RNC NIC COMPLETE EXAM QUESTIONS
WITH CORRECT DETAILED ANSWERS ||
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1.Which chest x-ray findings best represent primary surfactant deficiency? -
ANSWER ✔ Hypoexpansion due to atelectasis, air bronchograms from atelectasis
of the alveoli interspersed with open airways and a reticulogranular pattern, and
open alveoli interspersed with atelectatic alveoli are the classic findings of
surfactant deficiency.
2. Which chest x ray findings best represent pneumonia? - ANSWER ✔ Bilateral
streakiness, hyperexpansion, reticulogranular pattern is found with pneumonia
3. Which chest x ray findings best represent a pneumomediastinum? - ANSWER
✔ Hypoexpansion, sail sign, fluid in the fissure
4. Proper placement of ETT - ANSWER ✔ Proper placement on an endotracheal
tube is midway between the thoracic inlet and the carina.
5. Anticholinergic side effects in neonate - ANSWER ✔ Anticholinergic drugs
block acetylcholine at parasympathetic muscarinic receptors. Their actions include
increased heart rate, pupil relaxation, and decreased tone and motility of the
gastrointestinal tract.
6. Digoxin MOA - ANSWER ✔ Inhibition of Na/K/ATPase pumps in the heart,
increasing cardiac cell potentials and contractility
7. Meconium ileus - ANSWER ✔ Inpissated meconium obstructs the terminal
ileum just prior to the ileocecal valve.
,8.Associated with Cystic Fybrosis (requires pancreatic enzymes to breakdown
digest intestinal contents)
9. imperforate anus - ANSWER ✔ a congenital defect in which the rectal opening
is missing or blocked.
10. Imperforate anus in female - ANSWER ✔ Meconium from a fistula external to
the hymen = rectovestibular fistula, most common in females
11. Imperforate anus in a male - ANSWER ✔ Most common lesion is the
rectoprostatic fistula , distal bowel and urethra
12. Tidal Volume - ANSWER ✔ Amount of air that moves in and out of the lungs
during a normal breath
13. Minute Ventilation - ANSWER ✔ total volume of air inhaled and exhaled each
minute
14. grunting - ANSWER ✔ Infant's attempt to increase functional residual capacity
(lung volume) when there is collapse aveoli. Infant will try to collapse vocal cords
to try and trap air in the lungs. Grunting sound is made when the infant exhals
through the partial closed vocal cords.
15.Grunting "splint open" small airways and helps to maintain functional residual
capacity in the aveoli.
16. Preductal oxygen saturation - ANSWER ✔ Attach oximeter probe to the right
palm at birth.
17. Fetal hyperinsulinemia and lung development - ANSWER ✔ Fetal
hyperinsulinemia contributes to delayed maturation of the lungs, which inhibits the
production of surfactant and increases the risk of surfactant deficiency related to
respiratory distress syndrome. The reticulograndular pattern is suggestive of
respiratory distress syndrome.
18. In an infant with tetralogy of Fallot, the severity of symptoms will be most
affected by which of the following? - ANSWER ✔ The presence of an obstruction
to right ventricular (RV) outflow with a large ventral septal defect causes a right-
,to-left shunt at the ventricular level with arterial desaturation. The greater the
obstruction and the lower the systemic vascular resistance, the greater is the right-
to-left shunt. Thus the clinical findings vary with the degree of RV outflow
obstruction. Patients with mild obstruction are minimally cyanotic or acyanotic.
Those with severe obstruction are most likely to be deeply cyanotic from birth.
Few children are asymptomatic. In those with significant RV outflow obstruction,
many have cyanosis at birth, and nearly all have cyanosis by age 4 months..
19. Transposition of the great vessels - ANSWER ✔ In transposition of the great
vessels, the degree of cyanosis depends on the amount of mixing between the
pulmonary and systemic circulations. Oxygenated pulmonary venous blood is
returned to the lungs, and desaturated systemic blood is returned to the body. Thus
the two circulations exist in parallel. Some mixing between them must occur to
allow oxygenated blood to reach the systemic circulation and the desaturated blood
to reach the lungs.
20. balloon septostomy with transposition of the great vessels - ANSWER ✔ When
an infant has a restrictive atrial septal defect (ASD), a balloon atrial septostomy, a
technique developed by William Rashkind in 1966, may be performed. The
procedure involves inserting a balloon-tipped catheter across the foramen ovale
into the left atrium. The balloon is then inflated and forcibly withdrawn so that the
catheter tears the septum primum and enlarges the ASD. Mixing should increase
immediately, with a corresponding increase in arterial oxygen saturation.
21. CCHD screening - ANSWER ✔ A screen result would be considered positive
if any oxygen saturation measures less than 90%, oxygen saturation is less than
95% in both extremities on three measures—each separated by 1 hour, or there is a
3% absolute difference in oxygen saturation between the right hand and foot on
three measures, each separated by 1 hour. Any screening that is >95% in either
extremity with no more than a 3% absolute difference in oxygen saturation
between the upper and lower extremity would be considered a "pass" result, and
screening would end.
22. An infant is born with low-set ears, excess nuchal skin, a broad chest, widely
spaced nipples, peripheral lymphedema, and absent pulses in the lower extremities.
The nurse suspects the infant has coarctation of the aorta. Which chromosomal
defect can cause this constellation of findings? - ANSWER ✔ Infants with Turner
syndrome can present with cardiovascular anomalies, short stature, low-set ears,
excess nuchal skin, a broad chest with widely spaced nipples, peripheral
, lymphedema, and ovarian dysgenesis. Common defects are coarctation of the aorta
and bicuspid aortic valve. About 30% of infants with Turner syndrome will have a
coarctation of the aorta.
23. VSD at 1 to 2 months of age can result in - ANSWER ✔ Infants with a small
isolated defect are often asymptomatic. The murmur of a small defect may be
detected within the first 24 to 36 hours of life, because the very restrictive opening
permits the normal rapid fall in pulmonary arterial resistance and pressures. In term
infants born at sea level with a large ventral septal defect, clinical deterioration
may occur at any time from approximately 3 to 12 weeks after birth.
24. A hyperoxia test PPHN results in - ANSWER ✔ <100% PaO2.
25. A hyperoxia test RDS vs. cardiac - ANSWER ✔ A hyperoxia test is performed
by administering 100% oxygen for 10 minutes and then measuring the arterial
preductal PaO2 (right radial artery). A significant increase in PaO2 levels,
particularly a Pa O2 level >150 mm Hg, makes the likely cause respiratory distress
rather than cardiac in origin.
26. Wolff-Parkinson-White syndrome - ANSWER ✔ episodic supraventricular
tachycardia that resolves spontaneously. An echocardiogram is performed, and
there is slurred upstroke of the QRS and the presence of a delta wave.
27. Milronone - ANSWER ✔ Milrinone also provides dose-dependent increase in
cardiac contractility and is a systemic and pulmonary vasodilator and thus an
effective agent in both right and left ventricular systolic dysfunction.
28. increasing PIP - ANSWER ✔ Increase tidal volume , decreases Pco2
29. Increasing the PEEP without increasing PIP - ANSWER ✔ May decrease tidal
volume and pco2 may rise
30. If pco2 already elevated - ANSWER ✔ Increasing PIP may be better option
31. Increasing inspiratory time reduces - ANSWER ✔ Exhalation time and may
cause Paco2 to rise
