RNC-NIC practice questions, answered option by option

Membranes ruptured at 0300 on Monday, and the infant was born at 0100 on Tuesday. For early-onset sepsis risk assessment, the nurse records rupture of membranes of

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

1. 14 hours, which is not prolonged

   Fourteen hours undercounts the interval across midnight; the true 22 hours is above the 18-hour threshold.
2. 22 hours, which is prolonged

   From 0300 Monday to 0100 Tuesday is 22 hours, past the 18-hour mark used in early-onset sepsis risk assessment.
3. 26 hours, which is prolonged

   Twenty-six hours adds 4 hours that did not pass; counting from 0300 to 0100 the next day gives 22.

Which maternal intrapartum regimen is considered adequate GBS prophylaxis when assessing the newborn's risk of early-onset sepsis?

1. Clindamycin 6 hours before delivery

   Clindamycin, used for severe penicillin allergy, is not counted as adequate prophylaxis in the newborn's risk assessment at any duration.
2. IV ampicillin 2 hours before delivery

   Ampicillin is an accepted drug, but 2 hours is under the 4-hour minimum, so the newborn is assessed as inadequately covered.
3. IV cefazolin 5 hours before delivery

   Penicillin, ampicillin or cefazolin given at least 4 hours before birth counts as adequate GBS prophylaxis, and 5 hours of cefazolin meets that bar.

In a growth-restricted 36-week neonate, the New Ballard physical items score lower than the obstetric dates predict. The component that better reflects true gestational age is the

1. physical maturity score

   The physical items are the ones distorted here: poor fetal nutrition reduces breast tissue and fat, so they underestimate maturity.
2. neuromuscular score

   Neuromuscular maturation tracks gestational age closely, while growth restriction shrinks breast tissue and fat and drags the physical items down.
3. weight-for-gestational-age percentile

   A weight percentile describes growth at a known age; it cannot be used to estimate the age itself.

Before the birth of a 750 g neonate expected at 26 weeks, the delivery room temperature should be set at

1. 28–30 °C (82–86 °F)

   A 28–30 °C room is warmer than recommended and adds a risk of overheating once wrap and warmer are in use.
2. 23–25 °C (74–77 °F)

   NRP calls for a delivery room of 23–25 °C when a birth before 32 weeks is expected, together with a radiant warmer, a hat and plastic wrap.
3. 20–22 °C (68–72 °F)

   A standard 20–22 °C room is too cool for an extremely preterm infant, whose temperature can fall within minutes of birth.

Which nursing practice helps reduce the risk of intraventricular hemorrhage in a 24-week neonate during the first 72 hours?

1. Neutral midline head position

   Keeping the head midline, often with the head of the bed slightly raised, avoids kinking the jugular veins and keeps cerebral venous outflow steady while the germinal matrix is most fragile.
2. Routine rapid volume boluses

   Rapid boluses cause swings in cerebral blood flow, a known trigger for germinal matrix bleeding; volume is given slowly and only when indicated.
3. Legs lifted high for diaper changes

   Lifting the legs high for a diaper change raises cerebral venous and arterial pressure; the hips are rolled to the side instead.

A 1.5 kg ventilated preterm infant has a stable PaCO₂ of 58 mmHg for several days, with pH 7.34 and HCO₃⁻ 30 mEq/L. The raised HCO₃⁻ is mainly caused by

1. Bicarbonate added to IV fluids

   Added bicarbonate would be a primary metabolic alkalosis; here the rise follows days of high CO₂ and only partly corrects the pH.
2. Respiratory compensation

   Respiratory compensation changes breathing to offset a metabolic problem; here the lungs are the primary problem and the kidneys compensate.
3. Renal bicarbonate retention

   With CO₂ held high for days, the kidneys hold on to more bicarbonate and pull the pH back toward normal; the raised level is renal compensation, not a new metabolic problem.

A term neonate at 50 hours of age, on day 2 of therapeutic hypothermia, has an asymptomatic glucose of 48 mg/dL on D10W at a GIR of 5 mg/kg/min. The most appropriate action is to

1. Increase dextrose delivery and recheck

   After 48 hours of age the goal is above 60 mg/dL, so a value of 48 on an infusion calls for a higher glucose infusion rate (faster rate or stronger dextrose) and a recheck.
2. Give a D25W 2 mL/kg IV bolus

   D25W is too concentrated for a neonatal bolus; when one is needed it is D10W 2 mL/kg, and an asymptomatic infant on an infusion needs a higher GIR instead.
3. Make no change to the infusion

   A value in the high 40s can be accepted on the first day, but by 50 hours the target is above 60 mg/dL, so leaving the infusion unchanged undertreats.

