NSG 3500 Exam 4 – Maternal Health 2026/2027 |
Galen College of Nursing | Actual Questions &
Detailed Rationales
TABLE OF CONTENTS
1. Newborn Transition & Initiation of Respirations
2. APGAR & Immediate Newborn Assessment
3. Thermoregulation & Environmental Adaptation
4. Physical Assessment & Normal Newborn Findings
5. Newborn Feeding & Nutrition
6. Glucose, Jaundice & Hematologic Problems
7. Respiratory Distress & Neonatal Complications
8. Prematurity, Infection & Other Neonatal Conditions
9. Congenital Conditions & Newborn Safety
10.Integrated Maternal-Newborn Clinical Judgment
SECTION I — NEWBORN TRANSITION & INITIATION OF RESPIRATIONS
1. Which change is most important for successful transition from fetal to
neonatal life?
A. Closure of the ductus venosus
B. Establishment of effective respirations
C. Passage of meconium
D. Closure of the umbilical ring
Answer: B. Establishment of effective respirations
,Rationale: Effective ventilation is essential immediately after birth because the
newborn must transition from placental gas exchange to pulmonary gas
exchange. Lung expansion lowers pulmonary vascular resistance and supports the
cardiovascular transition.
2. Which four factors stimulate initiation of breathing in the newborn?
A. Chemical, sensory, thermal, and mechanical factors
B. Hormonal, nutritional, infectious, and mechanical factors
C. Cardiovascular, renal, gastrointestinal, and sensory factors
D. Thermal, nutritional, hormonal, and immune factors
Answer: A. Chemical, sensory, thermal, and mechanical factors
Rationale: The first breath is stimulated by chemical changes such as increased
carbon dioxide and decreased oxygen, sensory stimulation, temperature change,
and mechanical changes associated with birth. Together these stimulate the
respiratory center and promote lung expansion.
3. Which chemical change most directly stimulates the newborn respiratory
center after birth?
A. Decreased carbon dioxide
B. Increased oxygen
C. Increased carbon dioxide
D. Decreased hydrogen ions
Answer: C. Increased carbon dioxide
Rationale: Rising carbon dioxide and associated acidosis stimulate the medullary
respiratory center. The newborn responds by initiating breathing to remove
carbon dioxide and increase oxygenation.
4. Which assessment finding indicates that a newborn is experiencing effective
respiratory adaptation?
,A. Respiratory rate of 70/min with grunting
B. Respiratory rate of 44/min with symmetrical chest movement
C. Central cyanosis with irregular respirations
D. Persistent nasal flaring and retractions
Answer: B. Respiratory rate of 44/min with symmetrical chest movement
Rationale: A normal newborn respiratory rate is approximately 30–60
breaths/min. Symmetrical chest movement without signs of respiratory distress
indicates effective adaptation.
5. Which newborn finding requires immediate nursing intervention?
A. Acrocyanosis during the first hours of life
B. Respiratory rate of 48/min
C. Central cyanosis of the tongue and mucous membranes
D. Periodic breathing without color change
Answer: C. Central cyanosis of the tongue and mucous membranes
Rationale: Central cyanosis suggests inadequate oxygenation and requires
immediate assessment and intervention. Acrocyanosis of the hands and feet can
be normal during early transition.
6. What is the primary purpose of pulmonary surfactant?
A. Increase pulmonary vascular resistance
B. Prevent alveolar collapse
C. Increase mucus production
D. Stimulate fetal circulation
Answer: B. Prevent alveolar collapse
Rationale: Surfactant reduces surface tension within the alveoli, helping them
remain open during expiration. Premature infants may have insufficient
surfactant and are therefore at increased risk for respiratory distress syndrome.
, 7. A newborn born at 30 weeks' gestation develops respiratory distress shortly
after birth. Which condition should the nurse suspect?
A. Respiratory distress syndrome
B. Physiologic jaundice
C. Neonatal abstinence syndrome
D. Meconium passage
Answer: A. Respiratory distress syndrome
Rationale: Premature newborns are at risk for respiratory distress syndrome
because immature lungs may produce inadequate surfactant. Typical findings
include grunting, nasal flaring, retractions, tachypnea, and oxygenation problems.
8. Which respiratory finding is considered abnormal in a term newborn?
A. Respiratory rate of 42/min
B. Brief periodic breathing
C. Mild irregularity of respirations
D. Persistent expiratory grunting
Answer: D. Persistent expiratory grunting
Rationale: Grunting is a compensatory mechanism that helps maintain alveolar
pressure and is a sign of respiratory distress. Persistent grunting requires prompt
evaluation.
