RNC NIC EXAM ACTUAL EXAM 2026 | REGISTERED NURSE CERTIFIED IN
NEONATAL INTENSIVE CARE EXAM | COMPLETE QUESTIONS AND CORRECT
ANSWERS | UPDATED VERSION
Question 1
A pregnant patient at 30 weeks' gestation presents with regular uterine contractions. Which
biochemical marker is most useful in this clinical scenario for predicting the likelihood of
preterm birth within the next 7 to 14 days?
A) Serum alpha-fetoprotein
B) Fetal fibronectin
C) Lecithin-to-sphingomyelin (L/S) ratio
D) Placental alpha-microglobulin-1
E) Maternal glucose-6-phosphate
Correct Answer: B) fetal fibronectin
Rationale: Fetal fibronectin (fFN) is a "glue-like" protein that holds the fetal sac to the
uterine lining. It is normally present in vaginal secretions up to 22 weeks and again at the
end of pregnancy. Between 22 and 34 weeks, its presence in a cervicovaginal swab suggests
a disruption of the attachment between the membranes and the decidua. While its positive
predictive value is modest, its negative predictive value is excellent (approximately 99%),
meaning a negative test result indicates a very low risk of delivery within the next two
weeks.
Question 2
A bedside immunoassay known as AmniSure is performed to evaluate a patient for premature
rupture of membranes (PROM). This test specifically identifies which glycoprotein that is highly
abundant in amniotic fluid?
A) Fetal fibronectin
B) Thermogenin
C) Placenta α-microglobulin-1 (PAMG-1)
D) Phosphatidylglycerol
E) Bilirubin
Correct Answer: C) placenta α-microglobulin-1
Rationale: Placenta α-microglobulin-1 (PAMG-1) is a protein found in high concentrations
in amniotic fluid but very low concentrations in vaginal secretions. The AmniSure test
, 2
utilizes antibodies to detect even minute amounts of this protein in the vaginal canal, which
serves as a highly accurate indicator that the fetal membranes have ruptured. This test is
less likely to be affected by the presence of semen or small amounts of blood compared to
traditional nitrazine or ferning tests.
Question 3
When evaluating an electronic fetal monitoring (EFM) strip during active labor, which of the
following is considered the single most reliable indicator of adequate fetal oxygenation and an
intact central nervous system?
A) Fetal heart rate accelerations
B) Absence of variable decelerations
C) Moderate fetal heart rate baseline variability
D) Absence of early decelerations
E) A baseline heart rate between 110 and 160 bpm
Correct Answer: C) moderate fetal heart rate variability
Rationale: Baseline variability reflects the healthy "tug-of-war" between the sympathetic
and parasympathetic nervous systems of the fetus. Moderate variability (6–25 bpm)
indicates that the fetus is well-oxygenated and that the brainstem is effectively regulating
the heart rate. Minimal or absent variability can be a warning sign of fetal hypoxia,
metabolic acidemia, or the effects of maternal medications (such as opioids or magnesium).
Question 4
Which fetal heart rate pattern is characterized by a gradual decrease and return to baseline that
begins before the peak of a uterine contraction and is caused by fetal head compression?
A) Late decelerations
B) Variable decelerations
C) Early decelerations
D) Sinusoidal pattern
E) Prolonged decelerations
Correct Answer: C) Early decelerations
Rationale: Early decelerations are considered "benign" or "safe." They are a vagal
, 3
response triggered by the compression of the fetal head against the cervix or pelvic floor
during a contraction. They are characterized by a "mirror image" appearance relative to
the contraction (the nadir of the FHR occurs at the peak of the contraction). They do not
indicate fetal distress and do not require clinical intervention provided variability remains
normal.
Question 5
During labor monitoring, the nurse observes fetal heart rate decelerations that begin after the
peak of the contraction and return to baseline well after the contraction has ended. What is the
physiological significance of this finding?
A) It is a normal response to umbilical cord compression.
B) It is a sign of decreased uteroplacental blood flow and potential fetal acidemia.
C) It indicates the fetus is in a deep sleep cycle.
D) It suggests the mother is experiencing a vasovagal episode.
E) It is a benign response to head compression.
Correct Answer: B) They are a sign of decreased blood flow to the placenta, which can lead
to fetal acidemia
Rationale: Late decelerations are "ominous" signs. They occur when the placenta cannot
provide sufficient oxygen during a contraction (uteroplacental insufficiency). This results in
fetal hypoxia and the activation of chemoreceptors, which triggers a delayed drop in the
heart rate. Repetitive late decelerations, especially with decreased variability, are highly
suggestive of fetal metabolic acidosis and require immediate intrauterine resuscitation or
delivery.