A term neonate on mask ventilation has HR 130/min, good chest rise and a preductal SpO₂ of 68% at 5 minutes on FiO₂ 0.21. The nurse should

1. Perform MR SOPA corrective steps

   Corrective steps fix ineffective ventilation; good chest rise and a heart rate of 130 show ventilation is already working.
2. Increase FiO₂ straight to 1.0

   Going straight to 100% oxygen is reserved for chest compressions; with a heart rate of 130 it only risks hyperoxia.
3. Increase FiO₂ in small steps

   With effective ventilation and a good heart rate, a preductal SpO₂ of 68% at 5 minutes is under the 80–85% target, so oxygen is titrated upward gradually.

To protect sleep in a stable 30-week neonate, routine care such as diaper changes and assessments is best done

1. During periods of deep sleep

   Handling an infant in deep sleep fragments sleep and causes physiologic instability, even when the infant does not cry.
2. On a fixed 3-hour schedule

   A fixed clock schedule ignores the infant's state and often interrupts deep sleep.
3. During the infant's awake periods

   Cue-based care times handling to when the infant is awake or drowsy, which protects the deep sleep needed for brain development.

A 27-week neonate spends weeks lying with the head turned to one side or the other. Without careful positioning, the most common head-shape change is

1. Brachycephaly

   Brachycephaly is a flat back of the head from prolonged supine lying, the usual pattern in term infants kept on their backs.
2. Dolichocephaly

   A soft preterm skull resting on alternating sides flattens laterally and grows long and narrow, the shape called dolichocephaly.
3. Craniosynostosis

   Craniosynostosis is early fusion of a skull suture, not a shape change caused by position.

A 680 g neonate born at 24 weeks is in an incubator at low humidity. On day 2 the serum sodium is 152 mEq/L (152 mmol/L) and weight has fallen 12%. The most appropriate change is to

1. Increase total fluid intake

   A rising sodium with 12% weight loss in a 24-week infant at low humidity is free-water loss through immature skin, corrected with more fluid and more humidity.
2. Give furosemide to clear sodium

   Furosemide makes the kidneys lose water along with sodium, which deepens the dehydration that is driving the high sodium.
3. Add sodium to the IV fluids

   Adding sodium to a hypernatremic infant pushes the level higher; the problem is a water deficit, not a lack of sodium.

On a radiograph, the tip of a high umbilical arterial catheter should lie at

1. T1–T3

   T1–T3 is too high, close to the aortic arch and the vessels to the head and arms.
2. T10–L2

   T10–L2 is the zone to avoid because the major abdominal branches arise there; a low line sits at L3–L4 instead.
3. T6–T9

   A high umbilical arterial line tip sits in the descending aorta at T6–T9, above the celiac, mesenteric and renal arteries.

A neonate presents with abdominal distension, bilious vomiting, and failure to pass meconium within 24 hours. Contrast enema shows a transition zone in the sigmoid colon. What is the definitive diagnostic test?

1. Suction rectal biopsy

   Hirschsprung disease is confirmed when a suction rectal biopsy shows no ganglion cells in the submucosa; the enema only suggests it.
2. Abdominal ultrasound

   Ultrasound can show dilated bowel but cannot show whether ganglion cells are present.
3. Upper GI contrast study

   An upper GI study looks for malrotation with volvulus; it cannot diagnose aganglionosis of the colon.

A term neonate who fed well for 48 hours becomes lethargic and feeds poorly. A blood gas shows pH 7.50 and PaCO₂ 28 mmHg with a normal bicarbonate. Which laboratory test is the most important to obtain next?

1. Serum lactate level

   Lactate rises in organic acidemias and mitochondrial disease, which usually give a metabolic acidosis rather than this alkalosis.
2. Plasma ammonia

   Lethargy after a healthy start plus respiratory alkalosis is the classic picture of a urea cycle disorder; high ammonia drives hyperventilation and must be measured at once.
3. Urine ketone level

   Urine ketones point toward organic acidemias or maple syrup urine disease, again usually with acidosis, not a primary respiratory alkalosis.

During whole-body therapeutic hypothermia, the neonate's core temperature should be monitored with

1. Axillary thermometer, hourly

   Hourly axillary checks are peripheral and intermittent, so overshoot below the target range goes unnoticed between readings.
2. Esophageal probe, continuously

   Whole-body cooling is servo-controlled from a core reading, and an esophageal (or rectal) probe gives that core temperature continuously.
3. Skin probe, continuously

   A skin probe reads surface temperature, which drifts far from core during cooling and cannot guide the servo.

