RNC-NIC study guide, one NICU category at a time

A 39-week neonate weighs 2,450 g (6th percentile); length is at the 25th percentile and head circumference at the 20th percentile. These findings are most consistent with

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

1. asymmetric SGA from placental insufficiency

   A weight below the 10th percentile with length and head growth spared is the head-sparing pattern of late-pregnancy placental insufficiency.
2. appropriate size for gestational age

   A weight at the 6th percentile is under the 10th-percentile cutoff, so the infant is small for gestational age even though length and head size are normal.
3. symmetric SGA from a congenital infection

   Symmetric restriction lowers weight, length and head size together, as after an early insult such as congenital infection; here length and head are spared.

For a neonate born at less than 26 weeks, the New Ballard examination is most accurate when performed

1. at 72 to 96 hours of age

   At 72–96 hours is the late edge of the window allowed for infants of 26 weeks or more; under 26 weeks the exam belongs in the first 12 hours.
2. between 24 and 48 hours of age

   By 24–48 hours postnatal changes in skin and tone have started, which costs accuracy in the most immature infants.
3. within 12 hours of birth

   Below 26 weeks the New Ballard is most accurate in the first 12 hours, before skin and posture change with time outside the uterus.

A 39-week neonate with mature skin, ears, and plantar creases has weak arm recoil, a popliteal angle of 160°, and a heel that reaches the ear with little resistance. The nurse should

1. document a normal term examination

   A term infant should show brisk flexor recoil and a tight popliteal angle; calling these findings normal misses the hypotonia.
2. revise the gestational age to 28 weeks

   Tone findings alone should not override clearly mature physical signs; the mismatch is a tone problem, not a dating error.
3. evaluate the infant for a cause of hypotonia

   Mature skin, ears and creases date this infant at term, so weak recoil, a 160° popliteal angle and an easy heel-to-ear mean low tone that needs a cause.

A 28-week infant receiving gentamicin has urine output of 0.4 mL/kg/hr over 12 hours and a rising creatinine. What should the nurse anticipate?

1. Checking a serum trough level

   Oliguria with a rising creatinine means the aminoglycoside is clearing slowly; a trough level guides holding the next dose or lengthening the interval.
2. Doubling the maintenance fluid rate

   Doubling fluids in an oliguric preterm infant risks fluid overload and does nothing about drug accumulation.
3. Giving a furosemide dose of 1 mg/kg

   Furosemide adds its own ototoxicity to an aminoglycoside and does not treat the cause of the falling urine output.

The best sign that a growing preterm infant is ready to move from an incubator to an open crib is

1. a weight of 2,500 g or more

   Units that use a weight cue set it far lower, around 1,600–1,800 g, and still require a stable temperature; 2,500 g is neither needed nor enough by itself.
2. a stable temperature at a low air setting

   Moving to a crib depends on holding a normal temperature with little added heat; staying stable at a low incubator air setting shows thermoregulation is ready.
3. the achievement of full oral feedings

   Full oral feeding is a separate milestone; many infants move to a crib while still gavage-fed, and feeding says nothing about heat balance.

Before a chest radiograph of a 26-week, 750 g neonate, the nurse prewarms the x-ray plate and covers it. This mainly prevents heat loss by

1. Convection

   Convection is heat carried off by moving air, such as drafts or an open portal, not by contact with a cold surface.
2. Radiation

   Radiant loss goes to cooler surfaces that do not touch the infant, such as incubator walls near a cold window.
3. Conduction

   A cold plate pressed against the skin draws heat by direct contact, which is conduction; warming and covering it removes that gradient.

A well-appearing term newborn has scattered petechiae and a platelet count of 18,000/mm³. The mother's platelet count is normal, and she had no illness during pregnancy. The most likely cause is

1. Neonatal alloimmune thrombocytopenia

   Severe thrombocytopenia in a well newborn whose mother's count is normal fits maternal antibodies against a paternal platelet antigen, most often HPA-1a.
2. Maternal autoimmune thrombocytopenia

   Maternal autoimmune disease such as ITP lowers the mother's own platelet count, which is normal here.
3. Congenital cytomegalovirus infection

   Congenital CMV usually makes the infant look unwell, with growth restriction, hepatosplenomegaly or microcephaly, rather than isolated petechiae in a well baby.

