occurring before 20 weeks gestation it has been traditional to give 250 units (50 micrograms) of anti-D immunoglobulin


  1. The products need prescribing; maternity units in the UK are now starting to develop patient group directions, since these give midwives a more direct and proactive role in ensuring that all rhesus negative mothers have easy access to


  1. Prematurity
  2. prophylaxis
  3. proactive
  4. Lancet


It is pointless to treat mothers who have already started to produce antibodies to the D antigen, but important to remember that mothers with other antibodies (anti-c–, anti-Kell, etc.) may still require protection from the D antigen if they are rhesus (D) negative.


  1. Treatment with ribavirin may reduce the severity of bronchiolitis due to the respiratory syncytial virus (RSV) if started within 3 days of the onset of lower tract symptoms.


A.    Respiratory

B.     Digestive

C.     Circulatory

D.    Excretory



A nebulised bronchodilator such as salbutamol can produce short term symptomatic improvement, but does not increase oxygen saturation, or reduce the need for hospital admission.


  1. Ribavirin (first synthesised in 1972) is a stable, white, synthetic nucleoside with in vitro antiviral properties against RSV and the adenoviruses, as well as the influenza, parainfluenza, and virusesof


A.    Cholera

B.     Chicken pox

C.     Measles

D.    Polio


Treatment with ribavirin may reduce the severity of bronchiolitis due to the respiratory syncytial virus (RSV) if started within 3 days of the onset of lower respiratory tract symptoms



  1. Ribavirin’s clinical use is therefore currently limited to high risk children  with proven lower respiratory tract RSV infection There is some evidence that it can be mutagenic in cell culture, and may) induce benign glandular.


  1. Tumours
  2. Cancer
  3. Infection
  4. Mineralization

It needs to be remembered that the drug is efficacious only if given early in the course of the disease. There is only one study suggesting that its use speeds recovery in ventilator dependent infants and there is little evidence that it reduces the time it takes for the patient to stop shedding live virus particles.


  1. Unsubstantiated reports suggest that it may be of value in parainfluenza lung infection and in measles in infancy. The only common adverse effect in children on standard treatment is conjunctivitis, but little is known about possible long term morbidity or


  1. Toxicity          
  2. Mineralization
  3. Hypercalciuria
  4. Thrombocytopenia

While widespread US experience suggests that ribavirin is safe, most clinicians in Europe believe that further evidence of efficacy is needed.



  1. RSV infection is easily and rapidly diagnosed from a nasopharyngeal wash specimen using immunofluorescence or an enzyme linked immunoabsorbent assay (ELISA) test, as outlined in the monograph on palivizumab


  1. palivizumab
  2. placental
  3. Reabsorption
  4. Hypercalciuria

Infected babies should be nursed in isolation and nosocomial spread limited by careful attention to hand washing.


  1. Palivizumab (q.v.) is sometimes used to reduce the risk that RSV infection will precipitate hospital readmission in babies with bronchopulmonary dysplasia severe enough to need home


A.    Carbondioxide

B.     Oxygen

C.     Sulphue dioxide

D.    Nitrogen

An immune globulin with a high titre of RSV neutralising antibody has also been used in North America, as outlined in the same monograph.


  1. Administer nebulised ribavirin (20 mg/ml) for between 12 and 20 hours per day using a small particle aerosol generator (SPAG), preferably a modified Easy Vent constant positive airway pressure (CPAP) device.this SPAG is used for


  1. 3–7 days
  2. 7-9days
  3. 9-11days
  4. 11-15 days

Early treatment may be appropriate in high risk children with proven infection to try to reduce the chance of their needing ventilator support.


  1. Rifampicin is used with isoniazid (q.v.) to treat tuberculosis, and with vancomycin or teicoplanin (q.v.) to treat severe staphylococcal infection.


A.    Genital infection

B.     Skin infection

C.     Lungs infection

D.    staphylococcal infection.

It is also given prophylactically to the contacts of patients with meningococcal or haemophilus

infection, and has a role in the treatment of cholestatic pruritis.


