1. A neonate at 2 hours of life has respiratory distress, scaphoid abdomen, and decreased breath
sounds on the left. Which medication should the nurse prepare to administer?
A. Beractant (Survanta)
B. Naloxone
C. Epinephrine
D. Sodium bicarbonate
Rationale: Scaphoid abdomen and decreased left breath sounds indicate diaphragmatic hernia.
Beractant is not the primary medication; however, among options, surfactant may be used for
associated lung immaturity. Immediate intubation and gastric decompression are key, but
surfactant can be given for respiratory failure. Beractant is the only respiratory-specific medication
listed.
2. A newborn’s physical exam reveals a gap in the spine without any sac protrusion or opening.
This finding is most consistent with which condition?
A. Meningocele
B. Myelomeningocele
C. Spina Bifida Occulta
D. Craniosynostosis
Rationale: Spina bifida occulta is a hidden defect with a vertebral gap but no external sac or spinal
opening, often found incidentally.
3. A 3-day-old infant has an absent Moro reflex, poor feeding, and high-pitched cry. Which
underlying process is most likely?
A. Hypoglycemia
B. Bilirubin encephalopathy (kernicterus)
C. Neonatal abstinence syndrome
D. Hypocalcemia
Rationale: Absent Moro reflex in the context of hyperbilirubinemia suggests bilirubin-induced
neurologic dysfunction, or kernicterus.
4. The nurse notes a newborn’s head has a hard ridge along the sagittal suture, no fontanel
palpable, and a misshapen skull that has not changed since birth. What diagnosis does this
support?
,A. Positional plagiocephaly
B. Craniosynostosis
C. Hydrocephalus
D. Caput succedaneum
Rationale: Premature fusion of cranial sutures causes a hard ridge, absent fontanels, and a
misshapen head that does not resolve, unlike positional molding.
5. A preterm infant receiving oxygen therapy develops retinopathy of prematurity. Which
pathophysiologic process explains this?
A. Retinal artery thrombosis
B. Fibrous tissue replacement of retina from high oxygen
C. Retinal detachment from birth trauma
D. Congenital cytomegalovirus infection
Rationale: High oxygen levels in premature infants cause retinal vaso-obliteration followed by
abnormal neovascularization, leading to fibrous tissue and retinal damage.
6. A newborn has an asymmetrical face with the head persistently turned to one side as if looking
over the shoulder. Which condition does this describe?
A. Torticollis from cervical spine injury
B. Congenital torticollis
C. Plagiocephaly
D. Facial nerve palsy
Rationale: Congenital torticollis presents with asymmetrical face and head positioning “looking
over the shoulder” due to sternocleidomastoid tightness.
7. A newborn’s pulse oximeter shows 62% at 1 minute of life. What is the expected SpO2 at 5
minutes in a healthy term neonate during transition?
A. 70-75%
B. *80-85%*
C. 90-95%
D. 100%
*Rationale: SpO2 increases by about 5% per minute from 60-65% at 1 minute to 85-90% by 10
minutes, so at 5 minutes approximately 80-85% is expected.*
8. A postpartum client with hypertension and epigastric pain has lab results showing platelets
85,000, AST 120, and LDH 600. Which syndrome is the priority concern?
A. Gestational hypertension
,B. HELLP syndrome
C. Acute fatty liver of pregnancy
D. Idiopathic thrombocytopenic purpura
Rationale: Hemolysis (elevated LDH), elevated liver enzymes (AST), and low platelets (＜100,000)
define HELLP syndrome, a severe preeclampsia variant.
9. A newborn with phenylketonuria is being discharged. Which dietary instruction should the
nurse emphasize to the parents?
A. High protein, no fruits
B. Low protein, no artificial sweeteners
C. No carbohydrates, high fat
D. Unlimited breast milk, no formula
Rationale: PKU requires low protein intake and avoidance of aspartame (artificial sweetener)
because phenylalanine accumulates and causes brain damage.
10. A post-term infant has dry, peeling, cracking skin noted on admission. What is the correct term
for this finding?
A. Erythema toxicum
B. Desquamation
C. Cutis marmorata
D. Harlequin color change
Rationale: Desquamation refers to peeling and cracking skin commonly seen in post-term infants
due to loss of vernix and prolonged amniotic fluid exposure.
