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Question 1

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A newborn is delivered at 38 weeks gestation. The mother has a history of type 1 diabetes with poor glycemic control during pregnancy. Which newborn complication is most likely?

Polycythemia

Hypoglycemia

Jaundice

Anemia

to track

2026 Statistics

Key Facts: RNC-LRN Exam

175

Exam Questions

NCC

Pass/Fail

Passing Standard

Criterion-referenced

3 hrs

Exam Duration

NCC

$325

Exam Fee

NCC

45%

General Management

Largest section

3 years

Certification Validity

NCC

The RNC-LRN exam has 175 questions in 3 hours with a criterion-referenced passing standard. The four content domains are: General Assessment (15%), Pathophysiologic Conditions (37%), General Management (45%), and Professional Issues (3%). Requires RN license and 2,000 hours of neonatal nursing experience. Certification valid for 3 years. Exam fee is $325.

Sample RNC-LRN Practice Questions

Try these sample questions to test your RNC-LRN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A newborn is delivered at 38 weeks gestation. The mother has a history of type 1 diabetes with poor glycemic control during pregnancy. Which newborn complication is most likely?

A.Polycythemia

B.Hypoglycemia

C.Jaundice

D.Anemia

Explanation: Infants of diabetic mothers are at high risk for hypoglycemia due to hyperinsulinemia. Maternal hyperglycemia causes fetal hyperglycemia, which stimulates fetal insulin production. After delivery, the glucose supply is abruptly cut off, but insulin levels remain high, causing hypoglycemia. Blood glucose should be monitored closely in these infants.

2A mother with active herpes simplex virus (HSV) lesions delivers vaginally. What is the most appropriate immediate management for the newborn?

A.Routine newborn care with standard precautions

B.Immediate initiation of IV acyclovir and HSV surveillance cultures

C.Administration of HSV vaccine within 12 hours

D.Isolation from mother with formula feeding only

Explanation: Infants born to mothers with active genital HSV lesions at delivery are at high risk (30-50%) for neonatal herpes infection, which can be devastating. The standard of care includes immediate initiation of IV acyclovir prophylaxis and obtaining surface cultures (eyes, mouth, rectum) for HSV surveillance.

3A newborn is assessed using the New Ballard Score. Which finding indicates a post-term infant (42+ weeks)?

A.Lanugo covering the entire back

B.Leathery, cracked, and wrinkled skin

C.Ear cartilage that springs back slowly

D.Breast tissue measuring 5mm in diameter

Explanation: The New Ballard Score assesses neuromuscular and physical maturity. Post-term infants (42+ weeks) typically show signs of placental insufficiency including leathery, cracked, and wrinkled skin due to loss of subcutaneous fat and vernix. Preterm infants have more lanugo, less breast tissue, and slower ear recoil.

4Using the Dubowitz Gestational Age Assessment, a newborn scores -1 on the popliteal angle. What gestational age does this suggest?

A.Less than 26 weeks

B.28-30 weeks

C.36-38 weeks

D.40+ weeks (term)

Explanation: The popliteal angle is part of neuromuscular maturity assessment. A score of -1 (leg cannot be extended to measure angle; the heel touches the ear) indicates full-term gestation (40+ weeks). Preterm infants have a larger popliteal angle (more extendable), scoring +4 or higher before 26 weeks.

5During a newborn assessment, the nurse notes a systolic murmur at the left lower sternal border that is louder when the infant is crying. The infant is pink with normal vital signs. What is the most likely cause?

A.Ventricular septal defect

B.Patent ductus arteriosus

C.Innocent/physiologic murmur

D.Tetralogy of Fallot

Explanation: Innocent (physiologic) murmurs are common in newborns, heard at the left lower sternal border, and often louder with increased cardiac output such as during crying. The benign presentation (pink, normal vitals) supports this. Pathologic murmurs like VSD or PDA typically have other associated findings.

6A nurse is assessing a 4-hour-old newborn and notes a soft, cystic swelling over the right parietal-occipital area that crosses the suture line. What is this finding called?

A.Cephalohematoma

B.Caput succedaneum

C.Subgaleal hemorrhage

D.Skull fracture

Explanation: Caput succedaneum is edema of the scalp soft tissues caused by pressure during delivery. It is soft, pitting, and crosses suture lines. Cephalohematoma is a subperiosteal collection that does NOT cross suture lines and feels more firm. Subgaleal hemorrhage is potentially life-threatening and involves a larger area.

7A nurse is performing the Neonatal Behavioral Assessment Scale (NBAS) on a 3-day-old infant. Which reflex, if absent, would be most concerning for neurologic integrity?

A.Moro reflex

B.Tonic neck reflex

C.Palmar grasp reflex

D.Sucking reflex

Explanation: The Moro reflex is a primitive reflex that should be present at birth. Absence or asymmetry of the Moro reflex may indicate neurologic injury, brachial plexus injury, or other significant pathology. While other reflexes are important, the Moro reflex assesses integration of multiple neural pathways and is a key indicator of central nervous system integrity.

8A term newborn has a hematocrit of 68% at 2 hours of age. The infant appears plethoric and is tachypneic. What is the priority nursing intervention?

A.Initiate phototherapy for jaundice

B.Monitor for hypoglycemia and provide IV fluids

C.Prepare for partial exchange transfusion

D.Administer supplemental oxygen and obtain chest x-ray

Explanation: A hematocrit of 68% indicates polycythemia (normal newborn Hct is 50-60%). Polycythemic infants are at risk for hypoglycemia due to increased metabolic demands and hyperinsulinemia. They may also develop hypoglycemia, hyperviscosity syndrome, and jaundice. Priority is monitoring glucose and maintaining hydration.

9A premature infant born at 32 weeks develops grunting, nasal flaring, and retractions at 2 hours of age. Chest x-ray shows a "ground glass" appearance with air bronchograms. What is the most likely diagnosis?

A.Transient tachypnea of the newborn

B.Respiratory distress syndrome (RDS)

C.Neonatal pneumonia

D.Meconium aspiration syndrome

Explanation: Respiratory distress syndrome (RDS), also called hyaline membrane disease, is caused by surfactant deficiency. Classic presentation includes grunting, nasal flaring, retractions, and tachypnea in premature infants. The chest x-ray shows a characteristic "ground glass" appearance with air bronchograms due to atelectasis.

10A term infant delivered by cesarean section develops tachypnea (RR 80) shortly after birth. The infant is pink with mild retractions. Chest x-ray shows fluid in the fissures and prominent perihilar markings. What is the most appropriate management?

A.Immediate intubation and surfactant administration

B.Supplemental oxygen and supportive care

C.Antibiotic therapy for presumed pneumonia

D.Chest tube placement for pneumothorax

Explanation: Transient tachypnea of the newborn (TTN) is caused by delayed clearance of fetal lung fluid, commonly seen after cesarean delivery. Chest x-ray shows fluid in fissures and prominent perihilar vascular markings. Treatment is supportive with supplemental oxygen as needed. The condition typically resolves within 24-72 hours.

About the RNC-LRN Exam

The RNC-LRN (Low Risk Neonatal Nursing Certification) validates expertise in providing care for healthy, at-risk, and convalescing neonates in Level I, Level II, and transitional nurseries. The exam covers general assessment, pathophysiologic conditions, general management, and professional issues related to neonatal nursing practice.

Questions

175 scored questions

Time Limit

3 hours

Passing Score

Pass/Fail (Criterion-referenced)

Exam Fee

$325 (NCC (National Certification Corporation))

RNC-LRN Exam Content Outline

45%

General Management

Resuscitation and stabilization, nutrition and feeding, pharmacology, fluid and electrolyte management, oxygenation and ventilation, thermoregulation, neurodevelopmental care, infection control, psychosocial support, pain management, and discharge planning

37%

Pathophysiologic Conditions

Cardiovascular disorders, respiratory conditions, neurologic conditions, GI/GU disorders, musculoskeletal and integumentary conditions, genetic/metabolic/endocrine disorders, and hematologic conditions

15%

General Assessment

Maternal risk factors, birth history, physical assessment, gestational age assessment, neurobehavioral assessment, laboratory data interpretation, and family history evaluation

Professional Issues

Ethics, legal issues, patient safety, quality improvement, evidence-based practice, and professional standards in neonatal nursing

How to Pass the RNC-LRN Exam

What You Need to Know

Passing score: Pass/Fail (Criterion-referenced)
Exam length: 175 questions
Time limit: 3 hours
Exam fee: $325

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

RNC-LRN Study Tips from Top Performers

1Master General Management (45%) — resuscitation, feeding, thermoregulation, and neurodevelopmental care

2Study respiratory conditions — RDS, TTN, meconium aspiration, and PPHN pathophysiology and management

3Know cardiovascular assessment — murmurs, ductal-dependent lesions, and CHD presentation in newborns

4Understand thermoregulation — neutral thermal environment, brown fat metabolism, and rewarming protocols

5Review pharmacology — common neonatal medications, dosing considerations, and side effects

6Learn developmental care — positioning, clustering care, minimizing stress, and family-centered care

Frequently Asked Questions

What is the RNC-LRN certification?

RNC-LRN (Low Risk Neonatal Nursing Certification) is a specialty certification from NCC for registered nurses who care for healthy, at-risk, and convalescing neonates in Level I, Level II, and transitional nurseries. It validates expertise in neonatal assessment, pathophysiology, and general management.

How many questions are on the RNC-LRN exam?

The RNC-LRN exam has 175 multiple-choice questions with a 3-hour time limit. The exam uses criterion-referenced scoring, meaning the passing standard is based on the difficulty of the questions rather than a fixed percentage. Approximately 150 questions are scored.

What are the prerequisites for the RNC-LRN exam?

You need an active, unrestricted RN license in the US or Canada, and at least 2,000 hours of neonatal nursing experience (including direct patient care, education, research, or administration) within the last 2 years.

What is the most heavily tested topic on the RNC-LRN exam?

General Management accounts for 45% of the exam — the largest content area. This includes resuscitation and stabilization, nutrition and feeding, pharmacology, fluid/electrolyte management, oxygenation/ventilation, thermoregulation, neurodevelopmental care, and infection control.

How should I prepare for the RNC-LRN exam?

Plan for 150-200 hours of study. Focus on General Management (45%) including feeding, thermoregulation, and resuscitation. Study Pathophysiologic Conditions (37%) including respiratory distress, cardiac defects, and neurologic conditions. Review General Assessment (15%) including gestational age assessment and newborn screening. Complete 200+ practice questions with detailed explanations.