Neonatal Intensive Care Nursing Practice Test

RNC-NIC test Format | Course Contents | Course Outline | test Syllabus | test 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 2025
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Question: 1175
ent plan for their critically ill infant. What strategy should the nurse utilize to promote share on-making while addressing the parents' concerns?
assure parents that the staff's experience is sufficient
st on the medical team's authority in making decisions
ilitate an open discussion where parents can voice their concerns er: C
nation: Facilitating an open discussion allows parents to express their concerns and feel hear the way for collaborative decision-making in the context of their infant's care.
ion: 1176
thcare provider is assessing a post-term neonate who exhibits signs of lethargy and poor fee of the following complications should be considered?
perthermia poglycemia
onatal abstinence syndrome er: B
nation: Post-term neonates are at an increased risk for hypoglycemia, particularly if there is a of maternal diabetes or if the infant is not feeding effectively.
During a family meeting, a nurse notices a conflict between parents and staff regarding the proposed treatm d
decisi
1. Re
2. Insi
3. Fac Answ
Expla d,
paving
Quest
A heal ding.
Which
1. Hy
2. Hy
3. Ne
Answ Expla
history
Question: 1177
A nurse is evaluating a neonate with suspected hypoxic-ischemic encephalopathy (HIE). Which of the following findings is most concerning?
1. Hypertonia
2. Seizures
3. 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?
1. Asymmetrical facial features
cessive drooling er: A
nation: Asymmetrical facial features are characteristic of cleft lip and palate, indicating the pr ondition.
ion: 1179
nurse assesses an infant with suspected heart failure and notes a gallop rhythm on auscultation. W his finding suggest?
reased fluid overload rmal heart function ntricular hypertrophy
er: A
nation: A gallop rhythm indicates increased fluid overload, which is commonly associated wi ailure in neonates.
ion: 1180
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?
Abnormal respiratory sounds
2. Ex
Answ
Expla esence
of the c
Quest
A hat
does t
1. Inc
2. No
3. Ve
Answ
Expla th
heart f Quest A
1. Total carbohydrate content
2. Electrolyte balance
3. 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?
1. Metabolic acidosis
2. Elevated white blood cell count
3. High blood pH level Answer: A
nation: Meconium aspiration syndrome often leads to respiratory distress and can result in olic acidosis due to impaired gas exchange and subsequent hypoxia.
ion: 1182
nurse is discussing the factors that can impede the grieving process with a family. Which of the ing factors is least likely to be considered a barrier to effective grieving?
periencing unresolved feelings of guilt. gaging in avoidance behaviors.
ving a strong support system in place. er: C
nation: A strong support system can facilitate the grieving process, while avoidance behavior lved guilt are barriers that can hinder emotional healing.
ion: 1183
ssessing the nutritional needs of a neonate receiving donor breast milk, which of the follow should the nurse consider to ensure adequate nutrition?
donor's dietary habits age of the donor milk
infant's specific caloric needs
Expla metab
Quest
A
follow
1. Ex
2. En
3. Ha
Answ
Expla s and
unreso
Quest
When a ing
factors
1. The
2. The
3. The 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?
1. Immediate initiation of phenobarbital
2. Continuous EEG monitoring
3. 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.
ion: 1185
week gestation pregnant woman has been diagnosed with a cytomegalovirus (CMV) infectio of the following complications is most closely associated with this maternal infection for th
?
ngenital heart defects
crocephaly and sensorineural hearing loss onatal respiratory distress syndrome
er: B
nation: CMV is known to cause significant neurological complications in neonates, including cephaly and sensorineural hearing loss, making it a critical infection to monitor during pregn
ion: 1186
naging a newborn with respiratory distress syndrome, which of the following therapies is ered a standard intervention prior to the administration of surfactant?
gh-flow nasal cannula oxygen therapy aled nitric oxide therapy
ntrolled mechanical ventilation
er: C
Quest
A 32- n.
Which e
neonate
1. Co
2. Mi
3. Ne
Answ Expla
micro ancy.