  1. The most active antistaphylococcal agent Known first developed in 1966 interferes with DNA dependent RNA polymerase. It has activity against many mycobacteria, Neisseria meningitidis, and N gonorrhoeae and is the


  1. bactericidal antibiotic
  2. viral antibiotic
  3. calcipenic
  4. fungal antibiotic

Resistant strains of Mycobacterium and Staphylococcus emerge quickly if rifampicin is used

alone, it is recommended that it should always be used in combination with a second antibiotic,



  1. Rifampicin is readily absorbed when given by mouth. It is highly protein bound and undergoes enterohepatic recirculation. Up to 30% may be excreted unchanged, but the metabolites are excreted in urine and


  1. billirubin
  2. cytoplasm
  3. bile
  4. mucous


Dose intervals do not need to be modified in the presence of renal failure. Rifampicin colours urine and other secretions red.


  1. Transient jaundice can be ignored, but treatment must be stopped at once if thrombocytopenia, nausea, and vomiting, or other signs of more serious toxicity, develop in any of the following


  1. heart
  2. liver
  3. lungs
  4. gall bladder



Such adverse effects are rare in children unless there is prior liver disease. Rifampicin crosses the placenta, but its use is not contraindicated in pregnancy, it is said to be associated with an increased risk of neonatal bleeding meriting routine IM vitamin K prophylaxis



  1. Chloramphenicol, corticosteroids, most benzodiazepines, digoxin, fluconazole, nifedipine, phenobarbital, phenytoin, theophylline, and warfarin (q.v.) are all metabolised very


  1. slowly
  2. rapidly
  3. continuously
  4. None of the above.


Rifampicin induces microsomal liver enzymes and therefore affects the metabolism of a wide range of other drugs.



  1. Treatment of HIV infection with the protease inhibitors nelfinavir or ritonavir (q.v.) greatly increases the clearance of rifampicin, making cotreatment with the unwise


  1. drug
  2. medicin
  3. syrup
  4. fluid


Rifampicin also induces its own metabolism and, as a result, clearance increases markedly during the first 2 weeks of use.



  1. Treatment of tuberculosis Seek expert advice. Give 10 mg/kg once a day by mouth (20 mg/kg if meningitis is suspected), together with isoniazid (q.v.).Warn parents that the urine may turn


  1. Yellow
  2. White
  3. Red
  4. Black


Pruritis due to cholestasis: Try 5 mg/kg twice a day. Monitor liver function for the first month. Rifampicin should not be given IM. A 20 mg/ml syrup is also available with an undiluted shelf life of 3 years. Do not co-infuse with any alkaline solution.


  1. Meningococcal carriage can be eliminated by giving four doses at 12 hour intervals, but this dose should be given once a day for 4 days to any unvaccinated child less than 4 years old exposed to known infection with Haemophilus.


  1. Tuberculosis
  2. Influenza
  3. Cholera
  4. Night blindness



Prophylaxis against meningococcal and haemophilus infection: Give a 5 mg/kg dose to children under 1 month old, and a 10 mg/kg dose to older children.




  1. Ritonavir is used to control HIV infection. Several drugs are best used in combination to prevent the development of drug resistance and optimise the suppression of


  1. Viral duplication
  2. viral replication
  3. viral depletion
  4. Bacterial infection.


Ritonavir is a protease inhibitor that binds to HIV-protease causing the formation of immature viral particles that are incapable of infecting other cells



  1. Placental transfer is very limited and there is no evidence of teratogenicity but, to increase information on safety, all use in pregnancy should be reported (anonymously) to the Antiretroviral Pregnancy Register, as outlined in the monograph on


A.    osteopenia

B.     zidovudine

C.     dopamine

D.    morphine

(The quantity of drugs excreted in breast milk is not yet known.its use is still under controlled trial evaluation, the manufacturers are not yet ready to recommend the use of ritonavir in children under 2 years old.)



  1. The one which is a related protease inhibitor that shares many of the same pharmacological properties as ritonavir and Infants seem to need as much as 50 mg/kg three times a day by mouth, is called as



  1. Nelfinavir
  2. Spiramycin
  3. dobutamine
  4. sulphur


(It is probably better to start with 40 mg/kg twice a day in the first 4 weeks of life until drug handling is better understood.)


