Continuing Education Course Test Directions. Course Objectives:

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1 Infection in the Neonate 1. Please fill out the answer form and include all requested information. We are unable to issue a certificate without complete information. 2. All questions and answers are developed from the information provided in the book. Select the one best answer and fill in the corresponding circle on the answer form. 3. Mail the answer form to NICU Ink, 1425 N. McDowell Blvd. Ste. 105, Petaluma, CA , with a check for $50.00 (processing fee) made payable to NICU Ink. This fee is non-refundable. 4. Retain the test for your records. 5. You will be notified of your test results within 6 8 weeks. 6. If you pass the test (80%) you will earn 20 contact hours* (5 hours pharmacology credit) for the course. Provider, Academy of Neonatal Nursing, approved by the California Board of Registered Nursing, Provider #CEP 6261, for 20 contact hours; and Florida Board of Nursing, Provider #FBN 3218, content code The Academy of Neonatal Nursing is accredited as a provider of continuing education by the American Nurses Credentialing Center s Commission on Accreditation (COA). 7. An answer key is available upon request with completion of the exam. *Contact hours based on a 60-minute hour. Iowa participants: Calculate contact hours based on 50-minute hour After reading the content and taking the test, the participant will be able to: Course Objectives: 1. Describe the characteristics used to differentiate the following microorganisms: bacteria, viruses, fungi, and protozoa. 2. Outline factors that determine the effects of microorganisms on the human body. 3. Identify common commensal organisms. 4. Define innate and adaptive immunities. 5. Outline the embryologic development of the immune system. 6. Discuss the role of each component of the immune system in the prevention-response to infection. 7. Outline methods used to detect intrauterine infection. 8. Discuss organisms responsible for intrauterine infections. 9. Identify historic trends in neonatal bacterial infections. 10. Outline risk factors for neonatal bacterial infections. 11. Discuss the incidence of neonatal bacterial infection. 12. Discuss treatment of viral infections in the neonate. Test Directions 1. Which of the following is an example of an epithet? a. coli c. Staphylococcus epidermidis b. Escherichia 2. Which of the following bacteria is arranged in chains? a. Neisseria c. Streptococcus b. Staphylococcus 3. Bacteria that grow with or without oxygen are referred to as: a. facultative anerobes c. obligate anerobes b. obligate aerobes 4. Endotoxins are produced by bacteria in which of the following families? a. Enterobacteriaceae c. Streptococcus b. Mycoplasma 1 5. Viruses with capsides are more likely to be transmitted by: a. airborne droplets c. fecal-oral route b. blood and body fluids 6. Which of the following is a characteristic of a DNA virus? a. assembly errors are more common b. genomes remain in the infected cell c. replication takes place in the cytoplasm 7. Owl-eye inclusion bodies are characteristic of infections caused by: a. cytomegalovirus c. rotavirus b. enterovirus 8. Hemagglutination is a feature of which type of virus? a. echovirus c. varicella b. influenza

2 9. Which of the following is an example of a dimorphic fungus? a. Candida c. Ureaplasma b. Histoplasma 10. Most antifungal treatment is based on the fact that the inner cell wall in a fungus contains: a. cholesterol c. triglycerides b. ergosterol 11. Most protozoa develop which of the following as a protective mechanism? a. cysts c. spores b. slime layer 12. Laboratory diagnosis of an acute infection with Toxoplasma gondii is made by measurement of: a. antibody titers c. rapid antigen detection b. inclusion bodies 13. Commensal organisms are also referred to as: a. normal flora c. pathogens b. parasites 14. The ability of E. coli to cause cystitis is improved by the presence of: a. capsules c. pili b. hyaluronidase 15. Which of the following proteins assists bacteria in penetrating host cells? a. hemolysin c. leukocidin b. internalin 16. Bacterial secretion of kinase results in: a. breakdown of red blood cells c. loosening of tissue