RNC-NIC Neonatal Evaluation & Monitoring 5 — Questions and Answers
Question 1: A neonate with suspected sepsis has a C-reactive protein (CRP) of 0.4 mg/dL at 12 hours of life. The nurse understands that:
- A normal CRP rules out early-onset sepsis
- CRP peaks 24-48 hours after the onset of infection, so an early normal value does not exclude sepsis (Correct answer)
- CRP is not a useful marker for neonatal sepsis
- A CRP above 0.2 mg/dL always indicates bacterial infection
Correct answer: CRP peaks 24-48 hours after the onset of infection, so an early normal value does not exclude sepsis
CRP is an acute-phase reactant that rises 24-48 hours after infection onset, so a normal early value should not be used to exclude sepsis.
Question 2: During skin assessment of a 24-week neonate on day of life 1, the nurse observes gelatinous, red, transparent skin with visible veins. Using the NSRAS or Braden Q tool, this finding indicates:
- Intact skin with low breakdown risk
- Extremely high skin breakdown risk requiring protective measures (Correct answer)
- Normal vernix distribution
- Evidence of in-utero infection
Correct answer: Extremely high skin breakdown risk requiring protective measures
Extremely immature skin in micro-preemies is a primary pressure injury and TEWL risk, warranting immediate protective skin care interventions.
Question 3: A term infant at 12 hours of life has a hematocrit of 68%. The infant appears plethoric with mild respiratory distress. The most appropriate next step is:
- Repeat hematocrit in 4 hours
- Obtain a central venous hematocrit to confirm polycythemia (Correct answer)
- Initiate partial exchange transfusion immediately
- Begin IV fluid bolus with normal saline
Correct answer: Obtain a central venous hematocrit to confirm polycythemia
Capillary hematocrits can be falsely elevated; a central venous sample is required to confirm polycythemia before considering partial exchange transfusion.
Question 4: Which parameter is the MOST reliable indicator of adequate fluid balance in a VLBW neonate in the first week of life?
- Daily urine specific gravity
- Serum creatinine level
- Daily weight trend correlated with fluid intake and output (Correct answer)
- Blood urea nitrogen (BUN)
Correct answer: Daily weight trend correlated with fluid intake and output
Daily weight trend combined with fluid intake and output provides the most comprehensive picture of fluid balance in VLBW neonates.
Question 5: A 29-week neonate's cranial ultrasound on day 7 reveals periventricular leukomalacia (PVL). The nurse counsels the family that this finding is most associated with an increased risk of:
- Intraventricular hemorrhage on subsequent scans
- Cerebral palsy and cognitive impairment (Correct answer)
- Congenital heart disease
- Retinopathy of prematurity requiring laser therapy
Correct answer: Cerebral palsy and cognitive impairment
PVL involves white matter injury adjacent to the ventricles and is strongly associated with spastic diplegia (cerebral palsy) and neurodevelopmental impairment.
Question 6: A neonate on day 3 of life has urine output of 0.5 mL/kg/hr despite adequate fluid intake. Serum creatinine is rising. Which condition is the most likely cause of oliguria?
- Pre-renal acute kidney injury from dehydration
- Post-renal obstruction from posterior urethral valves
- Intrinsic renal failure from hypoxic-ischemic injury (Correct answer)
- Normal transitional physiology
Correct answer: Intrinsic renal failure from hypoxic-ischemic injury
Rising creatinine with oliguria unresponsive to fluid administration on day 3 suggests intrinsic renal parenchymal injury, most commonly from perinatal hypoxia-ischemia.
Question 7: When monitoring a neonate receiving phototherapy for hyperbilirubinemia, which assessment finding requires the nurse to immediately pause therapy and notify the physician?
- Loose green stools
- Bronze discoloration of the skin (Correct answer)
- Transient macular rash
- Increased insensible water losses
Correct answer: Bronze discoloration of the skin
Bronze baby syndrome — bronze skin discoloration during phototherapy — occurs in neonates with direct hyperbilirubinemia and signals that phototherapy may be contraindicated.
RNC-NIC Neonatal Evaluation & Monitoring 5
A neonate with suspected sepsis has a C-reactive protein (CRP) of 0.4 mg/dL at 12 hours of life.
The nurse understands that: