Neonatal Nursing Exam Questions and Verified
Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Study Guide for Neonatal Intensive Care
Nursing
1. A nurse in the NICU is assessing a preterm infant born at 28 weeks gestation receiving
mechanical ventilation. The infant suddenly develops cyanosis, hypotension, and
diminished breath sounds on the left side with a shift of apical heart sounds to the right.
What is the immediate nursing priority action?
A. Increase the fraction of inspired oxygen (FiO2) to 1.0.
B. Prepare for emergency needle decompression of the left chest.
C. Re-intubate the infant with a larger endotracheal tube.
D. Administer a 10 mL/kg normal saline fluid bolus.
Rationale: The sudden onset of unilateral decreased breath sounds, cyanosis, and
mediastinal shift indicates a tension pneumothorax. Emergency needle aspiration is required
to relieve intrathoracic pressure and restore venous return and ventilation.
2. A nurse is evaluating a term newborn 30 minutes after delivery. The infant's heart rate
is 130 bpm, respiratory rate is 72 breaths/min with mild intercostal retractions and
intermittent grunting, and pre-ductal oxygen saturation is 93%. What condition should
the nurse suspect?
A. Transient Tachypnea of the Newborn (TTN)
B. Respiratory Distress Syndrome (RDS)
C. Meconium Aspiration Syndrome (MAS)
D. Congenital Diaphragmatic Hernia
Rationale: Transient Tachypnea of the Newborn (TTN) is caused by delayed clearance of
fetal lung fluid, commonly seen following Cesarean birth or rapid vaginal delivery. Symptoms
like mild tachypnea and grunting usually appear shortly after birth and resolve within 24–72
hours with supportive care.
3. A preterm infant born at 30 weeks gestation is started on total parenteral nutrition
(TPN). Which clinical monitoring parameter is crucial to prevent central nervous system
damage related to rapid fluid and solute shifts?
A. Serum calcium levels
B. Daily head circumference measurements
C. Serum sodium concentration and blood glucose levels
D. Serum bilirubin levels
Rationale: Hypernatremia or rapid fluctuations in serum sodium cause osmotic shifts between
intracellular and extracellular compartments in the immature brain, significantly increasing the
risk of Intraventricular Hemorrhage (IVH).
, 4. A nurse is caring for a 3-day-old infant in the NICU who exhibits abdominal distention,
gastric residuals before feeds, bloody stools, and lethargy. An abdominal x-ray reveals
pneumatosis intestinalis. What condition does this confirm?
A. Hirschsprung disease
B. Meconium ileus
C. Hypertrophic pyloric stenosis
D. Necrotizing Enterocolitis (NEC)
Rationale: Pneumatosis intestinalis (gas within the intestinal wall) is the pathognomonic
radiographic sign of Necrotizing Enterocolitis (NEC). Management involves immediate
cessation of enteral feeds, gut decompression, broad-spectrum IV antibiotics, and surgical
consultation.
5. An infant born at 39 weeks gestation to a mother with gestational diabetes is admitted
to the nursery. The nurse notes jitteriness, high-pitched crying, and hypotonia at 2 hours
of life. What is the priority diagnostic test?
A. Bedside point-of-care blood glucose evaluation
B. Serum calcium level
C. Blood gas analysis
D. Complete blood count with manual differential
Rationale: Infants of diabetic mothers are at high risk for rebound hypoglycemia due to
maternal hyperglycemia-induced fetal hyperinsulinemia. Bedside blood glucose testing
identifies hypoglycemia (<40 mg/dL) so early feeding or IV dextrose can prevent neurological
injury.
6. A neonatal nurse performs an assessment on a newborn born at 32 weeks. The nurse
notes absence of the Moro reflex on the right side, along with a adducted right arm,
internally rotated shoulder, and pronated forearm ("waiter's tip" posture). Which injury
occurred?
A. Clavicular fracture
B. Facial nerve paralysis
C. Erb-Duchenne paralysis (Erb's palsy)
D. Klumpke's paralysis
Rationale: Erb's palsy involves injury to the upper brachial plexus roots (C5-C6), typically
caused by traction during shoulder dystocia delivery. It presents with loss of shoulder
abduction, external rotation, and forearm supination ("waiter's tip").
7. A infant receiving intensive phototherapy for hyperbilirubinemia requires close
monitoring. Which nursing care measure is mandatory during phototherapy?