11. A nurse calculates that a 3.5 kg term neonate needs approximately how many kilocalories per
day?
A. 200 kcal
B. 350 kcal
C. 500 kcal
D. 700 kcal
*Rationale: Term neonates require about 100 kcal/kg/day, so 3.5 kg × 100 = 350 kcal/day.*
12. A woman with blood type O negative gives birth to a type A positive infant. Which
complication is the infant at highest risk for?
A. Respiratory distress syndrome
B. ABO incompatibility
C. Polycythemia
, D. Neonatal sepsis
Rationale: ABO incompatibility occurs when a type O mother has antibodies against type A or B
blood, potentially causing hemolytic disease in the newborn.
13. A nurse is evaluating a biophysical profile (BPP). Which component assesses fetal muscle tone?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Gross body movements with flexion/extension
D. Reactive nonstress test
Rationale: Fetal tone on BPP is demonstrated by at least one episode of active extension and
flexion of limbs or trunk.
14. A pregnant patient with severe preeclampsia has a serum creatinine of 1.3 mg/dL. What does
this value indicate?
A. Normal renal function
B. Mild dehydration
C. Worsening preeclampsia with renal involvement
D. Gestational diabetes complication
*Rationale: Normal pregnancy creatinine is 0.5-0.9 mg/dL; >1.1 mg/dL suggests impaired kidney
function in preeclampsia.*
15. A 34-week gestation infant has respiratory distress lasting 8 hours and then resolves. This is
most consistent with which diagnosis?
A. Respiratory distress syndrome
B. Transient tachypnea of the newborn (TTN)
C. Meconium aspiration syndrome
D. Congenital pneumonia
*Rationale: TTN typically resolves within 6-24 hours due to delayed absorption of fetal lung fluid,
unlike other causes of respiratory distress.*
16. An amniocentesis at 35 weeks shows an L/S ratio of 2:1 and phosphatidylglycerol present.
What conclusion should the nurse draw?
A. High risk for respiratory distress syndrome
B. Fetal lung maturity is achieved
C. Amniotic fluid infection is likely
D. Neural tube defect is present
*Rationale: L/S ratio ≥2:1 and presence of PG indicate pulmonary maturity and low risk of RDS.*
sounds on the left. Which medication should the nurse prepare to administer?
A. Beractant (Survanta)
B. Naloxone
C. Epinephrine
D. Sodium bicarbonate
Rationale: Scaphoid abdomen and decreased left breath sounds indicate diaphragmatic hernia.
Beractant is not the primary medication; however, among options, surfactant may be used for
associated lung immaturity. Immediate intubation and gastric decompression are key, but
surfactant can be given for respiratory failure. Beractant is the only respiratory-specific medication
listed.
2. A newborn’s physical exam reveals a gap in the spine without any sac protrusion or opening.
This finding is most consistent with which condition?
A. Meningocele
B. Myelomeningocele
C. Spina Bifida Occulta
D. Craniosynostosis
Rationale: Spina bifida occulta is a hidden defect with a vertebral gap but no external sac or spinal
opening, often found incidentally.
3. A 3-day-old infant has an absent Moro reflex, poor feeding, and high-pitched cry. Which
underlying process is most likely?
A. Hypoglycemia
B. Bilirubin encephalopathy (kernicterus)
C. Neonatal abstinence syndrome
D. Hypocalcemia
Rationale: Absent Moro reflex in the context of hyperbilirubinemia suggests bilirubin-induced
neurologic dysfunction, or kernicterus.
4. The nurse notes a newborn’s head has a hard ridge along the sagittal suture, no fontanel
palpable, and a misshapen skull that has not changed since birth. What diagnosis does this
support?
,A. Positional plagiocephaly
B. Craniosynostosis
C. Hydrocephalus
D. Caput succedaneum
Rationale: Premature fusion of cranial sutures causes a hard ridge, absent fontanels, and a
misshapen head that does not resolve, unlike positional molding.
5. A preterm infant receiving oxygen therapy develops retinopathy of prematurity. Which
pathophysiologic process explains this?
A. Retinal artery thrombosis
B. Fibrous tissue replacement of retina from high oxygen
C. Retinal detachment from birth trauma
D. Congenital cytomegalovirus infection
Rationale: High oxygen levels in premature infants cause retinal vaso-obliteration followed by
abnormal neovascularization, leading to fibrous tissue and retinal damage.
