RNC-NIC Thermoregulation 4 — Questions and Answers
Question 1: During kangaroo care (skin-to-skin), which physiological mechanism primarily accounts for heat transfer from the parent to the neonate?
- Radiation from parent's body
- Conduction through direct skin contact (Correct answer)
- Convection via warm air trapped between bodies
- Evaporation prevention by the parent's skin
Correct answer: Conduction through direct skin contact
During skin-to-skin care, heat transfers from the warmer parent's skin directly to the cooler neonate's skin via conduction.
Question 2: A neonate receiving therapeutic hypothermia develops a heart rate of 88 bpm and a core temperature of 33.5°C. What is the MOST appropriate nursing action?
- Immediately warm the infant to reverse bradycardia
- Notify the physician and continue monitoring, as bradycardia is expected during cooling (Correct answer)
- Administer atropine to correct the bradycardia
- Increase the cooling blanket temperature by 0.5°C
Correct answer: Notify the physician and continue monitoring, as bradycardia is expected during cooling
Mild bradycardia (HR 80–100 bpm) is an expected and acceptable physiologic response during therapeutic hypothermia and does not require intervention unless accompanied by hemodynamic compromise.
Question 3: A nurse is caring for a 25-week infant under a radiant warmer with a humidity level of 80%. The purpose of maintaining high humidity is to:
- Prevent infection by keeping skin moist
- Reduce transepidermal water loss and evaporative heat loss (Correct answer)
- Improve oxygenation by humidifying inspired gases
- Decrease the risk of intraventricular hemorrhage
Correct answer: Reduce transepidermal water loss and evaporative heat loss
High humidity in the incubator or under a radiant warmer reduces the gradient between the infant's skin and the environment, decreasing transepidermal water loss and evaporative heat loss through immature skin.
Question 4: Which finding would MOST likely indicate that a neonate in therapeutic hypothermia has been rewarmed too rapidly?
- Seizure activity on amplitude-integrated EEG (Correct answer)
- Blood glucose of 110 mg/dL
- Heart rate of 155 bpm
- Mild peripheral edema
Correct answer: Seizure activity on amplitude-integrated EEG
Rebound seizures are a known complication of excessively rapid rewarming after therapeutic hypothermia and indicate neurological deterioration.
Question 5: An RNC-NIC nurse knows that the thermoreceptors primarily responsible for initiating non-shivering thermogenesis in neonates are located in the:
- Skin surface
- Peripheral blood vessels
- Hypothalamus and spinal cord (Correct answer)
- Carotid body chemoreceptors
Correct answer: Hypothalamus and spinal cord
Central thermoreceptors in the hypothalamus and spinal cord detect core temperature changes and trigger the sympathetic response that initiates BAT thermogenesis.
Question 6: A 34-week neonate's temperature drops from 36.8°C to 35.9°C during a bath. This temperature is classified as:
- Normal variation within acceptable range
- Mild hypothermia (Correct answer)
- Moderate hypothermia
- Severe hypothermia
Correct answer: Mild hypothermia
According to WHO classification, mild hypothermia in neonates is defined as a core temperature of 36.0–36.4°C; a reading of 35.9°C falls just into this category.
Question 7: When weaning a preterm infant from an incubator to an open crib, which criterion is MOST important to confirm readiness?
- Gestational age of at least 36 weeks corrected
- Consistent weight gain and ability to maintain temperature in a gradually cooled incubator (Correct answer)
- Absence of respiratory support for at least 48 hours
- Weight greater than 1,800 grams with full oral feeds
Correct answer: Consistent weight gain and ability to maintain temperature in a gradually cooled incubator
The infant's demonstrated ability to maintain a stable temperature as the incubator is progressively weaned confirms thermoregulatory maturity, which is the primary readiness criterion.
RNC-NIC Thermoregulation 4
During kangaroo care (skin-to-skin), which physiological mechanism primarily accounts for heat transfer from the parent to the neonate?