Neonatal Nurse Practitioner Practice Exam

In the case of a vigorous neonate born with thick meconium present in the amniotic fluid, the immediate and appropriate next step after placing the baby on a warmed radiant warmer is to perform bulb syringe suctioning. This approach is intended to clear the airways of any meconium present to prevent potential airway obstruction and respiratory issues.

The rationale for utilizing bulb suctioning is that this method provides a way to manually clear secretions from both the mouth and the nose, facilitating the initial establishment of an airway. Since the neonate is vigorous, it is appropriate to start with this less invasive method before considering more advanced interventions if needed.

Other methods such as endotracheal suctioning may be necessary in certain scenarios, particularly if the neonate shows signs of respiratory distress or if the airway cannot be effectively cleared with simple suctioning. However, in a vigorous infant, the initial step should prioritively involve non-invasive suctioning techniques.

Evaluation of respirations forms part of ongoing monitoring but does not serve as an immediate intervention after the initial placement and warming. Meanwhile, an intrapartum vaginal examination is not relevant after the baby is born and does not contribute to immediate neonatal resuscitation efforts.