  1. No strategy seems capable of eliminating all virus from the body, so some clinicians would prefer to use as little potentially toxic drug treatment as is compatible with inhibiting all detectable virus


  1. duplication
  2. replication
  3. multiplication
  4. division



Vigorous treatment is clearly indicated where there is a high HIV RNA viral load because there is a high risk of rapid disease progression. The best strategy where there is only a low viral load is less clear.


  1. Ritonavir and nelfinavir are best taken with food, but didanosine (mentioned in the monograph on lamivudine) is best given on an empty stomach so simultaneous administration should be avoided. Since ritonavir and nelfinavir are partly metabolised by the liver’s cytochrome


A.    P450 enzyme system,

B.     G450 enzyme system

C.     S420 enzyme system

D.    C230 enzyme system



Their clearance is increased by cotreatment with a wide range of other drugs; these protease inhibitors can, in turn, increase the clearance of other drugs



  1. This is certainly true of carbamazepine, dexamethasone, phenobarbital, phenytoin, and theophylline (q.v.). Cotreatment with antihistamines, benzodiazepines, cisapride, rifampicin (q.v.) and a range of cardiac drugs


  1. glycerophosphate
  2. Calcium folinate
  3. flecainide
  4. sodium sulphate



As it is also discouraged because clearance is unpredictably decreased. Digoxin (q.v.) levels are variably affected. Always consult the manufacturer’s summary of product characteristics.



  1. Ritonavir is available as a sugar-free, but alcohol containing, 80 mg/ml solution (100 ml costs 90). The bitter taste can be disguised by giving the drug with chocolate flavoured milk; the product must not be mixed with water


  1. acid
  2. base
  3. water
  4. alkali


.Nelfinavir is available as a 50 mg/g powder that can be mixed, just before use, with water, milk, ice cream, or puddings, but crushed 250 mg tablets (costing 1 each) are more palatable.



  1. Rubella is a mild infectious illness with an incubation period of 14–21 days. Patients are infectious from 1 week before the rash appears for a period of about 10 days. Symptoms may be mild and the rash is often not diagnostic. Its another name is


  1. French measles
  2. German measles
  3. Italian measles
  4. Eurpeon measles



Diagnosis currently depends on testing paired sera samples taken 2–3 and 8–9 days after the first appearance of the rash for rubella antibody;



  1. Natural infection of Rubella causes lasting immunity. Maternal infection in early pregnancy can cause serious fetal damage (as first recognised by Gregg during the Australian epidemic in 1941), but the multifaceted nature of this damage became clear only.


  1. 30 years latter
  2. 25 years later
  3. 15 years later
  4. 20 years later


Immunoglobulin (750 mg of human normal immunoglobulin IM) is sometimes given to reduce the chance of clinical infection in pregnant seronegative mothers, but there is no good evidence that it does much good.




  1. Seronegative the male and female health service staff in maternity units which should also be vaccinated to prevent their transmitting rubella to pregnant patients. A mild reaction, with fever, rash, and arthralgia, may occur 1–3 weeks after vaccination is known as


  1. Seropositive
  2. Seronegative
  3. Poropositive
  4. Poronegative



Vaccination should be avoided in early pregnancy but there has been no recorded case of fetal damage in the USA, Canada, Sweden, Germany, or the UK among the significant number of mothers inadvertently immunised with the attenuated virus in early pregnancy.




  1. Do not give within 3 weeks of BCG administration. If a booster injection of the diphtheria and tetanus vaccine is to be given at the same time as primary MMR immunisation, the two products should be given into


  1. Same arms
  2. Opposite arms
  3. Same hands
  4. Opposite hands



More than one live vaccine can be given at different sites on the same day, but an interval of 3 weeks should be allowed if vaccination is not simultaneous.



