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RNC - NIC Test 2024 /2025 | Actual Questions and Answers Latest Updated
2024/2025 (Graded A+)
Correct ETT placement - ✔✔T1-T level of clavicles Correct UVC placement - ✔✔T 8- 9 0.5-1 cm above diaphragm Tip in inf. vena cava Correct UAC placement - ✔✔Low-L3- 4 Below renal arteries High-T6- 10 Correct PICC placement - ✔✔T3- 5 Lower 1/3 of s. Vena cava Normal weight loss of preterm infant - ✔✔ 10 - 15% Healthy term infant requires how many kcal/kg/day for normal growth? - ✔✔ 100 - 120 kcal/kg/day Formula to calculate GIR - ✔✔ml/kg/day x %dextrose ➗1. Normal GIR - ✔✔ 4 - 6 ml/kg/min initially May go as high as 12 Anomalies associated with esophageal atresia - ✔✔SGA VATER synd.
- vertebral
- imperf anus
- renal dysplasia Increased risk of mec plug? - ✔✔-premature
- IDM
- small left colon
- cystic fibrosis Signs of pyloric stenosis - ✔✔Distended stomach on x-ray with little or no gas below duodenum Can palpate "olive" Present at 2 to 3 weeks of life with Bile stained vomiting Normal temp range axillary - ✔✔36.5 to 37.4°C TTN vs RDS - ✔✔Usually requires less than 40% FI O Improves quicker Larger lung volumes Natural diuresis occurs at_____________ hours of age as condition improves - ✔✔ 48 - 72 hours Prolonged rupture of membranes - ✔✔Greater than 18 hours Difference in PaO2 of________ or greater documents ductal shunting - ✔✔15% With PPHN goal is to keep PaO2 ________or > - ✔✔ 50 Signs and symptoms of MAS - ✔✔Chest hyperinflated on x-ray
Assess and treat PDA Treat underlying disease processes Apneic event - ✔✔Cessation of respiration for 20 seconds, or less if accompanied by cyanosis, pallor, decreased tone, bradycardia Causes pulmonary hypoplasia - ✔✔1) conditions that limit lung growth (CCAM, DH)
- oligohydramnios (thoracic compression)
- associated congenital malformations (Potters, phrenic nerve absence) Normal blood gas results - ✔✔ph 7.35-7. PaCO2 35- 45 PaO2 50- 80 HCO3 22- 26 BE - 2 to + Vent Setting VT (tidal volume) - ✔✔-Primary factor affecting oxygenation and ventilation
- should be 4-5 ml/kg Vent Settings
- To increase ventilation - ✔✔Increase rate Vent settings
- to increase oxygenation - ✔✔Increase FiO2, PEEP, or VT
Inclusion criteria for ECMO - ✔✔1) GA > 34 weeks
- BE > 2000 grams
- reversible lung disease
- no lethal anomalies or brain injuries
- IVH Gr 2 or <
- no significant bleeding issues Vent Setting Rate - ✔✔Set rate at 30-40/minute for respiratory failure Set rate at 20-30/minute for no respiratory failure Adjust to maintain PCO2 40- 50 Rate >40/minute can lead to air trapping Vent setting PIP - ✔✔Determines VT and affects PaO Determined by weight, GA, lung compliance, & airway resistance 20 is appropriate for most preterm infants Look at chest wall movement Vent Setting PEEP - ✔✔Physiologic PEEP is about 2cm Usually set at 4-7cm
7 can cause air leaks Aids maintaining FRC Stabilizes and recruits atelectatic areas Increase compliance and V/Q mismatch Vent setting MAP - ✔✔Average distending pressure throughout complete respiratory cycle Major determinant of oxygenation Increased MAP causes barotrauma
Boot shaped heart on x-ray is diagnostic of - ✔✔Tetrology of Fallot CHD's with increased pulmonary bloodflow - ✔✔1) PDA
- VSD
- ASD
- endocardial cushion defect Most common CHD - ✔✔VSD (nearly 50%) Treatment of VSD - ✔✔ 50 - 75% of small VSDs close on their own Large VSDs may get smaller Treat mild CHF with Digoxin and diuretics Surgery at 6 to 12 months of age if needed ASD s/s - ✔✔Failure to thrive Recurrent respiratory infections Most common CHD with Trisomy 21 - ✔✔Endocardial cushion defect Obstructive CHD's with pulmonary venous congestion - ✔✔1) coarctation of aorta
