RNC-NIC Neonatal Assessment 5 — Questions and Answers
Question 1: A neonate at 28 weeks gestation has a PaO2 of 45 mmHg on room air. The nurse understands that fetal hemoglobin (HbF) affects oxygen transport by:
- Shifting the oxyhemoglobin dissociation curve to the right, releasing O2 more readily
- Shifting the oxyhemoglobin dissociation curve to the left, binding O2 more avidly (Correct answer)
- Having no significant effect on oxygen affinity compared to adult hemoglobin
- Decreasing total hemoglobin binding capacity
Correct answer: Shifting the oxyhemoglobin dissociation curve to the left, binding O2 more avidly
Fetal hemoglobin has a higher oxygen affinity (left-shifted curve) than adult hemoglobin, allowing it to extract oxygen from maternal blood at the placenta but also making O2 release to tissues less efficient.
Question 2: A nurse assesses a neonate and notes jaundice visible on the thighs and upper arms. Using Kramer's rule, this distribution of jaundice corresponds to an estimated serum bilirubin level of approximately:
- 5-7 mg/dL
- 8-10 mg/dL
- 12-14 mg/dL (Correct answer)
- 15-18 mg/dL
Correct answer: 12-14 mg/dL
Kramer's rule estimates that jaundice extending to the thighs (zone 4) correlates with serum bilirubin levels of approximately 12-14 mg/dL, progressing cephalocaudally with rising levels.
Question 3: During assessment of a neonate with suspected meconium aspiration syndrome (MAS), the nurse should prioritize monitoring for which complication?
- Hypercalcemia from increased bone resorption
- Persistent pulmonary hypertension of the newborn (PPHN) (Correct answer)
- Metabolic alkalosis from vomiting
- Hyperglycemia from cortisol release
Correct answer: Persistent pulmonary hypertension of the newborn (PPHN)
Meconium aspiration causes pulmonary vasoconstriction and airway obstruction, frequently leading to persistent pulmonary hypertension of the newborn (PPHN) as a serious complication.
Question 4: A nurse is assessing a neonate for pain using the NIPS (Neonatal Infant Pain Scale). Which parameter is included in this tool?
- Blood pressure variability
- Oxygen saturation trend
- Facial expression (Correct answer)
- Pupillary response
Correct answer: Facial expression
The NIPS assesses facial expression, cry, breathing pattern, arm position, leg position, and state of arousal — blood pressure, SpO2, and pupillary response are not included.
Question 5: A neonate born at 39 weeks gestation has a head circumference of 37 cm, length of 52 cm, and weight of 3,900 g. These measurements plot at the 90th, 75th, and 85th percentiles respectively. This infant is classified as:
- Large for gestational age (LGA)
- Appropriate for gestational age (AGA) (Correct answer)
- Small for gestational age (SGA)
- Macrosomic requiring glucose screening
Correct answer: Appropriate for gestational age (AGA)
All measurements between the 10th and 90th percentiles classify the neonate as appropriate for gestational age (AGA), indicating normal intrauterine growth.
Question 6: A nurse observes a neonate having a seizure characterized by eye deviation, repetitive sucking movements, and pedaling leg motions without tonic-clonic components. This seizure type is classified as:
- Clonic seizure
- Tonic seizure
- Subtle seizure (Correct answer)
- Myoclonic seizure
Correct answer: Subtle seizure
Subtle seizures are the most common neonatal seizure type, manifesting as eye deviation, oral-buccal movements (sucking, chewing), and autonomic changes without classic tonic-clonic activity.
Question 7: When assessing a neonate's skin turgor, the nurse pinches abdominal skin and it returns slowly over 3 seconds. In a 3-day-old term neonate, this finding most likely indicates:
- Normal finding due to physiological weight loss
- Dehydration requiring fluid assessment (Correct answer)
- Hyperbilirubinemia causing skin changes
- Polycythemia reducing skin elasticity
Correct answer: Dehydration requiring fluid assessment
Skin turgor that returns slowly (tenting) in a neonate indicates dehydration and warrants assessment of fluid intake, urine output, weight loss percentage, and fontanelle status.
RNC-NIC Neonatal Assessment 5
A neonate at 28 weeks gestation has a PaO2 of 45 mmHg on room air.
The nurse understands that fetal hemoglobin (HbF) affects oxygen transport by: