1
Santa Clara County NICU
Nurse Examination
Comprehensive 150-
Question Multiple-Choice
Examination a well
detailed one 2025 /
2026 written and graded
A+ upgraded
, 2
Instructions to Candidates
This examination consists of 150 multiple-choice questions designed to assess advanced clinical
knowledge, critical thinking, and evidence-based practice in neonatal intensive care nursing
within the context of Santa Clara County healthcare settings. Each question has one correct
answer. Select the best answer among the options provided. Questions cover assessment,
pathophysiology, pharmacology, procedures, ethical-legal considerations, family-centered care,
and transport/emergency management. A rationale is provided for each correct answer.
Time Allowed: 3 hours
SECTION A: NEONATAL ASSESSMENT AND PHYSICAL EXAMINATION (Questions 1–20)
1. A 34-week gestation neonate in the Santa Clara Valley Medical Center (SCVMC) NICU has a
heart rate of 92 bpm, respiratory rate of 58 breaths/min, and axillary temperature of 36.2°C.
According to SCVMC standardized newborn orders, which action should the nurse take first?
• A. Continue routine monitoring as vitals are within normal limits
• B. Notify the physician immediately as the temperature is below 36.5°C
• C. Increase the incubator temperature by 1°C
• D. Perform a heel stick for blood glucose
-detailed answer 100% correct :- B
Rationale: SCVMC standardized orders require physician notification for axillary temperature
below 36.5°C on two consecutive measurements. A single reading of 36.2°C in a preterm infant
warrants prompt notification to prevent cold stress complications. Temperature instability in
preterm infants can lead to hypoxia, acidosis, and increased mortality.
2. During a neurodevelopmental assessment of a 38-week gestation infant, the nurse notes
that the infant's anterior fontanel is full and tense. What is the most appropriate initial
nursing action?
• A. Document the finding as normal
• B. Elevate the head of the bed to 30 degrees
• C. Notify the neonatologist immediately
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• D. Administer prescribed acetaminophen
-detailed answer 100% correct :- C
Rationale: A full, tense anterior fontanel in a term infant is a sign of increased intracranial
pressure and requires immediate medical evaluation. Potential causes include hydrocephalus,
intracranial hemorrhage, or meningitis. Prompt notification enables timely diagnostic
intervention.
3. The nurse is performing a pre-ductal and post-ductal pulse oximetry screening on a 24-
hour-old term infant at SCVMC. The pre-ductal saturation is 94% and the post-ductal
saturation is 89%. What is the most appropriate nursing action?
• A. Document the findings and continue routine care
• B. Repeat the screening in 4 hours
• C. Notify the physician as the screening has not passed
• D. Administer supplemental oxygen at 2 L/min
-detailed answer 100% correct :- C
Rationale: SCVMC protocol requires pulse oximetry screening at 24 hours of life, with physician
notification if the screen is not passed. A difference of >3% between pre-ductal and post-ductal
saturations or saturations <90% suggests possible critical congenital heart disease. The nurse
should notify the provider for further evaluation.
4. A preterm infant at 30 weeks gestation is being assessed for respiratory distress. Which of
the following assessment findings would be MOST concerning?
• A. Respiratory rate of 55 breaths/min
• B. Mild intercostal retractions
• C. Grunting with expiration
• D. Heart rate of 155 bpm
-detailed answer 100% correct :- C
Rationale: Expiratory grunting is a sign of impending respiratory failure in neonates, indicating
the infant is attempting to maintain functional residual capacity by generating positive end-
, 4
expiratory pressure. While tachypnea (RR 55) and mild retractions are common in preterm
infants with respiratory distress, grunting requires immediate intervention.
5. The nurse is performing a head-to-toe assessment on a 2-day-old term infant. Which
finding requires immediate physician notification according to SCVMC protocol?
• A. Hematocrit of 62%
• B. Weight loss of 6% from birth weight
• C. Transcutaneous bilirubin of 8 mg/dL
• D. Heart rate of 140 bpm
-detailed answer 100% correct :- A
Rationale: SCVMC protocol requires physician notification for hematocrit less than 40 or greater
than 65. A hematocrit of 62% is concerning for polycythemia, which can lead to hyperviscosity,
impaired tissue perfusion, and potential neurological sequelae. This finding warrants immediate
evaluation.
6. When auscultating breath sounds in a mechanically ventilated neonate, the nurse notes
diminished breath sounds on the left side with tracheal deviation to the right. What is the
priority nursing action?
• A. Increase the peak inspiratory pressure
• B. Reposition the endotracheal tube
• C. Notify the provider and prepare for chest tube insertion
• D. Administer a bronchodilator
-detailed answer 100% correct :- C
Rationale: Diminished breath sounds on one side with tracheal deviation to the contralateral
side is a classic presentation of tension pneumothorax, a life-threatening emergency in
ventilated neonates. Immediate notification of the provider and preparation for needle
decompression or chest tube insertion is critical.
