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RNC-LRN Exam Format | RNC-LRN Course Contents | RNC-LRN Course Outline | RNC-LRN Exam Syllabus | RNC-LRN Exam Objectives

Certification: Low Risk Neonatal Nursing (RNC-LRN)

Issuing Organization: National Certification Corporation (NCC)

Eligibility: Requires an active RN license and recent experience in low-risk neonatal nursing

Exam Format: Computer-based, multiple-choice questions

Exam Length: 3 hours (180 minutes)

Number of Questions: 175 (150 scored + 25 pretest/un-scored)

Passing Score: Determined by a criterion-referenced standard (exact percentage not disclosed)



- Maternal risk factors and birth history

- Fetal Anatomy and Physiology

- Fetal Assessment

- GBS screening

- Nonstress testing

- Biophysical profile

- Antepartal screening

- Cord gases

- Maternal age

- Medical Conditions

-Maternal age

-Diabetes

-Blood disorders

-Infectious diseases

- CMV

- Toxoplasmosis

- syphilis

- herpes

- hepatitis HIV

- gonorrhea

- Chlamydia

- GB

-Maternal depression



- Pregnancy Related

-Hypertensive Disorders

- Eclampsia

- HELLP syndrome

- Amniotic fluid disorders (Amniotic bands, Polyhydramnios, Oligohydramnios)

- Maternal hemorrhage

- Placental abruption

- Placenta previa

- Multiple gestations

- Chorioamnionitis

- Cord Accidents



- Maternal medications during labor and delivery (tocolytics, analgesia, anesthesia)

- Complications of Labor

- Abnormal labor patterns

- Abnormal fetal heart rate patterns (altered variability, decelerations [early, late, variable]; tachycardia, bradycardia (category I, II and III fetal heart rate tracings)

- Operative/instrument assisted birth

- Preterm/postterm

- Meconium

- Breech and other malpresentation

- Life-style and Environmental Conditions

- Substance use

- Teratogen exposure

- Medication use



- Physical and gestational age exam Gestational Age

- Physical Characteristics, Etiologies and/or Risks and Complications of

- Preterm

- Term

- Post-term

- Late preterm

- AGA

- SGA

- LGA

- Intrauterine growth restriction

- Symmetrical

- Asymmetrical



- Physical Assessment

- Cardiac examination findings

- Heart rate, rhythms and sounds

- Point of maximal intensity

- Blood pressure

- Peripheral pulses

- Perfusion

- Color

- Respiratory Physical Assessment

- Respiratory rate and breath sounds

- Respiratory patterns

- Thorax and Chest

- Abdominal examination findings

- Stooling patterns

- Neonatal skin exam

- Characteristics of normal neonatal skin

- Musculoskeletal exam

- Neurological exam



- Reflexes

- Moro

- Rooting and sucking

- Palmar grasp

- Plantar grasp

- Stepping

- Babinski

- Tonic neck

- Gag

- Anal wink reflex

- Tone

- Techniques

- Pull to sit

- Truncal tone exam



- Head, ear, eyes, nose, mouth exam

- Fontanelles and cranial sutures

- Neck appearance

- Ear appearance, shape and placement

- Hearing

- Nasal patency

- Symmetry of the mouth

- Evaluation of pigmentation and movement

- Evaluation of cornea/sclera

- Eye prophylaxis

- Complications/Variations

- Skull/neck variations & abnormalities

- Molding

- Cephalhematoma

- Caput succedaneum

- Craniosynostosis

- Craniotabes

- Cystic hygroma

- Pierre Robin

- Variations & abnormalities

- Conjunctivitis

- Cleft lip and palate

- Epsteins pearls

- Natal teeth

- Choanal atresia

- Retinopathy of prematurity

- Tracheomalacia

- Micronathia



- Laboratory and Diagnostic Data

- Blood

- Glucose

- Complete blood count with differential

- Cultures

- Rh (Coombs)

