RNC-NIC Neonatal Evaluation & Monitoring 3 — Questions and Answers
Question 1: A neonate born at 30 weeks has persistent metabolic acidosis with base deficit of -10. Which assessment finding is most consistent with this lab result?
- Bounding pulses and warm extremities
- Prolonged capillary refill and mottled skin (Correct answer)
- Bradycardia with hypertension
- Tachypnea with normal peripheral perfusion
Correct answer: Prolonged capillary refill and mottled skin
Poor perfusion signs such as prolonged capillary refill and mottled skin reflect inadequate tissue oxygen delivery, consistent with metabolic acidosis.
Question 2: Which electrolyte abnormality is most commonly associated with jitteriness, seizures, and hypotonia in the first 48 hours of life in a preterm neonate?
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperkalemia
- Hypomagnesemia
Correct answer: Hypocalcemia
Hypocalcemia is the most common cause of neonatal jitteriness and seizures in the first 48 hours, particularly in preterm infants.
Question 3: When evaluating a neonate's chest X-ray, which finding is characteristic of respiratory distress syndrome (RDS)?
- Hyperinflation with flattened diaphragm
- Ground-glass appearance with air bronchograms (Correct answer)
- Cardiomegaly with pulmonary venous congestion
- Unilateral opacity with mediastinal shift
Correct answer: Ground-glass appearance with air bronchograms
RDS presents with a diffuse ground-glass appearance and air bronchograms due to widespread alveolar collapse from surfactant deficiency.
Question 4: A 36-week infant has a total serum bilirubin of 12 mg/dL at 24 hours of life. According to the Bhutani nomogram, this falls in which zone?
- Low risk
- Low-intermediate risk
- High-intermediate risk
- High risk (Correct answer)
Correct answer: High risk
A bilirubin of 12 mg/dL at 24 hours plots in the high-risk zone on the Bhutani hour-specific nomogram, requiring immediate evaluation and likely phototherapy.
Question 5: Which assessment tool is specifically validated to evaluate pain in preverbal neonates in the NICU setting?
- Glasgow Coma Scale
- FLACC Scale
- NPASS (Neonatal Pain, Agitation, and Sedation Scale) (Correct answer)
- Ramsay Sedation Scale
Correct answer: NPASS (Neonatal Pain, Agitation, and Sedation Scale)
The NPASS is a validated, NICU-specific tool that assesses both pain/agitation and sedation levels in neonates.
Question 6: A neonate at 28 weeks has a head circumference of 24 cm. Over the next week, the HC grows to 27 cm. What does this finding suggest?
- Normal brain growth for gestational age
- Posthemorrhagic hydrocephalus (Correct answer)
- Catch-up growth from intrauterine growth restriction
- Craniosynostosis
Correct answer: Posthemorrhagic hydrocephalus
Head circumference growth exceeding 1 cm/week in a preterm neonate is a red flag for posthemorrhagic hydrocephalus and warrants cranial ultrasound.
Question 7: During abdominal assessment of a NICU infant, the nurse notes distension, absent bowel sounds, and bloody stools. Which condition should be suspected first?
- Malrotation with volvulus
- Necrotizing enterocolitis (NEC) (Correct answer)
- Hirschsprung disease
- Meconium ileus
Correct answer: Necrotizing enterocolitis (NEC)
The triad of abdominal distension, absent bowel sounds, and bloody stools is the classic presentation of necrotizing enterocolitis in preterm neonates.
RNC-NIC Neonatal Evaluation & Monitoring 3
A neonate born at 30 weeks has persistent metabolic acidosis with base deficit of -10.
Which assessment finding is most consistent with this lab result?