Exam (elaborations)
RNC NIC EXAM QUESTIONS AND ANSWERS
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Exam of 69 pages for the course RNC-NIC at RNC-NIC (RNC NIC EXAM)
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RNC NIC EXAMGIR - answer6-8mcg/kg/min caloric intake
D10 Bolus - answer2mL/kg
Fluid Volume Bolus - answer10mL/kg
Term Parenteral Fluid Requirement - answer80mL/kg/day
Enteral 100-150 mlk/kg/day
Preterm Parenteral Fluid Requirement - answer120
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 - answerWBC x (%) Segmented neutrophils + band
neutrophils + metamyelocytes
Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent)
15,000 x .53 = 7950
ANC <1800 suggestive of infection
Normal Range
Mature WBCs - answerPoly, Segs, Neutrophils
Immature WBCs - answerMeta, Bands, Stabs
Platelet Range - answer150-400k
Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral
infection, but usual onset does not occur until 1 to 3 days after infection onset (late
indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver
function test results, and l ow p latelet count), pregnancy-induced hypertension, and
intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18,
and 21, Turner's syndrome, and hemolytic disease.
CRP level - answerCRP 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 - answerCurrently, 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 - answercongenital infection include: intrauterine growth
restriction, hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly,
hydrocephalus, intracerebral calcifications, hearing loss, chorioretinitis, and optic
atrophy.
Endotracheal Measurement - answer6 + wt in kg
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
carina.
Polyethelane Wrap for Infant < 29 weeks - answerDry infants head only
Place infant in bag, from neck down
Remove bag once infant is in an NTE and humidified environment
UAC Placement - answerHigh Placement T6-T9
Low Placement L3-L4
UVC Placement - answer1 to 2cm above the diaghragm
Low Lying 2-4cm in the cord
Chest Tube Placement - answerMid Clavicular line with distal chest tube hole inside the
thoracic space
lecithin/sphingomyelin (L/S) ratio - answerAn L/S ratio greater than 2:1 is considered to
indicate fetal lung maturity.
Anatomic events Five stages of lung development - answer1. 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. There are three divisions on the right side and two on
the left side that will eventually become the lobes of the lungs.
,2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage
appears; main bronchi are formed; demarcation of major lobes occurs; formation of new
bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no
connection made with terminal air sacs. The lung at this time undergoes 14 more
generations of branching and the formation of the terminal bronchioles. The lung
resembles an exocrine organ because of surrounding loose mesenchymal tissues,
hence the name pseudoglandular .
3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e.,
respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for
surface-active material storage are seen; capillaries invade terminal airway walls; type II
alveolar epithelial cells appear. Airway changes from glandular to tubular and increases
in length and diameter. 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 - answerWeight 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 - answerLower weight, height, length, and head circumference for
gestational age
Results from intrauterine viral infection, chromosomal genetic abnormalities, long
standing disease
Prostaglandin E1 (alprostadil) - answerPrevent premature closure of the PDA
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
Indomethicin (NSAID - answer1. Hypoglycemia
2. Platelet dysfunction
3. Gastrointestinal perforation w/ steroids
4. Renal effects, decreases urine output!
Used if PDA fails to close to prevent pulmonary over circulation and PPHN
, Diuretics effects - answer1. Metabolic Alkalosis
2. Ototoxicity
3. Decreased calcium absorption in bones
Theophylline - answerBronchodilator. Opens airways.
Short half life, caffeine preferred treatment due to longer half life and more tolerable
side effect profile.
Digoxin - answerEnhances contractility
Inhibits Na + K+ ATP
Reduces HR, CI'd if HR <60
Hypokalemia increases drug concentration
Most frequent disorder associated with downsyndrome - answerDeudonal Atresia
Double Bubble
May see VSD, AV Canal, Tetralogy of Fallot
Upper GI Gold Standard for - answerMalrotation
Position for gastroschesis - answerLateral (side lying) to prevent occlusion of the
mesenteric arteries that supply blood to the bowel. Tie bag to the axilla.
VACTERAL, associated with what two disorders? - answerTEF/EA
vertebral defects
anal atresia
cardiac anomalies
trachoesophageal fistula
radial defects
renal and limb anomalies
Hirschbrung Disease - answerStarts in distal rectum
Clinical sign : failure to pass meconium within first 24-48 hours
May be associated with bilious emesis and a distended abdomen
Associated with CF
Types of test to determine diagnosis: Barium enema, biopsy of rectum
Congenital Diaphragmatic Hernia - answerSpace occupying lesion, intestinal contents
fill the lung cavity
Presents with a scaphoid abdomen, barrel chest
Can result in pulmonary hypoplasia, pulmonary hypertension
Requires intubation, HFOV, ECMO
Insert OG or NG tube
CPAP is Contraindicated!
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