bonds b. dissolving of clots 17. Members of which bacterial family produce hemolysin? a. Escherichia c. Streptococcus b. Staphylococcus 18. Lipopolysaccharide has been shown to cause which of the following? a. fever c. vomiting b. hemorrhage 19. Factors that determine resident flora include: a. colonization with pathogens c. temperature b. presence of transient organisms 20. Normal flora in the gastrointestinal tract are responsible for the synthesis of vitamin: a. B 12 c. K b. D 21. The site where bacteria reside prior to transferring to a host is known as the: a. fomite c. vector b. reservoir 22. Which of the following is part of innate immunity? a. antibodies c. lymphocytes b. skin ph 23. Which of following chemical mediators is released by white blood cells? a. acute-phase proteins c. kinins b. histamine 24. In the early stages of inflammation, which phagocytic cell is most prevalent? a. lymphocyte c. polymorphonuclear leukocyte b. monocyte 25. The ability to squeeze between capillary endothelial cells is referred to as: a. chemotaxis c. margination b. diapedesis 26. Which of the following cells is responsible for the immune system s ability to remember antigen exposures? a. B cells c. T cells b. natural killer cells 27. Hematopoietic stem cells are first produced in the: a. bone marrow c. yolk sac b. liver 28. The primary site of hematopoiesis between the 5th and 20th weeks of gestation is the: a. kidney c. spleen b. liver 29. Granulocytes constitute what percentage of circulating leukocytes? a c b The life span of granulocyte cells is days. a. 2 3 c b Polymorphonucleocytes (PMNs) remain in the circulating pool for hours. a. 4 c. 16 b Which of the following is responsible for chemotaxis of PMNs? a. B cells c. platelet-activating factor b. interferon 2

3 Infection in the Neonate 33. Production and release of PMNs is regulated by: a. cytokines c. T cells b. monocytes 34. Eosinophils comprise what percentage of circulating leukocytes? a. 2 5 c b Eosinophils play an important role in infections caused by: a. bacteria c. viruses b. parasites 36. Mast cells are found in which of the following locations? a. blood c. skin b. muscle 37. Histamine is released from granules found in: a. basophils c. PMNs b. eosinophils 38. Where do T lymphocytes mature and differentiate? a. bone marrow c. thymus b. liver 39. In the fetus, circulating B cell levels reach adult equivalents by which week of gestation? a. 10 c. 20 b When stimulated by an antigen, B cells differentiate into: a. mast cells c. plasma cells b. natural killer cells 41. Placental transfer by IgG begins during which week of gestation? a. 17 c. 25 b What is the half-life of IgG (in days)? a. 7 c. 21 b In neonates, B cells preferentially synthesize: a. IgA c. IgM b. IgG 44. In addition to B cells, helper T cells interact with to aid in pathogen destruction. a. basophils c. PMNs b. monocytes 45. Helper T cell function reaches adult levels by how many months of age? a. 6 c. 18 b In newborns, the most important deficiency in cell-mediated immunity is a shortage of which type of T cell? a. helper c. suppressor b. memory 47. Natural killer cells target and destroy which of the following? a. flagellated bacteria c. virus-infected cells b. protozoa 48. For how many hours do monocytes remain in circulation? a. 8 c. 24 b Macrophages found in the liver are referred to as: a. histiocytes c. mesangial cells b. Kupffer cells 50. Which of the following is known to activate monocytes? a. cytokines c. platelet-activating factor b. mast cells 51. Which of the following interleukins is secreted by activated monocytes? a. 6 c. 10 b Which of the following is released by platelet granules? a. complement c. serotonin b. histamine 53. Where are Langerhans cells found? a. cerebrospinal fluid c. mucous membranes b. connective tissues 54. Which is the most abundant immunoglobulin in humans? a. IgA c. IgM b. IgG 55. Which immunoglobulin is most efficient in activating the classical complement pathway? a. A c. M b. G 56. The largest concentration of IgE is found in the gastrointestinal tract and the: a. cerebrospinal fluid c. mucous membranes b. lungs 57. Allergic reactions and anaphylactic shock are mediated by which class of immunoglobulin? a. IgA c. IgE b. IgD 3