6. A newborn has an asymmetrical face with the head persistently turned to one side as if looking
over the shoulder. Which condition does this describe?
A. Torticollis from cervical spine injury
B. Congenital torticollis
C. Plagiocephaly
D. Facial nerve palsy
Rationale: Congenital torticollis presents with asymmetrical face and head positioning “looking
over the shoulder” due to sternocleidomastoid tightness.
7. A newborn’s pulse oximeter shows 62% at 1 minute of life. What is the expected SpO2 at 5
minutes in a healthy term neonate during transition?
A. 70-75%
B. *80-85%*
C. 90-95%
D. 100%
*Rationale: SpO2 increases by about 5% per minute from 60-65% at 1 minute to 85-90% by 10
minutes, so at 5 minutes approximately 80-85% is expected.*
8. A postpartum client with hypertension and epigastric pain has lab results showing platelets
85,000, AST 120, and LDH 600. Which syndrome is the priority concern?
A. Gestational hypertension
,B. HELLP syndrome
C. Acute fatty liver of pregnancy
D. Idiopathic thrombocytopenic purpura
Rationale: Hemolysis (elevated LDH), elevated liver enzymes (AST), and low platelets (＜100,000)
define HELLP syndrome, a severe preeclampsia variant.
9. A newborn with phenylketonuria is being discharged. Which dietary instruction should the
nurse emphasize to the parents?
A. High protein, no fruits
B. Low protein, no artificial sweeteners
C. No carbohydrates, high fat
D. Unlimited breast milk, no formula
Rationale: PKU requires low protein intake and avoidance of aspartame (artificial sweetener)
because phenylalanine accumulates and causes brain damage.
10. A post-term infant has dry, peeling, cracking skin noted on admission. What is the correct term
for this finding?
A. Erythema toxicum
B. Desquamation
C. Cutis marmorata
D. Harlequin color change
Rationale: Desquamation refers to peeling and cracking skin commonly seen in post-term infants
due to loss of vernix and prolonged amniotic fluid exposure.
11. A nurse calculates that a 3.5 kg term neonate needs approximately how many kilocalories per
day?
A. 200 kcal
B. 350 kcal
C. 500 kcal
D. 700 kcal
*Rationale: Term neonates require about 100 kcal/kg/day, so 3.5 kg × 100 = 350 kcal/day.*
12. A woman with blood type O negative gives birth to a type A positive infant. Which
complication is the infant at highest risk for?
A. Respiratory distress syndrome
B. ABO incompatibility
C. Polycythemia
, D. Neonatal sepsis
Rationale: ABO incompatibility occurs when a type O mother has antibodies against type A or B
blood, potentially causing hemolytic disease in the newborn.
13. A nurse is evaluating a biophysical profile (BPP). Which component assesses fetal muscle tone?
A. Fetal breathing movements
B. Amniotic fluid volume
C. Gross body movements with flexion/extension
D. Reactive nonstress test
Rationale: Fetal tone on BPP is demonstrated by at least one episode of active extension and
flexion of limbs or trunk.
14. A pregnant patient with severe preeclampsia has a serum creatinine of 1.3 mg/dL. What does
this value indicate?
A. Normal renal function
B. Mild dehydration
C. Worsening preeclampsia with renal involvement
D. Gestational diabetes complication
*Rationale: Normal pregnancy creatinine is 0.5-0.9 mg/dL; >1.1 mg/dL suggests impaired kidney
function in preeclampsia.*
15. A 34-week gestation infant has respiratory distress lasting 8 hours and then resolves. This is
most consistent with which diagnosis?
A. Respiratory distress syndrome
B. Transient tachypnea of the newborn (TTN)
C. Meconium aspiration syndrome
D. Congenital pneumonia
*Rationale: TTN typically resolves within 6-24 hours due to delayed absorption of fetal lung fluid,
unlike other causes of respiratory distress.*
16. An amniocentesis at 35 weeks shows an L/S ratio of 2:1 and phosphatidylglycerol present.
What conclusion should the nurse draw?
A. High risk for respiratory distress syndrome
B. Fetal lung maturity is achieved
C. Amniotic fluid infection is likely
D. Neural tube defect is present
*Rationale: L/S ratio ≥2:1 and presence of PG indicate pulmonary maturity and low risk of RDS.*
