RNC-NIC Neonatal Intensive Care Nursing Practice Exam 90
Questions with Answers and Rationales
Respiratory Support and Thermoregulation
1. A 28-week infant develops grunting, retractions, and increasing oxygen need
soon after birth. Which mechanism commonly contributes to respiratory
distress syndrome?
A. Normal adult lung compliance
B. Surfactant deficiency with alveolar instability
C. Complete closure of every pulmonary vessel
D. Excess mature surfactant production
Correct answer: B. Surfactant deficiency with alveolar instability
Rationale: Immature lungs may produce inadequate surfactant, increasing surface
tension and alveolar collapse. Respiratory assessment and ordered support are
essential; this is not a normal breathing pattern.
2. What is a principal purpose of nasal CPAP in a preterm infant?
A. Eliminate the need for monitoring
B. Maintain distending pressure to help keep alveoli open
C. Replace all spontaneous respiratory effort in every infant
D. Remove all oxygen from inspired air
Correct answer: B. Maintain distending pressure to help keep alveoli open
Rationale: CPAP provides continuous distending pressure that supports lung
recruitment. The infant still requires assessment of breathing, oxygenation, interface
fit, and tolerance.
3. An infant on CPAP has increasing retractions and recurrent desaturation.
What should the nurse do?
A. Increase every setting independently without protocol
B. Assess the infant and equipment and promptly escalate deterioration
C. Silence the alarm and leave
D. Assume all desaturations are artifact
Correct answer: B. Assess the infant and equipment and promptly escalate
deterioration
Rationale: Worsening distress requires immediate patient assessment, equipment
review, and escalation. Alarms may reflect true deterioration; setting changes must
follow orders or authorized protocols.
Independent Practice Exam | 1
,4. After surfactant administration, lung compliance improves rapidly. What
requires close reassessment?
A. The parents' insurance number only
B. The color of the incubator
C. Ventilation and oxygen requirements
D. The future school schedule
Correct answer: C. Ventilation and oxygen requirements
Rationale: Surfactant can quickly change pulmonary mechanics and oxygen needs.
Close monitoring supports timely adjustment by the team and reduces risk from
excessive support.
5. A ventilated infant suddenly desaturates and has reduced chest movement.
What is the priority?
A. Complete routine feeding documentation
B. Assess airway patency, tube position, breathing, and equipment immediately
C. Wait for the next blood gas
D. Assume the monitor is incorrect
Correct answer: B. Assess airway patency, tube position, breathing, and equipment
immediately
Rationale: Acute deterioration may reflect tube displacement, obstruction,
equipment failure, or a pulmonary complication. Immediate bedside assessment and
emergency support take priority over delayed testing.
6. Which finding raises concern for pneumothorax in a ventilated neonate?
A. An unchanged diaper count
B. Steady feeding tolerance
C. Sudden deterioration with asymmetric breath sounds
D. Improved oxygenation with equal air entry
Correct answer: C. Sudden deterioration with asymmetric breath sounds
Rationale: A sudden change with asymmetric ventilation suggests air leak and
requires urgent evaluation. Respiratory and circulatory compromise can progress
rapidly.
Independent Practice Exam | 2
, 7. Why must oxygen therapy in a preterm infant be carefully titrated?
A. Higher oxygen is always harmless
B. Oxygen saturation targets are identical for every infant
C. Monitoring is unnecessary when oxygen is prescribed
D. Both inadequate and excessive oxygen exposure can cause harm
Correct answer: D. Both inadequate and excessive oxygen exposure can cause harm
Rationale: Preterm infants are vulnerable to hypoxemia and oxygen-related injury.
Use the prescribed target range and device, reassessing clinical status rather than
applying a universal setting.
8. A pulse oximeter shows a low value while its waveform is poor. What should
the nurse do?
A. Assess the infant and verify probe placement and signal quality
B. Increase oxygen indefinitely without reassessment
C. Ignore the infant until the sensor improves
D. Remove all monitoring permanently
Correct answer: A. Assess the infant and verify probe placement and signal quality
Rationale: Clinical assessment and signal verification help distinguish artifact from
true hypoxemia. A poor waveform does not justify ignoring a potentially unstable
infant.
9. An infant has apnea with bradycardia and desaturation. What is
appropriate?
A. Disconnect monitoring to reduce alarms
B. Wait for spontaneous resolution regardless of severity
C. Offer an oral feed during apnea
D. Provide immediate protocol-directed assessment and support and document the
event
Correct answer: D. Provide immediate protocol-directed assessment and support
and document the event
Rationale: Associated bradycardia and desaturation make apnea clinically
significant. Immediate response follows unit protocols, with evaluation for
underlying causes and accurate event documentation.
