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Neonatal Intensive Care Nursing Practice Test

RNC-NIC exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Number of Questions: The examination consists of 175 multiple-choice questions.
Duration: Candidates are given 3 hours to complete the exam.
Passing Score: The passing score may vary; candidates are encouraged to check the NCC website for the most current passing standards.

- Antepartum Risk Factors and Birth History
- Effects of maternal medical complications
- hematologic
- thrombocytopenia
- hypertension
- chronic- gestational hypertension- HELLP Syndrome
- infections
- CMV- Toxoplasmosis- syphilis- herpes- hepatitis- HIV- gonorrhea- chlamydia
- renal disease
- Problems associated with amniotic fluid and membranes
- amniotic bands
- oligohydramnios
- polyhydramnios
- PROM and chorioamnionitis
- Significance of findings:
- alpha-fetoprotein/triple quad/screen
- biophysical profile
- diagnostic ultrasound
- Recognize neonatal significance of fetal heart rate patterns
- altered variability
- decelerations
- early- late- variable
- tachycardia- bradycardia

- Effects of maternal medications on the neonate
- tocolytics
- analgesia- anesthesia
- Problems in labor - impact on the neonate
- breech and other malpresentation
- maternal hemorrhage
- meconium
- Obstetric emergencies (impact on the neonate)
- abruptio placenta
- cord prolapse
- placenta previa
- Impact of methods of delivery on the neonate
- forceps- vacuum- cesarean

- Physical and Gestational Age Assessment
- Interpretation of growth curves
- weight- length and head circumference
- Physical and neuromuscular characteristics
- preterm
- term
- post-term
- AGA
- SGA
- LGA
- Associated risks with
- Preterm
- post-term
- SGA/IUGR
- LGA

- Normal/abnormal findings regarding:
- general appearance
- head- eyes- ears- nose & throat
- neck
- chest
- cardiovascular
- respiratory
- abdomen
- genitalia
- extremities
- spine/back
- skin
- maintaining skin integrity
- neuromuscular and reflexes

- Resuscitation and Stabilization
- Neonatal Cardiopulmonary Resuscitation (Per the American Heart Association & the American Academy of Pediatrics)
- initial evaluation (ABC)
- indications for ventilation
- indications for intubation
- indications for cardiac compressions
- medications
- Use of drugs
- epinephrine
- volume expanders
- Resuscitation and stabilization of the neonate with
- diaphragmatic hernia
- hydrops fetalis
- perinatal asphyxia
- upper airway obstruction

- Fluids- Electrolytes- and Glucose Homeostasis
- Normal fluid and electrolyte requirements
- Monitoring fluid and electrolyte status
- electrolytes
- urine output
- Effects of
- humidity
- maturity
- temperature
- Specific problems
- dehydration and overhydration
- gastrointestinal abnormalities
- insensible water loss
- patent ductus arteriosus
- post-asphyxia
- third spacing
- Parenteral fluid therapy

- Nutrition and Feeding
- Nutritional requirements and effects of excess & deficiency
- calories
- carbohydrates
- fat
- minerals
- protein
- vitamins
- Enteral feeding
- minimal enteral feedings (gut priming)
- gavage feeding
- bolus vs continuous feedings
- feeding cues
- feeding techniques
- bottle feeding
- formula composition

- breast feeding
- stimulating production
- composition of breast milk
- donor milk
- Parenteral nutrition
- indications
- composition
- complications
- Dietary supplements
- breast milk fortifiers
- glucose polymers
- iron
- MCT
- Vitamins
- probiotics
- Nutritional management for
- bronchopulmonary dysplasia
- prematurity
- short gut syndrome

- Oxygenation- Ventilation and Acid Base Homeostasis
- Oxygenation: interpretation and management
- hypoxia/hypoxemia
- oxygen saturation
- principles re: increasing/ decreasing FiO2 levels
- pulse oximeter
- Methods of oxygenation/ ventilation
- indications- complications
- noninvasive ventilation
- extracorporeal membrane oxygenation (ECMO)
- high flow nasal cannula