9. What is the purpose of grunting in a newborn with respiratory distress?
A. Increase airway obstruction
B. Maintain positive pressure in the alveoli
C. Decrease oxygen consumption
D. Promote fluid accumulation in the lungs
Answer: B. Maintain positive pressure in the alveoli
Galen College of Nursing | Actual Questions &
Detailed Rationales
TABLE OF CONTENTS
1. Newborn Transition & Initiation of Respirations
2. APGAR & Immediate Newborn Assessment
3. Thermoregulation & Environmental Adaptation
4. Physical Assessment & Normal Newborn Findings
5. Newborn Feeding & Nutrition
6. Glucose, Jaundice & Hematologic Problems
7. Respiratory Distress & Neonatal Complications
8. Prematurity, Infection & Other Neonatal Conditions
9. Congenital Conditions & Newborn Safety
10.Integrated Maternal-Newborn Clinical Judgment
SECTION I — NEWBORN TRANSITION & INITIATION OF RESPIRATIONS
1. Which change is most important for successful transition from fetal to
neonatal life?
A. Closure of the ductus venosus
B. Establishment of effective respirations
C. Passage of meconium
D. Closure of the umbilical ring
Answer: B. Establishment of effective respirations
,Rationale: Effective ventilation is essential immediately after birth because the
newborn must transition from placental gas exchange to pulmonary gas
exchange. Lung expansion lowers pulmonary vascular resistance and supports the
cardiovascular transition.
2. Which four factors stimulate initiation of breathing in the newborn?
A. Chemical, sensory, thermal, and mechanical factors
B. Hormonal, nutritional, infectious, and mechanical factors
C. Cardiovascular, renal, gastrointestinal, and sensory factors
D. Thermal, nutritional, hormonal, and immune factors
Answer: A. Chemical, sensory, thermal, and mechanical factors
Rationale: The first breath is stimulated by chemical changes such as increased
carbon dioxide and decreased oxygen, sensory stimulation, temperature change,
and mechanical changes associated with birth. Together these stimulate the
respiratory center and promote lung expansion.
3. Which chemical change most directly stimulates the newborn respiratory
center after birth?
A. Decreased carbon dioxide
B. Increased oxygen
C. Increased carbon dioxide
D. Decreased hydrogen ions
Answer: C. Increased carbon dioxide
Rationale: Rising carbon dioxide and associated acidosis stimulate the medullary
respiratory center. The newborn responds by initiating breathing to remove
carbon dioxide and increase oxygenation.
4. Which assessment finding indicates that a newborn is experiencing effective
respiratory adaptation?
,A. Respiratory rate of 70/min with grunting
B. Respiratory rate of 44/min with symmetrical chest movement
C. Central cyanosis with irregular respirations
D. Persistent nasal flaring and retractions
Answer: B. Respiratory rate of 44/min with symmetrical chest movement
Rationale: A normal newborn respiratory rate is approximately 30–60
breaths/min. Symmetrical chest movement without signs of respiratory distress
indicates effective adaptation.
5. Which newborn finding requires immediate nursing intervention?
A. Acrocyanosis during the first hours of life
B. Respiratory rate of 48/min
C. Central cyanosis of the tongue and mucous membranes
D. Periodic breathing without color change
Answer: C. Central cyanosis of the tongue and mucous membranes
Rationale: Central cyanosis suggests inadequate oxygenation and requires
immediate assessment and intervention. Acrocyanosis of the hands and feet can
be normal during early transition.
6. What is the primary purpose of pulmonary surfactant?
A. Increase pulmonary vascular resistance
B. Prevent alveolar collapse
C. Increase mucus production
D. Stimulate fetal circulation
Answer: B. Prevent alveolar collapse
Rationale: Surfactant reduces surface tension within the alveoli, helping them
remain open during expiration. Premature infants may have insufficient
surfactant and are therefore at increased risk for respiratory distress syndrome.
, 7. A newborn born at 30 weeks' gestation develops respiratory distress shortly
after birth. Which condition should the nurse suspect?
A. Respiratory distress syndrome
B. Physiologic jaundice
C. Neonatal abstinence syndrome
D. Meconium passage
Answer: A. Respiratory distress syndrome
Rationale: Premature newborns are at risk for respiratory distress syndrome
because immature lungs may produce inadequate surfactant. Typical findings
include grunting, nasal flaring, retractions, tachypnea, and oxygenation problems.
8. Which respiratory finding is considered abnormal in a term newborn?
A. Respiratory rate of 42/min
B. Brief periodic breathing
C. Mild irregularity of respirations
D. Persistent expiratory grunting
Answer: D. Persistent expiratory grunting
Rationale: Grunting is a compensatory mechanism that helps maintain alveolar
pressure and is a sign of respiratory distress. Persistent grunting requires prompt
evaluation.
9. What is the purpose of grunting in a newborn with respiratory distress?
A. Increase airway obstruction
B. Maintain positive pressure in the alveoli
C. Decrease oxygen consumption
D. Promote fluid accumulation in the lungs
Answer: B. Maintain positive pressure in the alveoli
