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The C-ELBW exam has 125 questions and runs 2 hours.
These 10 free C-ELBW questions are organized by exam domain, so you can see how each part of the Care of the Extremely Low Birth Weight Neonate blueprint is tested. Reveal the answer and explanation under each question.
Fifteen minutes after surfactant administration, a 720-g infant born at 25 weeks remains on pressure-limited ventilation with unchanged settings. Exhaled tidal volume has risen from 4.5 to 8 mL/kg, SpO2 is 99% on FiO2 0.45, and an arterial gas shows pH 7.53 and PaCO2 26 mmHg. Chest expansion is symmetric. Which adjustment best addresses the new findings?
Correct answer: B - Reduce inspiratory pressure and titrate FiO2 downward.
Before changing treatment for persistent hyperglycemia, the team reviews every infusion running into an infant whose prescribed dosing weight is 0.80 kg. Aqueous parenteral nutrition contains 12.5% dextrose and runs at 3.2 mL/hour; a separate 5% dextrose medication carrier runs at 0.8 mL/hour; and a 20% lipid emulsion runs at 0.4 mL/hour. There are no other infusions or enteral feeds. What total intravenous glucose infusion rate should be used in this review?
Correct answer: B - 9.2 mg/kg/min
A newly born 26-week infant is apneic. After 30 seconds of mask positive-pressure ventilation, the ECG heart rate is 54/min, unchanged from the initial reading. There is no visible chest movement, and the mask has an audible leak. A team member prepares to start compressions. What must take priority?
Correct answer: C - Correct the leak and airway position to establish lung-inflating ventilation.
The parent of an 880-g infant asks to provide skin-to-skin care. The infant remains intubated but has had stable ventilator settings, temperature, and perfusion for 48 hours, tolerates routine handling, and receives no vasoactive medication. The airway is secure, and staff experienced in transferring ventilated infants are available. How should the team plan the first session?
Correct answer: A - Arrange monitored skin-to-skin care with coordinated airway and line support.
During heel sampling, an infant at 29 weeks postmenstrual age has a Premature Infant Pain Profile-Revised (PIPP-R) score of 15 despite containment and non-nutritive sucking. The infant is intubated but receives neither sedation nor neuromuscular blockade. Brow bulge, eye squeeze, and physiologic changes are observed, but no cry is audible. Which interpretation should guide the pain plan for the next procedure?
Correct answer: B - The score indicates moderate-to-severe pain despite the absence of an audible cry.
Free intraperitoneal air is detected in a 6-day-old, 630-g infant born at 24 weeks. Enteral feeding has not yet begun. Necrotizing enterocolitis and spontaneous intestinal perforation are both being considered while surgical management is arranged. What additional finding would most strongly favor spontaneous intestinal perforation?
Correct answer: D - A single ileal perforation with otherwise healthy surrounding bowel.
An echocardiogram on day 6 identifies a 1.8-mm left-to-right patent ductus arteriosus in an infant born at 26 weeks weighing 780 g. There is no left-heart enlargement or reversed diastolic flow in the descending aorta. The infant is comfortable on CPAP in room air, tolerates advancing feeds, and has normal perfusion and urine output. The ductal diameter prompts a suggestion to begin ibuprofen. Which approach is best supported by the whole assessment?
Correct answer: C - Continue expectant management, following the respiratory course and reassessing ductal hemodynamics.
At the 36-week postmenstrual-age assessment, an infant born at 25 weeks still requires nasal CPAP at 6 cm H2O. FiO2 has been 0.21 for the preceding week, but attempts to remove CPAP produce increased work of breathing. Applying the Jensen 2019 definition of bronchopulmonary dysplasia, which entry belongs in the outcome record?
Correct answer: D - Grade 2, because noninvasive positive-pressure support is still required.
A gentamicin dosing review is requested for a 12-day-old infant born at 25 weeks. Serum creatinine has risen from 0.45 to 1.10 mg/dL over 48 hours; 0.45 mg/dL was the lowest value in the preceding seven days. Urine output has remained 2.6 mL/kg/hour. Which is the highest neonatal modified KDIGO stage met by these findings?
Correct answer: D - Stage 2, based on the increase to more than twice the preceding baseline.
Maya and Lena were born at 24 weeks. Maya died, and Lena remains in intensive care. Their mother cries when staff celebrate Lena's weight gain, while their father asks detailed questions about the ventilator. The mother says, "He only talks about oxygen. How can he not care that Maya died?" Which response most appropriately supports the family?
Correct answer: A - "People can grieve differently. What support would each of you find helpful?"
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