- Mechanical ventilation
- conventional
- high frequency
- other methods of oxygen delivery (hood- nasal cannula)
- Blood gases: interpretation and management
- metabolic acidosis (compensated & uncompensated)
- metabolic alkalosis (compensated & uncompensated)
- respiratory acidosis (compensated & uncompensated)
- respiratory alkalosis (compensated & uncompensated)
- mixed
- serum lactate

- Thermoregulation and Integumentary
- Mechanisms of heat loss and production
- assessment of thermal state
- responses to hypothermia and cold stress
- responses to hyperthermia
- Maintaining a neutral thermal environment
- Management of thermoregulation problems
- evaporation
- conduction
- convection
- radiation
- hypothermia and cold stress
- hyperthermia
- Equipment
- Incubators and radiant warmers
- Heat mattresses and wraps
- Skin Care

- Pharmacology- Pharmacokinetics and Pharmacodynamics
- Principles of neonatal pharmacology
- administration methods/issues
- absorption from GI tract- skin and muscle
- blood drug levels (toxic vs therapeutic)
- drug distribution in the body
- drug excretion
- drug incompatibilities
- drug withdrawal (therapeutic drugs)
- drug resistance
- Dosage calculations

- Common drugs
- anesthetics and analgesia (sedatives)
- antibiotics
- anticonvulsants
- antiviral drugs
- bronchodilators
- cardiovascular agents
- CNS stimulants (caffeine- etc)
- Diuretics
- muscle relaxants
- Management of the drug exposed neonate
- Fetal alcohol syndrome
- Neonatal abstinence syndrome and scoring
- Substance use and abuse
- Laboratory drug testing

- Neuroprotective and Neurodevelopmental Care
- Neurobehavioral development
- Habituation
- motor organization
- state organization
- sensory/interaction capabilities
- Self-regulatory (stability) and stress responses
- autonomic
- motoric
- state/sleep cycles
- attentional
- Impact of the NICU environment
- physical
- light
- sound
- social
- caregiver-infants interactions
- patterns of caregiving

- Intervention strategies
- reducing noise levels
- reducing light levels/diurnal patterns
- altering care patterns
- handling/positioning
- kangaroo care/skin-to-skin
- nonnutritive sucking
- Provision of sensory experiences
- auditory
- tactile
- visual
- vestibular and proprioceptive
- Pain
- assessment
- non-pharmacologic interventions

- Cardiovascular
- Transition to Extrauterine Life
- Cyanosis
- central vs peripheral
- cardiac vs pulmonary
- Specific Problems
- For all problems: presentation/assessment causes- management- complications- outcome
- arrhythmias
- cardiac tamponade
- congestive heart failure
- congenital heart defects
- AV canal

- coarctation of the aorta
- hypoplastic left heart
- pulmonary stenosis and atresia
- tetralogy of fallot
- transposition of the great vessels
- total anomalous pulmonary venous return
- ventricular septal defect
- cyanotic vs acyanotic disease
- hypertension
- patent ductus arteriosus
- shock
- Cardiovascular assessment
- blood pressure
- EKG
- cardiopulmonary monitoring
- indwelling lines

- Respiratory
- Normal pulmonary function- surfactant
- Specific respiratory problems
- For all problems: presentation/assessment causes- management- complications- outcome
- apnea of prematurity
- bronchopulmonary dysplasia
- diaphragmatic hernia/paralysis
- hypoplastic lungs
- meconium aspiration
- persistent pulmonary hypertension
- pneumothorax/air leaks

- pulmonary hemorrhage
- respiratory distress syndrome
- transient tachypnea of the newborn•
- newborn• Specific therapies
- For all problems: presentation/assessment causes- management- complications- outcome
- endotracheal intubation
- suctioning
- surfactant replacement therapy
- chest tubes and drainage systems

