RNC NIC EXAM WITH COMPLETE SOLUTIONS
LATEST UPDATE
GIR - ANSWER 6-8mcg/kg/min caloric intake
D10 Bolus - ANSWER 2mL/kg
Fluid Volume Bolus - ANSWER 10mL/kg
Term Parenteral Fluid Requirement - ANSWER 80mL/kg/day
Enteral 100-150 mlk/kg/day
Preterm Parenteral Fluid Requirement - ANSWER 120
Enteral 150-200ml/kig/day
GIR Calculation - ANSWER (%dextrose x IV rate) / (6 x wt in kg)
I/T ratio - ANSWER %Metas + Bands / %Metas + Bands + Segs
I/T ratio greater than >0.2 to >.25 suggestive of infection
>0.8 associated with shock
Absolute Neutrophil COUNT - ANSWER WBC x (%) Segmented neutrophils + band
neutrophils + metamyelocytes
,Example. 15,000 x 35 segs + 15 bands + 3 metas (converts to percent)
15,000 x .53 = 7950
ANC <1800 suggestive of infection
Normal Range
Mature WBCs - ANSWER Poly, Segs, Neutrophils
Immature WBCs - ANSWER Meta, Bands, Stabs
Platelet Range - ANSWER 150-400k
Thrombocytopenia (< 100,000/mm3 ): may be related to bacterial sepsis or viral
infection but typical onset is not seen until 1 to 3 days after the onset of infection (late
sign); May also be seen with maternal HELLP syndrome (hemolysis, elevated liver
function test results, and low platelet count), pregnancy-induced hypertension, and
intrauterine growth restriction, and with some syndromes including trisomies 13,18, and
21, Turner's syndrome, and hemolytic disease.
CRP level - ANSWER CRP level usually <1.6 for the first two days of life
Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged
rupture of membranes.
Most common pathogens - ANSWER Currently, GBS
E. coli
Candidas - ANSWER -Diaper dermatitis presents with intense erythema and satellite
lesions.
-Congenital candidiasis presents with widespread erythematous maculopapular rash,
and preterm infants may present with pneumonia.
,Congenital CMV infection - ANSWER congenital infection include: intrauterine growth
restriction, hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly,
hydrocephalus, intracerebral calcifications, hearing loss, chorioretinitis, and optic
atrophy.
Endotracheal Measurement - ANSWER 6 + wt in kg
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
carina.
Polyethelane Wrap for Infant < 29 weeks - ANSWER Dry infants head only
Place infant in bag, from neck down
Remove bag when infant is in an NTE and humidified environment
UAC Placement - ANSWER High Placement T6-T9
Low Placement L3-L4
UVC Placement - ANSWER 1 to 2cm above the diaghragm
Low Lying 2-4cm in the cord
Chest Tube Placement - ANSWER Mid Clavicular line with distal chest tube hole inside
the thoracic space
lecithin/sphingomyelin (L/S) ratio - ANSWER An L/S ratio greater than 2:1 is considered
to indicate fetal lung maturity.
Anatomic events Five stages of lung development - ANSWER 1. Embryonic development
(weeks 1 to 5). The endoderm-derived embryonic foregut provides a single lung bud that
begins to divide ventrocaudally through the mesenchyme surrounding the foregut. The
pulmonary vein develops and extends to join the lung bud. The trachea develops at the
, end of the embryonic period. On the right side, there are three divisions and two on the
left side which later develop into the lobes of the lungs.
2. Pseudoglandular period (weeks 6 to 16).
All conducting airways are formed. Appearances of cartilage; formation of main
bronchi; demarcation of major lobes; new bronchi formation complete; capillary bed
formation with connecting bronchial blood supply; no connection made with terminal air
sacs. In this stage, the lung has gone through 14 generations of branching and terminal
bronchiole development. Because the loose mesenchymal tissues have enveloped the
lung at this stage, it takes the appearance of an exocrine organ, hence the name
pseudoglandular. 3. Canalicular period, from week 16 to 26.
The gas exchanging acinar units are formed, or the respiratory units.
There appears glycogen-rich cuboidal cells and inclusions for surface-active material
storage; capillaries invade terminal airway walls; type II alveolar epithelial cells appear.
