UR 202/ NUR202 Exam 3 –
N
Maternal-Newborn Nursing Guide ACTUAL
EXAM 2026/2027 | Maternal-Newborn
Nursing Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
### PART A – MULTIPLE CHOICE (Q1-60) *[Continued from Q41]*
* *Q41 (Neonatal complications – hypothermia):** A preterm infant has an axillary temperature of
35.8°C (96.4°F). Which intervention is the PRIORITY?
A. Place the infant under a radiant warmer and monitor temperature
B. Wrap the infant in blankets and place a cap on the head
C. Give the infant a warm bath to raise body temperature
D. Increase the room temperature to 80°F (26.7°C)
**[CORRECT]** A
*Rationale: Neonatal hypothermia (temperature <36.5°C) in preterm infants requires immediate
placement under a radiant warmer or in an incubator with servo-control to maintain neutral
thermal environment (36.5-37.5°C); preterm infants have limited brown fat and cannot
effectively thermoregulate. Wrapping in blankets is insufficient for preterm infants. Warm baths
cause evaporative heat loss. Increasing room temperature is inadequate. Clinical pearl: Cold
stress increases oxygen consumption, metabolic acidosis, and hypoglycemia; the neutral
thermal environment is the ambient temperature at which oxygen consumption is minimal and
body temperature is maintained with basal metabolic rate.*
* *Q42 (Neonatal complications – retinopathy of prematurity):** A preterm infant at 28 weeks
gestation is receiving oxygen therapy. Which SpO2 target range is MOST appropriate to
minimize the risk of retinopathy of prematurity (ROP)?
A. 85-89%
B. 90-95%
C. 96-100%
D. 80-84%
**[CORRECT]** B
*Rationale: The optimal SpO2 target for preterm infants <32 weeks gestation is 90-95% (or
91-95% per some protocols) to balance the risks of ROP and bronchopulmonary dysplasia
(BPD) from hyperoxia against the risks of hypoxia, brain injury, and death from hypoxemia.
Targets <90% increase mortality and neurodevelopmental impairment. Targets >95% increase
ROP and BPD. Clinical pearl: ROP is caused by abnormal retinal vascularization in response to
hyperoxia and is a leading cause of childhood blindness; screening eye examinations are
, erformed at 4-6 weeks chronological age or 31-32 weeks postmenstrual age, whichever is
p
later.*
* *Q43 (Congenital anomalies – neural tube defects):** A newborn has a sac-like protrusion in
the lumbosacral area with exposed neural tissue and cerebrospinal fluid leakage. The nurse
should FIRST:
A. Cover the defect with a sterile, moist, non-adherent dressing.
B. Perform range-of-motion exercises on the lower extremities.
C. Place the infant prone with hips flexed and covered with a dry sterile dressing.
D. Prepare the infant for immediate surgical closure within 24 hours.
**[CORRECT]** A
*Rationale: Myelomeningocele (open neural tube defect) requires immediate protection of the
exposed neural tissue with a sterile, moist, non-adherent dressing (saline-soaked gauze
covered with a sterile drape) to prevent infection and desiccation; the infant is positioned prone
or side-lying to avoid pressure on the defect. ROM exercises are not an immediate priority. A dry
dressing can adhere to neural tissue and cause damage. Surgical closure is typically performed
within 24-72 hours but protecting the defect is the immediate nursing priority. Clinical pearl: Folic
acid 400 mcg daily before conception and through the first trimester reduces NTD risk by 70%;
high-risk women (previous NTD) need 4 mg daily.*
* *Q44 (Congenital anomalies – congenital heart defects):** A newborn has a loud, harsh
holosystolic murmur at the left lower sternal border. The infant is tachypneic, diaphoretic with
feeding, and has poor weight gain. Which defect is MOST likely?
A. Atrial septal defect (ASD)
B. Ventricular septal defect (VSD)
C. Patent ductus arteriosus (PDA)
D. Tetralogy of Fallot (TOF)
**[CORRECT]** B
*Rationale: A large VSD presents with a loud, harsh holosystolic murmur at the left lower sternal
border, signs of congestive heart failure (tachypnea, diaphoresis with feeding, poor weight gain,
hepatomegaly), and increased pulmonary blood flow; small VSDs may be asymptomatic. ASD
has a fixed split S2 and systolic ejection murmur. PDA has a continuous "machine-like" murmur.
