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RNC-NIC® Practice Questions – Original Questions
with Answers and Detailed Rationales
1. A 28-week gestation infant is delivered and requires
resuscitation. After initial stabilization, the infant is noted to
have grunting, nasal flaring, and intercostal retractions. The
most likely cause is:
A) Patent ductus arteriosus
B) Respiratory distress syndrome due to surfactant
deficiency
C) Meconium aspiration syndrome
D) Transient tachypnea of the newborn
Answer: B) Respiratory distress syndrome due to surfactant
deficiency
Rationale: Premature infants (especially <32 weeks) have
immature type II alveolar cells that produce insufficient
surfactant. This leads to alveolar collapse, decreased lung
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compliance, and the classic signs of respiratory distress:
grunting, nasal flaring, and retractions. Transient tachypnea
is more common in term or late preterm infants after
cesarean delivery. Meconium aspiration is seen in term or
post-term infants. PDA may cause murmur and increased
pulmonary blood flow but is not the primary cause of
immediate respiratory distress.
2. A nurse is caring for a 30-week gestation infant receiving
mechanical ventilation for RDS. Which blood gas value
indicates adequate oxygenation?
A) PaO2 of 45 mmHg
B) PaO2 of 80 mmHg
C) PaCO2 of 55 mmHg
D) pH of 7.25
Answer: B) PaO2 of 80 mmHg
Rationale: For a premature infant, a PaO2 of 50-80 mmHg is
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generally acceptable. A PaO2 of 80 mmHg indicates
adequate oxygenation. PaO2 of 45 mmHg indicates
hypoxemia. PaCO2 of 55 mmHg indicates hypercapnia. A
pH of 7.25 suggests acidosis.
3. Which of the following is a sign of neonatal abstinence
syndrome (NAS) in an infant exposed to opioids in utero?
A) Lethargy and poor feeding
B) Hypertonia, irritability, and high-pitched crying
C) Bradycardia and hypothermia
D) Decreased respiratory rate
Answer: B) Hypertonia, irritability, and high-pitched crying
Rationale: NAS is characterized by central nervous system
hyperirritability including hypertonia, tremors, irritability,
high-pitched crying, and sleep disturbances. Lethargy and
poor feeding are not typical; these infants often have
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increased muscle tone and exaggerated reflexes. They may
also have tachypnea, not decreased respiratory rate.
4. A term infant is born via emergency cesarean section for
fetal bradycardia. The infant has a heart rate of 80 bpm and
is apneic at birth. The first step in neonatal resuscitation is:
A) Begin chest compressions
B) Administer epinephrine
C) Provide warmth, dry, stimulate, and position airway
D) Intubate immediately
Answer: C) Provide warmth, dry, stimulate, and position
airway
Rationale: According to NRP guidelines, the initial steps of
resuscitation are to provide warmth, dry the infant, stimulate
breathing, and position the airway (sniffing position). If the
infant remains apneic or bradycardic after these steps,
positive pressure ventilation is initiated. Chest compressions
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RNC-NIC® Practice Questions – Original Questions
with Answers and Detailed Rationales
1. A 28-week gestation infant is delivered and requires
resuscitation. After initial stabilization, the infant is noted to
have grunting, nasal flaring, and intercostal retractions. The
most likely cause is:
A) Patent ductus arteriosus
B) Respiratory distress syndrome due to surfactant
deficiency
C) Meconium aspiration syndrome
D) Transient tachypnea of the newborn
Answer: B) Respiratory distress syndrome due to surfactant
deficiency
Rationale: Premature infants (especially <32 weeks) have
immature type II alveolar cells that produce insufficient
surfactant. This leads to alveolar collapse, decreased lung
1|Page
, Page |2
compliance, and the classic signs of respiratory distress:
grunting, nasal flaring, and retractions. Transient tachypnea
is more common in term or late preterm infants after
cesarean delivery. Meconium aspiration is seen in term or
post-term infants. PDA may cause murmur and increased
pulmonary blood flow but is not the primary cause of
immediate respiratory distress.
2. A nurse is caring for a 30-week gestation infant receiving
mechanical ventilation for RDS. Which blood gas value
indicates adequate oxygenation?
A) PaO2 of 45 mmHg
B) PaO2 of 80 mmHg
C) PaCO2 of 55 mmHg
D) pH of 7.25
Answer: B) PaO2 of 80 mmHg
Rationale: For a premature infant, a PaO2 of 50-80 mmHg is
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, Page |3
generally acceptable. A PaO2 of 80 mmHg indicates
adequate oxygenation. PaO2 of 45 mmHg indicates
hypoxemia. PaCO2 of 55 mmHg indicates hypercapnia. A
pH of 7.25 suggests acidosis.
3. Which of the following is a sign of neonatal abstinence
syndrome (NAS) in an infant exposed to opioids in utero?
A) Lethargy and poor feeding
B) Hypertonia, irritability, and high-pitched crying
C) Bradycardia and hypothermia
D) Decreased respiratory rate
Answer: B) Hypertonia, irritability, and high-pitched crying
Rationale: NAS is characterized by central nervous system
hyperirritability including hypertonia, tremors, irritability,
high-pitched crying, and sleep disturbances. Lethargy and
poor feeding are not typical; these infants often have
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, Page |4
increased muscle tone and exaggerated reflexes. They may
also have tachypnea, not decreased respiratory rate.
4. A term infant is born via emergency cesarean section for
fetal bradycardia. The infant has a heart rate of 80 bpm and
is apneic at birth. The first step in neonatal resuscitation is:
A) Begin chest compressions
B) Administer epinephrine
C) Provide warmth, dry, stimulate, and position airway
D) Intubate immediately
Answer: C) Provide warmth, dry, stimulate, and position
airway
Rationale: According to NRP guidelines, the initial steps of
resuscitation are to provide warmth, dry the infant, stimulate
breathing, and position the airway (sniffing position). If the
infant remains apneic or bradycardic after these steps,
positive pressure ventilation is initiated. Chest compressions
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