RNC-NIC NEONATAL INTENSIVE CARE NURSING EXAM–
COMPLETE STUDY GUIDE | PRACTICE QUESTIONS AND
ANSWERS-RATIONALES | EXAM PREP | DOWNLOAD INSTANT
PDF | GUARANTEED PASS || LATEST EXAM 2026-2027
1. A 28-week gestation infant born via emergent cesarean delivery for severe placental
abruption presents with pale skin, a capillary refill time of 5 seconds, a heart rate of 180
beats per minute, and a blood pressure of 42/20 mmHg. Laboratory evaluation reveals a
hemoglobin of 7.2 g/dL. Which of the following is the most appropriate immediate
intervention by the neonatal intensive care nurse?
A. Administer a 10 mL/kg bolus of packed red blood cells (PRBC) over 2 to 4 hours.
B. Administer a 10 mL/kg bolus of normal saline rapidly over 5 to 10 minutes.
C. Initiate an emergency transfusion of type-specific or O-negative uncrossed packed red
blood cells at 10 to 20 mL/kg.
D. Infuse a 20 mL/kg bolus of 5% albumin solution to rapidly expand intravascular volume.
Acute hemorrhagic shock from abruption requires immediate replacement of oxygen-carrying
capacity with packed red blood cells rather than volume expanders or crystalloids, which
dilute remaining clotting factors and red cell mass.
2. A term infant exhibits excessive drooling, choking, and cyanosis with the first feeding
attempt. An attempt to pass a nasogastric tube fails because the tube meets resistance at
approximately 10 centimeters from the nares. What is the most likely diagnosis?
A. Congenital diaphragmatic hernia
B. Esophageal atresia with or without tracheoesophageal fistula
C. Choanal atresia
D. Duodenal atresia
Inability to pass a small catheter past the upper esophagus accompanied by choking and
excessive secretions during initial feeding trials is classic for esophageal atresia.
3. An infant born at 32 weeks gestation is receiving nasal continuous positive airway
pressure (nCPAP) at a pressure of +6 cm H2O and a fraction of inspired oxygen (FiO2) of
0.30. Arterial blood gas results show pH 7.31, PaCO2 52 mmHg, PaO2 58 mmHg, and
HCO3 24 mEq/L. Which of the following ventilator management changes is indicated?
,A. Increase the FiO2 to 0.45 to improve oxygenation.
B. Increase the nCPAP pressure to +8 cm H2O to improve lung volume and recruitment.
C. Intubate the infant immediately and initiate conventional mechanical ventilation.
D. Administer a dose of exogenous surfactant via endotracheal tube.
The infant demonstrates mild respiratory acidosis with borderline oxygenation on low CPAP
pressure, suggesting atelectasis and under-recruitment; increasing CPAP improves functional
residual capacity and ventilation-perfusion matching without requiring invasive intubation.
4. During routine assessment of a 26-week premature infant receiving total parenteral
nutrition (TPN) and lipids through a peripheral intravenous line, the nurse notes
blanching, coolness, and swelling around the insertion site. What is the immediate priority
nursing action?
A. Apply warm compresses to the site to encourage absorption of the fluid.
B. Stop the infusion immediately, attempt to aspirate residual fluid from the catheter hub,
and notify the practitioner.
C. Flush the line with heparinized saline to clear potential obstruction.
D. Elevate the extremity and continue monitoring the site every 15 minutes.
Prompt cessation of the infusion prevents further tissue infiltration. Attempting gentle
aspiration may remove a fraction of the extravasated vesicant solution prior to catheter
removal.
5. A 2-day-old term infant with suspected sepsis develops sudden abdominal distention,
bilious emesis, and rectal bleeding. Abdominal radiograph demonstrates pneumatosis
intestinalis. Which condition does this finding most strongly support?
A. Necrotizing enterocolitis (NEC)
B. Spontaneous intestinal perforation
C. Hirschsprung disease
D. Meconium ileus
Pneumatosis intestinalis, the presence of gas within the bowel wall, is the radiographic
hallmark of necrotizing enterocolitis, reflecting mucosal injury and bacterial invasion.
,6. An infant with persistent pulmonary hypertension of the newborn (PPHN) is undergoing
high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) therapy.
Which of the following parameters is most critical for the nurse to monitor continuously?
A. Serum direct bilirubin levels
B. Methemoglobin and nitrogen dioxide levels
C. Serum ionized calcium concentrations
D. Cerebrospinal fluid protein levels
Inhaled nitric oxide therapy can induce elevations in methemoglobin and toxic nitrogen
dioxide gas, requiring frequent laboratory and environmental monitoring during
administration.
7. A 30-week infant presents with intermittent episodes of apnea accompanied by
bradycardia and oxygen desaturation. The nurse initiates tactile stimulation, which
successfully terminates the event. What is the most appropriate foundational
pharmacological intervention if these episodes persist?
