NURS 345 Final Exam Questions with
Guaranteed Pass Solutions 2025-2026
Edition.
Initiating Breathing (Newborn Adaptation) - Answer - must be deep enough to displace liquid
in the airways and retain some air in the alveoli so that subsequent breaths are less difficult
- surfactant will allow alveoli to remain open and decrease surface tension at the air-liquid
interface
- may take a few hours for fluid to absorb which explains why newborns may have audible
crackles after birth
What promotes lung fluid clearance? - Answer - screaming & crying (also promotes oxygen
intake)
- pressure of passing through the vaginal canal
How much fluid is in the fetal lungs at term? - Answer 80-100 ml
Initiating Breathing - 4 Key Physiological Processes - Answer 1. Mechanical/reabsorptive:
thoracic squeeze through SVD; lymphatic system clears fluid
2. Chemical: asphyxia triggers onset of breathing, cord clamping, and chemical sensors trigger
breathing centre
3. Sensory: tactile, auditory, visual stimuli and gravity.
4. Thermal: sudden change in temperature will stimulate breathing.
Nursing Assessment & Care at Birth (9) - Answer 1. Dry the baby (prevents cold stress)
2. Skin-to-skin, breastfeeding
3. Apgar score
4. Vitals
5. Identify the baby (security tags)
6. Weight, length, head circumference
7. VitK and eye prophylaxis
8. Head to toe
9. Newborn bath (6 hrs or later)
,Types of Assessment (4) - Answer 1. Initial Assessment (APGAR, measurements)
2. Assessment for gestational age
3. Physical and neuro assessment (Ballard tool)
4. H2T (including reflexes)
APGAR Score - Answer a scale (/10) to evaluate a newborn infant's physical status at 1 min
after birth (initial adaptive response) and 5 minutes after birth (overall CNS score)
A = appearance/colour
P = pulse/HR, respiratory effort
G = reflex irritability (grimace)
A = activity/muscle tone
R = respiratory effort
At 1 minute, baby girl Normann has a HR of 140, weak cry, extremities are well flexed, moves
away from the bulb syringe and is pink with blue hands and feet.
At 5 minutes, she is crying well but her feet remain bluish. - Answer 1 Min = 8
- point deducted for colour
- point deducted for respiratory effort
5 Min = 9
Weighing a Newborn - Answer Typically 2500-4000 g
- can vary based on genetic composition
- birth weights <10% or >90% on a growth chart require further investigation.
- can lose up to 10% of birth weight 3-4 days post delivery due to meconium (laxative effect),
fluid loss, decreased intake
Weight loss assessment - Answer birth weight - current weight/birth weight x 100% = % lost
Baby M's birth weight was 3150g. When you weigh the baby this morning at 46 hrs post-
delivery, the baby's weight is 2820g. What is the percentage of weight loss?
Will you need to take action? - Answer 1. 10.5%
,Chest measurement - Answer 30-35 cm (not routine - done for fetal anomalies, fluid
collection....)
Length Measurement - Answer - crown to heel
- 44-55 cm
- moulding can affect measurement
Gestation age assessment - Preterm - Answer 20-37 weeks
Gestation age assessment - Late Preterm - Answer 35-36 + 6/7 days
Gestation age assessment - Term - Answer 37 weeks +
Gestation age assessment - Early Term - Answer 37-38 wks
Gestation age assessment - Post-term - Answer after 41st week
Gestational Age by Physical Assessment - Answer - linked to mortality, morbidity, appropriate
screening during pregnancy
- estimated during pregnancy based on LMP, ultrasound, symphasis fundal height (SFH)
- determined post-birth by neuromuscular and physical maturity (Ballard Tool)
Ballard Assessment - Answer Determines gestational age by maturity rating
- physical assessment = 1st 2 hrs
- neuro assessment = 1st 24 hrs
Newborn Daily Assessment - Answer - colour
- respiratory effort
- tone
- sleep-wake patterns
- feeding
, - parental interaction and learning needs
Key Nursing Assessment Priorities During Transition (Birth-72 hrs) - Answer - think pink:
cyanosis and hyperbilirubinemia
- think warm: thermoregulation and hypothermia
- think sweet: hypoglycemia
Where to obtain history? - Answer Newborn record Part 1 & 2
Observational Assessment: Newborn Behaviour/Activity - Answer Periods of Reactivity:
1st period = at birth, crying/alert, latch at breast
Sleep = recovery, less interested in feeding
2nd period = interest in feeding, interaction
Infant States - Answer - deep sleep
- light sleep (REM)
- drowsy
- quiet alert
- active alert
- crying
Newborn Vitals - Answer Temp = 36.5-37.3/37.5
HR = 120-160, (Brady <100, Tachy 180-200)
RR = 30/40-60 (tachypnea >60, bradypnea 25-30, apnea <15 sec pauses, anything >20 sec =
absence of breathing)
- SpO2 only if indicated, BP not routinely done if healthy
Newborn risk factors for hypothermia - Answer - thin skin, with blood vessels close to surface
- little subcutaneous fat
- greater SA = lose heat 4x faster than adults
What does a flexed position help a newborn to thermoregulate? - Answer - flexed positioning
Guaranteed Pass Solutions 2025-2026
Edition.
Initiating Breathing (Newborn Adaptation) - Answer - must be deep enough to displace liquid
in the airways and retain some air in the alveoli so that subsequent breaths are less difficult
- surfactant will allow alveoli to remain open and decrease surface tension at the air-liquid
interface
- may take a few hours for fluid to absorb which explains why newborns may have audible
crackles after birth
What promotes lung fluid clearance? - Answer - screaming & crying (also promotes oxygen
intake)
- pressure of passing through the vaginal canal
How much fluid is in the fetal lungs at term? - Answer 80-100 ml
Initiating Breathing - 4 Key Physiological Processes - Answer 1. Mechanical/reabsorptive:
thoracic squeeze through SVD; lymphatic system clears fluid
2. Chemical: asphyxia triggers onset of breathing, cord clamping, and chemical sensors trigger
breathing centre
3. Sensory: tactile, auditory, visual stimuli and gravity.
4. Thermal: sudden change in temperature will stimulate breathing.
Nursing Assessment & Care at Birth (9) - Answer 1. Dry the baby (prevents cold stress)
2. Skin-to-skin, breastfeeding
3. Apgar score
4. Vitals
5. Identify the baby (security tags)
6. Weight, length, head circumference
7. VitK and eye prophylaxis
8. Head to toe
9. Newborn bath (6 hrs or later)
,Types of Assessment (4) - Answer 1. Initial Assessment (APGAR, measurements)
2. Assessment for gestational age
3. Physical and neuro assessment (Ballard tool)
4. H2T (including reflexes)
APGAR Score - Answer a scale (/10) to evaluate a newborn infant's physical status at 1 min
after birth (initial adaptive response) and 5 minutes after birth (overall CNS score)
A = appearance/colour
P = pulse/HR, respiratory effort
G = reflex irritability (grimace)
A = activity/muscle tone
R = respiratory effort
At 1 minute, baby girl Normann has a HR of 140, weak cry, extremities are well flexed, moves
away from the bulb syringe and is pink with blue hands and feet.
At 5 minutes, she is crying well but her feet remain bluish. - Answer 1 Min = 8
- point deducted for colour
- point deducted for respiratory effort
5 Min = 9
Weighing a Newborn - Answer Typically 2500-4000 g
- can vary based on genetic composition
- birth weights <10% or >90% on a growth chart require further investigation.
- can lose up to 10% of birth weight 3-4 days post delivery due to meconium (laxative effect),
fluid loss, decreased intake
Weight loss assessment - Answer birth weight - current weight/birth weight x 100% = % lost
Baby M's birth weight was 3150g. When you weigh the baby this morning at 46 hrs post-
delivery, the baby's weight is 2820g. What is the percentage of weight loss?
Will you need to take action? - Answer 1. 10.5%
,Chest measurement - Answer 30-35 cm (not routine - done for fetal anomalies, fluid
collection....)
Length Measurement - Answer - crown to heel
- 44-55 cm
- moulding can affect measurement
Gestation age assessment - Preterm - Answer 20-37 weeks
Gestation age assessment - Late Preterm - Answer 35-36 + 6/7 days
Gestation age assessment - Term - Answer 37 weeks +
Gestation age assessment - Early Term - Answer 37-38 wks
Gestation age assessment - Post-term - Answer after 41st week
Gestational Age by Physical Assessment - Answer - linked to mortality, morbidity, appropriate
screening during pregnancy
- estimated during pregnancy based on LMP, ultrasound, symphasis fundal height (SFH)
- determined post-birth by neuromuscular and physical maturity (Ballard Tool)
Ballard Assessment - Answer Determines gestational age by maturity rating
- physical assessment = 1st 2 hrs
- neuro assessment = 1st 24 hrs
Newborn Daily Assessment - Answer - colour
- respiratory effort
- tone
- sleep-wake patterns
- feeding
, - parental interaction and learning needs
Key Nursing Assessment Priorities During Transition (Birth-72 hrs) - Answer - think pink:
cyanosis and hyperbilirubinemia
- think warm: thermoregulation and hypothermia
- think sweet: hypoglycemia
Where to obtain history? - Answer Newborn record Part 1 & 2
Observational Assessment: Newborn Behaviour/Activity - Answer Periods of Reactivity:
1st period = at birth, crying/alert, latch at breast
Sleep = recovery, less interested in feeding
2nd period = interest in feeding, interaction
Infant States - Answer - deep sleep
- light sleep (REM)
- drowsy
- quiet alert
- active alert
- crying
Newborn Vitals - Answer Temp = 36.5-37.3/37.5
HR = 120-160, (Brady <100, Tachy 180-200)
RR = 30/40-60 (tachypnea >60, bradypnea 25-30, apnea <15 sec pauses, anything >20 sec =
absence of breathing)
- SpO2 only if indicated, BP not routinely done if healthy
Newborn risk factors for hypothermia - Answer - thin skin, with blood vessels close to surface
- little subcutaneous fat
- greater SA = lose heat 4x faster than adults
What does a flexed position help a newborn to thermoregulate? - Answer - flexed positioning