Independent Practice Exam | 3
Questions with Answers and Rationales
Respiratory Support and Thermoregulation
1. A 28-week infant develops grunting, retractions, and increasing oxygen need
soon after birth. Which mechanism commonly contributes to respiratory
distress syndrome?
A. Normal adult lung compliance
B. Surfactant deficiency with alveolar instability
C. Complete closure of every pulmonary vessel
D. Excess mature surfactant production
Correct answer: B. Surfactant deficiency with alveolar instability
Rationale: Immature lungs may produce inadequate surfactant, increasing surface
tension and alveolar collapse. Respiratory assessment and ordered support are
essential; this is not a normal breathing pattern.
2. What is a principal purpose of nasal CPAP in a preterm infant?
A. Eliminate the need for monitoring
B. Maintain distending pressure to help keep alveoli open
C. Replace all spontaneous respiratory effort in every infant
D. Remove all oxygen from inspired air
Correct answer: B. Maintain distending pressure to help keep alveoli open
Rationale: CPAP provides continuous distending pressure that supports lung
recruitment. The infant still requires assessment of breathing, oxygenation, interface
fit, and tolerance.
3. An infant on CPAP has increasing retractions and recurrent desaturation.
What should the nurse do?
A. Increase every setting independently without protocol
B. Assess the infant and equipment and promptly escalate deterioration
C. Silence the alarm and leave
D. Assume all desaturations are artifact
Correct answer: B. Assess the infant and equipment and promptly escalate
deterioration
Rationale: Worsening distress requires immediate patient assessment, equipment
review, and escalation. Alarms may reflect true deterioration; setting changes must
follow orders or authorized protocols.
Independent Practice Exam | 1
,4. After surfactant administration, lung compliance improves rapidly. What
requires close reassessment?
A. The parents' insurance number only
B. The color of the incubator
C. Ventilation and oxygen requirements
D. The future school schedule
Correct answer: C. Ventilation and oxygen requirements
Rationale: Surfactant can quickly change pulmonary mechanics and oxygen needs.
Close monitoring supports timely adjustment by the team and reduces risk from
excessive support.
5. A ventilated infant suddenly desaturates and has reduced chest movement.
What is the priority?
A. Complete routine feeding documentation
B. Assess airway patency, tube position, breathing, and equipment immediately
C. Wait for the next blood gas
D. Assume the monitor is incorrect
Correct answer: B. Assess airway patency, tube position, breathing, and equipment
immediately
Rationale: Acute deterioration may reflect tube displacement, obstruction,
equipment failure, or a pulmonary complication. Immediate bedside assessment and
emergency support take priority over delayed testing.
6. Which finding raises concern for pneumothorax in a ventilated neonate?
A. An unchanged diaper count
B. Steady feeding tolerance
C. Sudden deterioration with asymmetric breath sounds
D. Improved oxygenation with equal air entry
Correct answer: C. Sudden deterioration with asymmetric breath sounds
Rationale: A sudden change with asymmetric ventilation suggests air leak and
requires urgent evaluation. Respiratory and circulatory compromise can progress
rapidly.
Independent Practice Exam | 2
, 7. Why must oxygen therapy in a preterm infant be carefully titrated?
A. Higher oxygen is always harmless
B. Oxygen saturation targets are identical for every infant
C. Monitoring is unnecessary when oxygen is prescribed
D. Both inadequate and excessive oxygen exposure can cause harm
Correct answer: D. Both inadequate and excessive oxygen exposure can cause harm
Rationale: Preterm infants are vulnerable to hypoxemia and oxygen-related injury.
Use the prescribed target range and device, reassessing clinical status rather than
applying a universal setting.
8. A pulse oximeter shows a low value while its waveform is poor. What should
the nurse do?
A. Assess the infant and verify probe placement and signal quality
B. Increase oxygen indefinitely without reassessment
C. Ignore the infant until the sensor improves
D. Remove all monitoring permanently
Correct answer: A. Assess the infant and verify probe placement and signal quality
Rationale: Clinical assessment and signal verification help distinguish artifact from
true hypoxemia. A poor waveform does not justify ignoring a potentially unstable
infant.
9. An infant has apnea with bradycardia and desaturation. What is
appropriate?
A. Disconnect monitoring to reduce alarms
B. Wait for spontaneous resolution regardless of severity
C. Offer an oral feed during apnea
D. Provide immediate protocol-directed assessment and support and document the
event
Correct answer: D. Provide immediate protocol-directed assessment and support
and document the event
Rationale: Associated bradycardia and desaturation make apnea clinically
significant. Immediate response follows unit protocols, with evaluation for
underlying causes and accurate event documentation.
Independent Practice Exam | 3
