RNC-NIC Neonatal Cardiovascular Assessment and Care 1 — Questions and Answers
Question 1: What is the normal resting heart rate range for a term neonate?
- 60-80 bpm
- 100-160 bpm (Correct answer)
- 160-200 bpm
- 80-100 bpm
Correct answer: 100-160 bpm
Term neonates have a normal resting heart rate of 100-160 bpm, which is higher than adult norms due to their elevated metabolic demands.
Question 2: Which clinical finding is most characteristic of a hemodynamically significant patent ductus arteriosus (PDA) in a premature neonate?
- Persistent bradycardia and hypotension
- Decreased oxygen requirements over time
- Bounding peripheral pulses with a continuous murmur (Correct answer)
- Hypertension with decreased pulse pressure
Correct answer: Bounding peripheral pulses with a continuous murmur
A hemodynamically significant PDA causes bounding pulses due to wide pulse pressure and a characteristic continuous 'machinery' murmur from left-to-right shunting.
Question 3: Four-extremity blood pressure measurement in a neonate is performed primarily to screen for which condition?
- Pulmonary arterial hypertension
- Coarctation of the aorta (Correct answer)
- Tetralogy of Fallot
- Transposition of the great arteries
Correct answer: Coarctation of the aorta
Coarctation of the aorta creates a pressure gradient between the upper and lower extremities; a difference greater than 10-20 mmHg suggests significant coarctation.
Question 4: A neonate has a pre-ductal SpO2 of 98% and a post-ductal SpO2 of 88%. What does a difference greater than 3-5% most likely indicate?
- Normal physiologic variation between sites
- Persistent pulmonary hypertension or a ductal-dependent cardiac lesion (Correct answer)
- Respiratory distress syndrome only
- Peripheral vasoconstriction from cold stress
Correct answer: Persistent pulmonary hypertension or a ductal-dependent cardiac lesion
A pre-to-post-ductal SpO2 difference greater than 3-5% indicates right-to-left shunting through the ductus arteriosus, suggesting PPHN or a duct-dependent cardiac defect.
Question 5: Which congenital heart defect is considered ductal-dependent for systemic circulation, requiring prostaglandin E1 to maintain cardiac output?
- Ventricular septal defect (VSD)
- Atrial septal defect (ASD)
- Hypoplastic left heart syndrome (HLHS) (Correct answer)
- Pulmonary stenosis with intact ventricular septum
Correct answer: Hypoplastic left heart syndrome (HLHS)
HLHS has a severely underdeveloped left heart, making systemic perfusion entirely dependent on right-to-left flow through the ductus arteriosus; closing the ductus is fatal.
Question 6: A cyanotic neonate fails to improve despite administration of 100% supplemental oxygen (hyperoxia test). What is the most likely underlying cause?
- Respiratory distress syndrome
- Transient tachypnea of the newborn
- Cyanotic congenital heart disease (Correct answer)
- Meconium aspiration syndrome
Correct answer: Cyanotic congenital heart disease
Failure to improve SpO2 above 95% with 100% oxygen (hyperoxia test) strongly suggests cyanotic congenital heart disease with intracardiac right-to-left shunting that bypasses the lungs.
Question 7: What is the recommended SpO2 target range for most very preterm infants (less than 32 weeks) in the NICU to balance risk of retinopathy of prematurity against mortality?
- 85-89%
- 91-95% (Correct answer)
- 96-99%
- 80-85%
Correct answer: 91-95%
Current guidelines recommend SpO2 targets of 91-95% for very preterm infants, as targets below 90% increase mortality risk while targets above 95% increase risk of retinopathy of prematurity.
RNC-NIC Neonatal Cardiovascular Assessment and Care 1
What is the normal resting heart rate range for a term neonate?