- Gastrointestinal/Genitourinary
- Normal gastrointestinal function
- Maturation of GI tract
- Specific GI problems
- For all problems: presentation/assessment- causes- management- complications- outcome
- GE reflux
- GI bleeds perforation/peritonitis
- Hirschsprung’s disease
- intestinal obstructions (duodenal- jejunal- ileal-
- imperforate anus)
- meconium ileus/plug

- malrotation/volvulus
- necrotizing enterocolitis
- omphalocele/gastroschisis
- short gut syndrome
- ostomy care
- colitis
- bloody stools
- protein allergies

- Renal function/urinary output
- Specific genitourinary problems
- For all problems: presentation/assessment- causes- management- complications- outcome
- Genital
- ambiguous genitalia
- inguinal hernia
- testicular torsion
- Urinary tract
- asphyxial renal damage
- renal abnormalities
- renal failure
- renal vein thrombosis

- Hematopoietic
- Interpret laboratory values
- CBC
- hematocrit- hemoglobin
- platelets
- total and direct serum bilirubin
- direct and indirect antibody test
- Kleihauer Betke test
- Developmental differences
- fetal vs adult hemoglobin
- RBC differences
- Administration of blood and blood products
- techniques
- risks

- Hyperbilirubinemia
- physiologic jaundice
- causes of direct hyperbilirubinemia
- causes of indirect hyperbilirubinemia
- phototherapy
- Specific hematologic problems
- anemia
- coagulopathies/DIC
- polycythemia and hyperviscosity
- Rh and ABO incompatibility/ hydrops fetalis
- Thrombocytopenia

- Neurological/ Neuromuscular/Musculoskeletal
- Birth injuries (neuromuscular)
- Hydrocephalus
- Hypoxic ischemic encephalopathy
- Neural tube defects
- Germinal matrix hemorrhage
- Intraventricular hemorrhage
- Periventricular leukomalacia
- Seizures
- Subdural hemorrhageVI
- hemorrhageVI. Genetic- Metabolic and Endocrine

- Interpret laboratory values
- calcium- phosphorus magnesium
- glucose
- Metabolic screening
- PKU
- Thyroid
- CAH
- Sickle cell
- Galactosemia
- Glucose homeostasis

- Specific metabolic/endocrine problems
- For all problems: presentation/ assessment- causes- management- complications- outcome
- hypocalcemia and hypercalcemia
- rickets
- hypoglycemia and hyperglycemia
- infant of diabetic mother
- thyroid disorders
- adrenal disorders

- Mendelian inheritance patterns
- autosomal recessive
- autosomal dominant
- sex-linked
- Chromosomal anomalies and diseases
- Trisomy 13
- Trisomy 18
- Trisomy 21
- Multifactorial diseases
- DiGeorge
- Turners

- Head- Eyes- Ears- Nose and Throat
- Eye prophylaxis
- Specific problems
- cephalhematoma
- choanal atresia
- cleft palate/lip
- retinopathy of prematurity
- tracheal stenosis/atresia
- tracheomalacia
- tracheostomy
- vocal cord paralysis
- subgaleal
- trachea-esophageal atresia (TEF)
- esophageal atresia
- micrognathia
- micrognathiaVIII. Infection and Immunology

- Interpret laboratory values
- WBC and differential
- cerebrospinal fluid
- Immature host defenses
- Neonatal sepsis/meningitis
- Viral and fungal infections
- candidiasis
- cytomegalovirus
- hepatitis B
- herpes
- HIV/AIDS
- toxoplasmosis
- varicella

- Specific bacterial infections such as E coli infection
- Group B Streptococcal infection
- Early/late onset
- staphylococcal infection
- syphilis
- enterovirus
- Infection control procedures
- nosocomial infection

- Discharge Management- Family-Centered Care- Grieving- Palliative Care- Mental Health
- General discharge planning and parent teaching
- car seats
- CPR
- CCHD screening
- feeding
- immunizations
- SIDS/safe sleep/plagiocephaly
- Visitors
- Shaken baby

- Discharge planning and parent teaching for infants with special needs
- nutrition
- medications
- special equipment needs
- special care needs
- developmental follow up
- visual screening
- hearing screening
- motor delay (including cerebral palsy)
- cognitive/language delay
- Anticipatory grief
- Stages of grieving and common behaviors and interventions
- Factors which impede\enhance grief process
- Pathologic responses
- Maternal/paternal differences (incongruent grieving)

- Specific circumstances
- chronic sorrow
- death of a twin (triplets- etc)
- repeated obstetric loss (recurrent abortion-
- stillbirth- preterm delivery)
- sibling responses
- Support systems and referrals
- bereavement groups
- parent support groups
- palliative care
- Parent-infant attachment behaviors
- Parental stress responses
- high risk birth
- changes in status
- transfer

- Barriers to parent infant interaction
- Specific circumstances
- adolescent parents
- grandparents and other extended family
- long distance nurturing of parent/ infant attachment
- sibling responses and interventions
- Specific interventions with parents and extended family
- counseling techniques
- parent teaching
- Shared decision making
- parent-staff disagreements
- regarding treatment
- Principles of culturally sensitive care
- Maternal psychiatric issues
- Post-traumatic stress disorder
- Post-partum depression

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Nursing
RNC-NIC
NCC Neonatal Intensive Care Nursing 2026
https://killexams.com/pass4sure/exam-detail/RNC-NIC
Question: 1175
During a family meeting, a nurse notices a conflict between parents and staff regarding the proposed
treatment plan for their critically ill infant. What strategy should the nurse utilize to promote shared
decision-making while addressing the parents' concerns?
A. Reassure parents that the staff's experience is sufficient
B. Insist on the medical team's authority in making decisions
C. Facilitate an open discussion where parents can voice their concerns
Answer: C
Explanation: Facilitating an open discussion allows parents to express their concerns and feel heard,
paving the way for collaborative decision-making in the context of their infant's care.
Question: 1176
A healthcare provider is assessing a post-term neonate who exhibits signs of lethargy and poor feeding.
Which of the following complications should be considered?
A. Hyperthermia
B. Hypoglycemia
C. Neonatal abstinence syndrome
Answer: B
Explanation: Post-term neonates are at an increased risk for hypoglycemia, particularly if there is a
history of maternal diabetes or if the infant is not feeding effectively.
Question: 1177
A nurse is evaluating a neonate with suspected hypoxic-ischemic encephalopathy (HIE). Which of the
following findings is most concerning?
A. Hypertonia
B. Seizures
C. Lethargy
Answer: B
Explanation: The presence of seizures in a neonate with suspected HIE is concerning and typically
indicates significant neurological impairment.
Question: 1178
A healthcare provider is assessing an infant with a suspected diagnosis of cleft lip and palate. Which
finding would support this diagnosis during the physical examination?
A. Asymmetrical facial features
B. Abnormal respiratory sounds
C. Excessive drooling
Answer: A
Explanation: Asymmetrical facial features are characteristic of cleft lip and palate, indicating the presence
of the condition.
Question: 1179
A nurse assesses an infant with suspected heart failure and notes a gallop rhythm on auscultation. What
does this finding suggest?
A. Increased fluid overload
B. Normal heart function
C. Ventricular hypertrophy
Answer: A
Explanation: A gallop rhythm indicates increased fluid overload, which is commonly associated with
heart failure in neonates.
Question: 1180
A nurse is reviewing the formula composition for a neonate. Which component is most critical to
monitor in a low-birth-weight infant to prevent metabolic complications?
A. Total carbohydrate content
B. Electrolyte balance
C. Protein concentration
Answer: B
Explanation: Monitoring electrolyte balance is critical in low-birth-weight infants to prevent metabolic
complications, as they are at higher risk for imbalances that can affect overall health.
Question: 1181
In a case of meconium aspiration syndrome, which of the following laboratory findings is most likely to
be present?