  1. Pregnancy, immunodeficiency, immunosuppression, reticuloendothelial malignancy, and high dose corticosteroid treatment (the equivalent of more than 1 mg/kg of prednisolone per day, or 2 mg/kg ) are contraindications to vaccination, as is known hypersensitivity to gelatin or


A.    Gelatin

B.     neomycin.

C.     Both A and B

D.    None of  the above


A history of fits is not a contraindication to either the monovalent or the trivalent vaccine, but advice should be given on how to handle any febrile response to immunisation as outlined in the monograph on paracetamol



  1. 98% of patients probably achieve immunity to rubella with a single 05 ml deep IM injection of the monovalent or trivalent vaccine using a 25 mm, 23 gauge, needle. The management of anaphylaxis (which is very rare) is outlined in the monograph on.


A.    Mineralization

B.     Hyperparathyroidism

C.     absorption

D.    immunization


All cases of suspected congenital rubella (in people with or without symptoms) in the UK should be notified to the National Congenital Rubella Surveillance Programme. This can be done directly via the British Paediatric Surveillance Unit



  1. Salbutamol and terbutaline are β adrenergic stimulants widely used by asthmatics for their bronchodilator activity. Given IV, they can at least briefly inhibit preterm labour. Both can also, in the short term, control a sudden life threatening rise in plasma.


  1. Sodium
  2. Calcium
  3. Potassium
  4. Magnesium


Salbutamol is a synthetic sympathomimetic related to noradrenaline and isoprenaline (q.v.) that has its main effect on the β2 receptors in bronchial muscle. It was first developed in 1967.



  1. Inhaled salbutamol from a nebuliser seems to be of short term benefit in a minority of babies with chronic lung damage, but no trial has yet been done to show whether sustained use is helpful. Use seems to be of very little benefit in the majority of “wheezy” babies in the first life.



A.    2years

B.     4years

C.     6years

D.    8years


Drug binding to liver and muscle adrenergic receptors stimulates cyclic adenosine monophosphate (AMP) production, causing a rise in intracellular potassium uptake and a fall in plasma potassium.



  1. None of the steroid or β adrenergic drugs commonly used in asthma pose a threat to the baby, either during pregnancy or during lactation. IV betamimetics can be used to delay delivery for 2–3 days and “buy time” to effect transfer antenatal steroid


A.    Prophylaxis

B.     calcipenic

C.     osteopenia

D.    Hypercalciuria

The risk of such a potentially disastrous complication does, nevertheless, make such treatment unwise in mothers with cardiac disease, hyperthyroidism, or diabetes



  1. Mothers with impaired renal function or a multiple pregnancy may also be at increased risk. Betamimetics cross the placenta but alter the fetal heart rate  than the maternal heart rate. This alteration is basically


A.    Less than

B.     Equal to

C.     Greater than

D.    Stable rate


Transient neonatal hypoglycaemia and hyperinsulinaemia have been noted after birth. Such use has not been shown to have any impact on perinatal morbidity or mortality.



  1. Potassium toxicity (hyperkalaemia) is relatively common in low birth weight babies in the first 3 days of life, and seems to correlate with low systemic blood flow soon after delivery. Plasma potassium levels are equal to are very common.



A.    >6.5mmol/l

B.     >5.6mmol/l

C.     <7.5mmol/l

D.    5.7mmol/l



Drug binding to liver and muscle adrenergic receptors stimulates cyclic adenosine monophosphate (AMP) production, causing a rise in intracellular potassium uptake and a fall in plasma potassium.



  1. Most babies are asymptomatic,cardiac arrhythmia can occur when potassium levels exceed 75 mmol/l. Dialysis, exchange transfusion, polystyrene sulphonate resins and infusions of dextrose and insulin  have all been used to reduce plasma potassium levels and the consequential risk of


  1. Anemia
  2. Thelisimia
  3. Arrhythmia
  4. Leukemia


IV salbutamol offers a simpler and more rapid way of controlling anuric hyperkalaemia, lowering the plasma potassium by at least 1 mmol/l, and time may show it to be equally effective in idiopathic neonatal hyperkalaemia



  1. The treatment in which an infusion of 4 micrograms/kg IV over 5–10 minutes is given. Sustained benefit may sometimes require one repeat infusion after a minimum of 2 hours is called


