RNC NIC UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔imperforate anus - ✔✔a congenital defect in which the rectal opening is missing or
blocked.
✔✔Imperforate anus in female - ✔✔Meconium from a fistula external to the hymen =
rectovestibular fistula, most common in females
✔✔Imperforate anus in a male - ✔✔Most common lesion is the rectoprostatic fistula ,
distal bowel and urethra
✔✔Tidal Volume - ✔✔Amount of air that moves in and out of the lungs during a normal
breath
✔✔Minute Ventilation - ✔✔total volume of air inhaled and exhaled each minute
✔✔grunting - ✔✔Infant's attempt to increase functional residual capacity (lung volume)
when there is collapse aveoli. Infant will try to collapse vocal cords to try and trap air in
the lungs. Grunting sound is made when the infant exhals through the partial closed
vocal cords.
Grunting "splint open" small airways and helps to maintain functional residual capacity
in the aveoli.
✔✔Preductal oxygen saturation - ✔✔Attach oximeter probe to the right palm at birth.
✔✔Fetal hyperinsulinemia and lung development - ✔✔Fetal hyperinsulinemia
contributes to delayed maturation of the lungs, which inhibits the production of
surfactant and increases the risk of surfactant deficiency related to respiratory distress
syndrome. The reticulograndular pattern is suggestive of respiratory distress syndrome.
✔✔In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by
which of the following? - ✔✔The presence of an obstruction to right ventricular (RV)
outflow with a large ventral septal defect causes a right-to-left shunt at the ventricular
level with arterial desaturation. The greater the obstruction and the lower the systemic
vascular resistance, the greater is the right-to-left shunt. Thus the clinical findings vary
with the degree of RV outflow obstruction. Patients with mild obstruction are minimally
cyanotic or acyanotic. Those with severe obstruction are most likely to be deeply
cyanotic from birth. Few children are asymptomatic. In those with significant RV outflow
obstruction, many have cyanosis at birth, and nearly all have cyanosis by age 4
months..
✔✔Transposition of the great vessels - ✔✔In transposition of the great vessels, the
degree of cyanosis depends on the amount of mixing between the pulmonary and
,systemic circulations. Oxygenated pulmonary venous blood is returned to the lungs, and
desaturated systemic blood is returned to the body. Thus the two circulations exist in
parallel. Some mixing between them must occur to allow oxygenated blood to reach the
systemic circulation and the desaturated blood to reach the lungs.
✔✔balloon septostomy with transposition of the great vessels - ✔✔When an infant has
a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a technique
developed by William Rashkind in 1966, may be performed. The procedure involves
inserting a balloon-tipped catheter across the foramen ovale into the left atrium. The
balloon is then inflated and forcibly withdrawn so that the catheter tears the septum
primum and enlarges the ASD. Mixing should increase immediately, with a
corresponding increase in arterial oxygen saturation.
✔✔CCHD screening - ✔✔A screen result would be considered positive if any oxygen
saturation measures less than 90%, oxygen saturation is less than 95% in both
extremities on three measures—each separated by 1 hour, or there is a 3% absolute
difference in oxygen saturation between the right hand and foot on three measures,
each separated by 1 hour. Any screening that is >95% in either extremity with no more
than a 3% absolute difference in oxygen saturation between the upper and lower
extremity would be considered a "pass" result, and screening would end.
✔✔An infant is born with low-set ears, excess nuchal skin, a broad chest, widely spaced
nipples, peripheral lymphedema, and absent pulses in the lower extremities. The nurse
suspects the infant has coarctation of the aorta. Which chromosomal defect can cause
this constellation of findings? - ✔✔Infants with Turner syndrome can present with
cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest
with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common
defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with
Turner syndrome will have a coarctation of the aorta.
✔✔VSD at 1 to 2 months of age can result in - ✔✔Infants with a small isolated defect
are often asymptomatic. The murmur of a small defect may be detected within the first
24 to 36 hours of life, because the very restrictive opening permits the normal rapid fall
in pulmonary arterial resistance and pressures. In term infants born at sea level with a
large ventral septal defect, clinical deterioration may occur at any time from
approximately 3 to 12 weeks after birth.
✔✔A hyperoxia test PPHN results in - ✔✔<100% PaO2.
