RELIAS RN NICU NURSING CORE CONCEPTS RN EXAM 1 QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE
2026/2027.
Section One: Questions 1–100
Which factor most significantly contributes to heat loss in a preterm infant?
A. Large body surface area relative to weight
B. Increased subcutaneous fat
C. Ability to shiver effectively
D. High metabolic rate
🟢 A. Large body surface area relative to weight
🔴 RATIONALE: Preterm infants have a thin layer of subcutaneous fat and a large surface area in
proportion to their body mass, leading to rapid heat loss through radiation and conduction.
A neonate presents with scaphoid abdomen and respiratory distress. What should the nurse
suspect?
A. Necrotizing enterocolitis
B. Diaphragmatic hernia
C. Esophageal atresia
D. Pyloric stenosis
🟢 B. Diaphragmatic hernia
🔴 RATIONALE: A scaphoid abdomen in a newborn with respiratory distress is a classic sign of a
congenital diaphragmatic hernia, where abdominal contents shift into the thoracic cavity.
What is the priority nursing action for a newborn with suspected sepsis?
A. Administer oral glucose
B. Obtain blood cultures and start antibiotics
C. Perform a neurological exam
,D. Place in a radiant warmer only
🟢 B. Obtain blood cultures and start antibiotics
🔴 RATIONALE: Sepsis in a neonate can rapidly lead to septic shock; prompt identification
followed by immediate culture collection and empiric antibiotic therapy is critical.
Which assessment finding is indicative of respiratory distress syndrome (RDS)?
A. Grunting, nasal flaring, and retractions
B. Periods of apnea lasting 5 seconds
C. Normal capillary refill time
D. Clear breath sounds on auscultation
🟢 A. Grunting, nasal flaring, and retractions
🔴 RATIONALE: These are clinical manifestations of increased work of breathing and lung
collapse associated with surfactant deficiency in RDS.
A neonate is receiving phototherapy. Which nursing action is mandatory?
A. Covering the eyes to prevent retinal damage
B. Applying lotion to keep skin moist
C. Feeding every 6 hours
D. Keeping the infant swaddled
🟢 A. Covering the eyes to prevent retinal damage
🔴 RATIONALE: Intense light from phototherapy units can cause retinal damage; therefore,
protective eye shielding is required at all times while the lights are on.
Which blood gas result indicates uncompensated respiratory acidosis in a neonate?
A. pH 7.25, PaCO2 55 mmHg, HCO3 22 mEq/L
B. pH 7.45, PaCO2 40 mmHg, HCO3 24 mEq/L
C. pH 7.30, PaCO2 45 mmHg, HCO3 18 mEq/L
,D. pH 7.50, PaCO2 35 mmHg, HCO3 24 mEq/L
🟢 A. pH 7.25, PaCO2 55 mmHg, HCO3 22 mEq/L
🔴 RATIONALE: A low pH (acidosis), high PaCO2 (respiratory origin), and normal bicarbonate
level indicate that the respiratory system is the cause and compensation has not occurred.
What is the most common cause of metabolic acidosis in the NICU?
A. Hyperventilation
B. Tissue hypoxia
C. Excessive suctioning
D. Maternal diabetes
🟢 B. Tissue hypoxia
🔴 RATIONALE: Inadequate oxygen delivery to tissues leads to anaerobic metabolism and the
accumulation of lactic acid, causing metabolic acidosis.
When caring for an infant with an umbilical arterial catheter, what must the nurse monitor?
A. Heart rate every 15 minutes
B. Distal perfusion of the lower extremities
C. Presence of bowel sounds
D. Ability to suck
🟢 B. Distal perfusion of the lower extremities
🔴 RATIONALE: Catheters in the umbilical artery can cause vasospasm or thrombus formation,
potentially compromising blood flow to the legs and feet.
Which sign is an early indicator of Necrotizing Enterocolitis (NEC)?
A. Increased activity
B. Gastric residuals and abdominal distension
C. High blood pressure
, D. Meconium passage
🟢 B. Gastric residuals and abdominal distension
🔴 RATIONALE: Feeding intolerance, indicated by large or bilious gastric residuals and abdominal
distension, is often the first clinical sign of NEC.
What is the primary purpose of administering Vitamin K to a newborn?
A. To prevent jaundice
B. To stimulate appetite
C. To prevent hemorrhagic disease
D. To boost the immune system
🟢 C. To prevent hemorrhagic disease
🔴 RATIONALE: Newborns have a sterile gut and cannot synthesize Vitamin K, which is essential
for clotting factor production; supplementation prevents potential life-threatening bleeding.
A neonate on a ventilator shows sudden desaturation and bradycardia. What is the first action?
A. Change the ventilator settings
B. Suction the airway
C. Perform manual ventilation with an ambu-bag and check breath sounds
D. Call for a chest X-ray
🟢 C. Perform manual ventilation with an ambu-bag and check breath sounds
🔴 RATIONALE: When a ventilated patient desaturates, the nurse must assess for tube
displacement, obstruction, or pneumothorax by manually ventilating to assess compliance and
symmetry.
Which reflex is characterized by an infant extending the arms and legs when startled?
