RNC-NIC Pharmacology & Therapeutic Management 2

Question 1

A neonate with persistent pulmonary hypertension (PPHN) is started on inhaled nitric oxide (iNO). Which parameter most directly indicates a therapeutic response?

Accepted Answer

Improved oxygenation index (OI)

Answer

A decrease in the oxygenation index (OI = FiO2 × mean airway pressure × 100 / PaO2) indicates improved gas exchange and pulmonary vasodilation in response to iNO.

Question 2

A 28-week neonate requires caffeine citrate therapy. What is the recommended IV loading dose?

Accepted Answer

20 mg/kg

Answer

The standard caffeine citrate loading dose is 20 mg/kg IV, followed by a maintenance dose of 5–10 mg/kg/day.

Question 3

Which electrolyte abnormality is most commonly associated with prolonged furosemide therapy in neonates?

Accepted Answer

Hypokalemia

Answer

Furosemide causes urinary wasting of potassium, sodium, and chloride, making hypokalemia the most common electrolyte imbalance with chronic use.

Question 4

A NICU nurse prepares to administer indomethacin to close a hemodynamically significant PDA. Which finding is an absolute contraindication?

Accepted Answer

Serum creatinine of 1.2 mg/dL

Answer

Serum creatinine ≥1.8 mg/dL (or significant renal dysfunction) is a contraindication; a creatinine of 1.2 mg/dL warrants caution but is not an absolute cutoff—however, active renal impairment (oliguria <0.6 mL/kg/hr or elevated creatinine) contraindicates use.

Question 5

Vancomycin is prescribed for a neonate with culture-proven MRSA bacteremia. Which monitoring parameter is most important to guide dosing?

Accepted Answer

AUC/MIC ratio

Answer

Current guidelines recommend AUC/MIC-guided dosing (target AUC 400–600 mg·h/L) rather than trough-only monitoring to optimize efficacy and minimize nephrotoxicity.

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

RNC-NIC Pharmacology & Therapeutic Management 2