4 58. Of the following, which immunoglobulin class predominates during a secondary exposure to an antigen? a. IgE c. IgM b. IgG 59. Complement is synthesized by what organ? a. kidney c. spleen b. liver 60. Complement activation via the classic pathway is most often initiated by the presence of: a. antigen-antibody complexes c. plasma cells b. foreign molecules 61. Which of the following cytokines serves as the first line of defense in a viral infection? a. interferons c. tumor necrosis factor b. interleukins 62. Interleukins are produced by: a. B cells c. T cells b. monocytes 63. What is the role of fibronectins in the immune response? They: a. augment phagocytosis c. induce production of memory b. convert B cells to plasma cells cells 64. An elevation in which of the following is a marker for infection in neonates? a. C-reactive protein c. lactoferrin b. kinin 65. Viral nucleic acid sequences are identified by which of the following tests? a. cytology c. polymerase chain reaction b. electron microscopy 66. The definitive host of Toxoplasma gondii is the: a. cat c. pig b. dog 67. During acute infections, which stage of the parasite T. gondii predominates? a. bradyzoite c. tachyzoite b. sporozoite 68. What percentage of the U.S. population is seropositive for T. gondii? a. 20 c. 40 b Approximately 50 percent of infants with congenital T. gondii develop: a. chorioretinitis c. hydrocephalus b. congenital deafness 70. Diagnosis of congenital toxoplasmosis is confirmed by presence of which of the following in the cord blood? a. IgD c. IgM b. IgG 71. Congenital toxoplasmosis is treated by three or four 21-day courses of: a. folinic acid c. spiramycin b. pyrimethamine 72. Cytomegalovirus is a member of which family of viruses? a. picornaviridae c. retroviridae b. herpesviridae 73. Which of the following is the only known reservoir for CMV? a. cats c. humans b. cows 74. In the U.S., what percentage of middle- to upper-socioeconomic class women develops a primary CMV infection each year? a. 2 c. 6 b Five to fifteen percent of infants with asymptomatic CMV infection go on to develop learning disabilities or: a. blindness c. mental retardation b. hearing loss 76. Newborn findings in CMV disease include: a. cataracts c. thrombocytopenia b. hydrocephalus 77. Which of the following drugs is used to treat CMV chorioretinitis in adults? a. acyclovir c. vidarabine b. ganciclovir 78. Prodromal symptoms of rubella infection include: a. conjunctivitis c. myalgia b. diarrhea 79. Congenital anomalies associated with congenital rubella syndrome include: a. anencephaly c. peripheral pulmonic stenosis b. omphalocele 80. Syphilis is caused by a: a. Gram-positive cocci c. Gram-negative spirochete b. Gram-negative rod 81. The rash characteristic of secondary syphilis is typically found on the: a. face c. trunk b. palms 4

5 Infection in the Neonate 82. Early manifestations of congenital syphilis include: a. chorioretinitis c. hydrops fetalis b. deafness 83. Late findings characteristic of congenital syphilis include a. leukemia c. rickets b. mulberry molars 84. Which of the following is the treatment of choice for syphilis? a. clindamycin c. tetracycline b. penicillin 85. What is the incubation period for HSV infection? a. three days c. two weeks b. one week 86. The risk of neonatal HSV infection following vaginal delivery in a mother with a reactivated infection is percent. a. 0 5 c b Fetal findings in congenital HSV infection include which of the following? a. anencephaly c. vesicular skin lesions b. limb atrophy 88. In cases of skin, eye, and mouth (SEM) herpes disease, skin lesions usually appear in the first days of life. a. 5 c. 15 b The mortality rate for disseminated HSV disease is percent. a. 30 c. 50 b The recommended treatment for congenital HSV infection is: a. acyclovir c. vidarabine b. ganciclovir 91. Varicella virus is spread by which route? a. contaminated fomites c. respiratory droplets b. fecal-oral 92. A neonate whose mother develops varicella on delivery day should be given prophylactic: a. acyclovir c. VZIG b. varicella vaccine 93. Slap-cheek (Fifth) disease is caused by: a. enterovirus c. varicella zoster virus b. human parvovirus B Congenital infection with parvovirus is associated with: