RNC-NIC Infection Control 3 — Questions and Answers
Question 1: Which of the following practices is MOST effective in preventing ventilator-associated pneumonia (VAP) in intubated neonates?
- Routine endotracheal tube suctioning every 2 hours
- Elevating the head of bed to 30-45 degrees and maintaining inline suctioning (Correct answer)
- Changing the ventilator circuit every 24 hours
- Administering prophylactic antibiotics for all intubated neonates
Correct answer: Elevating the head of bed to 30-45 degrees and maintaining inline suctioning
Head-of-bed elevation reduces aspiration risk and is a core VAP bundle element; inline closed suctioning prevents circuit contamination.
Question 2: A NICU nurse is caring for a neonate with confirmed RSV (respiratory syncytial virus). Which isolation precaution category should be implemented IN ADDITION to Standard Precautions?
- Airborne Precautions only
- Contact Precautions only
- Droplet Precautions only
- Both Contact and Droplet Precautions (Correct answer)
Correct answer: Both Contact and Droplet Precautions
RSV spreads via large respiratory droplets and direct contact, requiring both Contact and Droplet Precautions in addition to Standard Precautions.
Question 3: Which clinical finding would MOST strongly support a diagnosis of early-onset sepsis (EOS) in a term neonate within 24 hours of birth?
- Serum glucose of 50 mg/dL
- Temperature of 37.8°C (100°F)
- Respiratory rate of 65 breaths/min with grunting and poor feeding (Correct answer)
- Mild jaundice with bilirubin of 8 mg/dL
Correct answer: Respiratory rate of 65 breaths/min with grunting and poor feeding
Respiratory distress combined with grunting and poor feeding in a term neonate within 24 hours of birth are classic early signs of EOS requiring immediate evaluation.
Question 4: When performing umbilical catheter care in the NICU, which practice BEST reduces infection risk at the insertion site?
- Apply topical antibiotic ointment to the catheter-skin junction daily
- Use sterile technique during insertion and keep the site clean and dry without routine antibiotic ointment (Correct answer)
- Change the umbilical catheter every 48 hours regardless of condition
- Cover the umbilical stump with an occlusive dressing
Correct answer: Use sterile technique during insertion and keep the site clean and dry without routine antibiotic ointment
Sterile technique at insertion and keeping the site clean without routine antibiotic ointment (which promotes resistant organisms) is the evidence-based standard for UAC/UVC care.
Question 5: A NICU nurse receives a neonate from labor and delivery whose mother had prolonged rupture of membranes (PROM) for 22 hours. What infection risk assessment finding is MOST significant?
- Maternal GBS status negative
- Maternal fever greater than 38°C (100.4°F) during labor (Correct answer)
- Neonate birth weight of 3,200 grams
- Apgar score of 8 at 5 minutes
Correct answer: Maternal fever greater than 38°C (100.4°F) during labor
Maternal intrapartum fever combined with PROM significantly increases the risk of chorioamnionitis and neonatal EOS, requiring immediate sepsis evaluation.
Question 6: Which of the following is a key advantage of using human breast milk (HBM) over formula in preterm neonates from an infection control perspective?
- HBM has higher caloric density than standard formula
- HBM contains immunoglobulins and lactoferrin that reduce the risk of NEC and sepsis (Correct answer)
- HBM eliminates the need for vitamin D supplementation
- HBM prevents all respiratory viral infections in preterm neonates
Correct answer: HBM contains immunoglobulins and lactoferrin that reduce the risk of NEC and sepsis
Breast milk provides passive immunity through IgA, lactoferrin, and other bioactive components that significantly reduce rates of NEC and late-onset sepsis in preterm neonates.
Question 7: A visitor with an active cold sore (herpes labialis) wants to visit their neonate in the NICU. What is the APPROPRIATE nursing response?
- Allow the visit with no restrictions since it is a minor infection
- Permit visitation only if the visitor wears a surgical mask
- Restrict direct contact with the neonate and educate the visitor to return when the lesion has healed (Correct answer)
- Allow the visit if the visitor performs hand hygiene before entering
Correct answer: Restrict direct contact with the neonate and educate the visitor to return when the lesion has healed
Active herpes simplex virus (HSV) oral lesions pose a life-threatening risk to neonates; visitors with active lesions must be restricted from direct contact until fully healed.
RNC-NIC Infection Control 3
Which of the following practices is MOST effective in preventing ventilator-associated pneumonia (VAP) in intubated neonates?