RNC NIC Exam Questions and answers |
With complete solution 2024/25
GIR - 6-8mcg/kg/min caloric intake
ii ii ii ii ii ii
ii D10 Bolus - 2mL/kg ii ii ii ii ii
ii Fluid Volume Bolus - 10mL/kg ii ii ii ii ii ii
Term Parenteral Fluid Requirement - 80mL/kg/day
ii ii ii ii ii ii ii ii
Enteral 100-150 mlk/kg/day ii ii
Preterm Parenteral Fluid Requirement - 120
ii ii ii ii ii ii ii ii
Enteral 150-200ml/kig/day ii
ii GIR Calculation - (%dextrose x IV rate) / (6 x wt in kg)
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
ii I/T ratio - %Metas + Bands / %Metas + Bands + Segs
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
I/T ratio greater than >0.2 to >.25 suggestive of infection
ii ii ii ii ii ii ii ii ii
>0.8 associated with shock ii ii ii
Absolute Neutrophil COUNT - WBC x (%) Segmented neutrophils + band neutrophils +
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
metamyelocytes
ii
Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent) ii ii ii ii ii ii ii ii ii ii ii ii ii
15,000 x .53 = 7950 ii ii ii ii
ANC <1800 suggestive of infection
ii ii ii ii
Normal Range ii
ii Mature WBCs - Poly, Segs, Neutrophils ii ii ii ii ii ii ii
ii Immature WBCs - Meta, Bands, Stabs ii ii ii ii ii ii ii
Platelet Range - 150-400k
ii ii ii ii ii ii
Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral ii ii ii ii ii ii ii ii ii ii ii
infection, but usual onset does not occur until 1 to 3 days after infection onset (late
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
function test results, and l ow p latelet count), pregnancy-induced hypertension, and
ii ii ii ii ii ii ii ii ii ii ii ii
intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
21, Turner's syndrome, and hemolytic disease.
ii ii ii ii ii ii
ii CRP level - CRP level usually <1.6 for the first two days of life
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
,Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged
ii ii ii ii ii ii ii ii ii ii
rupture of membranes.
ii ii ii
Most common pathogens - Currently, GBS
ii ii ii ii ii ii ii ii
E. coliii
Candidas - -Diaper dermatitis presents with intense erythema and satellite lesions.
ii
ii
ii ii ii ii ii ii ii ii ii ii ii ii ii
-Congenital candidiasis presents with widespread erythematous maculopapular rash, and ii ii ii ii ii ii ii ii
preterm infants may present with pneumonia.
ii ii ii ii ii ii
Congenital CMV infection - congenital infection include: intrauterine growth restriction,
ii ii ii ii ii ii ii ii ii ii ii ii
hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly, hydrocephalus,
ii ii ii ii ii ii
intracerebral calcifications, hearing loss, chorioretinitis, and optic atrophy.
ii ii ii ii ii ii ii ii
ii Endotracheal Measurement - 6 + wt in kg ii ii ii ii ii ii ii ii ii ii
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
ii ii ii ii ii ii ii ii ii ii ii ii ii
carina.
ii
Polyethelane Wrap for Infant < 29 weeks - Dry infants head only
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Place infant in bag, from neck down
ii ii ii ii ii ii
Remove bag once infant is in an NTE and humidified environment
ii ii ii ii ii ii ii ii ii ii
UAC Placement - High Placement T6-T9
ii ii ii ii ii ii ii ii
Low Placement L3-L4
ii ii
UVC Placement - 1 to 2cm above the diaghragm
ii ii ii ii ii ii ii ii ii ii ii ii
Low Lying 2-4cm in the cord
ii ii ii ii ii
Chest Tube Placement - Mid Clavicular line with distal chest tube hole inside the thoracic
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
space
ii
lecithin/sphingomyelin (L/S) ratio - An L/S ratio greater than 2:1 is considered to indicate
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fetal lung maturity.
