RNC NIC UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔IUGR asymmetrical - ✔✔Weight low for Gestation Age
Head Sparing (less restriction on brain growth)
Old man appearance
Appear wasted, thin
Results from: Poor Placental function
Maternal Hypertension*
Smoking
✔✔IUGR Symmetric - ✔✔Lower weight, height, length, and head circumference for
gestational age
Results from intrauterine viral infection, chromosomal genetic abnormalities, long
standing disease
✔✔Prostaglandin E1 (alprostadil) - ✔✔Prevent premature closure of the PDA
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
✔✔Indomethicin (NSAID - ✔✔1. Hypoglycemia
2. Platelet dysfunction
3. Gastrointestinal perforation w/ steroids
4. Renal effects, decreases urine output!
Used if PDA fails to close to prevent pulmonary over circulation and PPHN
✔✔Diuretics effects - ✔✔1. Metabolic Alkalosis
2. Ototoxicity
3. Decreased calcium absorption in bones
✔✔Theophylline - ✔✔Bronchodilator. Opens airways.
Short half life, caffeine preferred treatment due to longer half life and more tolerable
side effect profile.
✔✔Digoxin - ✔✔Enhances contractility
Inhibits Na + K+ ATP
Reduces HR, CI'd if HR <60
Hypokalemia increases drug concentration
✔✔Most frequent disorder associated with downsyndrome - ✔✔Deudonal Atresia
Double Bubble
May see VSD, AV Canal, Tetralogy of Fallot
,✔✔Upper GI Gold Standard for - ✔✔Malrotation
✔✔Position for gastroschesis - ✔✔Lateral (side lying) to prevent occlusion of the
mesenteric arteries that supply blood to the bowel. Tie bag to the axilla.
✔✔VACTERAL, associated with what two disorders? - ✔✔TEF/EA
vertebral defects
anal atresia
cardiac anomalies
trachoesophageal fistula
radial defects
renal and limb anomalies
✔✔Hirschbrung Disease - ✔✔Starts in distal rectum
Clinical sign : failure to pass meconium within first 24-48 hours
May be associated with bilious emesis and a distended abdomen
Associated with CF
Types of test to determine diagnosis: Barium enema, biopsy of rectum
✔✔Congenital Diaphragmatic Hernia - ✔✔Space occupying lesion, intestinal contents
fill the lung cavity
Presents with a scaphoid abdomen, barrel chest
Can result in pulmonary hypoplasia, pulmonary hypertension
Requires intubation, HFOV, ECMO
Insert OG or NG tube
CPAP is Contraindicated!
✔✔Clinical Signs of Pyloric Stenosis - ✔✔Dehydration
Non bilious projectile vomiting
Peristaltic waves in the epigastrium
Electrolyte disturbances
✔✔Diagnostic image test for cholestasis - ✔✔Hepatobiliary HIDA scan
✔✔Clinical signs of Biliary Atresia - ✔✔Acholic stools, bronze undertones, dark urine,
hepatosplenomegaly
✔✔Double bubble - ✔✔Dudeonal Atresia
✔✔Meconium Ileus - ✔✔Mechanical Obstruction of distal ilem due to intraluminal
accumulation of thick menconium
** Predominant cause cystic fibrosis
,S/s - abdominal distention, bilious vomiting, failure to pass meconium 12-24 hours
X-ray shows soap bubble or ground glass appearance of distal intestine
Treatment: Hypertonic contrast water soluble enema
✔✔Nephron develops at how many weeks
Best indicator of GFR on lab is? - ✔✔Develops at 34 weeks
Creatinine Clearance
✔✔Bruit auscultation over liver - ✔✔Arteriovenous malformation
✔✔VCUG - ✔✔Evaluate function and flow of kidneys
Abnormal finding in infants = Vesicoureteral reflux
Urine backflows from the bladder into the upper urinary tract
✔✔Midgut volvulus - ✔✔Twisting and spiraling of entire gut around the superior
mesenteric artery
Vascular compromise, necrosis, perforation
✔✔Upper GI study - ✔✔Evaluates structure and function of upper gi system containing:
1) the esophagus
2) the stomach
Water soluble contrast solution is swallowed series of x rays under fluoroscopy
Complications: vomiting, reflux, aspiration
Do NOT do an upper GI series on TEF/EA
✔✔Hydrops Fetalis - ✔✔Abnormal fluid in two or more fetal compartments such as
peritoneum, pericardium, skin, pleura
Caused by massive hemolysis , sensitized mother's antibody crosses the placenta and
attaches to fetal red blood cells
Perform thoracentesis, pericentisis
✔✔TEF most common type, interventions - ✔✔Type
✔✔Turner Syndrome - ✔✔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.
