RNC NIC FINAL EXAM ACTUAL QUESTIONS AND
SOLUTIONS RATED A+
✔✔Coartication of the aorta - ✔✔Coarctation of the aorta has the classic finding of
decreased perfusion and pulses in the lower extremities. These infants can develop
temperature instability and poor feeding. Congenital heart disease should be suspected
when infants present with an increase in respiratory rate in the absence of any other
respiratory signs of distress and cyanosis.
✔✔Gastroschesis care - ✔✔At the time of delivery, protection of the intestines is
important. The infant should be placed in a sterile bowel bag to allow for visualization of
the intestines. In absence of a sterile bowel, another option to protecting the intestines
includes covering the intestines with warm sterile saline-soaked gauze that covers the
exposed intestines and then applying a plastic covering over the gauze to prevent
evaporation and heat loss.
✔✔Cephelhematoma - ✔✔A cephalohematoma is a collection of blood between the
periosteum and the skull that does not cross the suture line. It may enlarge during the
24 hours after birth and may take several months to resolve. These infants are at a
higher risk for developing hyperbilirubinemia
✔✔The Kleihauer-Betke test - ✔✔identifies fetal cells in the maternal blood. Although
the Kelihauer-Betke test can be useful in determining whether the mother needs RhIgG,
it will not determine the infant's condition at the time of delivery.
✔✔High Resolution Ultrasonography - ✔✔High-resolution ultrasonography is useful for
determining ascites, pericardial and pleural effusion, and other conditions in the baby
before delivery. The test gives the resuscitation team the ability to anticipate what
degree of resuscitation may be needed.
✔✔Correct positon of endotracheal tube - ✔✔midway between the trachea and carina
✔✔Chest Compression and Ventilation Resuscitation - ✔✔90 Compressions a minute,
1/3 of the diameter
30 breathes a minute
✔✔Symmetric IUGR - ✔✔Symmetrical intrauterine growth restriction (IUGR) begins
early in gestation and is most often caused by intrauterine infection or genetic
abnormalities.
✔✔TTN Radiographic findings - ✔✔Infants with transient tachypnea of the newborn
have chest radiographic findings that include perihilar streaking, overexpansion,
haziness, increased vascular markings, and fluid in the fissure, which traps air in the
alveoli. This air trapping results in an increase in the anteroposterior diameter of the
chest, leaving the infant with a barrel-shaped chest.
,✔✔Transposition of the great vessels - ✔✔Transposition of the great vessels occurs
when the aorta arises from the right ventricle and the pulmonary artery arises from the
left ventricle. Marked cyanosis is a presenting feature of transposition because the aorta
carries deoxygenated blood from the right ventricle to the systemic circulation.
✔✔Gastroinsetinal defect associated with down syndrome - ✔✔duodenal atresia.
✔✔Ventral Septal Defect murmur type - ✔✔Harsh Holosystolic Murmur heard over
Apex
✔✔patent ductus arteriosus (PDA) location and murmur type - ✔✔In healthy term
infants the ductus arteriosus normally closes in the first 24 to 48 hours of life. The
murmur associated with a patent ductus arteriosus (PDA) is systolic and is best heard
over the upper left sternal border and sometimes radiates to the axilla.
✔✔Shunting of PDA - ✔✔In a newborn a patent ductus arteriosus causes right to left
shunting resulting in additional blood flow to the aorta. This causes peripheral pulses to
feel full and bounding.
✔✔The Ortolani test is used in assessing for what condition? - ✔✔The Ortolani test is
used in conjunction with the Barlow test to assess for developmental dysplasia of the
hip.
✔✔Varicella (chicken pox) - ✔✔Cicatricial scarring (hair follicles are replaced with scar
tissue) is a classic finding in congenital varicella. Limb hypoplasia and microphthalmia
(small eyes) are also described with this infection.
✔✔Erb palsy - ✔✔Shoulder dystocia places the infant at increased risk of Erb palsy, an
injury to the brachial plexus. With Erb palsy the Moro reflex is asymmetrical and the arm
and wrist are positioned in what is referred to as waiter's tip.
✔✔Laryngomalicia - ✔✔Laryngomalacia is the most common cause of stridor in infants
and typically presents in the first month of life. Risk factors include prematurity and
respiratory support.
