Free RNC-NIC Procedures Practice Questions with Answers

The most likely cause is pressure loss due to an open mouth or a system leak. In Bubble CPAP, vigorous bubbling indicates flow is reaching the water, but if the infant's mouth is open, the intended MAP (Mean Airway Pressure) is not maintained. Priority Action: Ensure the mouth is closed (using a chin strap or pacifier) and check the seal of the nasal interface. NCC Strategy: Focus on the circuit integrity. If bubbling occurs but the patient isn't responding, the pressure is escaping before it can provide alveolar stability. Distractor: Increasing the flow won't help if the leak (the mouth) isn't addressed first.

The ventilator delivers a backup or timed breath at the set rate and parameters. Rationale: A/C ensures a minimum minute ventilation. If the set rate is 40, the ventilator will deliver a breath every 1.5 seconds if no patient effort is detected. If the patient triggers a breath at 1.0 seconds, the timer resets. Exam Strategy: Understand that A/C and SIMV both provide a safety net (backup rate), but the difference lies in how they handle breaths *above* that rate.

Effect: Cooling significantly reduces the clearance of both Morphine and Phenobarbital (clearance can decrease by 25-50%). Mechanism: Hypothermia decreases hepatic enzyme activity (Cytochrome P450 system) and reduces the glomerular filtration rate (GFR). Clinical Pearl: Nurses must monitor for signs of drug toxicity, such as prolonged respiratory depression or excessive sedation. Dosing intervals for these medications often need to be extended (e.g., giving Phenobarbital every 24 hours instead of every 12). Exam Tip: NCC tests the need for decreased dosing or increased intervals during the 72-hour cooling period.

Low-dose Alteplase (tPA). If mechanical causes (kinking, clamped line) are ruled out, a thrombotic occlusion is suspected. The stopcock or negative pressure technique is used to instill tPA into the lumen. Note: For lipid-related occlusions, 20% ethanol may be used, and for acidic drug precipitates (e.g., calcium), 0.1N Hydrochloric acid might be considered, but tPA is the most common exam answer for general occlusions.

Tubing used for lipid emulsions (or 3-in-1 Admixtures) must be changed every 24 hours. This is due to the high lipid content's propensity to support rapid microbial growth, specifically Coagulase-negative Staphylococci and Malassezia furfur. For clear, non-lipid parenteral nutrition, bundles may allow up to 96 hours, but most high-acuity NICUs standardize all TPN/lipid tubing changes to every 24 hours to reduce errors. RNC-NIC Focus: Always prioritize the 24-hour limit for any lipid-containing fluid.