RNC-NIC Neonatal Intensive Care Nurse Basic 5 — Questions and Answers
Question 1: A neonate with persistent pulmonary hypertension (PPHN) does not improve with 100% oxygen. Which inhaled medication is the first-line treatment?
- Inhaled prostacyclin (epoprostenol)
- Inhaled nitric oxide (iNO) (Correct answer)
- Inhaled albuterol
- Inhaled surfactant
Correct answer: Inhaled nitric oxide (iNO)
Inhaled nitric oxide selectively dilates pulmonary vasculature without systemic hypotension and is the first-line therapy for PPHN.
Question 2: A NICU nurse is performing developmental positioning for a 28-week preterm neonate. Which position best supports flexion and midline orientation?
- Supine with arms extended at sides
- Prone with head turned to side and limbs extended
- Side-lying with knees and elbows flexed toward midline (Correct answer)
- Supine with neck hyperextended
Correct answer: Side-lying with knees and elbows flexed toward midline
Side-lying with flexed extremities brought toward midline mimics the fetal position and promotes neuromotor development.
Question 3: Which maternal history finding is an important risk factor for early-onset neonatal sepsis (EOS)?
- Maternal use of epidural analgesia
- Group B Streptococcus (GBS) colonization with inadequate intrapartum prophylaxis (Correct answer)
- Maternal hypothyroidism
- Maternal gestational hypertension
Correct answer: Group B Streptococcus (GBS) colonization with inadequate intrapartum prophylaxis
GBS colonization without adequate intrapartum antibiotics is a leading risk factor for early-onset neonatal sepsis.
Question 4: A nurse notices that a 34-week neonate receiving nasal CPAP has a distended abdomen. What is the most likely explanation?
- Bowel obstruction from NEC
- Air swallowing causing gastric distension (Correct answer)
- Hepatosplenomegaly from infection
- Ascites from hydrops fetalis
Correct answer: Air swallowing causing gastric distension
CPAP can cause air swallowing leading to gastric distension; an orogastric tube is often placed to vent the stomach.
Question 5: A nurse is preparing to discharge a NICU infant whose mother plans to breastfeed. Which instruction regarding breast milk storage is correct?
- Fresh breast milk is safe at room temperature for up to 12 hours
- Refrigerated breast milk is safe for up to 8 days
- Frozen breast milk should be thawed in a microwave for even heating
- Refrigerated breast milk is safe for up to 4 days (Correct answer)
Correct answer: Refrigerated breast milk is safe for up to 4 days
Refrigerated breast milk is safe for up to 4 days (96 hours) at or below 4°C per CDC guidelines for healthy infants.
Question 6: Which neonatal condition presents with 'double bubble' sign on abdominal X-ray?
- Pyloric stenosis
- Duodenal atresia (Correct answer)
- Hirschsprung disease
- Jejunal atresia
Correct answer: Duodenal atresia
Duodenal atresia produces the classic 'double bubble' sign representing air in the stomach and proximal duodenum with no distal gas.
Question 7: A nurse is caring for a neonate with suspected hypoxic-ischemic encephalopathy (HIE). Which intervention is the standard of care to improve neurological outcomes?
- Aggressive fluid resuscitation
- Therapeutic hypothermia (cooling to 33–34°C for 72 hours) (Correct answer)
- Prophylactic phenobarbital for all HIE cases
- Immediate hyperventilation to reduce cerebral edema
Correct answer: Therapeutic hypothermia (cooling to 33–34°C for 72 hours)
Therapeutic hypothermia (33–34°C for 72 hours) initiated within 6 hours of birth is the standard neuroprotective treatment for moderate-to-severe HIE.
RNC-NIC Neonatal Intensive Care Nurse Basic 5
A neonate with persistent pulmonary hypertension (PPHN) does not improve with 100% oxygen.
Which inhaled medication is the first-line treatment?