✔✔Omphacele and cardiac defect - ✔✔Among infants with omphalocele, 50% have
accompanying cardiac defects.
✔✔Scalded Scar Syndrome - ✔✔Scalded skin syndrome is an infection caused by
Staphylococcus aureus. Occurring most often in the diaper area or around the
umbilicus, it consists of vesicles that may coalesce to form bullae. When the vesicles
rupture they leave areas of denuded skin resembling a burn.
,✔✔Polhydraminos - ✔✔The presence of an esophageal atresia in an infant with
tracheoesophageal fistula prevents the fetus from swallowing amniotic fluid.
Polyhydramnios occurs as a result.
✔✔Candida Rash - ✔✔A candida rash is most often found in the groin and consists of
lesions over an erythematous base with satellite lesions extending beyond the groin.
✔✔Vocal Cord Paryli - ✔✔Vocal cord paralysis is a known complication of surgical
ligation of the ductus arteriosus. Symptoms of vocal cord paralysis include hoarseness
or stridor, choking, and feeding difficulty.
✔✔Assessing point of maximal intensity - ✔✔Because of the dominance of the right
ventricle, the point of maximal intensity is best heard over the fifth intercostal space in
the immediate newborn period.
✔✔In addition to hypoglycemia, an infant of a diabetic mother should be assessed for
the development of: - ✔✔hypocalcemia.
✔✔Lanugo in preterm infant - ✔✔Lanugo covers the entire body beginning at 20 weeks'
gestation and does not start disappearing until 28 weeks' gestation.
✔✔Assessment finding of term infant - ✔✔As gestation progresses beyond 38 weeks,
the subcutaneous tissue decreases, which causes the skin to wrinkle. At term gestation,
the breast tissue nodule measures up to 10 mm. There is cartilage present in the pinna,
which allows it to spring back from being folded.
✔✔Ampicillin 100mg/kg/dose - ✔✔Infuse 3-5 minutes followed with flush
✔✔ELBW, VLBW, LBW weights - ✔✔ELBW<100grams
VLBW <1500grams
LBW <2500grams
✔✔Potential problems with SGA - ✔✔An infant born at 40 weeks' gestation weighing
2000 g is well below the 10th percentile for weight and would be classified as small for
gestational age (SGA). Potential problems for which SGA infants are at risk include
polycythemia, hypoglycemia, hypothermia, hypoxia, and infection.
✔✔New Ballard Findings of Term Infant - ✔✔In postterm infants, the skin is cracked and
wrinkled, plantar creases cover the entire foot sole, and the skin is mostly bald of
lanugo. The ears are stiff with thick cartilage. The labia majora cover the labia minora as
well as the clitoris. Breast areolae are full with 5- to 10-mm buds.
✔✔Maintain Blood Glucose Levels - ✔✔50-110 mg/dL
, ✔✔Volvulus - ✔✔Vomiting of bile stained emesis
Make NPO
Decompress stomach
Abdomen film
Upper UGI study
Surgical correction to untwist bowel and restore blood flow
✔✔Placement of UVC - ✔✔Tip should be above diaphragm at inferior vena cava/right
atrial junction
✔✔Movement and flexion of extremities - ✔✔Generates warmth in muscles
Decreases surface area for heat loss
✔✔Brown fat - ✔✔Substance accumulated in increasing amounts as the infant
advances through gestation, especially third trimester
Brown fat is located around the kidneys, adrenal mediastinum, axillary regions.
In response to cold stress, norepinephrine is released into nerve endings in brown fat,
causing it to be burned or metabolized.
Process is called "non-shivering thermogenesis"
**Production of heat***
✔✔Response to cold stress - ✔✔Vasoconstriction
Prevents blood from reaching skin surface
Prolonged vasoconstriction may impair perfusion and tissues
Can cause apnea **
✔✔Conductive Heat Loss - ✔✔Involves transfer of heat between two solid objects. For
example, a mattress, scale, x-ray plate.
Ways to reduce conductive heat loss place a chemical thermal mattress underneath the
infant , clothing and hats, warm blanket on scale.
