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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