RNC NIC COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔Signs and symptoms of pyloric stenosis - ✔✔Dehydration, nonbilious projectile
vomiting, peristalic waves in the epigastrium, and electrolyte imbalances, including
hypochloremia, are clinical symptoms of pyloric stenosis.
✔✔biliary atresia - ✔✔Congenital absence of the opening from the common bile duct
into small intestine (duodenum).
Acholic stools, bronze undertones, dark urine, and hepatosplenomegaly are clinical
manifestations of biliary atresia.
✔✔What is the most prevalent thyroid disorder in preterm and low-birth-weight infants?
- ✔✔Serum levels of thyroid hormones in preterm neonates are significantly lower and
more variable than those of term neonates and correlate with gestational age and birth
weight.
✔✔Treatment to stop subgleal hemorrhage - ✔✔PRBCs, cryoprecipitate, NS volume
infusion, dopamine
✔✔Perinital Asphyxia role on calcium - ✔✔Perinatal asphyxia is a significant risk factor
for hypocalcemia in the neonate. Asphyxia stimulates a surge in calcitonin level, which
inhibits the release of calcium from the bone.
✔✔The signs and symptoms of an inborn error of metabolism in a newborn infant are
most likely to be mistaken for - ✔✔Sepsis
✔✔Which of the following is the most important element of management when caring
for a neonate with medium-chain acyl-coenzyme A dehydrogenase deficiency, a
disorder of fatty acid oxidation? - ✔✔Feed frequently and avoid prolonged periods of
fasting.
Rationale:
Infants who have fatty acid oxidation defects cannot break down fatty acids to supply
energy, so energy needs must be met exogenously. Long periods of fasting (and other
stressors) lead rapidly to hypoglycemia.
✔✔XX Virilization in Newborn for ambiguous genitalia - ✔✔Congenital adrenal
hyperplasia caused by 21-hydroxylase deficiency is the most common cause of
ambiguous genitalia in the newborn and is also the most common cause of virilization
(development of male characteristics in a female) in a genetically female infant.
,✔✔Signs and symptoms of adrenal hemorrhage, necessary imaging required to detect
enlarged adrenal glands - ✔✔The infant's history (macrosomia and breech
presentation), along with pallor and jaundice, lethargy with periods of irritability, poor
feeding, and vomiting, are signs of potential adrenal hemorrhage. The relatively large
size of the adrenal gland at birth may contribute to injury. A nurse should prepare for an
abdominal ultrasound before any treatments to determine the cause of the infant's
signs.
✔✔Signs and symptoms of DIC - ✔✔Disseminated intravascular coagulation (DIC) is an
acquired hemorrhagic disorder associated with an underlying disease such as septic
shock. Presenting signs of DIC include sudden hemorrhage, prolonged oozing,
petechiae, and purpura.
✔✔What are the expected laboratory results for a patient with disseminated
intravascular coagulation? - ✔✔Low platelet count, low fibrinogen level, and elevated D-
dimer level
✔✔apt test - ✔✔The Apt test distinguishes swallowed maternal blood from neonatal
gastrointestinal blood loss.
✔✔Kleihauer-Betke test - ✔✔The Kleihauer-Betke test looks for fetal hemoglobin in
maternal blood. A positive result in the test would imply that a prenatal hemorrhage had
occurred either through a fetal-maternal hemorrhage or a placenta or cord accident.
✔✔direct Coombs test - ✔✔A positive result on the direct Coombs test indicates that
maternal immunoglobulin G antibodies have crossed the placenta and are attached to
the surface of the baby's red blood cells.
✔✔The form of circulating bilirubin that places the infant at the highest risk for
kernicterus is: - ✔✔Indirect, free bilirubin is not attached to albumin and easily crosses
the blood-brain barrier, potentially resulting in signs of kernicterus.
✔✔polycythemia in newborn - ✔✔hematocrit >65%
seen in the first few hours or days of life
possible symptoms
-altered mental status
-poor feeding
-plethora (excessive blood in circulatory system or one organ or one area)
-acrocyanosis
-hyperbilirubinemia
✔✔Hemophilia A - ✔✔Hemophilia A has a normal or prolonged partial thromboplastin
time and a normal prothrombin time and platelet count. Factor VIII is deficient.