, ✔✔Supraventricular Tachycardia - ✔✔HR >220
Vagal Maneuvers:
1. Stimulate a gag
2. Suction at nasopharnx
3. Apply crushed ice to nose and forhead
Adenosine - antiarrythmiac agent
Drug restores normal sinus rhythm by allowing AV nodal conduction, interrupting its
reentry patterns
Rapid IV push (half life 5-10 seconds), follow up w/ 2-3mL sterile water
Reactions: Bradycardia, hypotension, heartblock, dyspnea
✔✔Situs Inversus totalis - ✔✔Liver located in the left abdomen
Heart located in the right chest
✔✔Infant of the diabetic mother - ✔✔May have CHD, Cardiomyopathy
CHD defects include: TGA, VSD, COA
IDM have respiratory issues, PPHN, RDS
Could also have polycythemia (venous HCT >65%)
High glucose uptake and high metabolic rate cuases a cellular hypoxia, leading to an
elevated erythropoietin level
Hypocalcemia, hypomagnesemia result from a functional hypoparathyroidsm due to
maternal magnesium loss
✔✔Trisomy 21 (Down Syndrome) - ✔✔Definitive Features
1. Small size
2. short round head flat facial profile
3. Epicanthal folds
4. upslanting palepbral fissures
5. Brushfield spots
6. small earts
7. Protruding tongue, short narrow palate
8. Simian crease (line across hand)
9. Excess skin on back of neck
*Duodenal atresia/umbilical hernia
✔✔Trisomy 18 (edwards syndrome) - ✔✔Rocker bottom feet w/ protrusion of calcaneus
Prominent occiput
Clenched fists w/overlapping fingers third and fourth fingers(camptodactyly)
SOLUTIONS RATED A+
✔✔IUGR asymmetrical - ✔✔Weight low for Gestation Age
Head Sparing (less restriction on brain growth)
Old man appearance
Appear wasted, thin
Results from: Poor Placental function
Maternal Hypertension*
Smoking
✔✔IUGR Symmetric - ✔✔Lower weight, height, length, and head circumference for
gestational age
Results from intrauterine viral infection, chromosomal genetic abnormalities, long
standing disease
✔✔Prostaglandin E1 (alprostadil) - ✔✔Prevent premature closure of the PDA
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
✔✔Indomethicin (NSAID - ✔✔1. Hypoglycemia
2. Platelet dysfunction
3. Gastrointestinal perforation w/ steroids
4. Renal effects, decreases urine output!
Used if PDA fails to close to prevent pulmonary over circulation and PPHN
✔✔Diuretics effects - ✔✔1. Metabolic Alkalosis
2. Ototoxicity
3. Decreased calcium absorption in bones
✔✔Theophylline - ✔✔Bronchodilator. Opens airways.
Short half life, caffeine preferred treatment due to longer half life and more tolerable
side effect profile.
✔✔Digoxin - ✔✔Enhances contractility
Inhibits Na + K+ ATP
Reduces HR, CI'd if HR <60
Hypokalemia increases drug concentration
✔✔Most frequent disorder associated with downsyndrome - ✔✔Deudonal Atresia
Double Bubble
May see VSD, AV Canal, Tetralogy of Fallot
,✔✔Upper GI Gold Standard for - ✔✔Malrotation
✔✔Position for gastroschesis - ✔✔Lateral (side lying) to prevent occlusion of the
mesenteric arteries that supply blood to the bowel. Tie bag to the axilla.
