Newborn Transition: Midterm Exam (Units 1-7) - Questions with
Correct Answers
100 questions
1. Transition from fetal to neonatal life is generally completed over:
A. The first several hours, with some changes continuing for days to weeks
B. The first 5 seconds
C. The first year
D. It never occurs
Correct Answer: A. The first several hours, with some changes continuing for days to weeks
Rationale: Major cardiopulmonary changes occur quickly, but shunt closure and metabolic
adaptation continue. Transition is not instantaneous or a year long.
2. Stimuli that help initiate the newborn's first breath include:
A. Warm amniotic fluid only
B. Maternal anesthesia
C. Silence
D. Mechanical compression of the chest during vaginal birth, cooling, and chemical changes
such as rising carbon dioxide
Correct Answer: D. Mechanical compression of the chest during vaginal birth, cooling, and
chemical changes such as rising carbon dioxide
Rationale: Thermal, tactile, chemical and mechanical stimuli trigger breathing. Warm fluid and
silence are not triggers, and maternal medications may depress breathing.
,3. Functional closure of the ductus arteriosus usually occurs within:
A. The first 30 seconds
B. 6 months
C. 2 years
D. About 12 to 72 hours after birth in healthy term infants, with anatomic closure over weeks
Correct Answer: D. About 12 to 72 hours after birth in healthy term infants, with anatomic
closure over weeks
Rationale: Most term infants close the ductus functionally within the first days, which is why
some ductal-dependent heart lesions present after discharge. Closure is not immediate or
delayed for months.
4. A difference between preductal and postductal oxygen saturation in a newborn may suggest:
A. Normal transition in all infants
B. Right-to-left shunting through the ductus arteriosus, as in pulmonary hypertension or certain
heart defects
C. A faulty thermometer
D. Hypoglycemia
Correct Answer: B. Right-to-left shunting through the ductus arteriosus, as in pulmonary
hypertension or certain heart defects
Rationale: A lower postductal value indicates deoxygenated blood entering the aorta through
the ductus. It is not explained by thermometers or glucose.
5. The ductus venosus closes after birth because:
A. Lung expansion pushes it closed
B. Umbilical venous blood flow stops when the cord is clamped
C. Prostaglandins increase
D. The kidneys begin working
Correct Answer: B. Umbilical venous blood flow stops when the cord is clamped
Rationale: Without umbilical flow, the ductus venosus collapses and later becomes the
ligamentum venosum. The other options do not explain closure.
,6. A normal newborn heart rate at rest is approximately:
A. 60 to 80 beats per minute
B. 180 to 220 beats per minute at rest
C. 40 to 60 beats per minute
D. 110 to 160 beats per minute, varying with activity and sleep
Correct Answer: D. 110 to 160 beats per minute, varying with activity and sleep
Rationale: Heart rate rises with crying and may dip slightly in deep sleep. Persistent rates
outside the normal range require evaluation.
7. Remnants of fetal structures after birth include:
A. Persistent umbilical arteries in all adults
B. An open foramen ovale in every adult
C. The ligamentum arteriosum from the ductus arteriosus and the ligamentum venosum from
the ductus venosus
D. Functioning ductus venosus throughout life
Correct Answer: C. The ligamentum arteriosum from the ductus arteriosus and the
ligamentum venosum from the ductus venosus
Rationale: Fetal shunts become fibrous ligaments, although a patent foramen ovale persists in
some people. The other statements are inaccurate.
8. The foramen ovale in the fetal heart allows blood to flow:
A. From the left ventricle to the right ventricle
B. From the aorta to the pulmonary artery
C. From the liver to the heart
D. From the right atrium to the left atrium, bypassing the lungs
Correct Answer: D. From the right atrium to the left atrium, bypassing the lungs
Rationale: Higher right atrial pressure in the fetus pushes oxygenated blood across to the left
side to reach the brain and body. It is not a ventricular, arterial or hepatic shunt.
, 9. Acrocyanosis in a newborn during the first 24 to 48 hours is:
A. A sign of congenital heart disease in all cases
B. Central cyanosis
C. A sign of sepsis
D. Normal bluish color of the hands and feet due to immature peripheral circulation
Correct Answer: D. Normal bluish color of the hands and feet due to immature peripheral
circulation
Rationale: Peripheral cyanosis of the extremities is common early. Central cyanosis of the lips,
tongue and trunk is abnormal and needs evaluation.
10. Surfactant production is generally sufficient for normal breathing by about:
A. 34 to 36 weeks' gestation
B. 20 weeks' gestation
C. 28 weeks in all fetuses
D. 42 weeks only
Correct Answer: A. 34 to 36 weeks' gestation
Rationale: Production increases in the third trimester, and maturity is usually adequate by
about 34 to 36 weeks. Earlier infants are at risk of respiratory distress syndrome.
11. The foramen ovale functionally closes after birth because:
A. Right atrial pressure rises above left
B. Left atrial pressure rises above right atrial pressure as pulmonary blood returns and the
placenta is removed
C. The ductus venosus opens
D. Lung fluid increases
Correct Answer: B. Left atrial pressure rises above right atrial pressure as pulmonary blood
returns and the placenta is removed
Rationale: Increased pulmonary venous return raises left atrial pressure, and clamping the cord
lowers right-sided venous return, pressing the flap closed. The other changes do not cause
closure.