A. Administering prophylactic oral vancomycin.
B. Covering the infant's eyes with opaque eye shields and protecting the gonads.
C. Keeping the infant fully dressed in cotton clothing.
Answers 2026-2027
Comprehensive Practice Test Bank & Clinical Study Guide for Neonatal Intensive Care
Nursing
1. A nurse in the NICU is assessing a preterm infant born at 28 weeks gestation receiving
mechanical ventilation. The infant suddenly develops cyanosis, hypotension, and
diminished breath sounds on the left side with a shift of apical heart sounds to the right.
What is the immediate nursing priority action?
A. Increase the fraction of inspired oxygen (FiO2) to 1.0.
B. Prepare for emergency needle decompression of the left chest.
C. Re-intubate the infant with a larger endotracheal tube.
D. Administer a 10 mL/kg normal saline fluid bolus.
Rationale: The sudden onset of unilateral decreased breath sounds, cyanosis, and
mediastinal shift indicates a tension pneumothorax. Emergency needle aspiration is required
to relieve intrathoracic pressure and restore venous return and ventilation.
2. A nurse is evaluating a term newborn 30 minutes after delivery. The infant's heart rate
is 130 bpm, respiratory rate is 72 breaths/min with mild intercostal retractions and
intermittent grunting, and pre-ductal oxygen saturation is 93%. What condition should
the nurse suspect?
A. Transient Tachypnea of the Newborn (TTN)
B. Respiratory Distress Syndrome (RDS)
C. Meconium Aspiration Syndrome (MAS)
D. Congenital Diaphragmatic Hernia
Rationale: Transient Tachypnea of the Newborn (TTN) is caused by delayed clearance of
fetal lung fluid, commonly seen following Cesarean birth or rapid vaginal delivery. Symptoms
like mild tachypnea and grunting usually appear shortly after birth and resolve within 24–72
hours with supportive care.
3. A preterm infant born at 30 weeks gestation is started on total parenteral nutrition
(TPN). Which clinical monitoring parameter is crucial to prevent central nervous system
damage related to rapid fluid and solute shifts?
A. Serum calcium levels
B. Daily head circumference measurements
C. Serum sodium concentration and blood glucose levels
D. Serum bilirubin levels
Rationale: Hypernatremia or rapid fluctuations in serum sodium cause osmotic shifts between
intracellular and extracellular compartments in the immature brain, significantly increasing the
risk of Intraventricular Hemorrhage (IVH).
, 4. A nurse is caring for a 3-day-old infant in the NICU who exhibits abdominal distention,
gastric residuals before feeds, bloody stools, and lethargy. An abdominal x-ray reveals
pneumatosis intestinalis. What condition does this confirm?
A. Hirschsprung disease
B. Meconium ileus
C. Hypertrophic pyloric stenosis
D. Necrotizing Enterocolitis (NEC)
Rationale: Pneumatosis intestinalis (gas within the intestinal wall) is the pathognomonic
radiographic sign of Necrotizing Enterocolitis (NEC). Management involves immediate
cessation of enteral feeds, gut decompression, broad-spectrum IV antibiotics, and surgical
consultation.
5. An infant born at 39 weeks gestation to a mother with gestational diabetes is admitted
to the nursery. The nurse notes jitteriness, high-pitched crying, and hypotonia at 2 hours
of life. What is the priority diagnostic test?
A. Bedside point-of-care blood glucose evaluation
B. Serum calcium level
C. Blood gas analysis
D. Complete blood count with manual differential
Rationale: Infants of diabetic mothers are at high risk for rebound hypoglycemia due to
maternal hyperglycemia-induced fetal hyperinsulinemia. Bedside blood glucose testing
identifies hypoglycemia (<40 mg/dL) so early feeding or IV dextrose can prevent neurological
injury.
6. A neonatal nurse performs an assessment on a newborn born at 32 weeks. The nurse
notes absence of the Moro reflex on the right side, along with a adducted right arm,
internally rotated shoulder, and pronated forearm ("waiter's tip" posture). Which injury
occurred?
A. Clavicular fracture
B. Facial nerve paralysis
C. Erb-Duchenne paralysis (Erb's palsy)
D. Klumpke's paralysis
Rationale: Erb's palsy involves injury to the upper brachial plexus roots (C5-C6), typically
caused by traction during shoulder dystocia delivery. It presents with loss of shoulder
abduction, external rotation, and forearm supination ("waiter's tip").
7. A infant receiving intensive phototherapy for hyperbilirubinemia requires close
monitoring. Which nursing care measure is mandatory during phototherapy?
A. Administering prophylactic oral vancomycin.
B. Covering the infant's eyes with opaque eye shields and protecting the gonads.
C. Keeping the infant fully dressed in cotton clothing.