Santa Clara County NICU
Nurse Examination
Comprehensive 150-
Question Multiple-Choice
Examination a well
detailed one 2025 /
2026 written and graded
A+ upgraded
, 2
Instructions to Candidates
This examination consists of 150 multiple-choice questions designed to assess advanced clinical
knowledge, critical thinking, and evidence-based practice in neonatal intensive care nursing
within the context of Santa Clara County healthcare settings. Each question has one correct
answer. Select the best answer among the options provided. Questions cover assessment,
pathophysiology, pharmacology, procedures, ethical-legal considerations, family-centered care,
and transport/emergency management. A rationale is provided for each correct answer.
Time Allowed: 3 hours
SECTION A: NEONATAL ASSESSMENT AND PHYSICAL EXAMINATION (Questions 1–20)
1. A 34-week gestation neonate in the Santa Clara Valley Medical Center (SCVMC) NICU has a
heart rate of 92 bpm, respiratory rate of 58 breaths/min, and axillary temperature of 36.2°C.
According to SCVMC standardized newborn orders, which action should the nurse take first?
• A. Continue routine monitoring as vitals are within normal limits
• B. Notify the physician immediately as the temperature is below 36.5°C
• C. Increase the incubator temperature by 1°C
• D. Perform a heel stick for blood glucose
-detailed answer 100% correct :- B
Rationale: SCVMC standardized orders require physician notification for axillary temperature
below 36.5°C on two consecutive measurements. A single reading of 36.2°C in a preterm infant
warrants prompt notification to prevent cold stress complications. Temperature instability in
preterm infants can lead to hypoxia, acidosis, and increased mortality.
2. During a neurodevelopmental assessment of a 38-week gestation infant, the nurse notes
that the infant's anterior fontanel is full and tense. What is the most appropriate initial
nursing action?
• A. Document the finding as normal
• B. Elevate the head of the bed to 30 degrees
• C. Notify the neonatologist immediately
, 3
• D. Administer prescribed acetaminophen
-detailed answer 100% correct :- C
Rationale: A full, tense anterior fontanel in a term infant is a sign of increased intracranial
pressure and requires immediate medical evaluation. Potential causes include hydrocephalus,
intracranial hemorrhage, or meningitis. Prompt notification enables timely diagnostic
intervention.
3. The nurse is performing a pre-ductal and post-ductal pulse oximetry screening on a 24-
hour-old term infant at SCVMC. The pre-ductal saturation is 94% and the post-ductal
saturation is 89%. What is the most appropriate nursing action?
• A. Document the findings and continue routine care
• B. Repeat the screening in 4 hours
• C. Notify the physician as the screening has not passed
• D. Administer supplemental oxygen at 2 L/min
-detailed answer 100% correct :- C
Rationale: SCVMC protocol requires pulse oximetry screening at 24 hours of life, with physician
notification if the screen is not passed. A difference of >3% between pre-ductal and post-ductal
saturations or saturations <90% suggests possible critical congenital heart disease. The nurse
should notify the provider for further evaluation.
4. A preterm infant at 30 weeks gestation is being assessed for respiratory distress. Which of
the following assessment findings would be MOST concerning?
• A. Respiratory rate of 55 breaths/min
• B. Mild intercostal retractions
• C. Grunting with expiration
• D. Heart rate of 155 bpm
-detailed answer 100% correct :- C
Rationale: Expiratory grunting is a sign of impending respiratory failure in neonates, indicating
the infant is attempting to maintain functional residual capacity by generating positive end-
, 4
expiratory pressure. While tachypnea (RR 55) and mild retractions are common in preterm
infants with respiratory distress, grunting requires immediate intervention.
5. The nurse is performing a head-to-toe assessment on a 2-day-old term infant. Which
finding requires immediate physician notification according to SCVMC protocol?
• A. Hematocrit of 62%
• B. Weight loss of 6% from birth weight
• C. Transcutaneous bilirubin of 8 mg/dL
• D. Heart rate of 140 bpm
-detailed answer 100% correct :- A
Rationale: SCVMC protocol requires physician notification for hematocrit less than 40 or greater
than 65. A hematocrit of 62% is concerning for polycythemia, which can lead to hyperviscosity,
impaired tissue perfusion, and potential neurological sequelae. This finding warrants immediate
evaluation.
6. When auscultating breath sounds in a mechanically ventilated neonate, the nurse notes
diminished breath sounds on the left side with tracheal deviation to the right. What is the
priority nursing action?
• A. Increase the peak inspiratory pressure
• B. Reposition the endotracheal tube
• C. Notify the provider and prepare for chest tube insertion
• D. Administer a bronchodilator
-detailed answer 100% correct :- C
Rationale: Diminished breath sounds on one side with tracheal deviation to the contralateral
side is a classic presentation of tension pneumothorax, a life-threatening emergency in
ventilated neonates. Immediate notification of the provider and preparation for needle
decompression or chest tube insertion is critical.