Correct Answers
100 questions
1. Transition from fetal to neonatal life is generally completed over:
A. The first several hours, with some changes continuing for days to weeks
B. The first 5 seconds
C. The first year
D. It never occurs
Correct Answer: A. The first several hours, with some changes continuing for days to weeks
Rationale: Major cardiopulmonary changes occur quickly, but shunt closure and metabolic
adaptation continue. Transition is not instantaneous or a year long.
2. Stimuli that help initiate the newborn's first breath include:
A. Warm amniotic fluid only
B. Maternal anesthesia
C. Silence
D. Mechanical compression of the chest during vaginal birth, cooling, and chemical changes
such as rising carbon dioxide
Correct Answer: D. Mechanical compression of the chest during vaginal birth, cooling, and
chemical changes such as rising carbon dioxide
Rationale: Thermal, tactile, chemical and mechanical stimuli trigger breathing. Warm fluid and
silence are not triggers, and maternal medications may depress breathing.
,3. Functional closure of the ductus arteriosus usually occurs within:
A. The first 30 seconds
B. 6 months
C. 2 years
D. About 12 to 72 hours after birth in healthy term infants, with anatomic closure over weeks
Correct Answer: D. About 12 to 72 hours after birth in healthy term infants, with anatomic
closure over weeks
Rationale: Most term infants close the ductus functionally within the first days, which is why
some ductal-dependent heart lesions present after discharge. Closure is not immediate or
delayed for months.
4. A difference between preductal and postductal oxygen saturation in a newborn may suggest:
A. Normal transition in all infants
B. Right-to-left shunting through the ductus arteriosus, as in pulmonary hypertension or certain
heart defects
C. A faulty thermometer
D. Hypoglycemia
Correct Answer: B. Right-to-left shunting through the ductus arteriosus, as in pulmonary
hypertension or certain heart defects
Rationale: A lower postductal value indicates deoxygenated blood entering the aorta through
the ductus. It is not explained by thermometers or glucose.
5. The ductus venosus closes after birth because:
A. Lung expansion pushes it closed
B. Umbilical venous blood flow stops when the cord is clamped
C. Prostaglandins increase
D. The kidneys begin working
Correct Answer: B. Umbilical venous blood flow stops when the cord is clamped
Rationale: Without umbilical flow, the ductus venosus collapses and later becomes the
ligamentum venosum. The other options do not explain closure.
,6. A normal newborn heart rate at rest is approximately:
A. 60 to 80 beats per minute
B. 180 to 220 beats per minute at rest
C. 40 to 60 beats per minute
D. 110 to 160 beats per minute, varying with activity and sleep
Correct Answer: D. 110 to 160 beats per minute, varying with activity and sleep
Rationale: Heart rate rises with crying and may dip slightly in deep sleep. Persistent rates
outside the normal range require evaluation.
7. Remnants of fetal structures after birth include:
A. Persistent umbilical arteries in all adults
B. An open foramen ovale in every adult
C. The ligamentum arteriosum from the ductus arteriosus and the ligamentum venosum from
the ductus venosus
D. Functioning ductus venosus throughout life
Correct Answer: C. The ligamentum arteriosum from the ductus arteriosus and the
ligamentum venosum from the ductus venosus
Rationale: Fetal shunts become fibrous ligaments, although a patent foramen ovale persists in
some people. The other statements are inaccurate.
8. The foramen ovale in the fetal heart allows blood to flow:
A. From the left ventricle to the right ventricle
B. From the aorta to the pulmonary artery
C. From the liver to the heart
D. From the right atrium to the left atrium, bypassing the lungs
Correct Answer: D. From the right atrium to the left atrium, bypassing the lungs
Rationale: Higher right atrial pressure in the fetus pushes oxygenated blood across to the left
side to reach the brain and body. It is not a ventricular, arterial or hepatic shunt.
, 9. Acrocyanosis in a newborn during the first 24 to 48 hours is:
A. A sign of congenital heart disease in all cases
B. Central cyanosis
C. A sign of sepsis
D. Normal bluish color of the hands and feet due to immature peripheral circulation
Correct Answer: D. Normal bluish color of the hands and feet due to immature peripheral
circulation
Rationale: Peripheral cyanosis of the extremities is common early. Central cyanosis of the lips,
tongue and trunk is abnormal and needs evaluation.
10. Surfactant production is generally sufficient for normal breathing by about:
A. 34 to 36 weeks' gestation
B. 20 weeks' gestation
C. 28 weeks in all fetuses
D. 42 weeks only
Correct Answer: A. 34 to 36 weeks' gestation
Rationale: Production increases in the third trimester, and maturity is usually adequate by
about 34 to 36 weeks. Earlier infants are at risk of respiratory distress syndrome.
11. The foramen ovale functionally closes after birth because:
A. Right atrial pressure rises above left
B. Left atrial pressure rises above right atrial pressure as pulmonary blood returns and the
placenta is removed
C. The ductus venosus opens
D. Lung fluid increases
Correct Answer: B. Left atrial pressure rises above right atrial pressure as pulmonary blood
returns and the placenta is removed
Rationale: Increased pulmonary venous return raises left atrial pressure, and clamping the cord
lowers right-sided venous return, pressing the flap closed. The other changes do not cause
closure.