  1. Hyperkalaemia:
  2. dextrose
  3. insulin
  4. transfusion,



IV salbutamol offers a simpler and more rapid way of controlling anuric hyperkalaemia, lowering the plasma potassium by at least 1 mmol/l, and time may show it to be equally effective in idiopathic neonatal hyperkalaemia



  1. Salbutamol is available in 5 ml IV ampoules containing 50 micrograms/ml (costing 280 each). To give a 4 micrograms/kg infusion, take 16 ml of this product for each kilogram the baby weighs, dilute to 20 ml with 10% dextrose saline


  1. spleen
  2. saline
  3. atropine
  4. carmine


A less concentrated solution of dextrose or dextrose saline can be used if necessary. 25 mg (25 ml) Ventolin nebules (costing 17p) are available for nebulizer use, and ipratropium can be added to this fluid




  1. The skin of the very preterm baby is extremely delicate and very easily damaged. That of a baby born more than about 8 weeks early is not even waterproof and, in a baby born more than 12 weeks early, a lot of water leaks “insensibly” out of the body in this way in the first few days of life.


  1. Few moments
  2. Few hours
  3. Few days
  4. Few years


(Extra incubator humidity can halve insensible water loss during this time.) However, maturation occurs quite rapidly over a period of 10–14 days after birth as long as the skin is protected from damage during that time.



  1. Prevention is the key ingredient of good nursing care. Even minor trauma (such as the brisk removal of adhesive tape) can easily strip the skin of all its surface sheet of keratinised cells, leaving the baby with the equivalent of a third degree that is


  1. Skin damage
  2. Skin burn
  3. Skinning
  4. Skimming



Infection can also seriously damage the outer “waterproofing” layer of the preterm baby’s skin. As a result, the skin of a 2 week old baby born at 24 weeks gestation is much more waterproof than that of a 2 day old baby of 27 weeks gestation.



  1. Skin thin enough to let water out is also thin enough to let drugs in; the widely used skin disinfectant, hexachlorophene, had to be withdrawn in 1972 when its use was found to have caused damage of


  1. Skin
  2. Brain
  3. Liver
  4. Lungs


Alcoholic lotions not only penetrate the skin of the preterm baby but also damage the outer layer, causing haemorrhagic surface necrosis. The risk is highest when the skin is left lying in liquid alcohol for several minutes.




  1. Aniline dyes can cause methaemoglobinaemia by penetrating the skin even in the full term baby. Hydrocortisone, oestrogens, propylene glycol, urea, and lindane have all caused toxicity after absorption through the skin. Neomycin, if absorbed through damaged skin, can cause severe, lifelong


  1. Blindness
  2. Deafness
  3. Tuberculosis
  4. Diarrhea



The risk is highest when the skin is left lying in liquid alcohol for several minutes. Absorption of iodine, or povidone iodine, can make the preterm baby hypothyroid (as can the IV use of x-ray contrast media containing iodine)



  1. Babies should be towelled dry after birth to prevent dangerous hypothermia, but not bathed until the body temperature has stabilised (12–24 hours after birth). Soap and water suffices. Antisepticsthe things that  are not necessarily be used are


  1. Anticeptics
  2. Soups
  3. Lotions
  4. Shampoos


Babies usually need to be only “topped and tailed” most days after that. Small areas of vernix can be removed with acetone when monitoring leads need to be applied. Pretreatment with “tinc benz” (compound benzoin tincture BPC) can limit the damage caused by adhesive tape, etc.



  1. A pledget of collodion hardened cotton wool will stabilise a scalp drip better than tape or plaster.A pectin based barrier limits the skin damage caused by the tapes used to secure oral and nasal tubing. the most  useful barrier agent is


  1. Zinc carbonate
  2. Zinc sulphate
  3. Zinc ointment BP
  4. Zinc oxide


A transparent plastic wrap will do more than a blanket to prevent the stressful evaporative heat loss that occurs immediately after birth


  1. A waterproof, but water vapour permeable, transparent polyurethane dressing or spray can also provide a useful protective barrier over the skin during the first week of life, but it does not reduce loss of.