,✔✔ABO incompatibility - ✔✔ABO incompatibility affects babies when mothers have
blood group O and the babies have blood group A or B (seen as antigens)
Mom will make antibodies and attack fetal RBCs by maternal anti-ab antibodies
Protects against fetal RH disease because of rapid destruction of fetal A/B cells,
preventing RH antigen exposure
While it occurs more frequently than Rh isoimmunization (partially because of the use of
RhoGAM for Rh), the hemolytic disease is less severe.
✔✔Isoimmunization and Rh isomminuzation (incompatibility) - ✔✔Production by an
individual of antibodies against constituents of the tissues of another individual of the
same species
If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may
respond by making antibodies to destroy the Rh-positive erythrocytes.
✔✔RH Incompatibility and amniocentisis - ✔✔Because an amniocentesis can cause
minute amounts of fetal red blood cells to enter the maternal circulation, maternal
antibodies (IgM and IgG) can result if the mother is Rh negative and the baby is Rh
positive.
✔✔Neonatal autoimmune thrombocytopenia - ✔✔Neonatal alloimmune
thrombocytopenia has a similar pathophysiology to Rh incompatibility.
It occurs when maternal platelets come into contact with fetal platelets containing an
antigen lacking in the mother.
Maternal antibodies cross the placenta and coat the fetal platelets—primarily on
subsequent pregnancies.
The maternal platelet count is normal. Neonatal partial thromboplastin time and
prothrombin time are normal. Treatment of neonatal alloimmune thrombocytopenia
includes giving the baby washed maternal platelets, which are free of the platelet
antigen.
✔✔Breastmilk Jaundice presentation, value, cause, treatment - ✔✔Breast milk jaundice
occurs after 4 to 7 days of life and is related to two substances found in the maternal
breast milk that interfere with bilirubin conjugation and increase the resorption of
bilirubin from the intestine, resulting in increased indirect bilirubin. The resulting level of
total bilirubin is often between 12 and 20 mg/dl. In breast milk jaundice, stopping
feeding breast milk for 24 to 48 hours will decrease the level of the total bilirubin by 50%
✔✔Grade II IVH - ✔✔Grade II is an intraventricular hemorrhage without ventricular
dilation.
, ✔✔Grade III IVH - ✔✔blood within the ventricles and associated dilation of the ventricle.
✔✔Grade IV IVH - ✔✔blood within the ventricles and an echogenic focus within the
periventricular tissue.
✔✔Bicarb administration time and associated risks from rapid infusion - ✔✔Rapid
infusions of sodium bicarbonate may result in elevations of carbon dioxide, causing a
rapid dilation of cerebral blood vessels, which could lead to intracerebral hemorrhage.
Therefore infusing sodium bicarbonate at 4.2% concentration over 30 minutes will avoid
a rapid infusion of a hyperosmolar solution.
✔✔myelomeningocele position and treatment - ✔✔The infant should be positioned in
the prone kneeling position.
Initial delivery room management is to protect the lesion by covering with sterile gauze
moistened with warm sterile saline solution.
✔✔Klumpe Paralysis - ✔✔Klumpe paralysis exhibits swelling in the shoulder and
supraclavicular fossa, which can be accompanied by clavicle fracture. Due to intrinsic
muscle involvement of the hand, there is a clawlike appearance. There will be no grasp
of the affected hand.
✔✔Signs and symptoms of sublgeal hemorrhage - ✔✔Infants may present with signs of
shock, which include a rapidly falling hematocrit, hypovolemia, pallor, hypotension,
tachycardia, tachypnea, and hypotonia.
✔✔Residuals feeding normal - ✔✔-Feeding tube is aspirated every 2-4 hours
-Incompletely digested aspirates of less than 50% of the previous feedings, OR 2 to
4mL/kg may be normal
✔✔Residuals feedings abnormal - ✔✔>50% of amount of feeding given in 3hr
Or 2-4mL/kg
✔✔Abnormal residual in 24 hour interventions - ✔✔Consider infection screen
Discard residual
Hold feedings
✔✔Glucose is the primary - ✔✔Source of energy
✔✔Long Chain fatty acids (fats) - ✔✔Essential for brain development
✔✔HIE Candidates - ✔✔Candidates for therapeutic hypothermia must be greater than
or equal to 36 weeks' gestation
AND SOLUTIONS RATED A+
✔✔Signs and symptoms of pyloric stenosis - ✔✔Dehydration, nonbilious projectile
vomiting, peristalic waves in the epigastrium, and electrolyte imbalances, including
hypochloremia, are clinical symptoms of pyloric stenosis.