- aortic stenosis Most common CHD associated with Turner's syndrome - ✔✔Coarctation of aorta Treatment of coarctation of aorta - ✔✔Treat CHF aggressively PGE1 to maintain DA Surgical repair (can reoccur)
Aortic stenosis signs/symptoms - ✔✔None at birth Grade 2-6 harsh systolic murmur in upper RSB CHF S/S delayed by weeks but progresses rapidly Aortic stenosis treatment - ✔✔If critical PGE to maintain DA. First, balloon valvuloplasty (usually successful) Surgery if fails Obstructive defects with decreased pulmonary blood flow - ✔✔1) TOF
- pulmonary stenosis
- pulmonary atresia
- tricuspid atresia Most common cyanotic heart lesion - ✔✔TOF TOF on chest x-ray - ✔✔Boot shaped heart, normal size Components of TOF - ✔✔1) pulmonary stenosis
- VSD
- aorta overrides VSD
- RV hypertrophy Mixed CHD - ✔✔1) TGV
- Truncus arteriosus
- TAPVR
- HLHS Truncus arteriosus associated with which syndrome - ✔✔Di George Syndrome
Apert's syndrome - ✔✔Pyloric stenosis TEF/EA CHD Beckwith-Wiedeman - ✔✔Umbilical defect Posterior diaphragmatic hernia Pancreatic hyperplasia with low glucoses Fetal Dilantin syndrome - ✔✔Umbilical hernia Duodenal atresia Hypoplasia of nails and distal phalanges Craniofacial abnormalities Constellation of growth and performance delays Meckel-Gruber Syndrome - ✔✔Liver defects Patent urachus Omphalocele Malrotation Imperforate anus Sirenomelia - ✔✔Imperforate anus Trisomy 13 - ✔✔Malrotation CHD Coloboma Growth restriction Microcephaly Low-set malformed ears
Cleft lip & palate Holoproencephaly Cardiac malformation Omphalocele Renal malformation Trisomy 18 - ✔✔Umbilical defect Pyloric stenosis Malrotation TEF/EA CHD Abnormal Muscle tone Microcephaly Short sternum Low-set malformed ears Single umbilical artery Rocker bottom feet Growth deficiencies Craniofacial defects Acutis aplasia Polydactyly Single Palmer crease hand posturing with second and fifth digits overlapping third and fourth Cri du chat syndrome - ✔✔ Cardiac anomalies associated with IDM babies - ✔✔VSD TGV PDA
AST & ALT - ✔✔-most sensitive test for hepatocellular necrosis
- ALT more specific
- greater than 300+ Jaundice equals liver disease Gastroschisis - ✔✔Herniation of bowel through abdominal wall defect Predominately to right side Associated with prematurity, intestinal malrotation, and atresia Omphalocele - ✔✔Defective of abdominal wall into umbilical cord Often associated with a syndrome or other defects Diagnosis of gastroschisis or omphalocele - ✔✔Elevated AFP Treatment of gastroschisis or omphalocele - ✔✔Place in sterile owl bag Cover defect with warm sterile moist dressings Maintain NPO and gastric decompression Maintain sidelying position Bilious vomiting - ✔✔An obstruction distal to Ampulla of Vater s/s of TEF/EA - ✔✔Copious oral secretions, drooling Polyhydramnios Small stomach on ultrasound Coughing, choking, respiratory distress, or cyanosis Recurrent pneumonia Infants with EA or TEF should have an evaluation of which three systems? - ✔✔1) cardiac system
- renal system
- skeletal system Treatment of TEF/EA (pre-op) - ✔✔Elevate HOB Ventrol to drain Minimize crying to decrease swallow air No CPAP, intubate if need respiratory support Treatment of TEF/EA (post-op) - ✔✔Ventilate with low MAP Avoid need to re-intubate & only by experienced practitioners Suction length of ETT only Pyloric stenosis - ✔✔Obstruction of pylorus caused by hypertrophy of pyloric musculature Associated with Apert's syndrome trisomy 18 and trisomy 21 Pyloric stenosis incidence - ✔✔More common in white, full-term infants Trisomy 21 Males 5: Pyloric stenosis treatment - ✔✔May resolve spontaneously before one year of life Provide nutritional support May need surgical repair Duodenal stenosis atresia associated with - ✔✔Trisomy 21 CHD Intestinal malrotation TE abnormalities Anorectal defects
