NICU NURSING EXAM REVIEW
NEONATAL CARE COMPREHENSIVE EXAM 2026/2027
100 Questions and Correct Answers
Already Graded A+ | 100% Verified
Core Domains:
Neonatal Physiology & Development | Prematurity & High-Risk Newborn Care
Respiratory Support & Ventilation | Neonatal Pharmacology | Thermoregulation
Fluid & Electrolyte Balance | Neonatal Nutrition & Feeding | Infection Prevention
Family-Centered Neonatal Care | Emergency Stabilization of the Newborn
Neonatal Nursing–Aligned Format
, NICU Nursing Exam Review 2026/2027
Table of Contents
Table of Contents ...........................................................................................................................................2
Introduction ................................................................................................................................................... 3
Domain 1: Neonatal Physiology & Development .........................................................................................4
Domain 2: Prematurity & High-Risk Newborn Care ................................................................................. 10
Domain 3: Respiratory Support & Ventilation .......................................................................................... 16
Domain 4: Neonatal Pharmacology............................................................................................................22
Domain 5: Thermoregulation .................................................................................................................... 28
Domain 6: Fluid & Electrolyte Balance ......................................................................................................34
Domain 7: Neonatal Nutrition & Feeding ................................................................................................. 40
Domain 8: Infection Prevention ................................................................................................................ 46
Domain 9: Family-Centered Neonatal Care ...............................................................................................52
Domain 10: Emergency Stabilization of the Newborn ............................................................................. 58
Answer Key ................................................................................................................................................. 64
Page 2 of 38
, NICU Nursing Exam Review 2026/2027
Introduction
The NICU Nursing Exam Review for the 2026/2027 cycle is a comprehensive assessment designed to
evaluate competency in neonatal intensive care nursing. This examination measures knowledge of
neonatal physiology, management of premature and critically ill newborns, respiratory and nutritional
support, infection prevention, and safe evidence-based interventions in the NICU environment.
This examination consists of 100 multiple-choice questions in single-best-answer format, including
scenario-based neonatal assessment and clinical decision-making items. Each question includes a
detailed rationale explaining neonatal nursing priorities, safe interventions, and evidence-based
clinical decision-making in newborn intensive care.
The exam covers ten core domains: Neonatal Physiology & Development, Prematurity & High-Risk
Newborn Care, Respiratory Support & Ventilation, Neonatal Pharmacology, Thermoregulation, Fluid
& Electrolyte Balance, Neonatal Nutrition & Feeding, Infection Prevention, Family-Centered Neonatal
Care, and Emergency Stabilization of the Newborn. All correct answers are presented in bold and
green format for easy identification.
Page 3 of 38
, NICU Nursing Exam Review 2026/2027
Domain 1: Neonatal Physiology & Development
1. A newborn's heart undergoes significant circulatory changes after birth. Which statement
accurately describes the closure of the ductus arteriosus?
A. Functional closure occurs within 24-48 hours, with anatomical closure completed
within 2-3 weeks
B. The ductus arteriosus closes immediately at birth due to increased oxygen tension
C. Closure is primarily mediated by decreased prostaglandin E2 levels within the first hour
D. The ductus remains patent in all preterm infants regardless of gestational age
Rationale: The ductus arteriosus undergoes functional closure within 24-48 hours after birth due to
increased oxygen tension and decreased prostaglandin levels. Anatomical closure with fibrosis is
completed within 2-3 weeks. While oxygen and prostaglandins are key mediators, the process is not
immediate. Preterm infants have higher rates of patent ductus arteriosus due to decreased sensitivity
to oxygen and higher circulating prostaglandin levels, but it does not remain patent in all preterm
infants.
2. A nurse is caring for a 32-week gestational age infant. Which statement regarding fetal lung
development is most accurate?
A. At 32 weeks, the lungs are in the canalicular stage with developing terminal sacs
and immature surfactant production
B. Alveolar development is complete by 32 weeks gestation
C. Surfactant production begins at 28 weeks and reaches maturity by 32 weeks
D. Type II pneumocytes begin producing surfactant at 36 weeks gestation
Rationale: At 32 weeks gestation, the lungs are in the late canalicular to early saccular stage.
Terminal sacs are developing but surfactant production remains immature. Alveolar development
continues until 8 years of age. Surfactant production begins around 24-28 weeks but does not reach
maturity until approximately 34-36 weeks. Type II pneumocytes begin producing surfactant around
24 weeks, not 36 weeks. This knowledge is critical for anticipating respiratory distress in preterm
infants.