✔✔Convective Heat Loss - ✔✔Convective heat loss occurs when the infant's body heat
is swept away by air currents, such as when the infant is exposed to drafts from air
bents, air conditions, windows, doors, heaters, fans, incubator portholes
Incubator reduces convective heat loss by providing a warmer environment with an
enclosed space
SOLUTIONS RATED A+
✔✔Coartication of the aorta - ✔✔Coarctation of the aorta has the classic finding of
decreased perfusion and pulses in the lower extremities. These infants can develop
temperature instability and poor feeding. Congenital heart disease should be suspected
when infants present with an increase in respiratory rate in the absence of any other
respiratory signs of distress and cyanosis.
✔✔Gastroschesis care - ✔✔At the time of delivery, protection of the intestines is
important. The infant should be placed in a sterile bowel bag to allow for visualization of
the intestines. In absence of a sterile bowel, another option to protecting the intestines
includes covering the intestines with warm sterile saline-soaked gauze that covers the
exposed intestines and then applying a plastic covering over the gauze to prevent
evaporation and heat loss.
✔✔Cephelhematoma - ✔✔A cephalohematoma is a collection of blood between the
periosteum and the skull that does not cross the suture line. It may enlarge during the
24 hours after birth and may take several months to resolve. These infants are at a
higher risk for developing hyperbilirubinemia
✔✔The Kleihauer-Betke test - ✔✔identifies fetal cells in the maternal blood. Although
the Kelihauer-Betke test can be useful in determining whether the mother needs RhIgG,
it will not determine the infant's condition at the time of delivery.
✔✔High Resolution Ultrasonography - ✔✔High-resolution ultrasonography is useful for
determining ascites, pericardial and pleural effusion, and other conditions in the baby
before delivery. The test gives the resuscitation team the ability to anticipate what
degree of resuscitation may be needed.
✔✔Correct positon of endotracheal tube - ✔✔midway between the trachea and carina
✔✔Chest Compression and Ventilation Resuscitation - ✔✔90 Compressions a minute,
1/3 of the diameter
30 breathes a minute
✔✔Symmetric IUGR - ✔✔Symmetrical intrauterine growth restriction (IUGR) begins
early in gestation and is most often caused by intrauterine infection or genetic
abnormalities.
✔✔TTN Radiographic findings - ✔✔Infants with transient tachypnea of the newborn
have chest radiographic findings that include perihilar streaking, overexpansion,
haziness, increased vascular markings, and fluid in the fissure, which traps air in the
alveoli. This air trapping results in an increase in the anteroposterior diameter of the
chest, leaving the infant with a barrel-shaped chest.
,✔✔Transposition of the great vessels - ✔✔Transposition of the great vessels occurs
when the aorta arises from the right ventricle and the pulmonary artery arises from the
left ventricle. Marked cyanosis is a presenting feature of transposition because the aorta
carries deoxygenated blood from the right ventricle to the systemic circulation.
✔✔Gastroinsetinal defect associated with down syndrome - ✔✔duodenal atresia.
✔✔Ventral Septal Defect murmur type - ✔✔Harsh Holosystolic Murmur heard over
Apex
✔✔patent ductus arteriosus (PDA) location and murmur type - ✔✔In healthy term
infants the ductus arteriosus normally closes in the first 24 to 48 hours of life. The
murmur associated with a patent ductus arteriosus (PDA) is systolic and is best heard
over the upper left sternal border and sometimes radiates to the axilla.
✔✔Shunting of PDA - ✔✔In a newborn a patent ductus arteriosus causes right to left
shunting resulting in additional blood flow to the aorta. This causes peripheral pulses to
feel full and bounding.
✔✔The Ortolani test is used in assessing for what condition? - ✔✔The Ortolani test is
used in conjunction with the Barlow test to assess for developmental dysplasia of the
hip.
✔✔Varicella (chicken pox) - ✔✔Cicatricial scarring (hair follicles are replaced with scar
tissue) is a classic finding in congenital varicella. Limb hypoplasia and microphthalmia
(small eyes) are also described with this infection.
✔✔Erb palsy - ✔✔Shoulder dystocia places the infant at increased risk of Erb palsy, an
injury to the brachial plexus. With Erb palsy the Moro reflex is asymmetrical and the arm
and wrist are positioned in what is referred to as waiter's tip.
✔✔Laryngomalicia - ✔✔Laryngomalacia is the most common cause of stridor in infants
and typically presents in the first month of life. Risk factors include prematurity and
respiratory support.
✔✔Omphacele and cardiac defect - ✔✔Among infants with omphalocele, 50% have
accompanying cardiac defects.
