RNC-NIC Exam COMPREHENSIVE
QUESTIONS AND VERIFIED
ANSWERS 2025(GRADED A+)
DETAILED ANSWERS!!
amniocentesis - CORRECT ANSWER needle puncture of the amniotic sac to withdraw amniotic fluid for
analysis
- screens for chromosomal abnormalities
- typically performed early in 2nd trimester (15-20 wks), more accurate >20 wks d/t chromosomal
presence in fluid
- **also can be used later in pregnancy to assess fetal lung maturity**
- often recommended for AMA
thrombocytopenia (maternal) - CORRECT ANSWER - a generally benign maternal medical complication
that is due to hemodilution (increased RBCs)
- may be associated with hypertensive conditions r/t pregnancy
- may be associated with s/s of bleeding in the infant
risks of maternal thrombocytopenia - CORRECT ANSWER can result in:
- increased risk of bleeding in the mother, especially during the delivery
- **bleeding in the infant (oozing from umbilical cord, prolonged bleeding from heel sticks, bruising,
**petechiae
neonatal petechiae - CORRECT ANSWER - must consider hyperbilirubinemia/jaundice (breakdown of
RBCs)
- also associated with maternal thrombocytopenia
cytomegalovirus (CMV) - CORRECT ANSWER - **most common intrauterine infection**
- transmitted by exposure to infected blood or body fluids
- majority of infants asymptomatic at birth, but 5-15% have later sequelae (most commonly hearing and
vision loss)
contraindication for breastfeeding - CORRECT ANSWER - maternal HIV/AIDS infection
- **HIV/AIDS can be spread through breastfeeding**
signs of HIV in newborn - CORRECT ANSWER - poor weight gain
- **repeated fungal mouth infections** (thrush)
,- enlarged lymph nodes
- enlarged liver/spleen
- neurologic problems
- multiple bacterial infections, including pneumonia
chlamydia - CORRECT ANSWER - **most common bacterial sexually transmitted infection**
- *treatment: erythromycin*
signs/symptoms of neonatal chlamydia - CORRECT ANSWER - conjunctivitis in first few weeks
- late-onset: pneumonia at 3-4 months
- otitis media
- gastroenteritis
oligohydramnios - CORRECT ANSWER - AF volume <1 L at 36 weeks, <800 mL at term
- can lead to pulmonary hypoplasia d/t amniotic fluid's role in fetal pulmonary development
- **may be related to Potter sequence/renal agenesis** because AF is largely made up of fetal urine (no
urine if the baby has no kidneys)
- **can lead to hypoplastic lungs**
- can also lead to IUGR and positional deformities (baby can't move well)
Potter sequence (renal agenesis) - CORRECT ANSWER - **Renal agenesis -> oligohydramnios -> severe
pulmonary hypoplasia**
- association of defects beginning w/ bilateral renal agenesis d/t failure of the ureteric bud to divide
- urine formation does not occur --> low or absent amniotic fluid volumes
- fetal structures are compressed
- associated defects: abnormal genital dev., leg deformities, GI defects, arthrohyposis, pulmonary
hypoplasia
- *most infants will die within the first several days; often d/t associated lung hypoplasia*
hydramnios or polyhydramnios - CORRECT ANSWER - AF volume >2L
- **may be due to GI obstructions (e.g. esophageal atresia, duodenal to anal atresia) d/t the baby being
unable to swallow amniotic fluid, so the AF keeps building up in utero **
- also can be d/t tight nuchal cord or neurologic defects which may also obstruct or impair fetal
swallowing
PROM - CORRECT ANSWER - premature rupture of membranes, before the onset of labor
,- **risk of infection if directly proportional to the duration of ROM**
- **after 24 hours of ROM, the risk of infection escalates significantly**
PPROM - CORRECT ANSWER - preterm premature rupture of membranes, PROM occurring before 37
weeks
- does not necessarily lead to the onset of labor if it occurs too early, but after 24 hours of ROM, the risk
of infection escalates
- **risk of infection if directly proportional to the duration of ROM**
maternal serum alpha fetaprotein (MSAFP) - CORRECT ANSWER - aka triple or quad screen
- test during pregnancy that measures a major fetal protein produced in the fetal liver at >22 wks that is
present in the mother's blood
- maternal blood test that is a clue for some fetal anomalies, generally between 15-22 wks, optimally at
16-18 wks
- **elevated levels may be indicative of neural tube defects (not diagnostic, but is a clue)**
- low levels associated with Trisomy 21
Lecithin/Sphingomyelin (L/S) ratio - CORRECT ANSWER - test of amniotic fluid to assess fetal lung
maturity
- may help determine lung maturity to see when to deliver prematurely if necessary
- **normal: greater or equal to ~2**
- <2 indicates immature lungs, <1.5 is associated with a high risk of RDS
fetal heart rate (FHR) decelerations - CORRECT ANSWER - defined as a fetal heart rate decrease of at
least 15 bpm that lasts longer than 2 min. but less than 10 min.