In the TOP and ETTNO trials of ELBW infants, higher hemoglobin thresholds for transfusion, compared with lower thresholds,

1. did not reduce death or impairment at 2 years

   Both trials found the same rate of death or neurodevelopmental impairment at about 2 years with liberal and restrictive thresholds, which supports the lower thresholds and fewer donor exposures.
2. lowered the rates of BPD and severe ROP

   BPD, ROP and other major morbidities were similar in both arms, so no protective effect was shown.
3. did not change how many transfusions were given

   Infants in the higher-threshold arms received more transfusions; the extra blood bought no better outcome.

A firstborn female delivered from a frank breech position has a normal hip exam at birth. To screen for developmental dysplasia of the hip, the nurse anticipates

1. Hip ultrasound at 6 weeks of age

   For a breech girl with a normal hip exam, AAP guidance is ultrasound at about 6 weeks, once newborn ligamentous laxity has settled.
2. Hip ultrasound in the first 2 days

   Scanning in the first days overcalls normal newborn laxity and immature hips, producing false positives and needless treatment.
3. A pelvic radiograph at birth

   At birth the femoral heads are still cartilage and do not show on a radiograph; radiographs are used from about 4 months.

The mother of a stable 29-week infant asks why kangaroo care sessions should last at least 60 minutes. The nurse explains that this length

1. is needed to raise the infant's temperature

   Skin-to-skin contact warms a stable infant within minutes, so temperature is not the reason for long sessions.
2. lets the infant complete a sleep cycle

   Each transfer out of the incubator disturbs the infant, and holding for an hour or more allows settling and a full sleep cycle, which supports brain maturation.
3. lets a full feeding be digested

   Digestion does not set the session length; feedings are timed independently of kangaroo care.

Which practice in the daily care of a neonate's PICC breaks the central line maintenance bundle?

1. Changing a lifting dressing early, on day 6

   A dressing that is lifting, damp or soiled is replaced right away, even before the usual 7-day interval, so changing it on day 6 follows the bundle.
2. Scrubbing the hub for 15 seconds before each access

   Scrubbing the hub with friction before every access is the core of line maintenance, and 15 seconds is a common neonatal standard.
3. Changing the connector only when soiled

   Needleless connectors are changed on a set schedule, usually together with the administration set, so leaving one in place until it looks soiled breaks the bundle.

Three unrelated infants with the surname Garcia are admitted to the same NICU. Which temporary naming practice best reduces wrong-patient errors?

1. The bed space number in place of a name

   A bed space is a location, not an identifier; infants move between spaces, so a bed number cannot stand in for a name on the band.
2. Mother's first name plus newborn's sex

   Distinct naming, such as the mother's first name joined to the newborn's sex ('Mariasgirl'), separates infants who share a surname and is what current newborn identification standards call for.
3. 'Babygirl' or 'Babyboy' plus the family surname

   'Babygirl' or 'Babyboy' with a shared surname gives three infants nearly identical names, the pattern most linked to wrong-patient errors in newborns.

A former 32-week infant is ready for discharge. Before going home, the infant is observed for 90 minutes in the family's car safety seat. This screen mainly detects

1. a poor fit between seat and vehicle

   How the seat installs in the vehicle is checked by a trained installer, not by a timed observation of the infant in the seat.
2. cardiorespiratory events in the seat

   In the semi-reclined seat a preterm infant can have apnea, bradycardia or oxygen desaturation, so the infant is watched on a monitor for 90–120 minutes or the length of the trip home, whichever is longer.
3. reflux that worsens in an upright seat

   Reflux is common in preterm infants, but the car seat screen looks for breathing and heart rate events, not feeding symptoms.