✔✔Scalded Scar Syndrome - ✔✔Scalded skin syndrome is an infection caused by
Staphylococcus aureus. Occurring most often in the diaper area or around the
umbilicus, it consists of vesicles that may coalesce to form bullae. When the vesicles
rupture they leave areas of denuded skin resembling a burn.
,✔✔Polhydraminos - ✔✔The presence of an esophageal atresia in an infant with
tracheoesophageal fistula prevents the fetus from swallowing amniotic fluid.
Polyhydramnios occurs as a result.
✔✔Candida Rash - ✔✔A candida rash is most often found in the groin and consists of
lesions over an erythematous base with satellite lesions extending beyond the groin.
✔✔Vocal Cord Paryli - ✔✔Vocal cord paralysis is a known complication of surgical
ligation of the ductus arteriosus. Symptoms of vocal cord paralysis include hoarseness
or stridor, choking, and feeding difficulty.
✔✔Assessing point of maximal intensity - ✔✔Because of the dominance of the right
ventricle, the point of maximal intensity is best heard over the fifth intercostal space in
the immediate newborn period.
✔✔In addition to hypoglycemia, an infant of a diabetic mother should be assessed for
the development of: - ✔✔hypocalcemia.
✔✔Lanugo in preterm infant - ✔✔Lanugo covers the entire body beginning at 20 weeks'
gestation and does not start disappearing until 28 weeks' gestation.
✔✔Assessment finding of term infant - ✔✔As gestation progresses beyond 38 weeks,
the subcutaneous tissue decreases, which causes the skin to wrinkle. At term gestation,
the breast tissue nodule measures up to 10 mm. There is cartilage present in the pinna,
which allows it to spring back from being folded.
✔✔Ampicillin 100mg/kg/dose - ✔✔Infuse 3-5 minutes followed with flush
✔✔ELBW, VLBW, LBW weights - ✔✔ELBW<100grams
VLBW <1500grams
LBW <2500grams
✔✔Potential problems with SGA - ✔✔An infant born at 40 weeks' gestation weighing
2000 g is well below the 10th percentile for weight and would be classified as small for
gestational age (SGA). Potential problems for which SGA infants are at risk include
polycythemia, hypoglycemia, hypothermia, hypoxia, and infection.
✔✔New Ballard Findings of Term Infant - ✔✔In postterm infants, the skin is cracked and
wrinkled, plantar creases cover the entire foot sole, and the skin is mostly bald of
lanugo. The ears are stiff with thick cartilage. The labia majora cover the labia minora as
well as the clitoris. Breast areolae are full with 5- to 10-mm buds.
✔✔Maintain Blood Glucose Levels - ✔✔50-110 mg/dL
, ✔✔Volvulus - ✔✔Vomiting of bile stained emesis
Make NPO
Decompress stomach
Abdomen film
Upper UGI study
Surgical correction to untwist bowel and restore blood flow
✔✔Placement of UVC - ✔✔Tip should be above diaphragm at inferior vena cava/right
atrial junction
✔✔Movement and flexion of extremities - ✔✔Generates warmth in muscles
Decreases surface area for heat loss
✔✔Brown fat - ✔✔Substance accumulated in increasing amounts as the infant
advances through gestation, especially third trimester
Brown fat is located around the kidneys, adrenal mediastinum, axillary regions.
In response to cold stress, norepinephrine is released into nerve endings in brown fat,
causing it to be burned or metabolized.
Process is called "non-shivering thermogenesis"
**Production of heat***
✔✔Response to cold stress - ✔✔Vasoconstriction
Prevents blood from reaching skin surface
Prolonged vasoconstriction may impair perfusion and tissues
Can cause apnea **
✔✔Conductive Heat Loss - ✔✔Involves transfer of heat between two solid objects. For
example, a mattress, scale, x-ray plate.
Ways to reduce conductive heat loss place a chemical thermal mattress underneath the
infant , clothing and hats, warm blanket on scale.
✔✔Convective Heat Loss - ✔✔Convective heat loss occurs when the infant's body heat
is swept away by air currents, such as when the infant is exposed to drafts from air
bents, air conditions, windows, doors, heaters, fans, incubator portholes
Incubator reduces convective heat loss by providing a warmer environment with an
enclosed space
