SCHOOL OF NURSING AND NEONATAL
SCIENCES
NUR 355 NEONATAL CARE FINAL EXAMINATION PRACTICE
QUESTIONS AND ANSWERS WITH VERIFIED SOLUTIONS LATEST
2026-2027 UPDATE
Instructions: Answer all sixty (60) practice questions. Select the single best option for each
multiple-choice question. Highlighted options indicate correct answers along with verified solutions
and comprehensive rationales.
1. A term infant evaluated at 1 minute of life displays a heart rate of 115 bpm, a good
strong cry, active flexion of extremities, grimace on suctioning, and acrocyanosis. What
is the calculated Apgar score?
A) 7
B) 8
C) 9
D) 10
Rationale: Heart rate >100 (2) + Strong cry (2) + Active flexion (2) + Reflex grimace (2) + Acrocyanosis/pink body
with blue hands (1) = 9 points.
2. A neonate born at 38 weeks gestation has an Apgar score of 3 at 1 minute of life. What
is the priority resuscitation response?
A) Initiate positive pressure ventilation (PPV) with room air immediately
B) Administer IV epinephrine via umbilical vein
C) Perform chest compressions at a 3:1 ratio
D) Dry and provide tactile stimulation for 2 minutes
Rationale: An Apgar score of 0-3 reflects severe central nervous system depression; initiating PPV establishes
ventilation, which is the cornerstone of neonatal resuscitation.
3. During neonatal resuscitation, if the infant's heart rate remains below 60 beats per
minute after 30 seconds of effective positive pressure ventilation that produces chest
movement, what is the next intervention?
A) Administer IV atropine
B) Begin chest compressions coordinated with PPV at a 3:1 ratio
C) Increase oxygen concentration to 100% without compressions
D) Perform immediate endotracheal suctioning
, Rationale: According to Neonatal Resuscitation Program (NRP) guidelines, a persistent heart rate < 60 bpm
despite effective ventilation mandates initiating chest compressions coordinated with PPV (3 compressions to 1
breath).
4. What is the target pre-ductal oxygen saturation (SpO2) range at 5 minutes of life for a
term infant during post-birth resuscitation?
A) 60% to 65%
B) 70% to 75%
C) 80% to 85%
D) 95% to 100%
Rationale: Normal transition SpO2 targets rise gradually following birth; at 5 minutes of life, target pre-ductal
SpO2 is 80% to 85%.
5. A preterm neonate born at 28 weeks gestation exhibits expiratory grunting, intercostal
retractions, nasal flaring, and cyanosis on room air. What primary pathophysiological
mechanism drives Respiratory Distress Syndrome (RDS)?
A) Pulmonary surfactant deficiency leading to high alveolar surface tension and
atelectasis
B) Delayed clearance of fetal lung fluid
C) Meconium aspiration obstructing small airways
D) Structural hypoplasia of the left ventricle
Rationale: Insufficient surfactant production by immature Type II pneumocytes leads to widespread alveolar
collapse, decreased lung compliance, and hypoxia in RDS.
6. What classic radiographic appearance is seen on a chest X-ray of a premature infant
with severe Respiratory Distress Syndrome (RDS)?
A) Asymmetric patchy infiltrates with hyperinflation
B) Diffuse reticulogranular "ground-glass" appearance with air bronchograms
C) Cardiomegaly with pulmonary vascular congestion
D) Fluid in the interlobar fissures without atelectasis
Rationale: Alveolar micro-atelectasis gives the lung fields a diffuse "ground-glass" appearance with prominent air-
filled bronchi standing out (air bronchograms).
7. How is exogenous surfactant administered to a preterm infant with severe RDS in the
Neonatal Intensive Care Unit (NICU)?
