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Addressing Noise in the NICU

doi: 10.1097/01.ANC.0000337269.93341.d1
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CE Test Questions

GENERAL PURPOSE STATEMENT: To provide registered professional nurses with an interest in neonatal nursing with information relating to sound level criteria guidelines, physiologic neonatal affects of sound exposure, and factors that contribute to noise in neonatal intensive care units (NICUs) and nurseries.

LEARNING OBJECTIVES: After reading the 4 articles on neonatal noise levels and taking this test, registered professional nurses with an interest in neonatal nursing will be able to:

  1. List recommendations supported by results of research studies for criteria of sound levels in neonatal intensive care unit (NICU).
  2. Identify factors that contribute to excessive NICU noise levels.
  3. Identify how the human body is affected by high noise levels.
  4. Describe suggestions to decrease noise in hospitals and in the environment.
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Catherine L. Witt has disclosed that she has no financial relationships relevant to this continuing education activity.

This activity has been peer reviewed and determined to be objective and free from bias toward any product or service.

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Questions 1 to 6 apply to the article “A Descriptive Study of Noise in the Neonatal Intensive Care Unit: Ambient Levels and Perceptions of Contributing Factors.”

1. Which of the following are health problems that may be associated with higher intensities and loudness levels?

a. decreased urinary output

b. low blood sugar levels

c. elevated blood pressure

d. increased lower respiratory infections

2. Which statement describes the recommended noise criteria in the NICU that was established by a Sound Study Group?

a. hourly sound levels should not exceed 50 dB for 10% of the time

b. sound should not exceed a 1-second maximum level (L max) of 75 dB

c. sound impulses are allowed to fluctuate between 90 dB and 140 dB

d. hourly loudness level equivalent (L eq) in an occupied bed space should not exceed 35 dB

3. Which statement accurately describes results of the study by Zahr regarding use of small ear coverings for neonates to combat noise exposure?

a. great success for long-term usage in premature neonates

b. harmful effects for premature neonates with short-term use

c. positive benefits with long-term use on development of speech recognition

d. some positive benefits in reducing noise for short-term events, but potential problems with long-term use

4. Which statement correctly describes the sample used in the research study conducted by Darcy et al?

a. Three NICUs from the mid-Atlantic region of the U.S. participated in the study.

b. Five NICUs from the mid-western region of the U.S. participated in study.

c. All NICUs involved in the study were located in small U.S. rural hospital settings.

d. Of the NICUs that participated in the study, 4 were level IIIB units and 3 level IIIC units.

5. Which statement accurately reflects the noise level results measured in NICU sites from Darcy et al's study?

a. The day shift noise levels at all NICU sites had impulses below 65 dB.

b. The mean noise level for the day shift for all NICU sites was 44.183 dB.

c. There was minimal difference between day shift and night shift measurements.

d. The night shift noise levels at all NICU sites were within national sound guidelines.

6. In Darcy et al's study, interventions reported by nurses to decrease NICU sound levels were based mainly on

a. behavioral modifications.

b. physical environmental changes.

c. anticipating neonatal needs better to avoid crying babies.

d. utilizing ear covering equipment on premature neonates to decrease noise exposure.

Questions 7 to 11 apply to the article “Effect of Environmental Changes on Noise in the NICU.”

7. Which statement is true regarding hearing development?

a. Preterm infants are able to “tune out” background noise shortly after birth.

b. Cochlear functioning and hearing development occur at 16–19 weeks' gestation.

c. The developing ear of a fetus in utero has little protection from high frequency sound.

d. The intrauterine sensory experience may assist in focusing fetal attention on the mother's voice.

8. In past studies, what physiologic response(s) did term newborns have to noise levels greater than 80 dBA?

a. seizure activity

b. temporary paralysis

c. apnea and bradycardia

d. oliguria and dehydration

9. What were the results of the sound pressure level (SPL) sound variables after installation of the automatic paper towel dispensers?

a. significantly lower SPL sound variables

b. significantly higher SPL sound variables

c. minimal difference of SPL sound variables before and after installation

d. data were inconsistent regarding SPL sound variables before and after installation

10. Which of the four tested incubator models was identified as significantly quieter than the others through analysis of the three SPL variables?

a. Drager Caleo

b. Ohmeda Giraffe

c. Ohmeda Careplus

d. Ohmeda Omnibed

11. Which of the following was a finding of the sound levels during the Vocera Communication System trial?

a. L10 and Lmax were significantly lower.

b. L10 and Lmax were significantly higher.

c. Leq was significantly higher, but Lmax and L10 were significantly lower.

d. Leq and L10 mean levels were within nationally recommended NICU sound standards.

Questions 12 to 16 apply to the article “Recommended Permissible Noise Criteria for Occupied, Newly Constructed or Renovated Hospital Nurseries.”

12. What is the recommended limit on continuous sound in any occupied bed space?

a. an hourly Leq of 60 dB A-weighted slow response

b. an hourly L10 of 65 dB A-weighted slow response

c. 1-second duration Lmax of 70 dB A-weighted slow response

d. 5-second duration Lmax of 110 dB A-weighted slow response

13. What type of sound is described as an ongoing sound in a defined space associated with a given environment?

a. ambient

b. masking

c. transient

d. A-weighted

14. The noise criteria for the hourly Leq is intended to

a. preserve sleep for most healthy term infants most of the time.

b. create a startle response so that a healthy term infant can learn to handle stimuli.

c. create an in utero-type environment for preterm infants to enhance ear development.

d. physiologically stabilize the preterm infant's oxygen saturation and urine output.

15. What percentage of infants were disturbed or awakened at 70 dB (linear) as observed by Gadeke et al using 3-minute exposures to a broad band sound of 100 Hz to 700 Hz?

a. 25%

b. 45%

c. 75%

d. 100%

16. How can hospitals meet the sound criteria in nurseries?

a. the nursery area should include tile floors and hard surfaces

b. sound measurements should be taken sporadically for compliance monitoring

c. staff should be allowed to communicate at a level that they deem as reasonable

d. manufacturers of cribs and isolettes should develop these products to decrease sound

Questions 17 to 20 apply to “Letter from the Editor: Turn Down the Noise.”

17. Exposure to hospital noise levels louder than 80 dB

a. is normal sound criteria established by the Environmental Protection Agency (EPA).

b. is potentially dangerous and can affect the hair cells of the inner ear.

c. was considered within the established sound criteria guidelines by the EPA in 1974.

d. is appropriate stimuli to help establish normal wake cycles for premature infants.

18. According to the National Commission on Deafness and Other Communication Diseases, what percentage of people 20 to 69 years have suffered permanent hearing damage?

a. 5%

b. 7%

c. 10%

d. 18%

19. Which physiologic response to loud noise has been reported to help create a feeling of excitement and well-being?

a. slower respiratory rate b lowered blood pressure

c. increase in cortisol levels d. decreased intracranial pressure

20. Which of the following is not recommended to decrease noise exposure?

a. hold normal conversations with others at a level of 85 dB

b. educate yourself and others about the dangers of excess noise

c. use hearing protection such as ear plugs when exposed to excessive noise

d. choose quieter models of appliances and children's toys when purchasing new items



© 2008 National Association of Neonatal Nurses