- Blood gases

- Bilirubin

- Electrolytes

- Newborn screening



- Cardiovascular

- Basic physiology and anatomy

- Adaptation to extrauterine life

- Complications/Variations

- Pulmonary vascular resistance

- Abnormal rhythms

- Congenital heart disease

- Patent ductus arteriosus

- Coarctation of the aorta

- Septal defects

- Tetralogy of Fallot

- Transposition of the great vessels

- Congestive heart failure

- Hypertension/Hypotension

- Shock



- Respiratory

- Basic physiology and anatomy

- Adaptation to extrauterine life

- Complications/Variations

- Air leaks

- Apnea of prematurity

- Chronic lung disease

- Pneumothorax

- Pneumomediastinum

- Pneumonia

- Respiratory distress syndrome

- Transient tachypnea of the newborn

- Persistent pulmonary hypertension

- Meconium aspiration syndrome

- Diaphragmatic hernia



- Gastrointestinal and Genitourinary

- Basic physiology and anatomy

- Complications/Variations

- Diastasis of recti muscles

- Duodenal atresia

- Bowel obstruction

- Esophageal atresia/tracheoesophageal fistula

- Imperforate anus

- Omphalocele/gastroschisis

- Umbilical hernia

- Meconium ileus/plug

- GE reflux

- Necrotizing enterocolitis

- Short gut syndrome

- Malrotation/Volvulus

- Renal function/urinary output

- Complications

- Hypospadias

- Undescended testes

- Testicular abnormalities

- Hydrocele

- Inguinal hernia

- Vaginal discharge/abnormalities

- Renal abnormalities

- Circumcision

- Postoperative care



- Musculoskeletal and Integumentary

- Musculoskeletal Complications

- Congenital hip dysplasia

- Metatarsus adductus

- Polydactyly and syndactyly

- Torticollis

- Talipes equinovarus

- Fracture

- Physiologic basis for general skin care

- Variations

- Erythema toxicum

- Milia

- hyperpigmented skin lesions

- Hemangiomas/birth marks

- Petechiae

- Cafe au lait spots

- Other skin lesions, e.g. pustules, vesicles

- Umbilical cord

- Fat necrosis

- Diaper Dermatitis



- Neurological

- Basic physiology

- Motor function

- Complications/Variations

- Seizures

- Jitteriness

- Intracranial hemorrhage (subdural)

- Intraventricular hemorrhages

- Periventricular leukomalacia

- Hydrocephalus

- Neuromuscular birth Injuries

- Brachial plexus injuries

- Facial nerve injuries

- Neural tube defects

- Therapeutic hypothermia



- Hematology and hyperbilirubinemia

- Basic physiology

- Interpret lab values (CBC; hematocrit, hemoglobin, retic, platelets, total and direct serum bilirubin, direct and indirect antibody tests)

- Complications

- Anemia (Physiologic and non-physiologic)

- Bleeding disorders

- ABO/Rh incompatibility

- Polycythemia/hyperviscosity

- Sickle Cell

- Administration of blood and blood products

- Hyperbilirubinemia

- Basic physiology

- Complications

- Jaundice

- Physiologic jaundice

- Pathologic jaundice

- Breast feeding and jaundice

- Kernicterus

- Phototherapy

- G6PD



- Genetic, Metabolic and Endocrine Genetic Disorders

- Patterns of Inheritance

- Autosomal recessive, autosomal dominant, sex linked

- Complications

- Common chromosomal abnormalities (trisomy 21, 18 & 13)

- Birth defects/congenital anomalies

- Skeletal dysplasia

- Cystic Fibrosis

- DiGeorge (22q11.2 deletion syndrome)

- Turners

- Endocrine/Metabolic

- Interpreting lab values (Calcium, phosphorus, magnesium, glucose)

- Metabolic Disorders (PKU, Thyroid, CAH, Galactosemia)

- Complications

- Hypoglycemia

- Hypocalcemia

- Rickets/metabolic bone disease

- Infant of a diabetic mother



- Resuscitation and Stabilization

- General exam of status and need for resuscitation

- Management of resuscitation

- Airway

- Breathing

- Circulation

- Drug Therapy

- Evaluation of effectiveness of interventions

- Apgar scores

- CHD Screening



- Nutrition and Feeding

- Growth patterns (Growth curves)