A. Metabolic acidosis
B. Elevated white blood cell count
C. High blood pH level
Answer: A
Explanation: Meconium aspiration syndrome often leads to respiratory distress and can result in
metabolic acidosis due to impaired gas exchange and subsequent hypoxia.
Question: 1182
A nurse is discussing the factors that can impede the grieving process with a family. Which of the
following factors is least likely to be considered a barrier to effective grieving?
A. Experiencing unresolved feelings of guilt.
B. Engaging in avoidance behaviors.
C. Having a strong support system in place.
Answer: C
Explanation: A strong support system can facilitate the grieving process, while avoidance behaviors and
unresolved guilt are barriers that can hinder emotional healing.
Question: 1183
When assessing the nutritional needs of a neonate receiving donor breast milk, which of the following
factors should the nurse consider to ensure adequate nutrition?
A. The donor's dietary habits
B. The age of the donor milk
C. The infant's specific caloric needs
Answer: C
Explanation: Considering the infant's specific caloric needs is essential to ensure that the nutritional
requirements are met, as donor milk may need fortification to provide adequate nutrients for growth.
Question: 1184
A full-term neonate presents with seizures, and after further investigation, it is found that the infant has
suffered a hypoxic ischemic encephalopathy (HIE) event during delivery. Which of the following
interventions is considered a priority in the management of this condition?
A. Immediate initiation of phenobarbital
B. Continuous EEG monitoring
C. Administration of therapeutic hypothermia
Answer: C
Explanation: Therapeutic hypothermia is the standard of care for managing HIE in neonates, as it has
been shown to reduce the risk of long-term neurological impairment.
Question: 1185
A 32-week gestation pregnant woman has been diagnosed with a cytomegalovirus (CMV) infection.
Which of the following complications is most closely associated with this maternal infection for the
neonate?
A. Congenital heart defects
B. Microcephaly and sensorineural hearing loss
C. Neonatal respiratory distress syndrome
Answer: B
Explanation: CMV is known to cause significant neurological complications in neonates, including
microcephaly and sensorineural hearing loss, making it a critical infection to monitor during pregnancy.
Question: 1186
In managing a newborn with respiratory distress syndrome, which of the following therapies is
considered a standard intervention prior to the administration of surfactant?
A. High-flow nasal cannula oxygen therapy
B. Inhaled nitric oxide therapy
C. Controlled mechanical ventilation
Answer: C
Explanation: Controlled mechanical ventilation is often initiated prior to surfactant administration to
provide adequate ventilation and oxygenation in infants with RDS.
Question: 1187
In a family-centered care environment, a nurse is discussing the importance of parental involvement in
the NICU. Which of the following best illustrates a parent's active engagement in their infant's care?
A. Visiting the NICU only during designated hours
B. Delegating all care responsibilities to healthcare providers
C. Participating in care activities, such as diaper changes and feeding
Answer: C
Explanation: Actively participating in care activities helps parents feel more connected to their infant and
fosters a sense of competence and confidence in their parenting role.
Question: 1188
A nurse is discussing the potential consequences of overfeeding a neonate receiving enteral nutrition.
Which of the following conditions is most likely to occur if overfeeding is not managed appropriately?
A. Hypernatremia
B. Gastroesophageal reflux
C. Necrotizing enterocolitis
Answer: C
Explanation: Overfeeding can lead to necrotizing enterocolitis, a serious condition that can occur due to
excessive volume causing ischemia and inflammation in the intestines.
Question: 1189
During a routine assessment, a nurse notes a significant increase in bilirubin levels in a 5-day-old infant
who is exclusively breastfed. Considering the potential causes of indirect hyperbilirubinemia, which
condition should the nurse suspect is contributing to this infant's jaundice?
A. Physiologic jaundice
B. Hemolytic disease of the newborn
C. Breast milk jaundice
Answer: C