Question 6
Fetal heart rate drops that are abrupt (falling at least 15 bpm for at least 15 seconds), jagged in
shape, and do not have a consistent relationship with uterine contractions are known as:
A) Early decelerations
B) Late decelerations
C) Variable decelerations
, 4
D) Fetal tachycardia
E) Accelerated rhythms
Correct Answer: C) Variable decelerations
Rationale: Variable decelerations are the most common deceleration pattern and are caused
by umbilical cord compression. The sudden compression of the cord causes an abrupt
increase in fetal peripheral resistance and blood pressure, followed by a vagal response that
slows the heart rate. While often transient, persistent or "deep" variables can lead to fetal
hypoxia and require position changes for the mother to relieve pressure on the cord.
Question 7
The Biophysical Profile (BPP) evaluates fetal well-being by scoring five specific variables.
Which set correctly identifies these variables?
A) Fetal heart rate, maternal weight, fetal length, amniotic fluid, and glucose.
B) Fetal tone, fetal breathing, fetal movement, nonstress test (NST), and amniotic fluid volume.
C) Lung maturity, fetal weight, placental location, cord pH, and heart rate.
D) Maternal temperature, fetal sleep cycles, amniotic fluid color, NST, and movement.
E) Fetal tone, NST, crown-rump length, head circumference, and maternal BP.
Correct Answer: B) fetal tone, fetal breathing, fetal movement, nonstress test, and amniotic
fluid volume
Rationale: The BPP is a comprehensive assessment that combines ultrasound findings with
the NST. Each variable is given a score of 0 or 2. Fetal breathing, movement, and tone are
markers of acute CNS function and oxygenation, while amniotic fluid volume (AFV) is a
marker of chronic placental adequacy (as fetal urine production decreases in response to
chronic hypoxia). A total score of 8/10 or 10/10 is considered normal.
Question 8
In a woman at low risk for developing gestational diabetes (GDM), at what gestational age
should the nurse anticipate the standard glucose screening to be performed?
A) 12 to 16 weeks
B) 20 to 22 weeks
C) 24 to 28 weeks
NEONATAL INTENSIVE CARE EXAM | COMPLETE QUESTIONS AND CORRECT
ANSWERS | UPDATED VERSION
Question 1
A pregnant patient at 30 weeks' gestation presents with regular uterine contractions. Which
biochemical marker is most useful in this clinical scenario for predicting the likelihood of
preterm birth within the next 7 to 14 days?
A) Serum alpha-fetoprotein
B) Fetal fibronectin
C) Lecithin-to-sphingomyelin (L/S) ratio
D) Placental alpha-microglobulin-1
E) Maternal glucose-6-phosphate
Correct Answer: B) fetal fibronectin
Rationale: Fetal fibronectin (fFN) is a "glue-like" protein that holds the fetal sac to the
uterine lining. It is normally present in vaginal secretions up to 22 weeks and again at the
end of pregnancy. Between 22 and 34 weeks, its presence in a cervicovaginal swab suggests
a disruption of the attachment between the membranes and the decidua. While its positive
predictive value is modest, its negative predictive value is excellent (approximately 99%),
meaning a negative test result indicates a very low risk of delivery within the next two
weeks.
Question 2
A bedside immunoassay known as AmniSure is performed to evaluate a patient for premature
rupture of membranes (PROM). This test specifically identifies which glycoprotein that is highly
abundant in amniotic fluid?
A) Fetal fibronectin
B) Thermogenin
C) Placenta α-microglobulin-1 (PAMG-1)
D) Phosphatidylglycerol
E) Bilirubin
Correct Answer: C) placenta α-microglobulin-1
Rationale: Placenta α-microglobulin-1 (PAMG-1) is a protein found in high concentrations
in amniotic fluid but very low concentrations in vaginal secretions. The AmniSure test
, 2
utilizes antibodies to detect even minute amounts of this protein in the vaginal canal, which
serves as a highly accurate indicator that the fetal membranes have ruptured. This test is
less likely to be affected by the presence of semen or small amounts of blood compared to
traditional nitrazine or ferning tests.
Question 3
When evaluating an electronic fetal monitoring (EFM) strip during active labor, which of the
following is considered the single most reliable indicator of adequate fetal oxygenation and an
intact central nervous system?
