Neonatal Nurse Practitioner Practice Exam

A neonate, apneic and cyanotic after a mother was given Demerol prior to delivery, should first receive?

1. Administration of naloxone 0.1mg/kg

2. Bag and mask ventilation

3. Placement of endotracheal tube

4. Oxygen therapy

The correct answer is: Bag and mask ventilation

In the context of a neonate who is apneic and cyanotic, the priority intervention is the provision of bag and mask ventilation. When a newborn presents with these critical signs, immediate respiratory support is essential to restore adequate oxygenation and ventilation. Bag and mask ventilation is a rapid, effective way to help the infant breathe until further evaluation and treatment can be initiated. This intervention allows for the delivery of positive pressure breaths and assists in clearing carbon dioxide, which is vital in alleviating the immediate life-threatening condition of apneic and cyanotic status. It also helps to stabilize the neonate while further assessments and treatments are underway. Once the newborn is receiving adequate ventilation, additional interventions can be considered. For example, naloxone may be necessary if the respiratory depression is due to opioid exposure, such as from the mother's Demerol administration; however, ventilatory support should take precedence in an acute situation. Placement of an endotracheal tube may be required if there is insufficient response to bag and mask ventilation, but this is a more invasive procedure that typically follows initial stabilization efforts. Lastly, while oxygen therapy is important, it is insufficient alone for an apneic and cyanotic neonate without the support of effective ventilation.