a. cutaneous lesions c. nonimmune hydrops fetalis b. erythroblastosis fetalis 95. Which of the following bacteria is known to cause transplacental infections in neonates? a. Group B beta-hemolytic Streptococcus (GBS) b. Listeria monocytogenes c. Neisseria gonorrhoeae 96. What is the most important risk factor for neonatal sepsis? a. low birth weight c. prolonged rupture of b. maternal infection membranes 97. Organisms commonly responsible for early-onset neonatal infection include: a. L. monocytogenes c. S. aureus b. S. epidermidis 98. The mortality rate for late-onset neonatal infections is percent. a. 2 6 c b Group A Streptococcus commonly colonizes the: a. GI tract c. skin b. oropharynx 100. The most likely reservoir for Group B Streptococcus is: a. lower GI tract c. urinary tract b. oropharynx 101. What percentage of pregnant women is colonized with GBS? a c b Infants who are born to untreated GBS-positive women and who become colonized with GBS, have approximately what chance (percentage) of developing GBS sepsis? a. 1 c. 10 b What percentage of neonates with early-onset GBS are born to women with no risk factors? a. 25 c. 45 b Fifty percent of infants with late-onset GBS present with: a. meningitis c. septicemia b. pneumonia 105. The CDC guidelines recommend that pregnant women be screened for GBS at weeks of gestation. a c b In infants, Streptococcus viridans forms part of the normal flora of the: a. ears c. skin b. mouth 5

6 107. The major source of colonization for S. aureus is: a. breast milk c. respiratory equipment b. care provider s hands 108. Methicillin-resistant Staphylococcus aureus (MRSA) is commonly responsible for: a. meningitis c. septic arthritis b. pyelonephritis 109. S. aureus pneumonia is associated with the development of: a. pleural effusions c. pulmonary interstitial b. pneumatoceles emphysema 110. Risk factors for the development of a coagulase-negative Staphylococcus (CoNS) infection include: a. formula feeding c. a prolonged hospital stay b. presence of a central line 111. S. epidermidis infections are usually treated with: a. cephalosporins c. vancomycin b. gentamicin 112. Reported epidemics of listeriosis are usually associated with: a. contaminated food c. tainted blood b. parenteral nutrition 113. The most common site for a Gram-negative infection is: a. lungs c. urinary tract b. meninges 114. The most common cause of Gram-negative sepsis is: a. E. coli c. Nesseria gonorrhoeae b. Bacteroides fragilis 115. Shigella infections are usually limited to the: a. gastrointestinal tract c. urinary tract b. lungs 116. Citrobacter has been reported to cause: a. brain abscesses c. pseudomembranous colitis b. osteomyelitis 117. Haemophilus influenzae forms part of the normal flora of the: a. gastrointestinal tract c. upper respiratory tract b. skin 118. In infants, botulism has been associated with feeding of which of the following products? a. condensed milk c. honey b. corn syrup 119. Clostridium perfringens infection in neonates is associated with: a. cellulitis c. pharyngitis b. gastroenteritis 120. Gonococcal infections are more common in: a. autumn c. summer b. spring 121. Gonococcal ophthalmia neonatorum usually presents within how many days following delivery? a. 0 1 c. 6 8 b Low birth weight infants colonized with Ureaplasma urealyticum have an increased risk of developing: a. chronic lung disease c. patent ductus arteriosus b. necrotizing enterocolitis 123. Fetal tuberculosis acquired through the bloodstream results in infection of the lung or: a. heart c. liver b. kidney 124. Chlamydial infection in neonates presents as either conjunctivitis or: a. disseminated sepsis c. pneumonia b. meningitis 125. In North America, respiratory syncytial virus (RSV) season is typically: a. September December c. February June b. October April 126. The incubation period for RSV is days. a. 2 to 8 c. 10 to 14 b. 5 to The portal of entry for RSV is usually the: a. fecal-oral route c. broken skin b. eyes and nose 128. The recommended dose of palivizumab (Synagis) is mg/kg? a. 5 c. 15 b Which of the following immunoglobulins crosses the placenta? a. IgA c. IgM b. IgG 130. A person who has contracted varicella zoster is most contagious how many days prior to the rash appearing? a. 1 2 c. 5 6 b The recommended every 8 hour dose of acyclovir for treating varicella pneumonia is mg/kg. a. 5 c. 15 b. 10 6