3. Which physiological change occurs in the neonatal kidneys during the first week of life?
A. Glomerular filtration rate (GFR) increases gradually but remains lower than
adult values
B. The kidneys achieve full adult-level concentrating ability within 48 hours
C. Sodium reabsorption is highly efficient from birth
D. Renal blood flow reaches adult levels immediately after birth
Rationale: Neonatal GFR is approximately 15-20% of adult values at birth and increases gradually
over the first year of life. The kidneys have limited concentrating ability (maximum urine osmolality
Page 4 of 38
NEONATAL CARE COMPREHENSIVE EXAM 2026/2027
100 Questions and Correct Answers
Already Graded A+ | 100% Verified
Core Domains:
Neonatal Physiology & Development | Prematurity & High-Risk Newborn Care
Respiratory Support & Ventilation | Neonatal Pharmacology | Thermoregulation
Fluid & Electrolyte Balance | Neonatal Nutrition & Feeding | Infection Prevention
Family-Centered Neonatal Care | Emergency Stabilization of the Newborn
Neonatal Nursing–Aligned Format
, NICU Nursing Exam Review 2026/2027
Table of Contents
Table of Contents ...........................................................................................................................................2
Introduction ................................................................................................................................................... 3
Domain 1: Neonatal Physiology & Development .........................................................................................4
Domain 2: Prematurity & High-Risk Newborn Care ................................................................................. 10
Domain 3: Respiratory Support & Ventilation .......................................................................................... 16
Domain 4: Neonatal Pharmacology............................................................................................................22
Domain 5: Thermoregulation .................................................................................................................... 28
Domain 6: Fluid & Electrolyte Balance ......................................................................................................34
Domain 7: Neonatal Nutrition & Feeding ................................................................................................. 40
Domain 8: Infection Prevention ................................................................................................................ 46
Domain 9: Family-Centered Neonatal Care ...............................................................................................52
Domain 10: Emergency Stabilization of the Newborn ............................................................................. 58
Answer Key ................................................................................................................................................. 64
Page 2 of 38
, NICU Nursing Exam Review 2026/2027
Introduction
The NICU Nursing Exam Review for the 2026/2027 cycle is a comprehensive assessment designed to
evaluate competency in neonatal intensive care nursing. This examination measures knowledge of
neonatal physiology, management of premature and critically ill newborns, respiratory and nutritional
support, infection prevention, and safe evidence-based interventions in the NICU environment.
This examination consists of 100 multiple-choice questions in single-best-answer format, including
scenario-based neonatal assessment and clinical decision-making items. Each question includes a
detailed rationale explaining neonatal nursing priorities, safe interventions, and evidence-based
clinical decision-making in newborn intensive care.
The exam covers ten core domains: Neonatal Physiology & Development, Prematurity & High-Risk
Newborn Care, Respiratory Support & Ventilation, Neonatal Pharmacology, Thermoregulation, Fluid
& Electrolyte Balance, Neonatal Nutrition & Feeding, Infection Prevention, Family-Centered Neonatal
Care, and Emergency Stabilization of the Newborn. All correct answers are presented in bold and
green format for easy identification.
Page 3 of 38
, NICU Nursing Exam Review 2026/2027
Domain 1: Neonatal Physiology & Development
1. A newborn's heart undergoes significant circulatory changes after birth. Which statement
accurately describes the closure of the ductus arteriosus?
A. Functional closure occurs within 24-48 hours, with anatomical closure completed
within 2-3 weeks
B. The ductus arteriosus closes immediately at birth due to increased oxygen tension
C. Closure is primarily mediated by decreased prostaglandin E2 levels within the first hour
D. The ductus remains patent in all preterm infants regardless of gestational age
Rationale: The ductus arteriosus undergoes functional closure within 24-48 hours after birth due to
increased oxygen tension and decreased prostaglandin levels. Anatomical closure with fibrosis is
completed within 2-3 weeks. While oxygen and prostaglandins are key mediators, the process is not
immediate. Preterm infants have higher rates of patent ductus arteriosus due to decreased sensitivity
to oxygen and higher circulating prostaglandin levels, but it does not remain patent in all preterm
infants.
2. A nurse is caring for a 32-week gestational age infant. Which statement regarding fetal lung
development is most accurate?
A. At 32 weeks, the lungs are in the canalicular stage with developing terminal sacs
and immature surfactant production
B. Alveolar development is complete by 32 weeks gestation
C. Surfactant production begins at 28 weeks and reaches maturity by 32 weeks
D. Type II pneumocytes begin producing surfactant at 36 weeks gestation
Rationale: At 32 weeks gestation, the lungs are in the late canalicular to early saccular stage.
Terminal sacs are developing but surfactant production remains immature. Alveolar development
continues until 8 years of age. Surfactant production begins around 24-28 weeks but does not reach
maturity until approximately 34-36 weeks. Type II pneumocytes begin producing surfactant around
24 weeks, not 36 weeks. This knowledge is critical for anticipating respiratory distress in preterm
infants.
3. Which physiological change occurs in the neonatal kidneys during the first week of life?
A. Glomerular filtration rate (GFR) increases gradually but remains lower than
adult values
B. The kidneys achieve full adult-level concentrating ability within 48 hours
C. Sodium reabsorption is highly efficient from birth
D. Renal blood flow reaches adult levels immediately after birth
Rationale: Neonatal GFR is approximately 15-20% of adult values at birth and increases gradually
over the first year of life. The kidneys have limited concentrating ability (maximum urine osmolality
Page 4 of 38
