RNC-NIC Neonatal Assessment 2 — Questions and Answers
Question 1: A term neonate's anterior fontanelle is assessed as bulging and tense while the infant is quiet and supine. Which condition does this finding most suggest?
- Normal variant in a well-hydrated infant
- Increased intracranial pressure (Correct answer)
- Dehydration
- Premature fontanelle closure
Correct answer: Increased intracranial pressure
A bulging, tense anterior fontanelle in a quiet infant indicates increased intracranial pressure and requires immediate evaluation.
Question 2: When assessing a preterm neonate at 28 weeks gestational age, which skin finding is expected?
- Thick, leathery skin with deep creases
- Abundant vernix caseosa covering entire body
- Transparent, gelatinous skin with visible blood vessels (Correct answer)
- Peeling, dry skin with desquamation
Correct answer: Transparent, gelatinous skin with visible blood vessels
At 28 weeks gestation, the skin is thin, transparent, and gelatinous with easily visible underlying vasculature due to minimal subcutaneous fat and immature skin layers.
Question 3: A neonate is assessed using the Ballard Score. Which finding would indicate more advanced neuromuscular maturity?
- Scarf sign elbow crosses midline
- Popliteal angle of 180 degrees
- Square window angle of 0 degrees (Correct answer)
- Absent heel-to-ear maneuver resistance
Correct answer: Square window angle of 0 degrees
A square window angle of 0 degrees (wrist fully flexes to touch forearm) indicates advanced neuromuscular maturity, as tone and flexibility increase with gestational age.
Question 4: During a neonatal assessment, the nurse notes that the neonate's eyes deviate toward the right when the head is turned to the right. This is best described as:
- Rooting reflex
- Doll's eye reflex (oculocephalic reflex) (Correct answer)
- Moro reflex
- Tonic neck reflex
Correct answer: Doll's eye reflex (oculocephalic reflex)
The doll's eye reflex (oculocephalic reflex) is present when the eyes deviate in the direction the head is turned, indicating intact brainstem function in the neonate.
Question 5: A neonate born at 35 weeks gestation has a blood glucose of 38 mg/dL at 2 hours of life. The infant is jittery and has a weak cry. What is the priority nursing action?
- Repeat blood glucose in 30 minutes
- Initiate enteral feeding and reassess
- Administer IV dextrose bolus per protocol (Correct answer)
- Place infant under radiant warmer
Correct answer: Administer IV dextrose bolus per protocol
Symptomatic hypoglycemia (jitteriness, weak cry) with glucose below 40 mg/dL requires immediate IV dextrose bolus, as enteral feeding alone is insufficient for symptomatic neonates.
Question 6: Which assessment finding is associated with hypocalcemia in a neonate?
- Hypertension and bradycardia
- Jitteriness, tremors, and high-pitched cry (Correct answer)
- Hyperthermia and diaphoresis
- Abdominal distension and bilious vomiting
Correct answer: Jitteriness, tremors, and high-pitched cry
Neonatal hypocalcemia classically presents with neuromuscular irritability including jitteriness, tremors, and high-pitched cry due to decreased seizure threshold.
Question 7: A nurse assesses a neonate and notes the trachea is deviated to the right, breath sounds are absent on the left, and the abdomen appears scaphoid. Which condition is most likely?
- Tension pneumothorax on the right
- Congenital diaphragmatic hernia (Correct answer)
- Esophageal atresia with TEF
- Meconium aspiration syndrome
Correct answer: Congenital diaphragmatic hernia
Congenital diaphragmatic hernia presents with mediastinal shift, absent breath sounds on the affected side, and scaphoid abdomen due to abdominal organs herniated into the chest.
RNC-NIC Neonatal Assessment 2
A term neonate's anterior fontanelle is assessed as bulging and tense while the infant is quiet and supine.
Which condition does this finding most suggest?