TOF is a cyanotic defect with a systolic ejection murmur and tet spells. Clinical pearl: VSD is the
most common congenital heart defect (30-40% of all CHD); small defects often close
spontaneously by age 2; large defects require surgical closure if medical management
(diuretics, ACE inhibitors) fails.*
* *Q45 (Congenital anomalies – cyanotic heart defects):** A newborn with tetralogy of Fallot
suddenly becomes cyanotic and hyperpneic during crying. Which position should the nurse
place the infant in?
A. Supine with legs extended
B. Knee-chest (squatting) position
C. Prone with head elevated
D. Side-lying with neck hyperextended
, * *[CORRECT]** B
*Rationale: Tet spells (hypercyanotic episodes) in tetralogy of Fallot are caused by increased
right-to-left shunting through the VSD due to increased pulmonary vascular resistance; the
knee-chest (squatting) position increases systemic vascular resistance, which reduces
right-to-left shunting and improves pulmonary blood flow. Supine position worsens symptoms.
Prone and side-lying positions are not effective. Clinical pearl: Other interventions for tet spells
include calming the infant, oxygen administration, knee-chest position, morphine (reduces
respiratory drive and catecholamine release), IV fluids (increases preload), and beta-blockers
(propranolol) to reduce infundibular spasm.*
* *Q46 (Congenital anomalies – chromosomal disorders):** A newborn has hypotonia, a single
palmar crease (simian crease), upslanting palpebral fissures, and a small mouth with protruding
tongue. Which chromosomal disorder is MOST likely?
A. Trisomy 18 (Edwards syndrome)
B. Trisomy 13 (Patau syndrome)
C. Down syndrome (Trisomy 21)
D. Turner syndrome (45,X)
**[CORRECT]** C
*Rationale: Down syndrome (trisomy 21) is characterized by hypotonia, flat facial profile,
upslanting palpebral fissures, epicanthal folds, single palmar crease (simian crease), small
mouth with protruding tongue, and increased risk of congenital heart defects (AV canal, VSD).
Trisomy 18 features clenched fists with overlapping fingers, rocker-bottom feet, and
micrognathia. Trisomy 13 features polydactyly, microphthalmia, and holoprosencephaly. Turner
syndrome features webbed neck, short stature, and coarctation of the aorta. Clinical pearl: All
newborns with suspected Down syndrome should have echocardiography due to 40-50%
incidence of CHD; developmental delay is universal but varies in severity; early intervention
programs improve outcomes.*
* *Q47 (Congenital anomalies – metabolic disorders):** A newborn on day 3 of life has poor
feeding, lethargy, and a musty odor to the urine. Newborn screening results show elevated
phenylalanine. Which dietary intervention is required?
A. Lactose-free formula
B. Phenylalanine-restricted diet with special medical formula
C. Soy-based formula
D. High-protein diet to promote growth
**[CORRECT]** B
*Rationale: Phenylketonuria (PKU) is an autosomal recessive disorder of phenylalanine
metabolism; treatment requires a lifelong phenylalanine-restricted diet with special medical
formulas that provide protein without phenylalanine; untreated PKU causes severe intellectual
disability, seizures, and behavioral problems. Lactose-free formula is for galactosemia. Soy
formula is not specific for PKU. High-protein diets worsen PKU. Clinical pearl: Newborn
screening for PKU is performed 24-48 hours after protein feeding (usually before discharge);
maternal PKU requires strict diet control before and during pregnancy to prevent fetal
teratogenic effects (microcephaly, CHD, intellectual disability).*
N
Maternal-Newborn Nursing Guide ACTUAL
EXAM 2026/2027 | Maternal-Newborn
Nursing Guide | Verified Q&A | Pass
Guaranteed - A+ Graded
### PART A – MULTIPLE CHOICE (Q1-60) *[Continued from Q41]*
* *Q41 (Neonatal complications – hypothermia):** A preterm infant has an axillary temperature of
35.8°C (96.4°F). Which intervention is the PRIORITY?
A. Place the infant under a radiant warmer and monitor temperature
B. Wrap the infant in blankets and place a cap on the head
C. Give the infant a warm bath to raise body temperature
D. Increase the room temperature to 80°F (26.7°C)
**[CORRECT]** A
*Rationale: Neonatal hypothermia (temperature <36.5°C) in preterm infants requires immediate
placement under a radiant warmer or in an incubator with servo-control to maintain neutral
thermal environment (36.5-37.5°C); preterm infants have limited brown fat and cannot
effectively thermoregulate. Wrapping in blankets is insufficient for preterm infants. Warm baths
cause evaporative heat loss. Increasing room temperature is inadequate. Clinical pearl: Cold
stress increases oxygen consumption, metabolic acidosis, and hypoglycemia; the neutral
thermal environment is the ambient temperature at which oxygen consumption is minimal and
body temperature is maintained with basal metabolic rate.*
* *Q42 (Neonatal complications – retinopathy of prematurity):** A preterm infant at 28 weeks
gestation is receiving oxygen therapy. Which SpO2 target range is MOST appropriate to
minimize the risk of retinopathy of prematurity (ROP)?
