RNC-NIC Neonatal Assessment 4 — Questions and Answers
Question 1: A neonate at 32 weeks gestation is on CPAP. The nurse notes nasal flaring, subcostal retractions, and an oxygen requirement of 35%. The Silverman-Anderson score is being used. Which component is NOT part of this scoring system?
- Upper chest movement
- Grunting
- Nasal flaring
- Skin color/acrocyanosis (Correct answer)
Correct answer: Skin color/acrocyanosis
The Silverman-Anderson Retraction Score assesses upper chest movement, lower chest retractions, xiphoid retractions, nasal dilation, and expiratory grunt — skin color is not included.
Question 2: A nurse assesses a neonate and observes rhythmic, repetitive limb movements that cease when the extremity is held. This is most consistent with:
- Neonatal seizure activity
- Jitteriness (Correct answer)
- Myoclonic jerks
- Hyperekplexia
Correct answer: Jitteriness
Jitteriness is characterized by rhythmic, equal-amplitude tremors that are stimulus-sensitive and stop with passive restraint, distinguishing it from seizures which cannot be stopped by holding.
Question 3: In assessing a neonate for respiratory distress, grunting is heard. The physiological purpose of neonatal grunting is to:
- Increase respiratory rate to improve CO2 clearance
- Maintain positive end-expiratory pressure to prevent alveolar collapse (Correct answer)
- Signal pain or discomfort to caregivers
- Compensate for upper airway obstruction
Correct answer: Maintain positive end-expiratory pressure to prevent alveolar collapse
Grunting is produced by partial closure of the glottis during expiration, creating auto-PEEP to prevent alveolar collapse in neonates with reduced functional residual capacity.
Question 4: A 2-day-old term neonate is assessed and found to have a capillary refill time of 4 seconds in the central chest area. This finding indicates:
- Normal perfusion; central refill up to 5 seconds is acceptable
- Possibly impaired perfusion requiring further cardiovascular assessment (Correct answer)
- Peripheral vasoconstriction only, with no clinical significance
- Polycythemia causing sluggish flow
Correct answer: Possibly impaired perfusion requiring further cardiovascular assessment
Central capillary refill time greater than 3 seconds suggests impaired perfusion and warrants further cardiovascular assessment including blood pressure, heart rate, and perfusion status.
Question 5: During a neonatal neurological assessment, the nurse strokes the lateral sole of the foot from heel to toe. The great toe dorsiflexes and the other toes fan out. This response is:
- Abnormal Babinski — indicates corticospinal tract injury
- Normal Babinski response in neonates due to immature corticospinal tracts (Correct answer)
- A positive plantar grasp reflex
- Indicative of spinal cord transection
Correct answer: Normal Babinski response in neonates due to immature corticospinal tracts
The Babinski response (great toe extension and toe fanning) is normal in neonates because the corticospinal tracts are not yet myelinated, and typically disappears by 12-24 months.
Question 6: A neonate born to a mother with poorly controlled type 1 diabetes is assessed at 1 hour of life. Which physical finding is most expected in this infant?
- Intrauterine growth restriction with low birth weight
- Macrosomia with plethoric appearance (Correct answer)
- Microcephaly with small anterior fontanelle
- Absent Moro reflex due to hypoglycemia
Correct answer: Macrosomia with plethoric appearance
Infants of diabetic mothers (IDMs) are typically macrosomic and plethoric due to fetal hyperinsulinemia in response to maternal hyperglycemia promoting excessive fetal growth.
Question 7: When performing a gestational age assessment using the New Ballard Score on a neonate with significant edema, which component may be most affected and overestimated?
- Plantar surface creases (Correct answer)
- Ear cartilage formation
- Breast tissue development
- Lanugo distribution
Correct answer: Plantar surface creases
Plantar surface creases can be obscured or appear less prominent due to edema, potentially causing the examiner to underestimate maturity, though edema can also obscure assessment in other physical criteria.
RNC-NIC Neonatal Assessment 4
A neonate at 32 weeks gestation is on CPAP.
The nurse notes nasal flaring, subcostal retractions, and an oxygen requirement of 35%.
The Silverman-Anderson score is being used.
Which component is NOT part of this scoring system?