7 Infection in the Neonate 132. What is the minimum number of days of isolation required for neonates with a varicella zoster infection? a. 5 c. 10 b VZIG should be given within how many hours of exposure to the virus? a. 48 c. 96 b Enteroviruses spread by which of the following means? a. fomites c. respiratory droplets b. insect bites 135. Factors which contribute to enterovirus infection include: a. contaminated food c. winter season b. poor hygiene 136. Congenital enterovirus infection has been implicated in the development of: a. diabetes c. systemic lupus erythematosus b. heart disease 137. Which of the following cells are attacked by HIV? a. basophils c. neutrophils b. monocytes 138. Which of the following body fluids have been implicated in the spread of HIV? a. saliva c. urine b. semen 139. In cases of perinatal HIV infection, the median age of onset of symptoms is year(s). a. 1 c. 3 b Presenting features of HIV infection during the first year of life include: a. leukemia c. pulmonary tuberculosis b. oral candidiasis 141. Which of the following is one of the preferred methods of testing infants born to an HIV-positive woman? a. ELISA c. Western blot b. PCR 142. Treatment of HIV-positive pregnant women with zidovudine reduces the risk of perinatal infection from 25 percent to percent. a. 8 c. 16 b Which of the following side effects has been noted in infants treated with zidovudine? a. anemia c. thrombocytopenia b. neutropenia The drug of choice for Pneumocystis carinii pneumonia prophylaxis in neonates is: a. doxycycline c. trimethoprim/sulfamethoxazole b. metronidazole 145. Which of the following is one of the earliest signs of neonatal HIV infection? a. diaper dermatitis c. urinary tract infections b. hepatosplenomegaly 146. Adults with hepatitis A can be expected to shed virus for: a. 4 7 days c. several months b. 2 weeks 147. Neonates with hepatitis A infection typically: a. become jaundiced c. show mild nonspecific b. develop fever and malaise symptoms 148. The hepatitis B virus can survive on countertops for: a. several hours c. one week or more b. three or four days 149. In the majority of cases of neonatal hepatitis B infection, transmission occurs: a. at delivery c. in utero b. during breastfeeding 150. Features of fulminant neonatal hepatitis B infection include: a. elevated alanine aminotransferase (ALT) b. liver cirrhosis c. renal failure 151. Term infants born to HbsAg-negative mothers should receive their first dose of hepatitis vaccine by month(s) of age. a. one c. three b. two 152. Infants born to HBsAg-positive mothers should receive HBIG within how many hours after delivery? a. 12 c. 48 b In developed countries, the most common mode of transmission of hepatitis C (HCV) is: a. blood c. IV drug use b. fecal-oral 154. The average incubation period for HCV infection is weeks. a. 2 3 c. 6 7 b Transmission of hepatitis E (HEV) is via: a. blood c. sexual contact b. fecal-oral route

8 156. HEV epidemics have been noted in: a. Alaska c. Puerto Rico b. Mexico 157. In healthy people, Candida species normally colonize the: a. GI tract c. urethra b. nose 158. Susceptibility to Candida infection is increased in neonates infected with: a. HIV c. RSV b. HCV 159. Cutaneous Candida infection is characterized by what type of lesion? a. macular c. vesicular b. satellite 160. Symptoms of systemic candidiasis include: a. hyperglycemia c. thrombocytopenia b. renal failure 161. The recommended initial dose of amphotericin B is mg/kg given over 2 6 hours. a c b As an alternative to amphotericin B, which of the following drugs is used to treat systemic candidiasis? a. fluconazole c. mycostatin b. ketaconizole 163. The portal or mode of entry for Malassezia species is usually: a. intravenous catheters c. surgical procedures b. skin wounds 164. Treatment for Malassezia furfur infections includes: a. antifungal medication c. temporarily stopping lipids b. corticosteroids 165. The estimated rate of neonatal sepsis is infants per 1,000 live births. a. 1 8 c b The predominant organisms responsible for early-onset neonatal sepsis include: a. L. monocytogenes