ii ii ii
Anatomic events Five stages of lung development - 1. Embryonic development (weeks 1
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to 5). The endoderm-derived embryonic foregut provides a single lung bud that begins to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
divide ventrocaudally through the mesenchyme surrounding the foregut. The pulmonary
ii ii ii ii ii ii ii ii ii ii
vein develops and extends to join the lung bud. The trachea develops at the end of the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
embryonic period. There are three divisions on the right side and two on the left side that
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
will eventually become the lobes of the lungs.
ii
ii
ii ii ii ii ii ii ii ii
2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage
ii ii ii ii ii ii ii ii ii ii ii ii
appears; main bronchi are formed; demarcation of major lobes occurs; formation of new
ii ii ii ii ii ii ii ii ii ii ii ii ii
bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no
ii ii ii ii ii ii ii ii ii ii ii ii ii
connection made with terminal air sacs. The lung at this time undergoes 14 more
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
,generations of branching and the formation of the terminal bronchioles. The lung
ii ii ii ii ii ii ii ii ii ii ii ii
resembles an exocrine organ because of surrounding loose mesenchymal tissues, hence
ii ii ii ii ii ii ii ii ii ii ii
the name pseudoglandular .
ii
ii
ii ii ii ii
3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e.,
ii ii ii ii ii ii ii ii ii ii ii ii
respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for
ii ii ii ii ii ii ii ii ii ii ii
surface-active material storage are seen; capillaries invade terminal airway walls; type II
ii ii ii ii ii ii ii ii ii ii ii ii
alveolar epithelial cells appear. Airway changes from glandular to tubular and increases in
ii ii ii ii ii ii ii ii ii ii ii ii ii
length and diameter. Vascular system proliferates and the capillaries are now closer to the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
epithelium-conducting airways. Respiratory bronchioles that will participate in gas
ii ii ii ii ii ii ii ii ii
exchange can be differentiated.
ii
ii
ii ii ii ii
4. Terminal sac period (weeks 26 to birth). Around week 26 alveolar sacs are formed; air-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
blood surface area is limited for gas exchange; and type II cells are unable to release
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
surfactant in sufficient quantity to maintain air breathing. Capillary loops increase; type II
ii ii ii ii ii ii ii ii ii ii ii ii ii
cells cluster at alveolar ducts, beco
ii ii ii ii ii ii
IUGR asymmetrical - Weight low for Gestation Age
ii ii ii ii ii ii ii ii ii ii
Head Sparing (less restriction on brain growth)
ii ii ii ii ii ii
Old man appearance
ii ii
Appear wasted, thin ii ii
Results from: Poor Placental function ii ii ii ii
Maternal Hypertension* ii
Smoking
IUGR Symmetric - Lower weight, height, length, and head circumference for gestational
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
age
ii
Results from intrauterine viral infection, chromosomal genetic abnormalities, long standing
ii ii ii ii ii ii ii ii ii
disease
ii
ii Prostaglandin E1 (alprostadil) - Prevent premature closure of the PDA ii ii ii ii ii ii ii ii ii ii ii
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
ii ii ii ii ii
Indomethicin (NSAID - 1. Hypoglycemia
ii ii ii ii ii ii ii
2. Platelet dysfunction
ii ii
3. Gastrointestinal perforation w/ steroids
ii ii ii ii
4. Renal effects, decreases urine output!
ii ii ii ii ii ii
Used if PDA fails to close to prevent pulmonary over circulation and PPHN
ii ii ii ii ii ii ii ii ii ii ii ii
Diuretics effects - 1. Metabolic Alkalosis
ii ii ii ii ii ii ii ii
2. Ototoxicity
ii
3. Decreased calcium absorption in bones
ii ii ii ii ii
ii Theophylline - Bronchodilator. Opens airways. ii ii ii ii ii ii ii
, Short half life, caffeine preferred treatment due to longer half life and more tolerable side
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
effect profile.
