RNC-NIC Neonatal Intensive Care Nurse Basic 4 — Questions and Answers
Question 1: A 30-week premature neonate is started on caffeine citrate therapy. What is the primary indication for this medication in the NICU?
- Treatment of neonatal seizures
- Prevention and treatment of apnea of prematurity (Correct answer)
- Promotion of surfactant production
- Management of pulmonary hypertension
Correct answer: Prevention and treatment of apnea of prematurity
Caffeine citrate is the first-line treatment for apnea of prematurity, stimulating the central respiratory drive.
Question 2: Which complication is the NICU nurse most concerned about when a preterm infant receives a rapid IV fluid bolus?
- Hyperglycemia
- Intraventricular hemorrhage (Correct answer)
- Hypercalcemia
- Meconium aspiration
Correct answer: Intraventricular hemorrhage
Rapid fluid boluses can cause sudden fluctuations in cerebral blood flow, increasing the risk of intraventricular hemorrhage in preterm neonates.
Question 3: A nurse is preparing to administer surfactant to a 26-week neonate. Which route is used for administration?
- Nebulized via face mask
- Directly into the endotracheal tube (Correct answer)
- IV bolus over 30 minutes
- Subcutaneous injection
Correct answer: Directly into the endotracheal tube
Surfactant is instilled directly into the lungs via the endotracheal tube to coat alveolar surfaces and reduce surface tension.
Question 4: A neonate has a serum sodium of 125 mEq/L and is symptomatic with seizures. What is the most appropriate initial treatment?
- Restrict all IV fluids
- Administer hypertonic 3% saline slowly (Correct answer)
- Give oral sodium supplements
- Increase free water intake
Correct answer: Administer hypertonic 3% saline slowly
Symptomatic hyponatremia with seizures requires cautious correction with hypertonic saline to raise sodium rapidly enough to stop seizures.
Question 5: Which assessment tool is most commonly used to evaluate pain in nonverbal neonates in the NICU?
- Wong-Baker FACES Scale
- Numeric Rating Scale
- CRIES or N-PASS Scale (Correct answer)
- Visual Analog Scale
Correct answer: CRIES or N-PASS Scale
Validated neonatal pain tools like CRIES and N-PASS use behavioral and physiologic indicators since neonates cannot self-report pain.
Question 6: A neonate born to a mother with poorly controlled diabetes has a blood glucose of 28 mg/dL at 1 hour of life and is asymptomatic. What is the best initial management?
- Administer IV dextrose 10% bolus immediately
- Feed the infant breast milk or formula (Correct answer)
- Observe and recheck in 2 hours
- Start TPN
Correct answer: Feed the infant breast milk or formula
Asymptomatic hypoglycemia in a neonate able to feed is initially treated with a feeding of breast milk or formula before resorting to IV glucose.
Question 7: Which sign indicates that a neonate receiving phototherapy for hyperbilirubinemia should have therapy temporarily stopped?
- Bilirubin level decreasing by 1 mg/dL in 4 hours
- Temperature instability and bronze skin discoloration (Correct answer)
- Mild loose green stools
- Increased wakefulness and feeding
Correct answer: Temperature instability and bronze skin discoloration
Temperature instability or bronze baby syndrome (bronze skin, dark urine) are indications to reassess phototherapy and potential complications.
RNC-NIC Neonatal Intensive Care Nurse Basic 4
A 30-week premature neonate is started on caffeine citrate therapy.
What is the primary indication for this medication in the NICU?