A. Rooting reflex
B. Moro reflex
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |LATEST EXAM UPDATE
2026/2027.
Section One: Questions 1–100
Which factor most significantly contributes to heat loss in a preterm infant?
A. Large body surface area relative to weight
B. Increased subcutaneous fat
C. Ability to shiver effectively
D. High metabolic rate
🟢 A. Large body surface area relative to weight
🔴 RATIONALE: Preterm infants have a thin layer of subcutaneous fat and a large surface area in
proportion to their body mass, leading to rapid heat loss through radiation and conduction.
A neonate presents with scaphoid abdomen and respiratory distress. What should the nurse
suspect?
A. Necrotizing enterocolitis
B. Diaphragmatic hernia
C. Esophageal atresia
D. Pyloric stenosis
🟢 B. Diaphragmatic hernia
🔴 RATIONALE: A scaphoid abdomen in a newborn with respiratory distress is a classic sign of a
congenital diaphragmatic hernia, where abdominal contents shift into the thoracic cavity.
What is the priority nursing action for a newborn with suspected sepsis?
A. Administer oral glucose
B. Obtain blood cultures and start antibiotics
C. Perform a neurological exam
,D. Place in a radiant warmer only
🟢 B. Obtain blood cultures and start antibiotics
🔴 RATIONALE: Sepsis in a neonate can rapidly lead to septic shock; prompt identification
followed by immediate culture collection and empiric antibiotic therapy is critical.
Which assessment finding is indicative of respiratory distress syndrome (RDS)?
A. Grunting, nasal flaring, and retractions
B. Periods of apnea lasting 5 seconds
C. Normal capillary refill time
D. Clear breath sounds on auscultation
🟢 A. Grunting, nasal flaring, and retractions
🔴 RATIONALE: These are clinical manifestations of increased work of breathing and lung
collapse associated with surfactant deficiency in RDS.
A neonate is receiving phototherapy. Which nursing action is mandatory?
A. Covering the eyes to prevent retinal damage
B. Applying lotion to keep skin moist
C. Feeding every 6 hours
D. Keeping the infant swaddled
🟢 A. Covering the eyes to prevent retinal damage
🔴 RATIONALE: Intense light from phototherapy units can cause retinal damage; therefore,
protective eye shielding is required at all times while the lights are on.
Which blood gas result indicates uncompensated respiratory acidosis in a neonate?
A. pH 7.25, PaCO2 55 mmHg, HCO3 22 mEq/L
B. pH 7.45, PaCO2 40 mmHg, HCO3 24 mEq/L
C. pH 7.30, PaCO2 45 mmHg, HCO3 18 mEq/L
,D. pH 7.50, PaCO2 35 mmHg, HCO3 24 mEq/L
🟢 A. pH 7.25, PaCO2 55 mmHg, HCO3 22 mEq/L
🔴 RATIONALE: A low pH (acidosis), high PaCO2 (respiratory origin), and normal bicarbonate
level indicate that the respiratory system is the cause and compensation has not occurred.
What is the most common cause of metabolic acidosis in the NICU?
A. Hyperventilation
B. Tissue hypoxia
C. Excessive suctioning
D. Maternal diabetes
🟢 B. Tissue hypoxia
🔴 RATIONALE: Inadequate oxygen delivery to tissues leads to anaerobic metabolism and the
accumulation of lactic acid, causing metabolic acidosis.
When caring for an infant with an umbilical arterial catheter, what must the nurse monitor?
A. Heart rate every 15 minutes
B. Distal perfusion of the lower extremities
C. Presence of bowel sounds
D. Ability to suck
🟢 B. Distal perfusion of the lower extremities
🔴 RATIONALE: Catheters in the umbilical artery can cause vasospasm or thrombus formation,
potentially compromising blood flow to the legs and feet.
Which sign is an early indicator of Necrotizing Enterocolitis (NEC)?
A. Increased activity
B. Gastric residuals and abdominal distension
C. High blood pressure
, D. Meconium passage
🟢 B. Gastric residuals and abdominal distension
🔴 RATIONALE: Feeding intolerance, indicated by large or bilious gastric residuals and abdominal
distension, is often the first clinical sign of NEC.
What is the primary purpose of administering Vitamin K to a newborn?
A. To prevent jaundice
B. To stimulate appetite
C. To prevent hemorrhagic disease
D. To boost the immune system
🟢 C. To prevent hemorrhagic disease
🔴 RATIONALE: Newborns have a sterile gut and cannot synthesize Vitamin K, which is essential
for clotting factor production; supplementation prevents potential life-threatening bleeding.
A neonate on a ventilator shows sudden desaturation and bradycardia. What is the first action?
A. Change the ventilator settings
B. Suction the airway
C. Perform manual ventilation with an ambu-bag and check breath sounds
D. Call for a chest X-ray
🟢 C. Perform manual ventilation with an ambu-bag and check breath sounds
🔴 RATIONALE: When a ventilated patient desaturates, the nurse must assess for tube
displacement, obstruction, or pneumothorax by manually ventilating to assess compliance and
symmetry.
Which reflex is characterized by an infant extending the arms and legs when startled?
A. Rooting reflex
B. Moro reflex