cause of early decelerations - CORRECT ANSWER **head compression**
cause of variable decelerations - CORRECT ANSWER **cord compression**
cause of late decelerations - CORRECT ANSWER **hypoxemia or placental insufficiency**
fetal tachycardia - CORRECT ANSWER - fetal HR >160 for 10 or more min.
- sustained 170s-180s **think infection**
- also could be caused by acute hypoxemia/hypoxia, maternal fever, maternal anxiety, maternal
hyperthyroidism
effects of maternal magnesium sulfate on newborn - CORRECT ANSWER - tocolytic medication that can
be used for neuroprotection in preterm labor that can cause **neuromuscular or respiratory depression
in the newborn**
, effects of maternal prostaglandin inhibitors in newborn - CORRECT ANSWER - tocolytic medications
such as indomethacin that puts the fetus at risk of premature ductal closure in utero, pulmonary HTN,
and altered renal function if given to mother
effects of maternal betaminetics in newborn - CORRECT ANSWER - tocolytic medications such as
terbutaline that can cause **hypoglycemia in the newborn due to hyperinsulinemia** (baby's pancreas
produces too much insulin, thus lowering blood glucose)
risks of vacuum assisted delivered - CORRECT ANSWER - can case cephalohematoma, retinal
hemorrhage, and intracranial hemorrhage (rarely); consider **hyperbilirubinemia** --> may show as
bruising and bleeding
transillumination - CORRECT ANSWER - tool used for newborn physical exam that is a fiberoptic light
source attached to the end of a long, flexible tube
- fluid- or air-filled structures will transmit the light (light up), e.g. hydroceles, severe hydrocephalus,
pneumothorax
-**solid masses will NOT light up/transmit light, e.g. tumors, testicular torsion**
red reflex - CORRECT ANSWER - **reflex due to light reflecting off the interior lining of the eye
(fundus)**
- shows as a bright orange-red or pale/gray in darker skinned newborns
- absent or disrupted reflex could be congenital cataracts, glaucoma, or retinoblastoma
acrocyanosis - CORRECT ANSWER - **blue/pale discoloration of hands and feet, normal in the first 48
hours of life**
general pallor/cyanosis - CORRECT ANSWER - blue/pale discoloration outside of the first 48 hours of life
or outside of just the hands/feet that may be due to anemia, hypoxemia, or shock
how to differentiate between cyanosis and ecchymosis (bruising) - CORRECT ANSWER - **assess the
ability of the skin to blanch**
- **ecchymosis (bruising) will NOT blanch**
jaundice/icterus - CORRECT ANSWER - **yellow discoloration of the skin d/t hyperbilirubinemia**
- **ALWAYS an abnormal finding in the FIRST 24 HOURS OF LIFE**
general safe temperature range - CORRECT ANSWER 36 to 37.5 degrees C (96.8 to 99.5 degrees F)
craniotabes - CORRECT ANSWER - **aka congenital cranial osteoporosis, defined as a softening of the
skull bones**
- can occur in up to 1/3 of all newborns and can be a normal finding, especially in preemies
- **soft areas of the skull (especially along the suture line) can pop in and out like a ping pong ball
- **mostly found along the occipital and parietal bones
QUESTIONS AND VERIFIED
ANSWERS 2025(GRADED A+)
DETAILED ANSWERS!!