✔✔VACTERAL, associated with what two disorders? - ✔✔TEF/EA
vertebral defects
anal atresia
cardiac anomalies
trachoesophageal fistula
radial defects
renal and limb anomalies
✔✔Hirschbrung Disease - ✔✔Starts in distal rectum
Clinical sign : failure to pass meconium within first 24-48 hours
May be associated with bilious emesis and a distended abdomen
Associated with CF
Types of test to determine diagnosis: Barium enema, biopsy of rectum
✔✔Congenital Diaphragmatic Hernia - ✔✔Space occupying lesion, intestinal contents
fill the lung cavity
Presents with a scaphoid abdomen, barrel chest
Can result in pulmonary hypoplasia, pulmonary hypertension
Requires intubation, HFOV, ECMO
Insert OG or NG tube
CPAP is Contraindicated!
✔✔Clinical Signs of Pyloric Stenosis - ✔✔Dehydration
Non bilious projectile vomiting
Peristaltic waves in the epigastrium
Electrolyte disturbances
✔✔Diagnostic image test for cholestasis - ✔✔Hepatobiliary HIDA scan
✔✔Clinical signs of Biliary Atresia - ✔✔Acholic stools, bronze undertones, dark urine,
hepatosplenomegaly
✔✔Double bubble - ✔✔Dudeonal Atresia
✔✔Meconium Ileus - ✔✔Mechanical Obstruction of distal ilem due to intraluminal
accumulation of thick menconium
** Predominant cause cystic fibrosis
,S/s - abdominal distention, bilious vomiting, failure to pass meconium 12-24 hours
X-ray shows soap bubble or ground glass appearance of distal intestine
Treatment: Hypertonic contrast water soluble enema
✔✔Nephron develops at how many weeks
Best indicator of GFR on lab is? - ✔✔Develops at 34 weeks
Creatinine Clearance
✔✔Bruit auscultation over liver - ✔✔Arteriovenous malformation
✔✔VCUG - ✔✔Evaluate function and flow of kidneys
Abnormal finding in infants = Vesicoureteral reflux
Urine backflows from the bladder into the upper urinary tract
✔✔Midgut volvulus - ✔✔Twisting and spiraling of entire gut around the superior
mesenteric artery
Vascular compromise, necrosis, perforation
✔✔Upper GI study - ✔✔Evaluates structure and function of upper gi system containing:
1) the esophagus
2) the stomach
Water soluble contrast solution is swallowed series of x rays under fluoroscopy
Complications: vomiting, reflux, aspiration
Do NOT do an upper GI series on TEF/EA
✔✔Hydrops Fetalis - ✔✔Abnormal fluid in two or more fetal compartments such as
peritoneum, pericardium, skin, pleura
Caused by massive hemolysis , sensitized mother's antibody crosses the placenta and
attaches to fetal red blood cells
Perform thoracentesis, pericentisis
✔✔TEF most common type, interventions - ✔✔Type
✔✔Turner Syndrome - ✔✔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.
, ✔✔Supraventricular Tachycardia - ✔✔HR >220
Vagal Maneuvers:
1. Stimulate a gag
2. Suction at nasopharnx
3. Apply crushed ice to nose and forhead
Adenosine - antiarrythmiac agent
Drug restores normal sinus rhythm by allowing AV nodal conduction, interrupting its
reentry patterns
Rapid IV push (half life 5-10 seconds), follow up w/ 2-3mL sterile water
Reactions: Bradycardia, hypotension, heartblock, dyspnea
✔✔Situs Inversus totalis - ✔✔Liver located in the left abdomen
Heart located in the right chest
✔✔Infant of the diabetic mother - ✔✔May have CHD, Cardiomyopathy
CHD defects include: TGA, VSD, COA
IDM have respiratory issues, PPHN, RDS
Could also have polycythemia (venous HCT >65%)
High glucose uptake and high metabolic rate cuases a cellular hypoxia, leading to an
elevated erythropoietin level
Hypocalcemia, hypomagnesemia result from a functional hypoparathyroidsm due to
maternal magnesium loss
✔✔Trisomy 21 (Down Syndrome) - ✔✔Definitive Features
1. Small size
2. short round head flat facial profile
3. Epicanthal folds
4. upslanting palepbral fissures
5. Brushfield spots
6. small earts
7. Protruding tongue, short narrow palate
8. Simian crease (line across hand)
9. Excess skin on back of neck
*Duodenal atresia/umbilical hernia
✔✔Trisomy 18 (edwards syndrome) - ✔✔Rocker bottom feet w/ protrusion of calcaneus
Prominent occiput
Clenched fists w/overlapping fingers third and fourth fingers(camptodactyly)