A) Direct intratracheal instillation via an endotracheal tube
B) Continuous intravenous infusion
C) Nebulized inhalation via face mask
D) Intramuscular injection into the vastus lateralis
Rationale: Exogenous surfactant must be instilled directly into the tracheobronchial tree via an endotracheal tube
SCIENCES
NUR 355 NEONATAL CARE FINAL EXAMINATION PRACTICE
QUESTIONS AND ANSWERS WITH VERIFIED SOLUTIONS LATEST
2026-2027 UPDATE
Instructions: Answer all sixty (60) practice questions. Select the single best option for each
multiple-choice question. Highlighted options indicate correct answers along with verified solutions
and comprehensive rationales.
1. A term infant evaluated at 1 minute of life displays a heart rate of 115 bpm, a good
strong cry, active flexion of extremities, grimace on suctioning, and acrocyanosis. What
is the calculated Apgar score?
A) 7
B) 8
C) 9
D) 10
Rationale: Heart rate >100 (2) + Strong cry (2) + Active flexion (2) + Reflex grimace (2) + Acrocyanosis/pink body
with blue hands (1) = 9 points.
2. A neonate born at 38 weeks gestation has an Apgar score of 3 at 1 minute of life. What
is the priority resuscitation response?
A) Initiate positive pressure ventilation (PPV) with room air immediately
B) Administer IV epinephrine via umbilical vein
C) Perform chest compressions at a 3:1 ratio
D) Dry and provide tactile stimulation for 2 minutes
Rationale: An Apgar score of 0-3 reflects severe central nervous system depression; initiating PPV establishes
ventilation, which is the cornerstone of neonatal resuscitation.
3. During neonatal resuscitation, if the infant's heart rate remains below 60 beats per
minute after 30 seconds of effective positive pressure ventilation that produces chest
movement, what is the next intervention?
A) Administer IV atropine
B) Begin chest compressions coordinated with PPV at a 3:1 ratio
C) Increase oxygen concentration to 100% without compressions
D) Perform immediate endotracheal suctioning
, Rationale: According to Neonatal Resuscitation Program (NRP) guidelines, a persistent heart rate < 60 bpm
despite effective ventilation mandates initiating chest compressions coordinated with PPV (3 compressions to 1
breath).
4. What is the target pre-ductal oxygen saturation (SpO2) range at 5 minutes of life for a
term infant during post-birth resuscitation?
A) 60% to 65%
B) 70% to 75%
C) 80% to 85%
D) 95% to 100%
Rationale: Normal transition SpO2 targets rise gradually following birth; at 5 minutes of life, target pre-ductal
SpO2 is 80% to 85%.
5. A preterm neonate born at 28 weeks gestation exhibits expiratory grunting, intercostal
retractions, nasal flaring, and cyanosis on room air. What primary pathophysiological
mechanism drives Respiratory Distress Syndrome (RDS)?
A) Pulmonary surfactant deficiency leading to high alveolar surface tension and
atelectasis
B) Delayed clearance of fetal lung fluid
C) Meconium aspiration obstructing small airways
D) Structural hypoplasia of the left ventricle
Rationale: Insufficient surfactant production by immature Type II pneumocytes leads to widespread alveolar
collapse, decreased lung compliance, and hypoxia in RDS.
6. What classic radiographic appearance is seen on a chest X-ray of a premature infant
with severe Respiratory Distress Syndrome (RDS)?
A) Asymmetric patchy infiltrates with hyperinflation
B) Diffuse reticulogranular "ground-glass" appearance with air bronchograms
C) Cardiomegaly with pulmonary vascular congestion
D) Fluid in the interlobar fissures without atelectasis
Rationale: Alveolar micro-atelectasis gives the lung fields a diffuse "ground-glass" appearance with prominent air-
filled bronchi standing out (air bronchograms).
7. How is exogenous surfactant administered to a preterm infant with severe RDS in the
Neonatal Intensive Care Unit (NICU)?
A) Direct intratracheal instillation via an endotracheal tube
B) Continuous intravenous infusion
C) Nebulized inhalation via face mask
D) Intramuscular injection into the vastus lateralis
Rationale: Exogenous surfactant must be instilled directly into the tracheobronchial tree via an endotracheal tube