amniocentesis - CORRECT ANSWER needle puncture of the amniotic sac to withdraw amniotic fluid for
analysis
- screens for chromosomal abnormalities
- typically performed early in 2nd trimester (15-20 wks), more accurate >20 wks d/t chromosomal
presence in fluid
- **also can be used later in pregnancy to assess fetal lung maturity**
- often recommended for AMA
thrombocytopenia (maternal) - CORRECT ANSWER - a generally benign maternal medical complication
that is due to hemodilution (increased RBCs)
- may be associated with hypertensive conditions r/t pregnancy
- may be associated with s/s of bleeding in the infant
risks of maternal thrombocytopenia - CORRECT ANSWER can result in:
- increased risk of bleeding in the mother, especially during the delivery
- **bleeding in the infant (oozing from umbilical cord, prolonged bleeding from heel sticks, bruising,
**petechiae
neonatal petechiae - CORRECT ANSWER - must consider hyperbilirubinemia/jaundice (breakdown of
RBCs)
- also associated with maternal thrombocytopenia
cytomegalovirus (CMV) - CORRECT ANSWER - **most common intrauterine infection**
- transmitted by exposure to infected blood or body fluids
- majority of infants asymptomatic at birth, but 5-15% have later sequelae (most commonly hearing and
vision loss)
contraindication for breastfeeding - CORRECT ANSWER - maternal HIV/AIDS infection
- **HIV/AIDS can be spread through breastfeeding**
signs of HIV in newborn - CORRECT ANSWER - poor weight gain
- **repeated fungal mouth infections** (thrush)
,- enlarged lymph nodes
- enlarged liver/spleen
- neurologic problems
- multiple bacterial infections, including pneumonia
chlamydia - CORRECT ANSWER - **most common bacterial sexually transmitted infection**
- *treatment: erythromycin*
signs/symptoms of neonatal chlamydia - CORRECT ANSWER - conjunctivitis in first few weeks
- late-onset: pneumonia at 3-4 months
- otitis media
- gastroenteritis
oligohydramnios - CORRECT ANSWER - AF volume <1 L at 36 weeks, <800 mL at term
- can lead to pulmonary hypoplasia d/t amniotic fluid's role in fetal pulmonary development
- **may be related to Potter sequence/renal agenesis** because AF is largely made up of fetal urine (no
urine if the baby has no kidneys)
- **can lead to hypoplastic lungs**
- can also lead to IUGR and positional deformities (baby can't move well)
Potter sequence (renal agenesis) - CORRECT ANSWER - **Renal agenesis -> oligohydramnios -> severe
pulmonary hypoplasia**
- association of defects beginning w/ bilateral renal agenesis d/t failure of the ureteric bud to divide
- urine formation does not occur --> low or absent amniotic fluid volumes
- fetal structures are compressed
- associated defects: abnormal genital dev., leg deformities, GI defects, arthrohyposis, pulmonary
hypoplasia
- *most infants will die within the first several days; often d/t associated lung hypoplasia*
hydramnios or polyhydramnios - CORRECT ANSWER - AF volume >2L
- **may be due to GI obstructions (e.g. esophageal atresia, duodenal to anal atresia) d/t the baby being
unable to swallow amniotic fluid, so the AF keeps building up in utero **
- also can be d/t tight nuchal cord or neurologic defects which may also obstruct or impair fetal
swallowing
PROM - CORRECT ANSWER - premature rupture of membranes, before the onset of labor
,- **risk of infection if directly proportional to the duration of ROM**
- **after 24 hours of ROM, the risk of infection escalates significantly**
PPROM - CORRECT ANSWER - preterm premature rupture of membranes, PROM occurring before 37
weeks
- does not necessarily lead to the onset of labor if it occurs too early, but after 24 hours of ROM, the risk
of infection escalates
- **risk of infection if directly proportional to the duration of ROM**
maternal serum alpha fetaprotein (MSAFP) - CORRECT ANSWER - aka triple or quad screen
- test during pregnancy that measures a major fetal protein produced in the fetal liver at >22 wks that is
present in the mother's blood
- maternal blood test that is a clue for some fetal anomalies, generally between 15-22 wks, optimally at
16-18 wks
- **elevated levels may be indicative of neural tube defects (not diagnostic, but is a clue)**
- low levels associated with Trisomy 21
Lecithin/Sphingomyelin (L/S) ratio - CORRECT ANSWER - test of amniotic fluid to assess fetal lung
maturity
- may help determine lung maturity to see when to deliver prematurely if necessary
- **normal: greater or equal to ~2**
- <2 indicates immature lungs, <1.5 is associated with a high risk of RDS
fetal heart rate (FHR) decelerations - CORRECT ANSWER - defined as a fetal heart rate decrease of at
least 15 bpm that lasts longer than 2 min. but less than 10 min.