- Fluid/Calorie requirements

- CHO, Fats, Proteins

- Lactation

- Anatomy and physiology of lactation

- Composition of breast milk

- Maternal nutritional needs

- Normal breastfeeding process

- Positioning

- Latch On

- Suck/swallow/sequence

- Timing (frequency and duration)

- Feeding cues

- Contraindications to breastfeeding

- Maternal Complications

- Latch on problems

- Nipple problems

- Breast engorgement

- Insufficient milk supply

- Medication effects

- Therapeutic medications

- Infection/Mastitis

- Maternal illness

- Perinatal substance abuse (TCN)

- Maternal/newborn separation

- Breast reduction/augmentation

- Newborn complications

- Drug screening

- Multiple births

- Prematurity

- Patient Education

- Breast/nipple care

- Use of supplementary/ complementary feedings

- Use of breastfeeding devices

- Expressing and storing breast milk

- Colostrum

- Complications/Contraindications

- Donor milk

- Formula feeding

- Composition of formula

- Techniques

- Special needs (e.g. cleft palate, PKU)

- Dietary Supplements (Iron, MCT, Vitamins, probiotics, Fortifiers)

- Feeding techniques

- Tube feedings

- Feeding cues

- Special Nutritional considerations

- Chronic Lung Disease (CLD)

- Prematurity

- Short Gut syndrome



- Pharmacology, Pharmacokinetics and Pharmacodynamics

- Principles of administration

- Dosage

- Route

- 5 rights of medication administration

- Blood drug levels (toxic vs therapeutic)

- Pharmacokinetics

- Common drugs used in neonates

- Vitamin K

- Antibiotics

- Antibiotics

- Anticonvulsants

- Antimicrobials

- Antiretroviral

- Immunologic agents

- Bronchodilators

- CNS stimulants (Caffeine, etc)

- Diuretics

- Drugs for NAS

- Eye prophylaxis

- Vaccines

- Pain Assessment and Management

- Signs and symptoms

- Nonpharmacological interventions

- Pharmacological interventions



- Fluid, Electrolytes and Glucose Homeostasis

- Normal fluid and electrolyte requirements

- Monitoring fluid and electrolyte status

- electrolytes

- urine output

- Parenteral nutrition (indication, composition, complications)

- Lipids

- Metabolic panel

- PICC lines or midlines

- Umbilical lines

- Hypoglycemia



- Oxygenation, non-invasive ventilation and Acid-base balance

- Oxygenation: interpretation and management

- Hypoxia/hypoxemia

- Oxygen saturation (SaO2)

- Methods of oxygenation/ventilation

- non-invasive ventilation (high flow NC, CPAP, Nasal cannula, hood)

- Blood gas: interpretation and management

- Metabolic acidosis/alkalosis

- Respiratory acidosis/alkalosis

- Mixed



- Neurodevelopmental Care

- Neurobehavioral development

- habituation

- motor organization

- sensory/interaction capabilities

- state/sleep cycles

- Environmental impact on development

- Interventions (Reducing noise, light level, diurnal patterns, handling, positioning, kangaroo care/skin to skin)

- Nonnutritive sucking

- Complications of Substance Exposure in Utero

- Alcohol

- Heroin

- Methadone

- Cocaine

- Nicotine

- Subutex

- Cannabis (marijuana)

- Prescription drug abuse

- Neonatal Abstinence Syndrome (NAS)

- Methadone

- Cocaine

- Nicotine

- Subutex

- Cannabis (marijuana)

- Prescription drug abuse



- Infection and Immunology Immune System

- Basic physiology

- Interpret laboratory values

- WBC and differential

- CRP

- Antibody function

- IgA

- IgG

- IgM

- Infection Control

- Handwashing

- Visitation

- Standards precautions

- Complications/Variations

- Neonatal sepsis

- Septic shock

- Viral and fungal infections

- AIDS/HIV

- Cytomegalovirus

- Rubella

- Hepatitis B

- Varicella

- Toxoplasmosis

- Herpes

- Human papilloma virus

- Enterovirus

- Bacterial infections

- Group B streptococcus

- Staphylococcus

- E. coli

- Sexually Transmitted infections

- Gonorrhea

- Chlamydia

- Syphilis

- Early and late onset infections

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