c. S. pneumoniae b. Enterobacter 167. In addition to CoNS, an organism that is a common cause of lateonset sepsis in neonates is: a. Enterococcus c. Streptococcus b. Haemophilus influenzae Which of the following has been shown to be a key risk factor for neonatal sepsis? a. chorioamnionitis c. maternal urinary tract b. maternal upper respiratory infection tract infection 169. One of the most common neonatal risk factors for infection is: a. malpresentation c. multiple birth b. presence of meconium in the amniotic fluid 170. Which metabolic disorder is associated with neonatal infection? a. congenital adrenal hyperplasia c. tyrosinemia b. galactosemia 171. The most common manifestation of sepsis in very low birth weight (VLBW) infants is: a. apnea c. hypotension b. feeding intolerance 172. Signs of septic shock in the neonate include: a. hypoglycemia c. seizures b. oliguria 173. Signs that suggest the need for a lumbar puncture as part of the sepsis workup include: a. neutrophilia c. sustained tachycardia b. persistent metabolic acidosis 174. Which of the following can cause a false elevation in WBC count? a. hemolysis c. nucleated red blood cells b. Howell-Jolly bodies 175. Which of the following factors influences normal WBC and differential counts? a. birth weight c. maternal hypertension b. congenital heart disease 176. Which of the following is associated with persistent neutropenia after birth? a. asphyxia c. postmaturity b. hydrops fetalis 177. The immature to total neutrophil ratio (I:T ratio) is most reliable in: a. early-onset infection c. both early- and late-onset b. late-onset infection infection 178. In neonates, thrombocytopenia should be investigated any time the platelet count falls below /mm 3. a. 200,000 c. 100,000 b. 150, C-reactive protein (CRP) begins to rise how many hours after an inflammatory stimulus? a. 1 3 c. 7 9 b. 4 6

9 Infection in the Neonate 180. Which of the following can cause a false-positive elevation of CRP? a. asphyxia c. transient tachypnea b. meconium aspiration 181. For the most sensitive result, Interleukin-6 (IL-6) should be drawn within how many hours after birth? a. 12 c. 24 b Pneumonia occurs in approximately what percentage of neonatal intensive care unit patients? a. 5 c. 15 b The most common cause of perinatally-acquired pneumonia is: a. coagulase-negative Staphylococcus b. E. coli c. Group B Streptococcus 184. Organisms responsible for late-onset respiratory infections in NICU patients include: a. Haemophilus c. Shigella b. Klebsiella 185. Which of the following factors places neonates at increased risk of respiratory infection? a. absent cilia c. reduced concentrations of IgM b. diminished lung macrophage activity 186. Chest x-ray findings typical of neonatal pneumonia include: a. diffuse atelectasis c. pulmonary interstitial b. hyperinflation of the alveoli emphysema 187. Neonatal meningitis occurs at a rate of per 1,000 live births. a c b What percentage of infants with a positive blood culture go on to develop meningitis? a. 15 c. 25 b Which of the following is one of the organisms most commonly responsible for neonatal meningitis? a. Klebsiella c. S. aureus b. Listeria 190. In neonates, seizures may be more common in meningitis caused by: a. Gram-positive bacteria c. viruses b. Gram-negative bacteria 191. A cerebrospinal fluid (CSF) leukocyte count that is equal to or exceeds /mm 3, is indicative of meningitis. a. 12 c. 32 b Which of the following is the recommended initial therapy for suspected meningitis? a. ampicillin and an aminoglycoside b. ampicillin and a cephalosporin c. vancomycin and gentamicin 193. How many weeks should antibiotics be administered in cases of meningitis caused by a Gram-negative organism? a. two c. four b. three 194. Long-term complications of meningitis include: a. blindness c. reading problems b. microcephaly 195. Urinary tract infections are most often caused by: a. E. coli c. Klebsiella b. Group B Streptococcus 196. What definitive diagnostic test should be done to rule out a structural abnormality in neonates who have had a urinary tract infection (UTI)? a. intravenous pyelogram c. voiding cystourethrogram b. nuclear scan 197. What percentage of neonates with a UTI also have septicemia? a c b In the first eight weeks of life, otitis media is estimated to occur in what percentage of term infants? a. 34 c. 56 b Approximately 50 percent of neonates with otitis media also have: a. conjunctivitis c. tympanic perforation b. tonsillitis 200. Organisms commonly responsible for osteomyelitis in the neonate include: a. Clostridium c. S. aureus b. herpes 201. Joint infections caused by Gram-negative organisms are usually treated with gentamicin or: a. cefotaxime c. vancomycin b. erythromycin 202. Omphalitis is usually caused by Staphylococcus or: a. E. coli c. Streptococcus b. Pseudomonas 9

