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NSG 548 FINAL EXAM STUDY GUIDE EXAM HIGH-YIELD EXAM
LATEST VERSION QUESTIONS AND ANSWERS 2026 EDITION
NSG 548 Final Exam Study Guide: 250 Practice Questions with Rationales
SECTION 1: NEONATAL ASSESSMENT AND TRANSITION (Questions 1-40)
1. A full-term newborn is 12 hours old and has not yet passed meconium. What is the
nurse practitioner's priority action?
A. Continue to monitor as this is normal up to 48 hours
B. Notify the healthcare provider for further evaluation
C. Administer a glycerin suppository
D. Initiate oral feedings to stimulate peristalsis
Answer: B. Notify the healthcare provider for further evaluation
Rationale: Meconium should be passed within the first 24-48 hours of life. Failure to pass
meconium within the first 24 hours can indicate obstruction such as Hirschsprung disease,
meconium ileus (associated with cystic fibrosis), or other intestinal anomalies. Early
notification allows for diagnostic evaluation .
2. A newborn's mother asks the nurse practitioner about the baby's visual acuity. What
is the normal visual acuity of a newborn?
A. 20/50
B. 20/100
C. 20/200
D. 20/400
Answer: D. 20/400
Rationale: Newborns have visual acuity of approximately 20/400. They can follow a light to
midline, but their visual acuity is limited. Vision improves steadily throughout infancy,
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reaching 20/20 by about 6 months of age. This is a key developmental milestone to assess and
discuss with parents .
3. The nurse practitioner is performing a newborn eye examination. Which finding
indicates a normal red reflex?
A. Asymmetrical, with white spots in one eye
B. Symmetrical and absent of opacities, white, or dark spots
C. No red reflex visible in either eye
D. A dark spot in the center of both eyes
Answer: B. Symmetrical and absent of opacities, white, or dark spots
Rationale: A normal red reflex should be symmetrical and absent of opacities, white, or dark
spots. An asymmetrical red reflex with white or dark spots requires referral to an
ophthalmologist. A dark spot in the red reflex, an absent reflex, or leukocoria (white pupil)
may indicate retinoblastoma, cataracts, or other ocular pathology. In newborns, this test is
critical for early detection .
4. The nurse practitioner notes that a newborn has a bilateral, non-tender scrotal
swelling that transilluminates. This finding is consistent with:
A. Inguinal hernia
B. Testicular torsion
C. Hydrocele
D. Epididymitis
Answer: C. Hydrocele
Rationale: Hydrocele is a fluid collection in the scrotum that transilluminates and is typically
non-tender. It is common in newborns and usually resolves spontaneously. Inguinal hernia
presents with a non-transilluminating swelling that may increase with crying. Testicular
torsion presents with acute pain. Epididymitis presents with pain and tenderness .
5. A neonate is noted to have a flattened nasal bridge, wide-set eyes, low-set ears, and
overall hypotonia. Which diagnostic test should the nurse practitioner anticipate
ordering?
A. Hemoglobin electrophoresis
B. CT of the brain
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C. Meconium toxicology testing
D. Chromosomal blood testing
Answer: D. Chromosomal blood testing
Rationale: The physical findings described (flattened nasal bridge, wide-set eyes, low-set
ears, hypotonia) are characteristic of Down syndrome (Trisomy 21). Chromosomal blood
testing (karyotype) is the diagnostic test of choice. Early diagnosis allows for appropriate
screening and management of associated conditions .
6. A 3-day-old newborn has jaundice that has progressed to the abdomen and legs. The
infant is feeding poorly and is lethargic. The mother's blood type is O-negative. Which
finding is most likely?
A. Physiologic jaundice
B. Breast milk jaundice
C. Hemolytic disease of the newborn due to Rh incompatibility
D. Sepsis
Answer: C. Hemolytic disease of the newborn due to Rh incompatibility
Rationale: An O-negative mother with an infant presenting with early-onset (day 1-3), severe
jaundice, lethargy, and poor feeding is concerning for Rh isoimmunization. In Rh
incompatibility, the mother's immune system produces anti-Rh antibodies that cross the
placenta and cause hemolysis in the Rh-positive infant. Pathologic jaundice appears within
the first 24 hours and requires immediate evaluation .
