Neonatal Nurse Practitioner Examination – Rationale Samples

Question

Gallop rhythm in neonates with congestive heart failure occurs due to ventricular dilatation and

  • excess preload
  • increased blood flow diverted from extremities
  • reduced cardiac output

Rationale

Dilation of the heart occurs in response to the volume and pressure overload (excess preload). The gallop rhythm is the abnormal filling sound of the dilated ventricles.

Question

An x-ray of a neonate with worsening cyanosis, tachypnea and respiratory distress shows the following:
• Prominent main pulmonary artery segment
• Mild cardiomegaly
• Increased variable pulmonary vasculature

These findings are most consistent with

  • meconium aspiration syndrome
  • persistent pulmonary hypertension
  • respiratory distress syndrome

Rationale

While the clinical findings can be similar among all the diseases noted in the question, the x–ray findings are consistent with persistent pulmonary hypertension. X–rays of meconium aspiration syndrome show air trapping and hyperexpansion and patchy infiltrates. In respiratory distress syndrome, x–ray findings reflect a ground–glass appearance, air bronchograms and reticulogranular pattern.