Neonatal Nurse Practitioner Practice Exam

A 3-hour-old 41-week infant had a cyanotic episode during a diaper change. What is the most important evaluation for this infant?

1. PDA

2. PPHN

3. TTN

4. CHF

The correct answer is: PPHN

In this scenario, the most significant evaluation for a 3-hour-old infant who has experienced a cyanotic episode during a diaper change is pulmonary arterial hypertension, specifically persistent pulmonary hypertension of the newborn (PPHN). Cyanosis in a newborn, especially shortly after birth, indicates inadequate oxygenation and can be due to several underlying conditions. PPHN is a critical consideration because it involves an abnormal elevation of pulmonary arterial pressure, leading to decreased blood flow to the lungs and impaired oxygenation. The timing of the cyanotic episode immediately following birth suggests that the infant may not yet have adapted to postnatal life, where proper oxygenation is essential. If PPHN is present, it can result in significant respiratory distress and may require urgent intervention. While conditions like patent ductus arteriosus (PDA) and congestive heart failure (CHF) can also lead to cyanotic episodes, they generally present with other signs and symptoms that develop over a longer time frame. Transient tachypnea of the newborn (TTN) usually causes respiratory distress but is less likely to result in significant cyanosis. Therefore, assessing for PPHN is the priority in this clinical scenario given the acute nature and timing of the infant's symptoms.