A. Phenobarbital administration
B. Caffeine citrate loading and maintenance therapy
C. Continuous intravenous morphine infusion
D. Indomethacin therapy
Caffeine citrate is the standard methylxanthine used to stimulate the central respiratory center
and decrease the frequency of apnea of prematurity.
8. A term newborn delivered via vacuum extraction presents with a localized, soft swelling
over the parietal bone that does not cross suture lines. The infant is otherwise stable. What
is the correct documentation and clinical classification of this finding?
A. Caput succedaneum
B. Cephalohematoma
C. Subgaleal hemorrhage
D. Subdural hematoma
A cephalohematoma is a subperiosteal collection of blood restricted by the boundaries of the
cranial bone sutures, distinguishing it from caput succedaneum.
, 9. A nurse is caring for an extremely low birth weight (ELBW) infant receiving
phototherapy for hyperbilirubinemia. Which of the following nursing measures is essential
to include in the care plan?
A. Limiting fluid intake to prevent overhydration during phototherapy.
B. Ensuring absolute eye shielding with opaque patches while allowing maximum skin
surface exposure and monitoring hydration status.
C. Applying thick moisturizing lotions to enhance light absorption by the skin.
D. Keeping the incubator ports open continuously to prevent heat buildup.
Phototherapy requires protective eye shields to prevent retinal damage from high-intensity
light, alongside monitoring for increased insensible water losses and hydration changes.
10. An infant with congenital diaphragmatic hernia (CDH) is stabilized preoperatively.
Which of the following management strategies must be strictly avoided or minimized to
prevent lung injury?
A. Gentle ventilation with low peak inspiratory pressures
B. High peak inspiratory pressures and aggressive hyperventilation
C. Maintenance of adequate systemic blood pressure
D. Sedation and neuromuscular blockade administration
Aggressive high-pressure ventilation can rupture the hypoplastic contralateral lung in infants
with CDH, exacerbating barotrauma and mortality risks.
11. A 27-week preterm infant born 4 hours ago is noted to have bounding peripheral
pulses, a hyperactive precordium, and a systolic murmur heard best at the left upper
sternal border. Blood pressure demonstrates a wide pulse pressure. What congenital
cardiovascular shunt is most likely present?
A. Coarctation of the aorta
B. Patent ductus arteriosus (PDA)
C. Tetralogy of Fallot
D. Transposition of the great arteries
COMPLETE STUDY GUIDE | PRACTICE QUESTIONS AND
ANSWERS-RATIONALES | EXAM PREP | DOWNLOAD INSTANT
PDF | GUARANTEED PASS || LATEST EXAM 2026-2027
1. A 28-week gestation infant born via emergent cesarean delivery for severe placental
abruption presents with pale skin, a capillary refill time of 5 seconds, a heart rate of 180
beats per minute, and a blood pressure of 42/20 mmHg. Laboratory evaluation reveals a
hemoglobin of 7.2 g/dL. Which of the following is the most appropriate immediate
intervention by the neonatal intensive care nurse?
A. Administer a 10 mL/kg bolus of packed red blood cells (PRBC) over 2 to 4 hours.
B. Administer a 10 mL/kg bolus of normal saline rapidly over 5 to 10 minutes.
C. Initiate an emergency transfusion of type-specific or O-negative uncrossed packed red
blood cells at 10 to 20 mL/kg.
D. Infuse a 20 mL/kg bolus of 5% albumin solution to rapidly expand intravascular volume.
Acute hemorrhagic shock from abruption requires immediate replacement of oxygen-carrying
capacity with packed red blood cells rather than volume expanders or crystalloids, which
dilute remaining clotting factors and red cell mass.
2. A term infant exhibits excessive drooling, choking, and cyanosis with the first feeding
attempt. An attempt to pass a nasogastric tube fails because the tube meets resistance at
approximately 10 centimeters from the nares. What is the most likely diagnosis?
A. Congenital diaphragmatic hernia
B. Esophageal atresia with or without tracheoesophageal fistula
C. Choanal atresia
D. Duodenal atresia
Inability to pass a small catheter past the upper esophagus accompanied by choking and
excessive secretions during initial feeding trials is classic for esophageal atresia.
3. An infant born at 32 weeks gestation is receiving nasal continuous positive airway
pressure (nCPAP) at a pressure of +6 cm H2O and a fraction of inspired oxygen (FiO2) of
0.30. Arterial blood gas results show pH 7.31, PaCO2 52 mmHg, PaO2 58 mmHg, and
HCO3 24 mEq/L. Which of the following ventilator management changes is indicated?
,A. Increase the FiO2 to 0.45 to improve oxygenation.