Explanation: Breast milk jaundice can occur in infants who are breastfeeding and is due to substances in
breast milk that inhibit bilirubin conjugation, typically appearing after the first week of life.
Question: 1190
A nurse is preparing to discharge a preterm infant who required a prolonged NICU stay. Which follow-up
is most critical?
A. Neurodevelopmental assessment
B. Routine pediatrician visit
C. Immunization status check
Answer: A
Explanation: A neurodevelopmental assessment is critical for preterm infants due to their increased risk
of developmental delays and disabilities.
Question: 1191
A neonate is being cared for in the NICU, and the nurse is implementing neurodevelopmental care
strategies. Which of the following interventions would best promote positive sensory interactions?
A. Encouraging gentle, rhythmic touch during care
B. Providing limited opportunities for tactile stimulation
C. Keeping the neonate in a quiet, isolated area
Answer: A
Explanation: Encouraging gentle, rhythmic touch during care promotes positive sensory interactions,
fostering the infant's neurodevelopment and supporting their ability to engage with caregivers.
Question: 1192
A nurse is assessing a child with Williams syndrome, which is caused by a deletion on chromosome 7.
Which of the following features would most likely be present in this condition?
A. Distinctive facial features and cardiovascular problems
B. Tall stature and learning disabilities
C. Cardiac defects and webbed neck
Answer: A
Explanation: Williams syndrome is characterized by distinctive facial features, such as a broad forehead
and a small chin, as well as cardiovascular problems, particularly aortic stenosis.
Question: 1193
During a routine assessment, a post-term neonate shows signs of meconium aspiration syndrome. What
underlying condition should be prioritized in the assessment of this neonate?
A. Congenital heart disease
B. Increased risk of infection
C. Fetal distress during labor
Answer: C
Explanation: Post-term neonates are at a higher risk for meconium aspiration syndrome, often related to
fetal distress during labor, which can lead to the release of meconium into the amniotic fluid.
Question: 1194
A nurse is caring for an infant diagnosed with colitis. The mother expresses concern about the infant's
frequent diaper changes due to diarrhea. What is the best response by the nurse?
A. "This is a normal part of colitis."
B. "We will need to adjust the feeding plan."
C. "Frequent diaper changes will help prevent skin breakdown."
Answer: C
Explanation: Frequent diaper changes are important to prevent skin irritation and breakdown in infants
with diarrhea, especially in those with colitis.
Question: 1195
In managing neonatal seizures, which of the following first-line medications is commonly used?
A. Valproic acid
B. Phenytoin
C. Phenobarbital
Answer: C
Explanation: Phenobarbital is often the first-line medication for managing seizures in neonates due to its
efficacy and safety profile.
Question: 1196
A nurse is preparing to assess a neonate?s oxygen saturation using a pulse oximeter. Which site is
considered the most reliable for accurate readings in neonates?
A. Earlobe
B. Foot
C. Finger
Answer: B
Explanation: The foot is often considered the most reliable site for pulse oximetry readings in neonates,
especially when peripheral perfusion is poor.
Question: 1197
A nurse is educating parents about the importance of follow-up care for their infant diagnosed with Rh
incompatibility. Which statement by the parents indicates an understanding of their infant's ongoing care
needs?
A. "Feeding will prevent any serious issues."
B. "We won't need to monitor anything since the baby is fine now."
C. "We need to come back for bilirubin level checks."
Answer: C
Explanation: Regular bilirubin level checks are critical for infants with a history of Rh incompatibility to
monitor for potential rebound hyperbilirubinemia.
Question: 1198
A pregnant woman is found to have a positive HIV test. What is the most critical intervention to reduce
the risk of perinatal transmission?
A. Avoiding breastfeeding
B. Administering antiretroviral therapy during labor
C. Ensuring a routine cesarean delivery
Answer: B
Explanation: Administering antiretroviral therapy during labor can significantly reduce the viral load and
the risk of transmission to the neonate.
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