A.    Iodine

B.     Water

C.     Oil

D.    Fats



The use of a stay suture to fix every drain and catheter removes the need to stick any tape on the skin .The use of an emollient cream can reduce dermatitis and other signs of minor skin trauma, as can an emulsifying ointment, but excessive use can actually increase the risk of staphylococcal infection in the very preterm baby.



  1. Skin preparation is very important before any invasive procedure. Emollient creams and ointments improve the appearance and the integrity of the skin, but regular use in the very preterm baby does not reduce the risk of sepsis as was once thought. Clean hands are just as important, and supplementing a 30 second hand wash with an alcoholic hand rinse further reduces contamination.


A.    Pollution

B.     Contamination

C.     Admonition

D.    Absorption



Antiseptics are not necessary. people usually need to be only “topped and tailed” most days after that. Small areas of vernix can be removed with acetone when monitoring leads need to be applied. Keeping your body and hands clean is necessary for safety.




  1. Chlorhexidine is a bisguanide antiseptic used to cleanse skin and wounds, and to disinfect working surfaces and instruments. It is sometimes combined with cetrimide (a quaternary ammonium antiseptic). Both can cause skin


  1. Adversity
  2. Diversity
  3. Hypertension
  4. hypersensitivity




Hexachlorophene) is used on skin. All are rapidly bactericidal and particularly effective against Gram positive bacteria. Avoid contact with the eyes.



  1. Hexachlorophene is used on skin. All are rapidly bactericidal and particularly effective against Gram positive bacteria. Alcohol is a bactericidal antiseptic and disinfectant. Povidone–iodine (a also has a slowly lethal effect on bacteria, fungi, viruses, and


  1. Spores
  2. Nematods
  3. Annelids
  4. Moluscus


Preparation with 05% aqueous chlorhexidine reduced the risk of catheter related sepsis more than alcohol or povidone–iodine in a recent trial in adults. The latter two products also pose hazards when used on immature skin


  1. The importance of hand washing was brought home to all the staff in one nursery when five babies in different rooms developed a salmonella infection on a single day, from an unwell baby born to an unrecognised maternal carrier.


  1. Maternal carrier
  2. Paternal carrier
  3. Parental carrier
  4. Children carrier


The busy medical resident collected serum bilirubin specimens from all five one Christmas morning without washing his hands each time. Hand washing, to be effective, must, however, be sustained for at least 30 seconds.



  1. Sodium benzoate is excreted in the urine as hippurate after conjugation with glycine. As each glycine molecule contains a nitrogen atom, if there is complete conjugation, 1 mole of nitrogen is cleared for each mole of


  1. carbonate
  2. benzoate
  3. sulphate
  4. benzoate


Sodium benzoate and sodium phenylbutyrate are used to control the hyperammonaemia seen in children with urea cycle defects.



  1. Phenylbutyrate is oxidised to phenylacetate and excreted in the urine after conjugation with glutamine. Since phenylacetylglutamine contains two nitrogen atoms, 2 moles of nitrogen are cleared, if there is complete conjugation,for each mole of


  1. phenylbutyrate
  2. propylbenzoate
  3. butylcarbonate
  4. propanol



Both drugs can lower plasma ammonia levels in patients with urea cycle disorders. Sodium phenylbutyrate is more effective than sodium benzoate but is less palatable.



  1. Severe hyperammonaemia (500 mol/l) causes serious neurological damage, and urea cycle defects presenting in the neonatal period have a very poor prognosis. Circulating ammonia levels should be lowered as quickly as possible, if treatment is considered appropriate, using


  1. dialysis
  2. haemodialysis
  3. paralysis
  4. lymphadenopathy


Sodium benzoate and sodium phenylbutyrate can also be given, if available, while organising dialysis. These drugs are mainly used for the long term management of urea cycle disorders, including in patients with milder defects presenting after the neonatal period.