cause of early decelerations - CORRECT ANSWER **head compression**
cause of variable decelerations - CORRECT ANSWER **cord compression**
cause of late decelerations - CORRECT ANSWER **hypoxemia or placental insufficiency**
fetal tachycardia - CORRECT ANSWER - fetal HR >160 for 10 or more min.
- sustained 170s-180s **think infection**
- also could be caused by acute hypoxemia/hypoxia, maternal fever, maternal anxiety, maternal
hyperthyroidism
effects of maternal magnesium sulfate on newborn - CORRECT ANSWER - tocolytic medication that can
be used for neuroprotection in preterm labor that can cause **neuromuscular or respiratory depression
in the newborn**
, effects of maternal prostaglandin inhibitors in newborn - CORRECT ANSWER - tocolytic medications
such as indomethacin that puts the fetus at risk of premature ductal closure in utero, pulmonary HTN,
and altered renal function if given to mother
effects of maternal betaminetics in newborn - CORRECT ANSWER - tocolytic medications such as
terbutaline that can cause **hypoglycemia in the newborn due to hyperinsulinemia** (baby's pancreas
produces too much insulin, thus lowering blood glucose)
risks of vacuum assisted delivered - CORRECT ANSWER - can case cephalohematoma, retinal
hemorrhage, and intracranial hemorrhage (rarely); consider **hyperbilirubinemia** --> may show as
bruising and bleeding
transillumination - CORRECT ANSWER - tool used for newborn physical exam that is a fiberoptic light
source attached to the end of a long, flexible tube
- fluid- or air-filled structures will transmit the light (light up), e.g. hydroceles, severe hydrocephalus,
pneumothorax
-**solid masses will NOT light up/transmit light, e.g. tumors, testicular torsion**
red reflex - CORRECT ANSWER - **reflex due to light reflecting off the interior lining of the eye
(fundus)**
- shows as a bright orange-red or pale/gray in darker skinned newborns
- absent or disrupted reflex could be congenital cataracts, glaucoma, or retinoblastoma
acrocyanosis - CORRECT ANSWER - **blue/pale discoloration of hands and feet, normal in the first 48
hours of life**
general pallor/cyanosis - CORRECT ANSWER - blue/pale discoloration outside of the first 48 hours of life
or outside of just the hands/feet that may be due to anemia, hypoxemia, or shock
how to differentiate between cyanosis and ecchymosis (bruising) - CORRECT ANSWER - **assess the
ability of the skin to blanch**
- **ecchymosis (bruising) will NOT blanch**
jaundice/icterus - CORRECT ANSWER - **yellow discoloration of the skin d/t hyperbilirubinemia**
- **ALWAYS an abnormal finding in the FIRST 24 HOURS OF LIFE**
general safe temperature range - CORRECT ANSWER 36 to 37.5 degrees C (96.8 to 99.5 degrees F)
craniotabes - CORRECT ANSWER - **aka congenital cranial osteoporosis, defined as a softening of the
skull bones**
- can occur in up to 1/3 of all newborns and can be a normal finding, especially in preemies
- **soft areas of the skull (especially along the suture line) can pop in and out like a ping pong ball
- **mostly found along the occipital and parietal bones