10 203. Usual sites for scalded skin infection include the: a. buttocks c. toes b. neck 204. Which of the following can be used for the treatment of scalded skin infections? a. ampicillin c. oxycillin b. gentamicin 205. The most common cause of neonatal ophthalmia is: a. Chlamydia c. Streptococcus b. Haemophilus 206. Ophthalmia caused by Pseudomonas can result in the development of: a. a brain abscess c. renal failure b. pneumonia 207. What substance is responsible for the development of septic shock? a. cytokines c. histamine b. endotoxin 208. In septic shock, the release of which of the following results in decreased vascular tone? a. aldosterone c. prostacyclin b. IL During periods of moderate reduction in cardiac output, intense vasoconstriction can be experienced by which organ? a. bowel c. skin b. kidney 210. In septic shock, the initial effect on the heart is: a. a decrease in contractility c. an increase in afterload b. a decrease in preload 211. Which of the following would be an expected finding in early cardiogenic shock? a. hypertension c. warm, flushed skin b. respiratory acidosis 212. In septic shock, recurrent acidosis suggests a state of: a. cardiac decompensation c. respiratory failure b. hypoperfusion 213. Hypocalcemia in sepsis results from: a. elevated adrenaline level c. relative fluid overload b. impaired parathyroid function 214. The most common mechanism by which antibiotics work is in the inhibition of synthesis. a. cell wall c. protein b. nucleic acid 215. Drugs which inhibit cell wall synthesis include: a. clindamycin c. vancomycin b. gentamicin 216. Amphotericin B works by which of the following mechanisms? Inhibition of: a. cell membrane function c. protein synthesis b. cell wall synthesis 217. One of the drugs that functions by inhibiting nucleic acid synthesis include: a. ampicillin c. imipenem b. flucytosine 218. A newborn s ability to absorb oral antibiotics is diminished in part due to: a. acidic gastric ph c. rapid intestinal transit time b. decreased pancreatic enzyme activity 219. Compared with a term neonate, a preterm neonate may require a higher dose of an aminoglycoside because of the presence of increased: a. extracellular fluid c. intracellular fluid b. fat cells 220. Which of the following antibiotics has been shown to significantly displace bilirubin from albumin-binding sites? a. amphotericin c. vidarabine b. ceftriaxone 221. The chief pathway for elimination of antibiotics in the neonate is via the: a. gut c. lungs b. kidney 222. Therapy to treat possible infection caused by anaerobic organisms is warranted in cases of: a. bowel perforation c. urinary tract infection b. meningitis 223. Among aminoglycosides, which drug is reserved for infections caused by multiply-resistant strains? a. amikacin c. tobramycin b. gentamicin 224. When combined with penicillins, aminoglycosides provide synergistic activity against: a. anerobic organisms c. Gram-negative bacilli b. enterococci 225. An effective choice for the treatment of Treponema pallidum infections is: a. gentamycin c. penicillin b. rifampin 10