ii ii
Digoxin - Enhances contractility
ii ii ii ii ii ii
Inhibits Na + K+ ATP ii ii ii ii
Reduces HR, CI'd if HR <60 ii ii ii ii ii
Hypokalemia increases drug concentration ii ii ii
Most frequent disorder associated with downsyndrome - Deudonal Atresia
ii ii ii ii ii ii ii ii ii ii ii
Double Bubble ii
May see VSD, AV Canal, Tetralogy of Fallot
ii ii ii ii ii ii ii
ii Upper GI Gold Standard for - Malrotation
ii ii ii ii ii ii ii ii
Position for gastroschesis - Lateral (side lying) to prevent occlusion of the mesenteric
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
arteries that supply blood to the bowel. Tie bag to the axilla.
ii ii ii ii ii ii ii ii ii ii ii ii
ii VACTERAL, associated with what two disorders? - TEF/EA ii ii ii ii ii ii ii ii ii
vertebral defects ii
anal atresia
ii
cardiac anomalies ii
trachoesophageal fistula ii
radial defects ii ii
renal and limb anomalies
ii ii ii
Hirschbrung Disease - Starts in distal rectum
ii ii ii ii ii ii ii ii ii
Clinical sign : failure to pass meconium within first 24-48 hours
ii ii ii ii ii ii ii ii ii ii
May be associated with bilious emesis and a distended abdomen
ii ii ii ii ii ii ii ii ii
Associated with CF ii ii
Types of test to determine diagnosis: Barium enema, biopsy of rectum
ii ii ii ii ii ii ii ii ii ii
Congenital Diaphragmatic Hernia - Space occupying lesion, intestinal contents fill the
ii ii ii ii ii ii ii ii ii ii ii ii ii
lung cavity
ii ii ii
Presents with a scaphoid abdomen, barrel chest ii ii ii ii ii ii ii
Can result in pulmonary hypoplasia, pulmonary hypertension
ii ii ii ii ii ii
Requires intubation, HFOV, ECMO ii ii ii
Insert OG or NG tube ii ii ii ii ii
CPAP is Contraindicated! ii ii
Clinical Signs of Pyloric Stenosis - Dehydration
ii ii ii ii ii ii ii ii ii
Non bilious projectile vomiting
ii ii ii
Peristaltic waves in the epigastrium ii ii ii ii ii
Electrolyte disturbances ii
With complete solution 2024/25
GIR - 6-8mcg/kg/min caloric intake
ii ii ii ii ii ii
ii D10 Bolus - 2mL/kg ii ii ii ii ii
ii Fluid Volume Bolus - 10mL/kg ii ii ii ii ii ii
Term Parenteral Fluid Requirement - 80mL/kg/day
ii ii ii ii ii ii ii ii
Enteral 100-150 mlk/kg/day ii ii
Preterm Parenteral Fluid Requirement - 120
ii ii ii ii ii ii ii ii
Enteral 150-200ml/kig/day ii
ii GIR Calculation - (%dextrose x IV rate) / (6 x wt in kg)
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
ii I/T ratio - %Metas + Bands / %Metas + Bands + Segs
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
I/T ratio greater than >0.2 to >.25 suggestive of infection
ii ii ii ii ii ii ii ii ii
>0.8 associated with shock ii ii ii
Absolute Neutrophil COUNT - WBC x (%) Segmented neutrophils + band neutrophils +
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
metamyelocytes
ii
Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent) ii ii ii ii ii ii ii ii ii ii ii ii ii
15,000 x .53 = 7950 ii ii ii ii
ANC <1800 suggestive of infection
ii ii ii ii
Normal Range ii
ii Mature WBCs - Poly, Segs, Neutrophils ii ii ii ii ii ii ii
ii Immature WBCs - Meta, Bands, Stabs ii ii ii ii ii ii ii
Platelet Range - 150-400k
ii ii ii ii ii ii
Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral ii ii ii ii ii ii ii ii ii ii ii
infection, but usual onset does not occur until 1 to 3 days after infection onset (late
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
function test results, and l ow p latelet count), pregnancy-induced hypertension, and
ii ii ii ii ii ii ii ii ii ii ii ii
intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18, and
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
21, Turner's syndrome, and hemolytic disease.
ii ii ii ii ii ii
ii CRP level - CRP level usually <1.6 for the first two days of life
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
,Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged
ii ii ii ii ii ii ii ii ii ii
rupture of membranes.