✔✔A hyperoxia test RDS vs. cardiac - ✔✔A hyperoxia test is performed by
administering 100% oxygen for 10 minutes and then measuring the arterial preductal
PaO2 (right radial artery). A significant increase in PaO2 levels, particularly a Pa O2
level >150 mm Hg, makes the likely cause respiratory distress rather than cardiac in
origin.
,✔✔Wolff-Parkinson-White syndrome - ✔✔episodic supraventricular tachycardia that
resolves spontaneously. An echocardiogram is performed, and there is slurred upstroke
of the QRS and the presence of a delta wave.
✔✔Milronone - ✔✔Milrinone also provides dose-dependent increase in cardiac
contractility and is a systemic and pulmonary vasodilator and thus an effective agent in
both right and left ventricular systolic dysfunction.
✔✔increasing PIP - ✔✔Increase tidal volume , decreases Pco2
✔✔Increasing the PEEP without increasing PIP - ✔✔May decrease tidal volume and
pco2 may rise
✔✔If pco2 already elevated - ✔✔Increasing PIP may be better option
✔✔Increasing inspiratory time reduces - ✔✔Exhalation time and may cause Paco2 to
rise
✔✔A chest radiograph is ordered for an infant with a suspected patent ductus
arteriosus. The nurse should anticipate which of the following findings? - ✔✔Common
clinical manifestations of a patent ductus arteriosus include:
-increased pulmonary vasculature and cardiomegaly on chest radiograph
-bounding peripheral pulses,
and an active precordium.
-A widening pulse pressure with a low diastolic blood pressure may be present.
Unexplained acidosis may be present.
✔✔TTN Radiology Findings - ✔✔-Fluid in the fissures
-Perihilar streaking or opacity
-lung over inflation / pulmonary edema
✔✔Pneumonia Radiology Findings - ✔✔-Diffuse or focal infiltrates
-Hazy or opaque lung fields
-Lobar Consolidation
✔✔Meconium Aspiration Syndrome Radiologic Findings - ✔✔- Coarse, nodular
opacities, atelectasis, over inflation
✔✔TEF signs and symptoms - ✔✔Excessive salivation and choking, coughing, and
cyanosis with feeding
✔✔Congenital Diaphragmatic Hernia - ✔✔Abdomen may appear scaphoid (sunken).
Decreased breath sounds on side with hernia
-Intubate patient
, -Insert orogastric or nasogastric tube and frequently remove air from the stomach to
prevent the air from entering the bowel
***
✔✔Stridor - ✔✔strained, high-pitched sound heard on inspiration (associated with upper
airway obstruction)
-Expiration (usually associated with lower airway obstruction)
✔✔Choanal atresia - ✔✔-One or two nasal passages may be blocked
-When both are blocked by a bony septum or soft tissue membrane
-Infant may be cyanotic at rest, will pink up at crying
-Insert oral airway, or intubate
✔✔Pierre Robin - ✔✔-Small jaw, normal size tongue that obstructs the airway
-May have cleft palate
-To relieve airway obstruction, turn the infant prone
-If airway still obstructed despite positioning prone, insert nasopharngeal tube
✔✔PPHN - ✔✔-Affects term infants predominately
-Elevated Pulmonary Vascular Resistance causes right-to left shunting of blood passed
the PDA or FO which leads to hypoxemia
✔✔Pneumopericardium - ✔✔-Air becomes trapped in the pericardial sac that surrounds
the heart
-Air can accumulate and compress the heart impairing cardiac output
-S/s cyanosis, muffled or inaudible heart sounds,
✔✔Most common type of TEF - ✔✔Type C
Air can enter the stomach via the tracheal fistula
✔✔S/s of TEF - ✔✔Choking, coughing, cyanosis with feeding, risk of aspiration high
can cause pneumonia
Excessive salivation
**history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic
fluid, think TE and bowel obstruction
Remember VACTERL
✔✔Treatment of TEF - ✔✔-insert feeding tube into stomach, obtain chest xray to
determine if there is a pouch
-insert orgastric tube into stomach if there is no blind pouch to vent out air
-provide low continuous suction to remove secretions
-*turn infant prone, head of bed elevated 30 degrees to reduce reflux
**radiographic studies are CONTRAINDICATED!
SOLUTIONS RATED A+
✔✔imperforate anus - ✔✔a congenital defect in which the rectal opening is missing or
blocked.