11 Infection in the Neonate 226. Ampicillin is more effective than penicillin against most strains of: a. Group A Streptococcus c. Pneumococcus b. L. monocytogenes 227. Anti-staphylococcal penicillins include: a. nafcillin c. ticarcillin b. piperacillin 228. Compared to earlier penicillins, ticarcillin has increased activity against: a. E. coli c. Staphylococcus b. Proteus 229. Which of the following drugs is most active against Pseudomonas aeruginosa? a. azlocillin c. piperacillin b. mezlocillin 230. Third-generation cephalosporins are not suitable for single agent treatment of suspected sepsis because of their limited activity against: a. E. coli c. Listeria b. Klebsiella 231. The primary role of clindamycin in neonates is in the treatment of: a. Bacteroides c. Serratia b. Pseudomonas 232. Vancomycin is the drug of choice for the treatment of infections caused by: a. coagulase-negative Staphylococcus b. Enterococcus c. S. aureus 233. Rapid administration of IV amphotericin B may result in: a. respiratory arrest c. systemic hypotension b. seizures 234. The primary adverse effect of acyclovir is (an) altered: a. hematologic profile c. renal function b. liver function 235. Which antiviral drug is currently being investigated for the treatment of congenital CMV? a. acyclovir c. vidarabine b. ganciclovir 11

12 ANSWER FORM: Infection in the Neonate: A Comprehensive Guide to Assessment, Management, and Nursing Care Please completely fill in the circle of the one best answer using a dark pen. # Questions are numbered vertically. 1. a. 16. a. 31. a. 46. a. 61. a. 76. a. 91. a a a a. 2. a. 17. a. 32. a. 47. a. 62. a. 77. a. 92. a a a a. 3. a. 18. a. 33. a. 48. a. 63. a. 78. a. 93. a a a a. 4. a. 19. a. 34. a. 49. a. 64. a. 79. a. 94. a a a a. 5. a. 20. a. 35. a. 50. a. 65. a. 80. a. 95. a a a a. 6. a. 21. a. 36. a. 51. a. 66. a. 81. a. 96. a a a a. 7. a. 22. a. 37. a. 52. a. 67. a. 82. a. 97. a a a a. 8. a. 23. a. 38. a. 53. a. 68. a. 83. a. 98. a a a a. 9. a. 24. a. 39. a. 54. a. 69. a. 84. a. 99. a a a a. 10. a. 25. a. 40. a. 55. a. 70. a. 85. a a a a a. 11. a. 26. a. 41. a. 56. a. 71. a. 86. a a a a a. 12. a. 27. a. 42. a. 57. a. 72. a. 87. a a a a a. 13. a. 28. a. 43. a. 58. a. 73. a. 88. a a a a a. 14. a. 29. a. 44. a. 59. a. 74. a. 89. a a a a a. 15. a. 30. a. 45. a. 60. a. 75. a. 90. a a a a a. 12

13 Infection in the Neonate 151. a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a. Evaluation Directions Thank you for taking the time to assist us in evaluating the effectiveness of this course. Using the scale below, darken the circles corresponding to your responses. If an item is not applicable, leave it blank. Objectives: I am able to: Strongly Disagree Disagree Neutral Agree Strongly Agree 1. Describe the characteristics used to identify bacteria, viruses, fungi, and protozoa. 2. Outline factors that determine the effects of microorganisms on the human body. 3. Identify common commensal organisms. 4. Define innate and adaptive immunities. 5. Outline the embryologic development of the immune system. 6. Discuss the role of each component of the immune system in the prevention and response to infection. 7. Outline methods used to detect intrauterine infection. 8. Discuss organisms responsible for intrauterine infections as to incidence and diagnosis. 9. Identify historic trends in neonatal bacterial infections. 10. Outline risk factors for neonatal bacterial infections. 11. Discuss incidence of neonatal bacterial infections. 12. Discuss treatment of viral infections in the neonate. 13

14 Presentation: 1. The material presented was relevant to my practice. 2. The questions on the test reflected the content of this book. 3. The content of the book was comprehensive. 4. The test directions were clear. 5. I perceive the education level of this course to be: 1 = Basic; 2 = Intermediate; 3 = Advanced 6. How long did it take you to complete the course? hours minutes 7. In what level unit do you practice? I II III What subjects would you like to see offered for CE courses? Additional comments: Iowa participants may submit a copy of this evaluation directly to the Iowa Board of Nursing, 400 SW 8th St., Ste. B, Des Moines, IA Print clearly Name Address (to receive certificate via ) Nursing License # City State(s) of License State Zip Academy (ANN) Membership # Phone ( ) Please complete the evaluation form beginning on the previous page Mail with a $50.00 non-refundable processing fee for 20 contact hours (5 hours pharmacology credit) to NICU Ink, 1425 N. McDowell Blvd., Ste. 105, Petaluma, CA Test expires June 30, 2016 Please make check payable to NICU Ink. Enclose an additional $10.00 for rush processing. International Participants: International Money Order drawn on U.S. bank only. FOR OFFICE USE ONLY Received Check Grade Certificate Issued Reference # 14