ii ii ii
Most common pathogens - Currently, GBS
ii ii ii ii ii ii ii ii
E. coliii
Candidas - -Diaper dermatitis presents with intense erythema and satellite lesions.
ii
ii
ii ii ii ii ii ii ii ii ii ii ii ii ii
-Congenital candidiasis presents with widespread erythematous maculopapular rash, and ii ii ii ii ii ii ii ii
preterm infants may present with pneumonia.
ii ii ii ii ii ii
Congenital CMV infection - congenital infection include: intrauterine growth restriction,
ii ii ii ii ii ii ii ii ii ii ii ii
hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly, hydrocephalus,
ii ii ii ii ii ii
intracerebral calcifications, hearing loss, chorioretinitis, and optic atrophy.
ii ii ii ii ii ii ii ii
ii Endotracheal Measurement - 6 + wt in kg ii ii ii ii ii ii ii ii ii ii
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
ii ii ii ii ii ii ii ii ii ii ii ii ii
carina.
ii
Polyethelane Wrap for Infant < 29 weeks - Dry infants head only
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
Place infant in bag, from neck down
ii ii ii ii ii ii
Remove bag once infant is in an NTE and humidified environment
ii ii ii ii ii ii ii ii ii ii
UAC Placement - High Placement T6-T9
ii ii ii ii ii ii ii ii
Low Placement L3-L4
ii ii
UVC Placement - 1 to 2cm above the diaghragm
ii ii ii ii ii ii ii ii ii ii ii ii
Low Lying 2-4cm in the cord
ii ii ii ii ii
Chest Tube Placement - Mid Clavicular line with distal chest tube hole inside the thoracic
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
space
ii
lecithin/sphingomyelin (L/S) ratio - An L/S ratio greater than 2:1 is considered to indicate
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
fetal lung maturity.
ii ii ii
Anatomic events Five stages of lung development - 1. Embryonic development (weeks 1
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
to 5). The endoderm-derived embryonic foregut provides a single lung bud that begins to
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
divide ventrocaudally through the mesenchyme surrounding the foregut. The pulmonary
ii ii ii ii ii ii ii ii ii ii
vein develops and extends to join the lung bud. The trachea develops at the end of the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
embryonic period. There are three divisions on the right side and two on the left side that
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
will eventually become the lobes of the lungs.
ii
ii
ii ii ii ii ii ii ii ii
2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage
ii ii ii ii ii ii ii ii ii ii ii ii
appears; main bronchi are formed; demarcation of major lobes occurs; formation of new
ii ii ii ii ii ii ii ii ii ii ii ii ii
bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no
ii ii ii ii ii ii ii ii ii ii ii ii ii
connection made with terminal air sacs. The lung at this time undergoes 14 more
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
,generations of branching and the formation of the terminal bronchioles. The lung
ii ii ii ii ii ii ii ii ii ii ii ii
resembles an exocrine organ because of surrounding loose mesenchymal tissues, hence
ii ii ii ii ii ii ii ii ii ii ii
the name pseudoglandular .
ii
ii
ii ii ii ii
3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e.,
ii ii ii ii ii ii ii ii ii ii ii ii
respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for
ii ii ii ii ii ii ii ii ii ii ii
surface-active material storage are seen; capillaries invade terminal airway walls; type II
ii ii ii ii ii ii ii ii ii ii ii ii
alveolar epithelial cells appear. Airway changes from glandular to tubular and increases in
ii ii ii ii ii ii ii ii ii ii ii ii ii
length and diameter. Vascular system proliferates and the capillaries are now closer to the
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
epithelium-conducting airways. Respiratory bronchioles that will participate in gas
ii ii ii ii ii ii ii ii ii
exchange can be differentiated.
