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RNC-NIC Exam Format | RNC-NIC Course Contents | RNC-NIC Course Outline | RNC-NIC Exam Syllabus | RNC-NIC 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
- exam 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
- exam
- 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 exam
- 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
- Hirschsprungs 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/ exam, 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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