RNC-NIC Developmental Care 4 — Questions and Answers
Question 1: A neonatal nurse is educating a new NICU nurse about prone positioning in preterm infants. Which statement BEST reflects current evidence?
- Prone positioning is contraindicated in all NICU patients due to SIDS risk
- Prone positioning in monitored NICU settings can improve oxygenation and comfort but requires transition to supine before discharge (Correct answer)
- Supine positioning is never used in the NICU for preterm infants
- Lateral positioning is the only recommended developmental position
Correct answer: Prone positioning in monitored NICU settings can improve oxygenation and comfort but requires transition to supine before discharge
Prone positioning in continuously monitored NICU environments can improve oxygenation and comfort, but infants must be transitioned to supine sleeping before discharge to reduce SIDS risk at home.
Question 2: Which intervention is MOST appropriate to support pain management within a developmental care framework for a preterm infant requiring a heel stick?
- Administer morphine 30 minutes prior to all heel sticks
- Use non-pharmacologic measures such as sucrose, NNS, and containment (Correct answer)
- Perform the heel stick during active sleep to minimize awareness
- Avoid warming the heel as it increases circulation and pain sensitivity
Correct answer: Use non-pharmacologic measures such as sucrose, NNS, and containment
Non-pharmacologic measures including oral sucrose, non-nutritive sucking, and facilitated tucking/containment are evidence-based first-line pain management strategies for minor procedures in preterm infants.
Question 3: A 27-week infant is receiving phototherapy. Which modification BEST supports developmental care principles during this treatment?
- Continuous exposure to maximize bilirubin breakdown without interruption
- Eye shields, minimal handling, and scheduled brief breaks for kangaroo care when possible (Correct answer)
- Placing the infant prone to maximize skin surface area exposure
- Removing all positioning aids to allow unrestricted movement under lights
Correct answer: Eye shields, minimal handling, and scheduled brief breaks for kangaroo care when possible
Applying eye shields, minimizing unnecessary handling, and allowing kangaroo care breaks when medically appropriate integrates phototherapy with developmental care priorities.
Question 4: When performing oral care with colostrum for a ventilated preterm neonate, the PRIMARY developmental benefit is:
- Reducing the risk of necrotizing enterocolitis and providing oral immune protection (Correct answer)
- Eliminating the need for antibiotics in ventilated patients
- Preventing dental caries in deciduous teeth
- Stimulating meconium passage
Correct answer: Reducing the risk of necrotizing enterocolitis and providing oral immune protection
Colostrum oral care delivers immunologic factors directly to the oral mucosa and oropharynx, providing immune protection and reducing NEC risk while offering gentle oral sensory stimulation.
Question 5: A 31-week infant is being transitioned from gavage to oral feeding. Which sign indicates the infant is READY to attempt nipple feeding?
- Completing all gavage feeds within 15 minutes
- Rooting, mouthing, and sustained alertness at feeding time (Correct answer)
- Achieving 1,800 grams body weight
- Tolerating 60 mL per feeding without residuals
Correct answer: Rooting, mouthing, and sustained alertness at feeding time
Behavioral readiness cues including rooting, mouthing, and sustained alertness at feeding time indicate neurologic readiness for oral feeding attempts.
Question 6: Which of the following NICU practices is INCONSISTENT with developmental care principles?
- Dimming lights during rest periods
- Performing all care procedures regardless of the infant's current sleep state (Correct answer)
- Encouraging parental participation in daily cares
- Using rolled blankets to create boundaries around the infant
Correct answer: Performing all care procedures regardless of the infant's current sleep state
Performing care procedures without regard to the infant's sleep-wake state disrupts rest cycles and is inconsistent with developmentally supportive care principles.
Question 7: A developmental care specialist recommends 'facilitated tucking' during a painful procedure. This technique involves:
- Swaddling the infant tightly in a warm blanket post-procedure
- Gently holding the infant's flexed extremities in midline containment during the procedure (Correct answer)
- Placing the infant in a prone position with a pacifier
- Distracting the infant with a mobile above the warmer
Correct answer: Gently holding the infant's flexed extremities in midline containment during the procedure
Facilitated tucking involves the nurse or parent gently holding the infant's flexed arms and legs in a midline position during procedures, providing proprioceptive comfort and reducing pain response.
RNC-NIC Developmental Care 4
A neonatal nurse is educating a new NICU nurse about prone positioning in preterm infants.
Which statement BEST reflects current evidence?