✔✔Imperforate anus in female - ✔✔Meconium from a fistula external to the hymen =
rectovestibular fistula, most common in females
✔✔Imperforate anus in a male - ✔✔Most common lesion is the rectoprostatic fistula ,
distal bowel and urethra
✔✔Tidal Volume - ✔✔Amount of air that moves in and out of the lungs during a normal
breath
✔✔Minute Ventilation - ✔✔total volume of air inhaled and exhaled each minute
✔✔grunting - ✔✔Infant's attempt to increase functional residual capacity (lung volume)
when there is collapse aveoli. Infant will try to collapse vocal cords to try and trap air in
the lungs. Grunting sound is made when the infant exhals through the partial closed
vocal cords.
Grunting "splint open" small airways and helps to maintain functional residual capacity
in the aveoli.
✔✔Preductal oxygen saturation - ✔✔Attach oximeter probe to the right palm at birth.
✔✔Fetal hyperinsulinemia and lung development - ✔✔Fetal hyperinsulinemia
contributes to delayed maturation of the lungs, which inhibits the production of
surfactant and increases the risk of surfactant deficiency related to respiratory distress
syndrome. The reticulograndular pattern is suggestive of respiratory distress syndrome.
✔✔In an infant with tetralogy of Fallot, the severity of symptoms will be most affected by
which of the following? - ✔✔The presence of an obstruction to right ventricular (RV)
outflow with a large ventral septal defect causes a right-to-left shunt at the ventricular
level with arterial desaturation. The greater the obstruction and the lower the systemic
vascular resistance, the greater is the right-to-left shunt. Thus the clinical findings vary
with the degree of RV outflow obstruction. Patients with mild obstruction are minimally
cyanotic or acyanotic. Those with severe obstruction are most likely to be deeply
cyanotic from birth. Few children are asymptomatic. In those with significant RV outflow
obstruction, many have cyanosis at birth, and nearly all have cyanosis by age 4
months..
✔✔Transposition of the great vessels - ✔✔In transposition of the great vessels, the
degree of cyanosis depends on the amount of mixing between the pulmonary and
,systemic circulations. Oxygenated pulmonary venous blood is returned to the lungs, and
desaturated systemic blood is returned to the body. Thus the two circulations exist in
parallel. Some mixing between them must occur to allow oxygenated blood to reach the
systemic circulation and the desaturated blood to reach the lungs.
✔✔balloon septostomy with transposition of the great vessels - ✔✔When an infant has
a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a technique
developed by William Rashkind in 1966, may be performed. The procedure involves
inserting a balloon-tipped catheter across the foramen ovale into the left atrium. The
balloon is then inflated and forcibly withdrawn so that the catheter tears the septum
primum and enlarges the ASD. Mixing should increase immediately, with a
corresponding increase in arterial oxygen saturation.
✔✔CCHD screening - ✔✔A screen result would be considered positive if any oxygen
saturation measures less than 90%, oxygen saturation is less than 95% in both
extremities on three measures—each separated by 1 hour, or there is a 3% absolute
difference in oxygen saturation between the right hand and foot on three measures,
each separated by 1 hour. Any screening that is >95% in either extremity with no more
than a 3% absolute difference in oxygen saturation between the upper and lower
extremity would be considered a "pass" result, and screening would end.
✔✔An infant is born with low-set ears, excess nuchal skin, a broad chest, widely spaced
nipples, peripheral lymphedema, and absent pulses in the lower extremities. The nurse
suspects the infant has coarctation of the aorta. Which chromosomal defect can cause
this constellation of findings? - ✔✔Infants with Turner syndrome can present with
cardiovascular anomalies, short stature, low-set ears, excess nuchal skin, a broad chest
with widely spaced nipples, peripheral lymphedema, and ovarian dysgenesis. Common
defects are coarctation of the aorta and bicuspid aortic valve. About 30% of infants with
Turner syndrome will have a coarctation of the aorta.
✔✔VSD at 1 to 2 months of age can result in - ✔✔Infants with a small isolated defect
are often asymptomatic. The murmur of a small defect may be detected within the first
24 to 36 hours of life, because the very restrictive opening permits the normal rapid fall
in pulmonary arterial resistance and pressures. In term infants born at sea level with a
large ventral septal defect, clinical deterioration may occur at any time from
approximately 3 to 12 weeks after birth.
✔✔A hyperoxia test PPHN results in - ✔✔<100% PaO2.