Airway changes from glandular to tubular and increases in length and diameter. The
vascular system proliferates, and the capillaries are now closer to the
epithelium-conducting airways. Respiratory bronchioles that will participate in gas
exchange can be differentiated. 4. Terminal sac period (weeks 26 to birth). Around week
26 alveolar sacs are formed; air-blood surface area is limited for gas exchange; and
type II cells are unable to release surfactant in sufficient quantity to maintain air
breathing. Capillary loops increase; type II cells cluster at alveolar ducts, beco IUGR
asymmetrical - ANSWER Weight low for Gestation Age
Head Sparing (less restriction on brain growth)
Old man appearance
Appear wasted, thin
Results from: Poor Placental function
Maternal Hypertension*
Smoking
IUGR Symmetric - ANSWER Lower weight, height, length, and head circumference for
gestational age
Results from intrauterine viral infection, chromosomal genetic abnormalities, long
standing disease
Prostaglandin E1 (alprostadil) - ANSWER Prevent premature closure of the PDA
LATEST UPDATE
GIR - ANSWER 6-8mcg/kg/min caloric intake
D10 Bolus - ANSWER 2mL/kg
Fluid Volume Bolus - ANSWER 10mL/kg
Term Parenteral Fluid Requirement - ANSWER 80mL/kg/day
Enteral 100-150 mlk/kg/day
Preterm Parenteral Fluid Requirement - ANSWER 120
Enteral 150-200ml/kig/day
GIR Calculation - ANSWER (%dextrose x IV rate) / (6 x wt in kg)
I/T ratio - ANSWER %Metas + Bands / %Metas + Bands + Segs
I/T ratio greater than >0.2 to >.25 suggestive of infection
>0.8 associated with shock
Absolute Neutrophil COUNT - ANSWER WBC x (%) Segmented neutrophils + band
neutrophils + metamyelocytes
,Example. 15,000 x 35 segs + 15 bands + 3 metas (converts to percent)
15,000 x .53 = 7950
ANC <1800 suggestive of infection
Normal Range
Mature WBCs - ANSWER Poly, Segs, Neutrophils
Immature WBCs - ANSWER Meta, Bands, Stabs
Platelet Range - ANSWER 150-400k
Thrombocytopenia (< 100,000/mm3 ): may be related to bacterial sepsis or viral
infection but typical onset is not seen until 1 to 3 days after the onset of infection (late
sign); May also be seen with maternal HELLP syndrome (hemolysis, elevated liver
function test results, and low platelet count), pregnancy-induced hypertension, and
intrauterine growth restriction, and with some syndromes including trisomies 13,18, and
21, Turner's syndrome, and hemolytic disease.
CRP level - ANSWER CRP level usually <1.6 for the first two days of life
Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged
rupture of membranes.
Most common pathogens - ANSWER Currently, GBS
E. coli
Candidas - ANSWER -Diaper dermatitis presents with intense erythema and satellite
lesions.
-Congenital candidiasis presents with widespread erythematous maculopapular rash,
and preterm infants may present with pneumonia.
,Congenital CMV infection - ANSWER congenital infection include: intrauterine growth
restriction, hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly,
hydrocephalus, intracerebral calcifications, hearing loss, chorioretinitis, and optic
atrophy.
Endotracheal Measurement - ANSWER 6 + wt in kg
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
carina.
Polyethelane Wrap for Infant < 29 weeks - ANSWER Dry infants head only
Place infant in bag, from neck down
Remove bag when infant is in an NTE and humidified environment
UAC Placement - ANSWER High Placement T6-T9
Low Placement L3-L4
UVC Placement - ANSWER 1 to 2cm above the diaghragm
Low Lying 2-4cm in the cord
Chest Tube Placement - ANSWER Mid Clavicular line with distal chest tube hole inside
the thoracic space
lecithin/sphingomyelin (L/S) ratio - ANSWER An L/S ratio greater than 2:1 is considered
to indicate fetal lung maturity.
Anatomic events Five stages of lung development - ANSWER 1. Embryonic development
(weeks 1 to 5). The endoderm-derived embryonic foregut provides a single lung bud that
begins to divide ventrocaudally through the mesenchyme surrounding the foregut. The
pulmonary vein develops and extends to join the lung bud. The trachea develops at the
, end of the embryonic period. On the right side, there are three divisions and two on the
left side which later develop into the lobes of the lungs.
2. Pseudoglandular period (weeks 6 to 16).
All conducting airways are formed. Appearances of cartilage; formation of main
bronchi; demarcation of major lobes; new bronchi formation complete; capillary bed
formation with connecting bronchial blood supply; no connection made with terminal air
sacs. In this stage, the lung has gone through 14 generations of branching and terminal
bronchiole development. Because the loose mesenchymal tissues have enveloped the
lung at this stage, it takes the appearance of an exocrine organ, hence the name
pseudoglandular. 3. Canalicular period, from week 16 to 26.
The gas exchanging acinar units are formed, or the respiratory units.
There appears glycogen-rich cuboidal cells and inclusions for surface-active material
storage; capillaries invade terminal airway walls; type II alveolar epithelial cells appear.
Airway changes from glandular to tubular and increases in length and diameter. The
vascular system proliferates, and the capillaries are now closer to the
epithelium-conducting airways. Respiratory bronchioles that will participate in gas
exchange can be differentiated. 4. Terminal sac period (weeks 26 to birth). Around week
26 alveolar sacs are formed; air-blood surface area is limited for gas exchange; and
type II cells are unable to release surfactant in sufficient quantity to maintain air
breathing. Capillary loops increase; type II cells cluster at alveolar ducts, beco IUGR
asymmetrical - ANSWER Weight low for Gestation Age
Head Sparing (less restriction on brain growth)
Old man appearance
Appear wasted, thin
Results from: Poor Placental function
Maternal Hypertension*
Smoking
IUGR Symmetric - ANSWER Lower weight, height, length, and head circumference for
gestational age
Results from intrauterine viral infection, chromosomal genetic abnormalities, long
standing disease
Prostaglandin E1 (alprostadil) - ANSWER Prevent premature closure of the PDA