A) Fetal heart rate accelerations
B) Absence of variable decelerations
C) Moderate fetal heart rate baseline variability
D) Absence of early decelerations
E) A baseline heart rate between 110 and 160 bpm
Correct Answer: C) moderate fetal heart rate variability
Rationale: Baseline variability reflects the healthy "tug-of-war" between the sympathetic
and parasympathetic nervous systems of the fetus. Moderate variability (6–25 bpm)
indicates that the fetus is well-oxygenated and that the brainstem is effectively regulating
the heart rate. Minimal or absent variability can be a warning sign of fetal hypoxia,
metabolic acidemia, or the effects of maternal medications (such as opioids or magnesium).
Question 4
Which fetal heart rate pattern is characterized by a gradual decrease and return to baseline that
begins before the peak of a uterine contraction and is caused by fetal head compression?
A) Late decelerations
B) Variable decelerations
C) Early decelerations
D) Sinusoidal pattern
E) Prolonged decelerations
Correct Answer: C) Early decelerations
Rationale: Early decelerations are considered "benign" or "safe." They are a vagal
, 3
response triggered by the compression of the fetal head against the cervix or pelvic floor
during a contraction. They are characterized by a "mirror image" appearance relative to
the contraction (the nadir of the FHR occurs at the peak of the contraction). They do not
indicate fetal distress and do not require clinical intervention provided variability remains
normal.
Question 5
During labor monitoring, the nurse observes fetal heart rate decelerations that begin after the
peak of the contraction and return to baseline well after the contraction has ended. What is the
physiological significance of this finding?
A) It is a normal response to umbilical cord compression.
B) It is a sign of decreased uteroplacental blood flow and potential fetal acidemia.
C) It indicates the fetus is in a deep sleep cycle.
D) It suggests the mother is experiencing a vasovagal episode.
E) It is a benign response to head compression.
Correct Answer: B) They are a sign of decreased blood flow to the placenta, which can lead
to fetal acidemia
Rationale: Late decelerations are "ominous" signs. They occur when the placenta cannot
provide sufficient oxygen during a contraction (uteroplacental insufficiency). This results in
fetal hypoxia and the activation of chemoreceptors, which triggers a delayed drop in the
heart rate. Repetitive late decelerations, especially with decreased variability, are highly
suggestive of fetal metabolic acidosis and require immediate intrauterine resuscitation or
delivery.
Question 6
Fetal heart rate drops that are abrupt (falling at least 15 bpm for at least 15 seconds), jagged in
shape, and do not have a consistent relationship with uterine contractions are known as:
A) Early decelerations
B) Late decelerations
C) Variable decelerations
, 4
D) Fetal tachycardia
E) Accelerated rhythms
Correct Answer: C) Variable decelerations
Rationale: Variable decelerations are the most common deceleration pattern and are caused
by umbilical cord compression. The sudden compression of the cord causes an abrupt
increase in fetal peripheral resistance and blood pressure, followed by a vagal response that
slows the heart rate. While often transient, persistent or "deep" variables can lead to fetal
hypoxia and require position changes for the mother to relieve pressure on the cord.
Question 7
The Biophysical Profile (BPP) evaluates fetal well-being by scoring five specific variables.
Which set correctly identifies these variables?
A) Fetal heart rate, maternal weight, fetal length, amniotic fluid, and glucose.
B) Fetal tone, fetal breathing, fetal movement, nonstress test (NST), and amniotic fluid volume.
C) Lung maturity, fetal weight, placental location, cord pH, and heart rate.
D) Maternal temperature, fetal sleep cycles, amniotic fluid color, NST, and movement.
E) Fetal tone, NST, crown-rump length, head circumference, and maternal BP.
Correct Answer: B) fetal tone, fetal breathing, fetal movement, nonstress test, and amniotic
fluid volume
Rationale: The BPP is a comprehensive assessment that combines ultrasound findings with
the NST. Each variable is given a score of 0 or 2. Fetal breathing, movement, and tone are
markers of acute CNS function and oxygenation, while amniotic fluid volume (AFV) is a
marker of chronic placental adequacy (as fetal urine production decreases in response to
chronic hypoxia). A total score of 8/10 or 10/10 is considered normal.
Question 8
In a woman at low risk for developing gestational diabetes (GDM), at what gestational age
should the nurse anticipate the standard glucose screening to be performed?
A) 12 to 16 weeks
B) 20 to 22 weeks
C) 24 to 28 weeks
