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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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