B. Increase the nCPAP pressure to +8 cm H2O to improve lung volume and recruitment.
C. Intubate the infant immediately and initiate conventional mechanical ventilation.
D. Administer a dose of exogenous surfactant via endotracheal tube.
The infant demonstrates mild respiratory acidosis with borderline oxygenation on low CPAP
pressure, suggesting atelectasis and under-recruitment; increasing CPAP improves functional
residual capacity and ventilation-perfusion matching without requiring invasive intubation.
4. During routine assessment of a 26-week premature infant receiving total parenteral
nutrition (TPN) and lipids through a peripheral intravenous line, the nurse notes
blanching, coolness, and swelling around the insertion site. What is the immediate priority
nursing action?
A. Apply warm compresses to the site to encourage absorption of the fluid.
B. Stop the infusion immediately, attempt to aspirate residual fluid from the catheter hub,
and notify the practitioner.
C. Flush the line with heparinized saline to clear potential obstruction.
D. Elevate the extremity and continue monitoring the site every 15 minutes.
Prompt cessation of the infusion prevents further tissue infiltration. Attempting gentle
aspiration may remove a fraction of the extravasated vesicant solution prior to catheter
removal.
5. A 2-day-old term infant with suspected sepsis develops sudden abdominal distention,
bilious emesis, and rectal bleeding. Abdominal radiograph demonstrates pneumatosis
intestinalis. Which condition does this finding most strongly support?
A. Necrotizing enterocolitis (NEC)
B. Spontaneous intestinal perforation
C. Hirschsprung disease
D. Meconium ileus
Pneumatosis intestinalis, the presence of gas within the bowel wall, is the radiographic
hallmark of necrotizing enterocolitis, reflecting mucosal injury and bacterial invasion.
,6. An infant with persistent pulmonary hypertension of the newborn (PPHN) is undergoing
high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (iNO) therapy.
Which of the following parameters is most critical for the nurse to monitor continuously?
A. Serum direct bilirubin levels
B. Methemoglobin and nitrogen dioxide levels
C. Serum ionized calcium concentrations
D. Cerebrospinal fluid protein levels
Inhaled nitric oxide therapy can induce elevations in methemoglobin and toxic nitrogen
dioxide gas, requiring frequent laboratory and environmental monitoring during
administration.
7. A 30-week infant presents with intermittent episodes of apnea accompanied by
bradycardia and oxygen desaturation. The nurse initiates tactile stimulation, which
successfully terminates the event. What is the most appropriate foundational
pharmacological intervention if these episodes persist?
A. Phenobarbital administration
B. Caffeine citrate loading and maintenance therapy
C. Continuous intravenous morphine infusion
D. Indomethacin therapy
Caffeine citrate is the standard methylxanthine used to stimulate the central respiratory center
and decrease the frequency of apnea of prematurity.
8. A term newborn delivered via vacuum extraction presents with a localized, soft swelling
over the parietal bone that does not cross suture lines. The infant is otherwise stable. What
is the correct documentation and clinical classification of this finding?
A. Caput succedaneum
B. Cephalohematoma
C. Subgaleal hemorrhage
D. Subdural hematoma
A cephalohematoma is a subperiosteal collection of blood restricted by the boundaries of the
cranial bone sutures, distinguishing it from caput succedaneum.
, 9. A nurse is caring for an extremely low birth weight (ELBW) infant receiving
phototherapy for hyperbilirubinemia. Which of the following nursing measures is essential
to include in the care plan?
A. Limiting fluid intake to prevent overhydration during phototherapy.
B. Ensuring absolute eye shielding with opaque patches while allowing maximum skin
surface exposure and monitoring hydration status.
C. Applying thick moisturizing lotions to enhance light absorption by the skin.
D. Keeping the incubator ports open continuously to prevent heat buildup.
Phototherapy requires protective eye shields to prevent retinal damage from high-intensity
light, alongside monitoring for increased insensible water losses and hydration changes.
10. An infant with congenital diaphragmatic hernia (CDH) is stabilized preoperatively.
Which of the following management strategies must be strictly avoided or minimized to
prevent lung injury?
A. Gentle ventilation with low peak inspiratory pressures
B. High peak inspiratory pressures and aggressive hyperventilation
C. Maintenance of adequate systemic blood pressure
D. Sedation and neuromuscular blockade administration
Aggressive high-pressure ventilation can rupture the hypoplastic contralateral lung in infants
with CDH, exacerbating barotrauma and mortality risks.
11. A 27-week preterm infant born 4 hours ago is noted to have bounding peripheral
pulses, a hyperactive precordium, and a systolic murmur heard best at the left upper
sternal border. Blood pressure demonstrates a wide pulse pressure. What congenital
cardiovascular shunt is most likely present?
A. Coarctation of the aorta
B. Patent ductus arteriosus (PDA)
C. Tetralogy of Fallot
D. Transposition of the great arteries