ii
ii
ii ii ii ii
4. Terminal sac period (weeks 26 to birth). Around week 26 alveolar sacs are formed; air-
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
blood surface area is limited for gas exchange; and type II cells are unable to release
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
surfactant in sufficient quantity to maintain air breathing. Capillary loops increase; type II
ii ii ii ii ii ii ii ii ii ii ii ii ii
cells cluster at alveolar ducts, beco
ii ii ii ii ii ii
IUGR asymmetrical - Weight low for Gestation Age
ii ii ii ii ii ii ii ii ii ii
Head Sparing (less restriction on brain growth)
ii ii ii ii ii ii
Old man appearance
ii ii
Appear wasted, thin ii ii
Results from: Poor Placental function ii ii ii ii
Maternal Hypertension* ii
Smoking
IUGR Symmetric - Lower weight, height, length, and head circumference for gestational
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
age
ii
Results from intrauterine viral infection, chromosomal genetic abnormalities, long standing
ii ii ii ii ii ii ii ii ii
disease
ii
ii Prostaglandin E1 (alprostadil) - Prevent premature closure of the PDA ii ii ii ii ii ii ii ii ii ii ii
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
ii ii ii ii ii
Indomethicin (NSAID - 1. Hypoglycemia
ii ii ii ii ii ii ii
2. Platelet dysfunction
ii ii
3. Gastrointestinal perforation w/ steroids
ii ii ii ii
4. Renal effects, decreases urine output!
ii ii ii ii ii ii
Used if PDA fails to close to prevent pulmonary over circulation and PPHN
ii ii ii ii ii ii ii ii ii ii ii ii
Diuretics effects - 1. Metabolic Alkalosis
ii ii ii ii ii ii ii ii
2. Ototoxicity
ii
3. Decreased calcium absorption in bones
ii ii ii ii ii
ii Theophylline - Bronchodilator. Opens airways. ii ii ii ii ii ii ii
, Short half life, caffeine preferred treatment due to longer half life and more tolerable side
ii ii ii ii ii ii ii ii ii ii ii ii ii ii
effect profile.
ii ii
Digoxin - Enhances contractility
ii ii ii ii ii ii
Inhibits Na + K+ ATP ii ii ii ii
Reduces HR, CI'd if HR <60 ii ii ii ii ii
Hypokalemia increases drug concentration ii ii ii
Most frequent disorder associated with downsyndrome - Deudonal Atresia
ii ii ii ii ii ii ii ii ii ii ii
Double Bubble ii
May see VSD, AV Canal, Tetralogy of Fallot
ii ii ii ii ii ii ii
ii Upper GI Gold Standard for - Malrotation
ii ii ii ii ii ii ii ii
Position for gastroschesis - Lateral (side lying) to prevent occlusion of the mesenteric
ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii
arteries that supply blood to the bowel. Tie bag to the axilla.
ii ii ii ii ii ii ii ii ii ii ii ii
ii VACTERAL, associated with what two disorders? - TEF/EA ii ii ii ii ii ii ii ii ii
vertebral defects ii
anal atresia
ii
cardiac anomalies ii
trachoesophageal fistula ii
radial defects ii ii
renal and limb anomalies
ii ii ii
Hirschbrung Disease - Starts in distal rectum
ii ii ii ii ii ii ii ii ii
Clinical sign : failure to pass meconium within first 24-48 hours
ii ii ii ii ii ii ii ii ii ii
May be associated with bilious emesis and a distended abdomen
ii ii ii ii ii ii ii ii ii
Associated with CF ii ii
Types of test to determine diagnosis: Barium enema, biopsy of rectum
ii ii ii ii ii ii ii ii ii ii
Congenital Diaphragmatic Hernia - Space occupying lesion, intestinal contents fill the
ii ii ii ii ii ii ii ii ii ii ii ii ii
lung cavity
ii ii ii
Presents with a scaphoid abdomen, barrel chest ii ii ii ii ii ii ii
Can result in pulmonary hypoplasia, pulmonary hypertension
ii ii ii ii ii ii
Requires intubation, HFOV, ECMO ii ii ii
Insert OG or NG tube ii ii ii ii ii
CPAP is Contraindicated! ii ii
Clinical Signs of Pyloric Stenosis - Dehydration
ii ii ii ii ii ii ii ii ii
Non bilious projectile vomiting
ii ii ii
Peristaltic waves in the epigastrium ii ii ii ii ii
Electrolyte disturbances ii