✔✔biliary atresia - ✔✔Congenital absence of the opening from the common bile duct
into small intestine (duodenum).
Acholic stools, bronze undertones, dark urine, and hepatosplenomegaly are clinical
manifestations of biliary atresia.
✔✔What is the most prevalent thyroid disorder in preterm and low-birth-weight infants?
- ✔✔Serum levels of thyroid hormones in preterm neonates are significantly lower and
more variable than those of term neonates and correlate with gestational age and birth
weight.
✔✔Treatment to stop subgleal hemorrhage - ✔✔PRBCs, cryoprecipitate, NS volume
infusion, dopamine
✔✔Perinital Asphyxia role on calcium - ✔✔Perinatal asphyxia is a significant risk factor
for hypocalcemia in the neonate. Asphyxia stimulates a surge in calcitonin level, which
inhibits the release of calcium from the bone.
✔✔The signs and symptoms of an inborn error of metabolism in a newborn infant are
most likely to be mistaken for - ✔✔Sepsis
✔✔Which of the following is the most important element of management when caring
for a neonate with medium-chain acyl-coenzyme A dehydrogenase deficiency, a
disorder of fatty acid oxidation? - ✔✔Feed frequently and avoid prolonged periods of
fasting.
Rationale:
Infants who have fatty acid oxidation defects cannot break down fatty acids to supply
energy, so energy needs must be met exogenously. Long periods of fasting (and other
stressors) lead rapidly to hypoglycemia.
✔✔XX Virilization in Newborn for ambiguous genitalia - ✔✔Congenital adrenal
hyperplasia caused by 21-hydroxylase deficiency is the most common cause of
ambiguous genitalia in the newborn and is also the most common cause of virilization
(development of male characteristics in a female) in a genetically female infant.
,✔✔Signs and symptoms of adrenal hemorrhage, necessary imaging required to detect
enlarged adrenal glands - ✔✔The infant's history (macrosomia and breech
presentation), along with pallor and jaundice, lethargy with periods of irritability, poor
feeding, and vomiting, are signs of potential adrenal hemorrhage. The relatively large
size of the adrenal gland at birth may contribute to injury. A nurse should prepare for an
abdominal ultrasound before any treatments to determine the cause of the infant's
signs.
✔✔Signs and symptoms of DIC - ✔✔Disseminated intravascular coagulation (DIC) is an
acquired hemorrhagic disorder associated with an underlying disease such as septic
shock. Presenting signs of DIC include sudden hemorrhage, prolonged oozing,
petechiae, and purpura.
✔✔What are the expected laboratory results for a patient with disseminated
intravascular coagulation? - ✔✔Low platelet count, low fibrinogen level, and elevated D-
dimer level
✔✔apt test - ✔✔The Apt test distinguishes swallowed maternal blood from neonatal
gastrointestinal blood loss.
✔✔Kleihauer-Betke test - ✔✔The Kleihauer-Betke test looks for fetal hemoglobin in
maternal blood. A positive result in the test would imply that a prenatal hemorrhage had
occurred either through a fetal-maternal hemorrhage or a placenta or cord accident.
✔✔direct Coombs test - ✔✔A positive result on the direct Coombs test indicates that
maternal immunoglobulin G antibodies have crossed the placenta and are attached to
the surface of the baby's red blood cells.
✔✔The form of circulating bilirubin that places the infant at the highest risk for
kernicterus is: - ✔✔Indirect, free bilirubin is not attached to albumin and easily crosses
the blood-brain barrier, potentially resulting in signs of kernicterus.
✔✔polycythemia in newborn - ✔✔hematocrit >65%
seen in the first few hours or days of life
possible symptoms
-altered mental status
-poor feeding
-plethora (excessive blood in circulatory system or one organ or one area)
-acrocyanosis
-hyperbilirubinemia
✔✔Hemophilia A - ✔✔Hemophilia A has a normal or prolonged partial thromboplastin
time and a normal prothrombin time and platelet count. Factor VIII is deficient.