A neonate of a group O mother is jaundiced at 18 hours of age and is blood group A. Which test identifies antibody-mediated hemolysis in the infant?

1. Direct Coombs test

   The direct antiglobulin (Coombs) test detects maternal anti-A antibody coating the infant's red cells, confirming immune hemolysis.
2. Kleihauer-Betke test

   Kleihauer-Betke counts fetal cells in the mother's blood to size a fetomaternal hemorrhage, not antibody on the infant's cells.
3. Apt test on gastric aspirate

   The Apt test on gastric aspirate or stool tells swallowed maternal blood from fetal blood; it says nothing about hemolysis.

A 10-day-old infant has eyelid swelling and purulent conjunctival discharge. Chlamydia trachomatis PCR is positive. The appropriate treatment is

1. Oral erythromycin or azithromycin

   Chlamydial conjunctivitis is treated systemically, with oral erythromycin for 14 days or azithromycin for 3 days, because the organism can also cause pneumonia; watch for pyloric stenosis with erythromycin.
2. A single dose of IV cefotaxime

   A single dose of a third-generation cephalosporin treats gonococcal eye infection, not chlamydia.
3. Topical erythromycin ointment alone

   Topical treatment alone does not clear nasopharyngeal carriage or prevent chlamydial pneumonia.

Bronchopulmonary dysplasia in a neonate born at 26 weeks is diagnosed by the need for respiratory support or supplemental oxygen at

1. 28 days of life

   Oxygen for 28 days was a criterion in older definitions; the diagnosis and its grade are now set by the support needed at 36 weeks PMA.
2. 36 weeks postmenstrual age

   Current definitions assess BPD at 36 weeks postmenstrual age in infants born before 32 weeks and grade it by the support needed then.
3. 40 weeks postmenstrual age

   Term-equivalent age is not the standard assessment point; for infants born this early the assessment is fixed at 36 weeks PMA.

A large-for-gestational-age neonate has an omphalocele, macroglossia, and hypoglycemia. These findings suggest

1. Trisomy 21

   Trisomy 21 brings hypotonia and a protruding tongue, and its typical gut defect is duodenal atresia rather than omphalocele with overgrowth.
2. Beckwith-Wiedemann syndrome

   Overgrowth, macroglossia, an abdominal wall defect and hyperinsulinemic hypoglycemia are the hallmark combination of Beckwith-Wiedemann syndrome.
3. Congenital primary hypothyroidism

   Congenital hypothyroidism can enlarge the tongue but does not cause omphalocele, overgrowth or hypoglycemia; prolonged jaundice and a large fontanelle are more typical.

A 10-day-old former 32-week neonate is being evaluated for late-onset sepsis. Compared with an early-onset evaluation, the workup should add a

1. Bagged urine culture

   Bagged specimens are often contaminated by skin flora and cannot confirm a urinary infection.
2. Gastric aspirate culture

   Gastric aspirates reflect swallowed fluid and have no diagnostic value in a sepsis evaluation.
3. Catheter urine culture

   After the first days urinary infection becomes a real source of sepsis, so a urine culture by catheter or suprapubic tap is added to blood and CSF cultures.

A term neonate with encephalopathy has no cord or 1-hour blood gas available. Which finding provides evidence of perinatal asphyxia for cooling eligibility?

1. Ventilation still needed at 10 minutes

   When no early gas is available, cooling criteria accept assisted ventilation continuing at 10 minutes after birth as evidence of a significant hypoxic-ischemic insult, alongside encephalopathy on exam.
2. Free-flow oxygen needed at 5 minutes

   Brief free-flow oxygen at 5 minutes is a common transition need, not the severe depression the criteria require.
3. Meconium-stained amniotic fluid

   Meconium staining is common and nonspecific; it does not show the depth of the perinatal insult.

Polycythemia in an infant of a diabetic mother results mainly from

1. delayed cord clamping at delivery

   Delayed cord clamping adds blood volume in any birth, but it is not the mechanism behind the polycythemia typical of diabetic pregnancy.
2. insulin slowing red cell breakdown

   Insulin does not slow red cell breakdown; the extra cells come from increased production.
3. fetal hypoxemia raising erythropoietin

   Fetal hyperinsulinemia raises metabolic rate and oxygen consumption; the resulting relative hypoxemia stimulates erythropoietin and red cell production.

