RNC-NIC Neonatal Intensive Care Nurse Basic 3 — Questions and Answers
Question 1: A neonate at 27 weeks gestation is receiving mechanical ventilation. Which ventilator setting primarily controls oxygenation?
- Respiratory rate
- Peak inspiratory pressure
- FiO2 and PEEP (Correct answer)
- Inspiratory time
Correct answer: FiO2 and PEEP
Oxygenation is primarily regulated by FiO2 and PEEP, which determine mean airway pressure and alveolar recruitment.
Question 2: Which developmental care intervention has the strongest evidence for reducing pain during minor procedures in preterm neonates?
- Swaddling alone
- Oral sucrose with non-nutritive sucking (Correct answer)
- Dimming room lights
- Playing recorded lullabies
Correct answer: Oral sucrose with non-nutritive sucking
Oral sucrose combined with non-nutritive sucking is the best-evidenced pharmacologic and behavioral pain management strategy for minor neonatal procedures.
Question 3: A neonate with necrotizing enterocolitis (NEC) shows sudden abdominal distension, bloody stools, and a fixed dilated loop of bowel on X-ray. What is the priority intervention?
- Increase enteral feeds slowly
- Prepare the infant for surgical consultation (Correct answer)
- Administer probiotics
- Perform a barium enema
Correct answer: Prepare the infant for surgical consultation
A fixed dilated loop of bowel suggests intestinal perforation or necrosis, necessitating urgent surgical evaluation.
Question 4: Which blood glucose level requires immediate intervention in a symptomatic term neonate?
- Less than 60 mg/dL
- Less than 50 mg/dL
- Less than 40 mg/dL (Correct answer)
- Less than 70 mg/dL
Correct answer: Less than 40 mg/dL
A blood glucose below 40 mg/dL in a symptomatic term neonate requires immediate IV dextrose treatment per AAP guidelines.
Question 5: A neonate on total parenteral nutrition (TPN) develops signs of cholestasis. Which component of TPN is most associated with this complication?
- High glucose concentration
- Intravenous lipid emulsions (Correct answer)
- Excessive amino acid load
- Supplemental electrolytes
Correct answer: Intravenous lipid emulsions
Prolonged intravenous lipid emulsions are strongly associated with TPN-associated cholestasis in neonates.
Question 6: A nurse is caring for a neonate suspected of having congenital hypothyroidism. Which finding would be most consistent with this diagnosis?
- Jitteriness and tachycardia
- Jaundice, hypotonia, and large fontanelle (Correct answer)
- Microcephaly and hypertonia
- Petechiae and hepatosplenomegaly
Correct answer: Jaundice, hypotonia, and large fontanelle
Congenital hypothyroidism presents with prolonged jaundice, hypotonia, large fontanelle, and coarse features due to thyroid hormone deficiency.
Question 7: What is the correct sequence for the initial steps of neonatal resuscitation after birth?
- Warm, stimulate, clear airway, assess (Correct answer)
- Assess, clear airway, warm, stimulate
- Clear airway, warm, stimulate, give oxygen
- Stimulate, warm, assess, clear airway
Correct answer: Warm, stimulate, clear airway, assess
NRP guidelines specify: Warm, Dry/Stimulate, Clear airway if needed, then assess heart rate, respirations, and tone.
RNC-NIC Neonatal Intensive Care Nurse Basic 3
A neonate at 27 weeks gestation is receiving mechanical ventilation.
Which ventilator setting primarily controls oxygenation?