,✔✔ABO incompatibility - ✔✔ABO incompatibility affects babies when mothers have
blood group O and the babies have blood group A or B (seen as antigens)
Mom will make antibodies and attack fetal RBCs by maternal anti-ab antibodies
Protects against fetal RH disease because of rapid destruction of fetal A/B cells,
preventing RH antigen exposure
While it occurs more frequently than Rh isoimmunization (partially because of the use of
RhoGAM for Rh), the hemolytic disease is less severe.
✔✔Isoimmunization and Rh isomminuzation (incompatibility) - ✔✔Production by an
individual of antibodies against constituents of the tissues of another individual of the
same species
If fetal Rh-positive blood leaks into the Rh-negative mother's circulation, her body may
respond by making antibodies to destroy the Rh-positive erythrocytes.
✔✔RH Incompatibility and amniocentisis - ✔✔Because an amniocentesis can cause
minute amounts of fetal red blood cells to enter the maternal circulation, maternal
antibodies (IgM and IgG) can result if the mother is Rh negative and the baby is Rh
positive.
✔✔Neonatal autoimmune thrombocytopenia - ✔✔Neonatal alloimmune
thrombocytopenia has a similar pathophysiology to Rh incompatibility.
It occurs when maternal platelets come into contact with fetal platelets containing an
antigen lacking in the mother.
Maternal antibodies cross the placenta and coat the fetal platelets—primarily on
subsequent pregnancies.
The maternal platelet count is normal. Neonatal partial thromboplastin time and
prothrombin time are normal. Treatment of neonatal alloimmune thrombocytopenia
includes giving the baby washed maternal platelets, which are free of the platelet
antigen.
✔✔Breastmilk Jaundice presentation, value, cause, treatment - ✔✔Breast milk jaundice
occurs after 4 to 7 days of life and is related to two substances found in the maternal
breast milk that interfere with bilirubin conjugation and increase the resorption of
bilirubin from the intestine, resulting in increased indirect bilirubin. The resulting level of
total bilirubin is often between 12 and 20 mg/dl. In breast milk jaundice, stopping
feeding breast milk for 24 to 48 hours will decrease the level of the total bilirubin by 50%
✔✔Grade II IVH - ✔✔Grade II is an intraventricular hemorrhage without ventricular
dilation.
, ✔✔Grade III IVH - ✔✔blood within the ventricles and associated dilation of the ventricle.
✔✔Grade IV IVH - ✔✔blood within the ventricles and an echogenic focus within the
periventricular tissue.
✔✔Bicarb administration time and associated risks from rapid infusion - ✔✔Rapid
infusions of sodium bicarbonate may result in elevations of carbon dioxide, causing a
rapid dilation of cerebral blood vessels, which could lead to intracerebral hemorrhage.
Therefore infusing sodium bicarbonate at 4.2% concentration over 30 minutes will avoid
a rapid infusion of a hyperosmolar solution.
✔✔myelomeningocele position and treatment - ✔✔The infant should be positioned in
the prone kneeling position.
Initial delivery room management is to protect the lesion by covering with sterile gauze
moistened with warm sterile saline solution.
✔✔Klumpe Paralysis - ✔✔Klumpe paralysis exhibits swelling in the shoulder and
supraclavicular fossa, which can be accompanied by clavicle fracture. Due to intrinsic
muscle involvement of the hand, there is a clawlike appearance. There will be no grasp
of the affected hand.
✔✔Signs and symptoms of sublgeal hemorrhage - ✔✔Infants may present with signs of
shock, which include a rapidly falling hematocrit, hypovolemia, pallor, hypotension,
tachycardia, tachypnea, and hypotonia.
✔✔Residuals feeding normal - ✔✔-Feeding tube is aspirated every 2-4 hours
-Incompletely digested aspirates of less than 50% of the previous feedings, OR 2 to
4mL/kg may be normal
✔✔Residuals feedings abnormal - ✔✔>50% of amount of feeding given in 3hr
Or 2-4mL/kg
✔✔Abnormal residual in 24 hour interventions - ✔✔Consider infection screen
Discard residual
Hold feedings
✔✔Glucose is the primary - ✔✔Source of energy
✔✔Long Chain fatty acids (fats) - ✔✔Essential for brain development
✔✔HIE Candidates - ✔✔Candidates for therapeutic hypothermia must be greater than
or equal to 36 weeks' gestation
