RNC-NIC Neonatal Assessment 3 — Questions and Answers
Question 1: A term neonate has an Apgar score of 4 at 5 minutes. Which combination of findings accounts for this score?
- HR >100, weak cry, some flexion, grimace, pink body/blue extremities
- HR <100, weak cry, some flexion, grimace, pink body/blue extremities (Correct answer)
- HR >100, strong cry, active motion, cough, completely pink
- HR absent, no cry, limp tone, no response, pale/cyanotic
Correct answer: HR <100, weak cry, some flexion, grimace, pink body/blue extremities
An Apgar of 4 at 5 minutes with HR <100 (1), weak cry (1), some flexion (1), grimace (1), and acrocyanosis (0) totals 4, indicating moderate depression requiring intervention.
Question 2: During assessment of a 30-week preterm neonate, the nurse notes the absence of the cremasteric reflex in a male infant. This finding is:
- Abnormal and suggests spinal cord injury
- Normal for gestational age as the reflex develops near term (Correct answer)
- Indicative of undescended testes
- Associated with hypothyroidism
Correct answer: Normal for gestational age as the reflex develops near term
The cremasteric reflex is absent in preterm neonates and develops closer to term gestation, making its absence a normal finding at 30 weeks.
Question 3: A neonate at 26 weeks gestation has a lanugo distribution limited to the shoulders and upper back. Using the New Ballard Score, this physical maturity criterion scores:
- 0
- 1
- 2
- 3 (Correct answer)
Correct answer: 3
On the New Ballard Score, lanugo thinning with sparse areas on the back scores 3, as lanugo disappears progressively from the face and trunk toward the back with increasing maturity.
Question 4: When assessing muscle tone in a term neonate, the nurse places the infant in ventral suspension. Which finding indicates normal tone?
- The infant hangs limply with head and extremities dangling
- The infant maintains the head at 45 degrees below horizontal with some limb flexion (Correct answer)
- The infant holds the head fully extended above horizontal
- The infant shows no movement or resistance
Correct answer: The infant maintains the head at 45 degrees below horizontal with some limb flexion
In ventral suspension, a term neonate with normal tone maintains the head at approximately 45 degrees below horizontal with partial limb flexion, demonstrating appropriate axial and appendicular tone.
Question 5: A neonate is noted to have a positive Ortolani maneuver during hip assessment. The nurse understands this finding indicates:
- Hip flexion contracture
- A dislocated hip being reduced back into the acetabulum (Correct answer)
- Increased femoral anteversion
- Tibial torsion
Correct answer: A dislocated hip being reduced back into the acetabulum
A positive Ortolani sign (a palpable 'clunk' with abduction) indicates a dislocated femoral head relocating into the acetabulum, diagnostic of developmental dysplasia of the hip.
Question 6: A neonate's transcutaneous bilirubin (TcB) reading at 24 hours of life is above the high-risk zone on the Bhutani nomogram. What is the most appropriate next step?
- Initiate phototherapy based solely on the TcB result
- Obtain a serum total bilirubin to confirm and guide management (Correct answer)
- Discharge and recheck bilirubin at 48 hours
- Begin exchange transfusion immediately
Correct answer: Obtain a serum total bilirubin to confirm and guide management
TcB is a screening tool; a serum total bilirubin (TSB) must be obtained to confirm the level and guide treatment decisions per AAP guidelines.
Question 7: During a neonatal assessment, periorbital edema and subconjunctival hemorrhages are noted in a term infant born via vaginal delivery with forceps assistance. The nurse should:
- Notify the physician of suspected orbital fracture
- Document as expected findings related to birth trauma and monitor (Correct answer)
- Obtain ophthalmology consult emergently for corneal damage
- Initiate antibiotic eye prophylaxis immediately
Correct answer: Document as expected findings related to birth trauma and monitor
Periorbital edema and subconjunctival hemorrhages are common, benign birth trauma findings that resolve spontaneously and require documentation and routine monitoring.
RNC-NIC Neonatal Assessment 3
A term neonate has an Apgar score of 4 at 5 minutes.
Which combination of findings accounts for this score?