RNC-NIC: NCC's credential for neonatal intensive care nurses

A 32-week neonate received fentanyl 2 hours ago for intubation. To obtain accurate New Ballard neuromuscular scores, the nurse should

Pick the option you would mark on test day. The choice stays fixed, and every option then explains itself.

1. delay the neuromuscular items until sedation wears off

   Fentanyl and other sedatives depress tone and recoil, so neuromuscular items scored now would make the infant look less mature; physical items can be scored now and the neuromuscular ones finished once the drug has cleared.
2. score the neuromuscular items now as observed

   Scoring the neuromuscular items under sedation records drug-induced hypotonia as immaturity and underestimates gestational age.
3. repeat the whole examination at 7 days of age

   Repeating the whole examination at 7 days overshoots the window: New Ballard accuracy falls after about 96 hours, and the physical items never needed to wait.

During a PICC insertion in a 24-week neonate, the nurse provides facilitated tucking. This means

1. Wrapping the infant snugly in a blanket

   Wrapping in a blanket is swaddling, a different comfort method; tucking uses the caregiver's hands and leaves the cannulated limb reachable.
2. Rocking the infant gently in the arms

   Rocking is a soothing motion, not containment, and it cannot be done while a sterile line is being placed.
3. Holding the limbs flexed near the trunk

   Facilitated tucking is hands-on containment: the caregiver's hands hold the arms and legs softly flexed and midline close to the body, which blunts pain responses during the procedure.

What is the target temperature range for therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy?

1. 33–34 °C

   Whole-body cooling for moderate to severe HIE holds the core near 33.5 °C, within 33–34 °C, for 72 hours before slow rewarming.
2. 30–31 °C

   A core of 30–31 °C is colder than the protocol range and adds arrhythmia, coagulopathy and hypotension without proven extra benefit.
3. 35–36 °C

   A core of 35–36 °C is barely below normal and does not reach the neuroprotective range used in the cooling trials.

Before compassionate extubation of an infant with hypoplastic left heart syndrome, the nurse prepares the parents that the infant may

1. become calm and pink once the tube is out

   Promising a calm, pink infant sets parents up for alarm, because irregular breathing and color change are usual after the tube is removed.
2. have gasping breaths and color change

   Agonal gasping, mottling and cyanosis are expected as death approaches; describing them beforehand helps parents see them as part of dying, not suffering, while comfort medication continues.
3. need to be reintubated if gasping occurs

   Gasping after a planned comfort-care extubation is treated with comfort measures; reintubating would reverse the goals of care the family chose.