✔✔A hyperoxia test RDS vs. cardiac - ✔✔A hyperoxia test is performed by
administering 100% oxygen for 10 minutes and then measuring the arterial preductal
PaO2 (right radial artery). A significant increase in PaO2 levels, particularly a Pa O2
level >150 mm Hg, makes the likely cause respiratory distress rather than cardiac in
origin.
,✔✔Wolff-Parkinson-White syndrome - ✔✔episodic supraventricular tachycardia that
resolves spontaneously. An echocardiogram is performed, and there is slurred upstroke
of the QRS and the presence of a delta wave.
✔✔Milronone - ✔✔Milrinone also provides dose-dependent increase in cardiac
contractility and is a systemic and pulmonary vasodilator and thus an effective agent in
both right and left ventricular systolic dysfunction.
✔✔increasing PIP - ✔✔Increase tidal volume , decreases Pco2
✔✔Increasing the PEEP without increasing PIP - ✔✔May decrease tidal volume and
pco2 may rise
✔✔If pco2 already elevated - ✔✔Increasing PIP may be better option
✔✔Increasing inspiratory time reduces - ✔✔Exhalation time and may cause Paco2 to
rise
✔✔A chest radiograph is ordered for an infant with a suspected patent ductus
arteriosus. The nurse should anticipate which of the following findings? - ✔✔Common
clinical manifestations of a patent ductus arteriosus include:
-increased pulmonary vasculature and cardiomegaly on chest radiograph
-bounding peripheral pulses,
and an active precordium.
-A widening pulse pressure with a low diastolic blood pressure may be present.
Unexplained acidosis may be present.
✔✔TTN Radiology Findings - ✔✔-Fluid in the fissures
-Perihilar streaking or opacity
-lung over inflation / pulmonary edema
✔✔Pneumonia Radiology Findings - ✔✔-Diffuse or focal infiltrates
-Hazy or opaque lung fields
-Lobar Consolidation
✔✔Meconium Aspiration Syndrome Radiologic Findings - ✔✔- Coarse, nodular
opacities, atelectasis, over inflation
✔✔TEF signs and symptoms - ✔✔Excessive salivation and choking, coughing, and
cyanosis with feeding
✔✔Congenital Diaphragmatic Hernia - ✔✔Abdomen may appear scaphoid (sunken).
Decreased breath sounds on side with hernia
-Intubate patient
, -Insert orogastric or nasogastric tube and frequently remove air from the stomach to
prevent the air from entering the bowel
***
✔✔Stridor - ✔✔strained, high-pitched sound heard on inspiration (associated with upper
airway obstruction)
-Expiration (usually associated with lower airway obstruction)
✔✔Choanal atresia - ✔✔-One or two nasal passages may be blocked
-When both are blocked by a bony septum or soft tissue membrane
-Infant may be cyanotic at rest, will pink up at crying
-Insert oral airway, or intubate
✔✔Pierre Robin - ✔✔-Small jaw, normal size tongue that obstructs the airway
-May have cleft palate
-To relieve airway obstruction, turn the infant prone
-If airway still obstructed despite positioning prone, insert nasopharngeal tube
✔✔PPHN - ✔✔-Affects term infants predominately
-Elevated Pulmonary Vascular Resistance causes right-to left shunting of blood passed
the PDA or FO which leads to hypoxemia
✔✔Pneumopericardium - ✔✔-Air becomes trapped in the pericardial sac that surrounds
the heart
-Air can accumulate and compress the heart impairing cardiac output
-S/s cyanosis, muffled or inaudible heart sounds,
✔✔Most common type of TEF - ✔✔Type C
Air can enter the stomach via the tracheal fistula
✔✔S/s of TEF - ✔✔Choking, coughing, cyanosis with feeding, risk of aspiration high
can cause pneumonia
Excessive salivation
**history of polyhydraminos related to GI anomalies, fetus is unable to swallow amniotic
fluid, think TE and bowel obstruction
Remember VACTERL
✔✔Treatment of TEF - ✔✔-insert feeding tube into stomach, obtain chest xray to
determine if there is a pouch
-insert orgastric tube into stomach if there is no blind pouch to vent out air
-provide low continuous suction to remove secretions
-*turn infant prone, head of bed elevated 30 degrees to reduce reflux
**radiographic studies are CONTRAINDICATED!