(draws fluid into the intestine) Works for 60% of patients Surgical treatment Meconium plug syndrome - ✔✔A mechanical obstruction (usually in the distal segment of the colon and rectum) in the absence of an abnormality of ganglion cells or enzyme deficiency Mec plug syndrome, Causes - ✔✔1) IDM
- elevated mag level
- prematurity
- sepsis
- decreased tone due to CNS diagnosis Hirschsprung Disease - ✔✔A non-Mendelian congenital genetic absence of parasympathetic innervation to colon Involved intestine unable to relax, leading to functional obstruction Hirschsprung disease associated anomalies - ✔✔Sensorineural deafness Cardiovascular, skeletal, and limb anomalies Seen with the DiGeorge and X-linked Acueductal stenosis syndromes 3 to 10% of trisomy 21 have Hirschsprung's disease Ocular neuropathies Hirschsprung's disease treatment - ✔✔Rectal biopsy to confirm Surgical repair to remove parts of affected bowel NEC - ✔✔Cause thought to be multifactorial
- bowel ischemia
- bacterial colonization of gut
- enteral feeding Short bowel syndrome - ✔✔1) loss of stomach (well tolerated vitamin B 12 given to prevent anemia)
- loss of jejunum (major site of digestion and absorption) (tolerate well, other areas take over)
- loss of ileum (significant metabolic and nutritional consequences) Biliary atresia - ✔✔Obstruction of bile flow in bile duct system Bile fails to exit liver, leads to hepatic failure and fibrosis Biliary atresia treatment - ✔✔Best outcome- portoenterostomy followed by liver transplant Eagle-Barrett Syndrome - ✔✔1) absent abdominal musculature
- GU tract abnormalities
- undescended testicles Oligohydramnios Congenital diaphragmatic hernia Associated with - ✔✔Trisomy 13 Trisomy 18 Trisomy 21, Trisomy 45 Trisomy X Intestinal malrotation Congenital Diaphragmatic hernia
Hydrops fetalis causes - ✔✔Immune (Rh & ABO) Nonimmune
- CV-dysrhythmias, CHD, myocarditis
- chromosomal-trisomies, Turner's, achondroplasia
- infection-TORCH, parvovirus, congenital hepatitis
- hematologic-thalassemia, twin to twin transfusion, bone morrow failure
- renal-urinary obstruction
- pulmonary-hyperplasia, CCAM, CHD
- GI-in utero volvulus, Mec peritonitis, prune belly syndrome
- maternal-DM, SLE, toxemia
- placental/Cord- Chorioangioma, UV thrombosis, AV malformation
- idiopathic Immediate care of infant with hydrops - ✔✔Resuscitation Thoracentesis Pericardiocentesis Respiratory support CV support Transfusions Congenital adrenal hyperplasia (CAH) - ✔✔A group of autosomal recessive genetic disorders resulting from deficient activity of enzyme required to synthesize cortisol from cholesterol in adrenal cortex Most common cause of ambiguous genitalia Congenital adrenal hyperplasia (CAH) Treatment - ✔✔1) Restore physiological levels of cortisol
- suppress ACTH & androgen overproduction
- Watch fluid and electrolytes (esp low Na)
- lifelong here, may need increased doses of cortisol with illness Adrenal crisis and signs of cortisol insufficiency - ✔✔Complication of CAH S/S include shock, low blood pressure, acidosis, low glucose, seizures, sodium depletion Normal CBC values - ✔✔Hgb- 14 - 16 Hct- 45 - 55 Plts- 150 - 400 thousand Normal infant blood volume - ✔✔Term- 80 - 100 ml/kg Preterm- 90 - 105 ml/kg Physiological anemia of infancy - ✔✔Hemoglobin levels decline after birth Reaches physiologic nadir at 8-12 weeks RhoGAM given - ✔✔At 28 weeks Within 72 hours of delivery, amnio, or CV sampling Within 72 hours of possible maternal/fetal hemorrhage transfusion dose - ✔✔ 10 - 20 ml/kg Hemorrhagic disease of the newborn - ✔✔1) vitamin K deficiency
- decreased activity of factors II, VII, IX, X Polycythemia - ✔✔Hgb > 22 Hct > 65%