7. A preterm infant is placed in a radiant heat warmer immediately after birth. Which
nursing diagnosis is the intervention primarily addressing?
A. Ineffective thermoregulation
B. Impaired gas exchange
C. Risk for deficient fluid volume
D. Risk for infection
Answer: A. Ineffective thermoregulation
Rationale: Preterm infants are at high risk for ineffective thermoregulation due to immature
temperature control mechanisms, decreased subcutaneous fat, and large body surface area
relative to weight. A radiant warmer provides a controlled thermal environment to maintain
body temperature. Thermoregulation is a foundational priority in neonatal care .
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8. The nurse practitioner is assessing the anterior fontanel of a 2-month-old infant.
Which finding is normal at this age?
A. A bulging fontanel that is tense and firm
B. A sunken fontanel with depressed skin
C. A flat, soft fontanel that is easily palpated
D. A fontanel that has completely closed
Answer: C. A flat, soft fontanel that is easily palpated
Rationale: At 2 months, the anterior fontanel should be flat, soft, and easily palpated. It
should not be bulging (which suggests increased intracranial pressure) or sunken (which
suggests dehydration). The anterior fontanel typically closes between 12-18 months .
9. A newborn's weight is 7 lb at birth. The nurse practitioner should expect the newborn
to regain birth weight by what age?
A. 3-5 days
B. 10-14 days
C. 2-3 weeks
D. 1 month
Answer: B. 10-14 days
Rationale: Newborns typically regain their birth weight by 10-14 days of life. Weight loss
should not exceed 10% of birth weight in the first week. By 2 weeks, most infants have
regained and begun to gain beyond birth weight. This is a key milestone in newborn follow-
up .
10. A newborn has a positive Ortolani sign. Which condition does this finding suggest?
A. Developmental dysplasia of the hip
B. Hip fracture
C. Congenital dislocation of the knee
D. Normal finding
Answer: A. Developmental dysplasia of the hip
Rationale: A positive Ortolani sign (a "clunk" heard or felt when the hip is reduced) suggests
developmental dysplasia of the hip (DDH). This is an important screening finding in
newborns and requires further evaluation with ultrasound. A positive Barlow sign
(dislocating the hip) is also indicative of DDH .
NSG 548 FINAL EXAM STUDY GUIDE EXAM HIGH-YIELD EXAM
LATEST VERSION QUESTIONS AND ANSWERS 2026 EDITION
NSG 548 Final Exam Study Guide: 250 Practice Questions with Rationales
SECTION 1: NEONATAL ASSESSMENT AND TRANSITION (Questions 1-40)
1. A full-term newborn is 12 hours old and has not yet passed meconium. What is the
nurse practitioner's priority action?
A. Continue to monitor as this is normal up to 48 hours
B. Notify the healthcare provider for further evaluation
C. Administer a glycerin suppository
D. Initiate oral feedings to stimulate peristalsis
Answer: B. Notify the healthcare provider for further evaluation
Rationale: Meconium should be passed within the first 24-48 hours of life. Failure to pass
meconium within the first 24 hours can indicate obstruction such as Hirschsprung disease,
meconium ileus (associated with cystic fibrosis), or other intestinal anomalies. Early
notification allows for diagnostic evaluation .
2. A newborn's mother asks the nurse practitioner about the baby's visual acuity. What
is the normal visual acuity of a newborn?
A. 20/50
B. 20/100
C. 20/200
D. 20/400
Answer: D. 20/400
Rationale: Newborns have visual acuity of approximately 20/400. They can follow a light to
midline, but their visual acuity is limited. Vision improves steadily throughout infancy,
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reaching 20/20 by about 6 months of age. This is a key developmental milestone to assess and
discuss with parents .
3. The nurse practitioner is performing a newborn eye examination. Which finding
indicates a normal red reflex?
A. Asymmetrical, with white spots in one eye
B. Symmetrical and absent of opacities, white, or dark spots
C. No red reflex visible in either eye
D. A dark spot in the center of both eyes
Answer: B. Symmetrical and absent of opacities, white, or dark spots
Rationale: A normal red reflex should be symmetrical and absent of opacities, white, or dark
spots. An asymmetrical red reflex with white or dark spots requires referral to an
ophthalmologist. A dark spot in the red reflex, an absent reflex, or leukocoria (white pupil)
may indicate retinoblastoma, cataracts, or other ocular pathology. In newborns, this test is
critical for early detection .
