Mixed Deck — All RNC-NIC Topics Flashcards

A neonate born at 34 weeks has decreased tone, minimal response to stimulation, and poor suck. These findings are MOST consistent with:

Answer: Hypotonia from prematurity, birth asphyxia, or CNS depression

Hypotonia, poor responsiveness, and weak suck in a preterm infant suggest CNS depression from asphyxia, metabolic causes, or prematurity.

Which assessment tool is most commonly used to evaluate pain in nonverbal neonates in the NICU?

Answer: CRIES or N-PASS Scale

Validated neonatal pain tools like CRIES and N-PASS use behavioral and physiologic indicators since neonates cannot self-report pain.

Which assessment finding best indicates a neonate requires suctioning of the airway?

Answer: Audible secretions, increased work of breathing, or decreased SpO2

Suctioning should be clinically indicated by signs of airway obstruction such as audible secretions, respiratory distress, or desaturation.

Which clinical finding is most characteristic of a hemodynamically significant patent ductus arteriosus (PDA) in a premature neonate?

Answer: Bounding peripheral pulses with a continuous murmur

A hemodynamically significant PDA causes bounding pulses due to wide pulse pressure and a characteristic continuous 'machinery' murmur from left-to-right shunting.

High-frequency oscillatory ventilation (HFOV) is distinguished from conventional ventilation by:

Answer: Using very small tidal volumes at high frequencies

HFOV delivers very small tidal volumes (often less than dead space) at frequencies of 3–15 Hz to minimize lung injury.

Minimal enteral feeding (trophic feeding) in preterm infants is initiated to:

Answer: Stimulate gut development, improve intestinal maturity, and prime the GI tract

Trophic feeds of 10–20 mL/kg/day stimulate gut hormones, villous development, and enzyme maturation without significant caloric contribution.

Human milk fortifier (HMF) is added to breast milk for preterm infants because:

Answer: Breast milk alone does not meet the elevated protein, calcium, and phosphorus needs of preterm infants

Preterm infants have higher nutrient requirements for growth; HMF supplements protein, minerals, and vitamins to optimize preterm bone and growth outcomes.

A NICU nurse is assessing a neonate for patent ductus arteriosus. Which clinical finding is most characteristic?

Answer: Continuous machine-like murmur at the upper left sternal border

PDA produces a continuous machine-like murmur best heard at the upper left sternal border due to shunting between the aorta and pulmonary artery.

Persistent pulmonary hypertension of the newborn (PPHN) is characterized by:

Answer: Elevated pulmonary vascular resistance causing right-to-left shunting

PPHN involves failure of normal postnatal pulmonary vascular resistance reduction, causing right-to-left shunting through fetal channels.

A neonate with suspected NEC has abdominal X-ray showing pneumatosis intestinalis. This finding represents:

Answer: Gas within the intestinal wall, a pathognomonic sign of NEC

Pneumatosis intestinalis (intramural gas) is produced by gas-forming bacteria invading damaged intestinal mucosa and is pathognomonic for NEC.

Which complication is the NICU nurse most concerned about when a preterm infant receives a rapid IV fluid bolus?

Answer: Intraventricular hemorrhage

Rapid fluid boluses can cause sudden fluctuations in cerebral blood flow, increasing the risk of intraventricular hemorrhage in preterm neonates.

Which acid-base disturbance is most commonly seen in a neonate with severe respiratory distress syndrome?

Answer: Respiratory acidosis

RDS causes CO2 retention due to alveolar collapse, resulting in respiratory acidosis.

Indomethacin is used in the NICU to treat which condition?

Answer: Patent ductus arteriosus

Indomethacin is a COX inhibitor that promotes ductal closure by blocking prostaglandin synthesis, which keeps the PDA open.

A neonate develops supraventricular tachycardia (SVT) with a heart rate of 280 bpm and remains hemodynamically stable. Which intervention should the nurse attempt first?

Answer: Application of ice to the neonate's face to elicit the diving reflex

In stable neonatal SVT, vagal maneuvers such as applying ice to the face (eliciting the diving/oculocardiac reflex) are attempted first before pharmacological cardioversion with adenosine.

Which measurement is used to confirm ET tube placement after intubation in a neonate?

Answer: Colorimetric CO2 detector plus bilateral chest rise

Colorimetric CO2 detection combined with bilateral chest rise assessment is the recommended confirmation method for neonatal ETT placement.

The preferred method for monitoring core temperature in a NICU patient is:

Answer: Axillary temperature with a digital thermometer

Axillary temperature is the safest and most clinically used method in neonates; rectal measurement risks perforation in fragile preterm infants.

Which route of administration is preferred for emergency medications in neonates when IV access is unavailable?

Answer: Intraosseous (IO)

Intraosseous access provides rapid vascular access for emergency drug administration when IV access cannot be quickly established.

When administering gentamicin to a neonate, the nurse should monitor which laboratory value most closely?

Answer: Serum creatinine and BUN

Gentamicin is nephrotoxic and ototoxic; serum creatinine and BUN must be monitored to detect aminoglycoside-induced renal injury.

A preterm infant in an open radiant warmer has excessive insensible water losses primarily due to:

Answer: Thin, immature skin with high transepidermal water loss

Preterm infants have thin, poorly keratinized skin with minimal subcutaneous fat, causing dramatically elevated transepidermal water loss.

A nurse notes a neonate's skin color is blue centrally including the lips and mucous membranes. This is classified as:

Answer: Central cyanosis, indicating low arterial oxygen saturation

Central cyanosis involving mucous membranes indicates systemic hypoxemia and requires immediate assessment and intervention.