Quest
In ma consid
1. Hi
2. Inh
3. Co
Answ
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?
1. Visiting the NICU only during designated hours
2. Delegating all care responsibilities to healthcare providers
3. 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
of the following conditions is most likely to occur if overfeeding is not managed appropriat
pernatremia stroesophageal reflux crotizing enterocolitis
er: C
nation: Overfeeding can lead to necrotizing enterocolitis, a serious condition that can occur d ive volume causing ischemia and inflammation in the intestines.
ion: 1189
a routine assessment, a nurse notes a significant increase in bilirubin levels in a 5-day-old i exclusively breastfed. Considering the potential causes of indirect hyperbilirubinemia, whic ion should the nurse suspect is contributing to this infant's jaundice?
ysiologic jaundice
molytic disease of the newborn ast milk jaundice
er: C
nation: Breast milk jaundice can occur in infants who are breastfeeding and is due to substan ilk that inhibit bilirubin conjugation, typically appearing after the first week of life.
A nurse is discussing the potential consequences of overfeeding a neonate receiving enteral nutrition. Which ely?
1. Hy
2. Ga
3. Ne
Answ
Expla ue to
excess
Quest
During nfant
who is h
condit
1. Ph
2. He
3. Bre Answ
Expla ces in
breast m
Question: 1190
A nurse is preparing to discharge a preterm infant who required a prolonged NICU stay. Which follow-up is most critical?
1. Neurodevelopmental assessment
2. Routine pediatrician visit
3. 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?
viding limited opportunities for tactile stimulation eping the neonate in a quiet, isolated area
er: A
nation: Encouraging gentle, rhythmic touch during care promotes positive sensory interaction ng the infant's neurodevelopment and supporting their ability to engage with caregivers.
ion: 1192
nurse is assessing a child with Williams syndrome, which is caused by a deletion on chromosom of the following features would most likely be present in this condition?
tinctive facial features and cardiovascular problems stature and learning disabilities
diac defects and webbed neck er: A
nation: Williams syndrome is characterized by distinctive facial features, such as a broad fore mall chin, as well as cardiovascular problems, particularly aortic stenosis.
ion: 1193
Encouraging gentle, rhythmic touch during care
Pro
Ke
Answ
Expla s,
fosteri
Quest
A e 7.
Which
1. Dis
2. Tall
3. Car Answ
Expla head
and a s
Quest
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?
1. Congenital heart disease
2. Increased risk of infection
3. 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?
1. "This is a normal part of colitis."
2. "We will need to adjust the feeding plan."
er: C
nation: Frequent diaper changes are important to prevent skin irritation and breakdown in inf iarrhea, especially in those with colitis.
ion: 1195
naging neonatal seizures, which of the following first-line medications is commonly used? proic acid
nytoin nobarbital
er: C
nation: Phenobarbital is often the first-line medication for managing seizures in neonates due y and safety profile.
ion: 1196
nurse is preparing to assess a neonate�s oxygen saturation using a pulse oximeter. Which site is ered the most reliable for accurate readings in neonates?
lobe
"Frequent diaper changes will help prevent skin breakdown." Answ
Expla ants
with d Quest In ma
1. Val
2. Phe
3. Phe Answ
Expla to its
efficac
Quest
A
consid
1. Ear
2. Foot
3. 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?
1. "Feeding will prevent any serious issues."
2. "We won't need to monitor anything since the baby is fine now."
3. "We need to come back for bilirubin level checks." Answer: C
monitor for potential rebound hyperbilirubinemia.
ion: 1198
gnant woman is found to have a positive HIV test. What is the most critical intervention to r of perinatal transmission?
oiding breastfeeding
ministering antiretroviral therapy during labor uring a routine cesarean delivery
er: B
nation: Administering antiretroviral therapy during labor can significantly reduce the viral loa of transmission to the neonate.
Explanation: Regular bilirubin level checks are critical for infants with a history of Rh incompatibility to
Quest
A pre educe
the risk
1. Av
2. Ad
3. Ens Answ
Expla d and
the risk

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