4. The nurse practitioner notes that a newborn has a bilateral, non-tender scrotal
swelling that transilluminates. This finding is consistent with:
A. Inguinal hernia
B. Testicular torsion
C. Hydrocele
D. Epididymitis
Answer: C. Hydrocele
Rationale: Hydrocele is a fluid collection in the scrotum that transilluminates and is typically
non-tender. It is common in newborns and usually resolves spontaneously. Inguinal hernia
presents with a non-transilluminating swelling that may increase with crying. Testicular
torsion presents with acute pain. Epididymitis presents with pain and tenderness .
5. A neonate is noted to have a flattened nasal bridge, wide-set eyes, low-set ears, and
overall hypotonia. Which diagnostic test should the nurse practitioner anticipate
ordering?
A. Hemoglobin electrophoresis
B. CT of the brain
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C. Meconium toxicology testing
D. Chromosomal blood testing
Answer: D. Chromosomal blood testing
Rationale: The physical findings described (flattened nasal bridge, wide-set eyes, low-set
ears, hypotonia) are characteristic of Down syndrome (Trisomy 21). Chromosomal blood
testing (karyotype) is the diagnostic test of choice. Early diagnosis allows for appropriate
screening and management of associated conditions .
6. A 3-day-old newborn has jaundice that has progressed to the abdomen and legs. The
infant is feeding poorly and is lethargic. The mother's blood type is O-negative. Which
finding is most likely?
A. Physiologic jaundice
B. Breast milk jaundice
C. Hemolytic disease of the newborn due to Rh incompatibility
D. Sepsis
Answer: C. Hemolytic disease of the newborn due to Rh incompatibility
Rationale: An O-negative mother with an infant presenting with early-onset (day 1-3), severe
jaundice, lethargy, and poor feeding is concerning for Rh isoimmunization. In Rh
incompatibility, the mother's immune system produces anti-Rh antibodies that cross the
placenta and cause hemolysis in the Rh-positive infant. Pathologic jaundice appears within
the first 24 hours and requires immediate evaluation .
7. A preterm infant is placed in a radiant heat warmer immediately after birth. Which
nursing diagnosis is the intervention primarily addressing?
A. Ineffective thermoregulation
B. Impaired gas exchange
C. Risk for deficient fluid volume
D. Risk for infection
Answer: A. Ineffective thermoregulation
Rationale: Preterm infants are at high risk for ineffective thermoregulation due to immature
temperature control mechanisms, decreased subcutaneous fat, and large body surface area
relative to weight. A radiant warmer provides a controlled thermal environment to maintain
body temperature. Thermoregulation is a foundational priority in neonatal care .
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8. The nurse practitioner is assessing the anterior fontanel of a 2-month-old infant.
Which finding is normal at this age?
A. A bulging fontanel that is tense and firm
B. A sunken fontanel with depressed skin
C. A flat, soft fontanel that is easily palpated
D. A fontanel that has completely closed
Answer: C. A flat, soft fontanel that is easily palpated
Rationale: At 2 months, the anterior fontanel should be flat, soft, and easily palpated. It
should not be bulging (which suggests increased intracranial pressure) or sunken (which
suggests dehydration). The anterior fontanel typically closes between 12-18 months .
9. A newborn's weight is 7 lb at birth. The nurse practitioner should expect the newborn
to regain birth weight by what age?
A. 3-5 days
B. 10-14 days
C. 2-3 weeks
D. 1 month
Answer: B. 10-14 days
Rationale: Newborns typically regain their birth weight by 10-14 days of life. Weight loss
should not exceed 10% of birth weight in the first week. By 2 weeks, most infants have
regained and begun to gain beyond birth weight. This is a key milestone in newborn follow-
up .
10. A newborn has a positive Ortolani sign. Which condition does this finding suggest?
A. Developmental dysplasia of the hip
B. Hip fracture
C. Congenital dislocation of the knee
D. Normal finding
Answer: A. Developmental dysplasia of the hip
Rationale: A positive Ortolani sign (a "clunk" heard or felt when the hip is reduced) suggests
developmental dysplasia of the hip (DDH). This is an important screening finding in
newborns and requires further evaluation with ultrasound. A positive Barlow sign
(dislocating the hip) is also indicative of DDH .