A neonate awaiting cardiac surgery has received a prostaglandin E₁ infusion for 5 weeks. Which skeletal change is a recognized effect of this prolonged infusion?

1. Periosteal thickening of the long bones

   Weeks of PGE₁ can cause cortical hyperostosis, new periosteal bone along the long bones, which regresses after the infusion stops.
2. Metaphyseal cupping and fraying

   Cupping and fraying of the metaphyses is the radiographic picture of rickets or metabolic bone disease, not of prostaglandin exposure.
3. Early fusion of cranial sutures

   Craniosynostosis is a developmental suture disorder and is not a drug effect of PGE₁.

A neonate with truncus arteriosus is being prepared for surgical repair. Which medication is commonly used to manage pulmonary overcirculation while awaiting surgery?

1. Prostaglandin E₁

   Truncus arteriosus is not duct-dependent, so prostaglandin is not needed while awaiting repair.
2. Inhaled nitric oxide

   Inhaled nitric oxide lowers pulmonary resistance and would increase the overcirculation that needs controlling.
3. Furosemide

   As pulmonary resistance falls after birth, blood floods the lungs in truncus arteriosus; a diuretic such as furosemide controls the resulting heart failure until repair.

A term newborn has severe proximal hypospadias and bilateral nonpalpable gonads. The priority evaluation is

1. Reassurance and repair at 6–12 months

   Repair timing is beside the point until sex development and adrenal function are evaluated; a missed salt-wasting crisis can be fatal in the first weeks.
2. Circumcision before discharge

   Circumcision is withheld with hypospadias because the foreskin is kept for the repair, and here the diagnosis itself is uncertain.
3. Karyotype and testing for CAH

   Severe hypospadias with impalpable gonads is a disorder of sex development until proven otherwise; a karyotype, 17-hydroxyprogesterone and electrolytes look for a virilized female with salt-wasting CAH.

Parents refuse a life-saving blood transfusion for their 30-week infant on religious grounds. If discussion fails and the need is urgent, the team may

1. accept the parents' refusal as final

   Parents' religious freedom does not extend to refusing life-saving treatment for their child, so the refusal need not end the matter.
2. ask a grandparent to consent instead

   Grandparents have no legal authority to consent while the parents hold parental rights.
3. seek court authorization to treat

   When parents refuse treatment needed to save their child's life, the team can ask a court to authorize it, because parental refusal of life-saving care for a minor is not absolute.

To limit heat loss while giving care to a preterm neonate in an incubator, the nurse should

1. Work through the portholes

   Portholes give access to the infant while the warm, humidified air stays inside the incubator; larger openings let that air escape.
2. Turn off the servo during care

   Switching off the servo stops the heater from answering the fall in skin temperature that handling causes.
3. Open the front panel fully

   Opening the front panel releases the warmed air at once and cools the infant by convection and evaporation.

Gentamicin dosing intervals are longer in preterm neonates than in term infants mainly because of

1. Higher plasma protein binding

   Aminoglycosides bind very little to plasma proteins, so binding does not set their dosing interval.
2. Lower glomerular filtration rate

   Gentamicin is cleared almost entirely by the kidneys, and the low glomerular filtration of preterm infants prolongs its half-life, so doses are spaced further apart.
3. Larger extracellular water volume

   The larger extracellular water space explains the higher mg/kg dose, not the longer interval between doses.

In an ELBW infant, sodium is usually added to the IV fluids

1. after the initial diuresis begins

   ELBW infants are born with expanded extracellular fluid, so sodium is held until the postnatal diuresis and early weight loss are under way, typically on day 2 or 3, to avoid hypernatremia and fluid overload.
2. from the first hour of life

   Sodium from the first hour adds to an already expanded extracellular space and raises the risk of early hypernatremia.
3. once sodium is below 125 mEq/L

   Waiting until sodium falls below 125 mEq/L lets a dangerous hyponatremia develop before supplementation starts.

A NICU graduate does not pass the automated ABR hearing screen before discharge. Under the 1-3-6 benchmarks, the full audiologic diagnosis should be completed by

1. 6 months of age

   Six months is the target for starting early intervention; waiting that long for a diagnosis would delay services.
2. 3 months of age

   The 1-3-6 benchmarks are screening by 1 month, full audiologic diagnosis by 3 months and early intervention by 6 months, so diagnostic testing after a failed screen should be done by 3 months.
3. 1 month of age

   One month is the target for completing the hearing screen itself, not the diagnostic evaluation.