  1. While during the treatment of Acute Hyperammonean overdose can cause metabolic acidosis and a potentially fatal encephalopathy. There is a theoretical risk that this could displace bound bilirubin, so consider treating any severe


  1. jaundice.
  2. Hydrophobia
  3. Cholera
  4. Night blindness



Brusilow and Horwich recommend an IV loading dose of 250 mg/kg of each drug, given over 90 minutes, followed by a continuing maintenance infusion of each drug at 10 mg/kg per hour. Coinfusion is safe.


  1. During Maintenance treatment of Hyperammonean Up to 250 mg/kg per day of sodium benzoate can be given orally in 3–4 divided doses. The usual oral dose of sodium phenylbutyrate is also 250 mg/kg per day, but doses of up to 600 mg/kg per day

            can be given  into


  1. 2-3 doses
  2. 3-4 doses
  3. 4-5 doses
  4. 5-6 doses


The nausea and vomiting caused by the unpleasant taste of the raw products can be minimised by the use of a fruit flavoured solution. Note that 500 mg of sodium benzoate contains 35 mmol of sodium, and 500 mg of sodium phenylbutyrate contains 27 mmol of sodium.



  1. Drug dosages and diet should be adjusted to keep the plasma ammonia concentration below 60 mol/l, and the plasma glutamine level below 800 mol/l, while maintaining a normal essential amino acid profile.


  1. Base profile
  2. Acid profile
  3. Alkali profile
  4. Enzymes profile.


In arginase deficiency, aim to keep plasma arginine concentrations below 300 mol/l. The optimum dose of sodium benzoate remains uncertain. Monitoring of plasma levels is possible



  1. Sodium bicarbonate is one of the most important natural buffers of the hydrogen ion (acid) content of the blood, and the body responds to a build up of metabolic acids by increasing the amount of buffering


  1. Bicarbonate
  2. Bisulphate
  3. Binitrate
  4. Di nitrate


The neonatal kidney also has a limited ability to excrete acid. The infusion of small doses of sodium bicarbonate is a way of maintaining the acid–base balance of the blood by speeding up these processes.


  1. Controversy rages about the role of sodium bicarbonate therapy in neonatal medicine. it is now used less extensively with the recognition that it can cause sudden osmolar shifts that could be damaging to the br ain and that its excessive use can also cause



  1. hypertension
  2. hypothesis
  3. hypernatraemia
  4. haemorrhage,


it may possibly cause intraventricular haemorrhage, especially if administered rapidly. The drug still has a valuable role; however, because there is no doubt that serious acidosis compromises cardiac output and surfactant production as well as causing gastrointestinal ileus



  1. THAM is a useful alternative where there is CO2 retention or a risk of hypernatraemia (as for example, when a continuous alkaline infusion is employed in the management of persistent pulmonary hypertension) and is probably the drug of choice in the management of.


  1. cardiac arrest
  2. calcipenic arrest
  3. lungs rest
  4. mental stress


In a real emergency it is probably safe to give 2 mmol/kg IV “blind” in a severely asphyxiated infant, diluted, where possible, with an equal quantity of 10% dextrose, remembering that this will be largely ineffective if there is circulatory standstill until the drug reaches the heart and coronary circulation.



  1. In Exchange transfusion of pharmacological disease: Add 4 mmol of sodium bicarbonate to the first unit and 2 mmol to any second unit of CPD (citrate-phosphate-dextrose) blood used in an exchange transfusion undertaken in the first day of life to buffer the citrate load.


  1. Nitrate load
  2. Citrate load.
  3. Sulphate load
  4. Bicarbonate load


This advice constitutes the one exception to the rule that no drug should be added to blood or any blood product.


  1. In Oral treatmentof pharmacological diseases : Preterm babies often develop a late metabolic acidosis because of the kidney’s limited ability to excrete acid and this can inhibit weight gain


  1. Enzyme
  2.  acid
  3. alkali
  4. base


Give 2 mmol/kg of sodium bicarbonate once a day with feeds for 7 days to babies with a consistent urine pH of less than 54.Tissue extravasation due to IV administration can be managed with hyaluronidase . The use of a dilute preparation reduces the risk of serious tissue damage.