RNC-NIC Neonatal Evaluation & Monitoring 2 — Questions and Answers
Question 1: A neonate at 28 weeks gestation has a transcutaneous CO2 reading of 58 mmHg. Which action is most appropriate?
- Increase respiratory rate on the ventilator
- Decrease FiO2
- Obtain an arterial blood gas to confirm (Correct answer)
- Administer sodium bicarbonate immediately
Correct answer: Obtain an arterial blood gas to confirm
Transcutaneous monitors require correlation with ABG before ventilator changes, especially when values are borderline or unexpected.
Question 2: When assessing a neonate using the Ballard Maturational Assessment, which neuromuscular sign indicates greater gestational maturity?
- Increased scarf sign laxity
- Decreased popliteal angle (Correct answer)
- Greater square window angle
- Less recoil of the arms
Correct answer: Decreased popliteal angle
A decreased (more restricted) popliteal angle indicates greater muscle tone and neuromuscular maturity.
Question 3: A term neonate has a capillary blood glucose of 38 mg/dL at 2 hours of life. The infant is asymptomatic and breastfeeding. What is the priority nursing action?
- Initiate IV dextrose infusion
- Administer glucagon IM
- Recheck glucose after next feeding (Correct answer)
- Obtain a serum glucose via venipuncture immediately
Correct answer: Recheck glucose after next feeding
Asymptomatic late preterm and term neonates with borderline glucose levels are managed with feeding and recheck per institutional protocol.
Question 4: Which near-infrared spectroscopy (NIRS) value for cerebral regional oxygen saturation (rSO2) should prompt clinical concern in a NICU neonate?
- 65%
- 72%
- 80%
- 55% (Correct answer)
Correct answer: 55%
Cerebral rSO2 below 55-60% is generally considered a threshold for intervention, as it may signal inadequate cerebral oxygen delivery.
Question 5: A 34-week preterm infant on CPAP has nasal flaring, grunting, and subcostal retractions. Using the Silverman-Anderson score, how would this presentation most likely score?
- Score of 0 — no respiratory distress
- Score of 2-4 — mild distress
- Score of 5-7 — moderate distress (Correct answer)
- Score of 10 — severe distress
Correct answer: Score of 5-7 — moderate distress
The presence of three signs (flaring, grunting, retractions) but without see-saw respirations or xiphoid retractions typically places the score in the moderate range.
Question 6: During routine monitoring, a VLBW infant's oxygen saturation alarm sounds at 80%. The probe is properly placed. What is the first nursing action?
- Increase FiO2 by 10%
- Assess the infant directly for color, tone, and respiratory effort (Correct answer)
- Silence the alarm and reposition the probe
- Call the physician immediately
Correct answer: Assess the infant directly for color, tone, and respiratory effort
Direct patient assessment is always the first priority to determine if the desaturation is real or artifact before adjusting support.
Question 7: A neonate is noted to have a blood pressure of 28/14 mmHg (MAP 19 mmHg) at 26 weeks corrected age. Which statement best guides interpretation?
- This is normal for a 26-week neonate
- Mean arterial pressure should equal or exceed gestational age in weeks (Correct answer)
- Diastolic blood pressure is the most important value to monitor
- Systolic hypertension is the primary concern at this gestational age
Correct answer: Mean arterial pressure should equal or exceed gestational age in weeks
A commonly used clinical guideline is that MAP (in mmHg) should be at least equal to gestational age in weeks as a minimum acceptable threshold.
RNC-NIC Neonatal Evaluation & Monitoring 2
A neonate at 28 weeks gestation has a transcutaneous CO2 reading of 58 mmHg.
Which action is most appropriate?