A. 85-89%
B. 90-95%
C. 96-100%
D. 80-84%
**[CORRECT]** B
*Rationale: The optimal SpO2 target for preterm infants <32 weeks gestation is 90-95% (or
91-95% per some protocols) to balance the risks of ROP and bronchopulmonary dysplasia
(BPD) from hyperoxia against the risks of hypoxia, brain injury, and death from hypoxemia.
Targets <90% increase mortality and neurodevelopmental impairment. Targets >95% increase
ROP and BPD. Clinical pearl: ROP is caused by abnormal retinal vascularization in response to
hyperoxia and is a leading cause of childhood blindness; screening eye examinations are
, erformed at 4-6 weeks chronological age or 31-32 weeks postmenstrual age, whichever is
p
later.*
* *Q43 (Congenital anomalies – neural tube defects):** A newborn has a sac-like protrusion in
the lumbosacral area with exposed neural tissue and cerebrospinal fluid leakage. The nurse
should FIRST:
A. Cover the defect with a sterile, moist, non-adherent dressing.
B. Perform range-of-motion exercises on the lower extremities.
C. Place the infant prone with hips flexed and covered with a dry sterile dressing.
D. Prepare the infant for immediate surgical closure within 24 hours.
**[CORRECT]** A
*Rationale: Myelomeningocele (open neural tube defect) requires immediate protection of the
exposed neural tissue with a sterile, moist, non-adherent dressing (saline-soaked gauze
covered with a sterile drape) to prevent infection and desiccation; the infant is positioned prone
or side-lying to avoid pressure on the defect. ROM exercises are not an immediate priority. A dry
dressing can adhere to neural tissue and cause damage. Surgical closure is typically performed
within 24-72 hours but protecting the defect is the immediate nursing priority. Clinical pearl: Folic
acid 400 mcg daily before conception and through the first trimester reduces NTD risk by 70%;
high-risk women (previous NTD) need 4 mg daily.*
* *Q44 (Congenital anomalies – congenital heart defects):** A newborn has a loud, harsh
holosystolic murmur at the left lower sternal border. The infant is tachypneic, diaphoretic with
feeding, and has poor weight gain. Which defect is MOST likely?
A. Atrial septal defect (ASD)
B. Ventricular septal defect (VSD)
C. Patent ductus arteriosus (PDA)
D. Tetralogy of Fallot (TOF)
**[CORRECT]** B
*Rationale: A large VSD presents with a loud, harsh holosystolic murmur at the left lower sternal
border, signs of congestive heart failure (tachypnea, diaphoresis with feeding, poor weight gain,
hepatomegaly), and increased pulmonary blood flow; small VSDs may be asymptomatic. ASD
has a fixed split S2 and systolic ejection murmur. PDA has a continuous "machine-like" murmur.
TOF is a cyanotic defect with a systolic ejection murmur and tet spells. Clinical pearl: VSD is the
most common congenital heart defect (30-40% of all CHD); small defects often close
spontaneously by age 2; large defects require surgical closure if medical management
(diuretics, ACE inhibitors) fails.*
* *Q45 (Congenital anomalies – cyanotic heart defects):** A newborn with tetralogy of Fallot
suddenly becomes cyanotic and hyperpneic during crying. Which position should the nurse
place the infant in?
A. Supine with legs extended
B. Knee-chest (squatting) position
C. Prone with head elevated
D. Side-lying with neck hyperextended
, * *[CORRECT]** B
*Rationale: Tet spells (hypercyanotic episodes) in tetralogy of Fallot are caused by increased
right-to-left shunting through the VSD due to increased pulmonary vascular resistance; the
knee-chest (squatting) position increases systemic vascular resistance, which reduces
right-to-left shunting and improves pulmonary blood flow. Supine position worsens symptoms.
Prone and side-lying positions are not effective. Clinical pearl: Other interventions for tet spells
include calming the infant, oxygen administration, knee-chest position, morphine (reduces
respiratory drive and catecholamine release), IV fluids (increases preload), and beta-blockers
(propranolol) to reduce infundibular spasm.*
* *Q46 (Congenital anomalies – chromosomal disorders):** A newborn has hypotonia, a single
palmar crease (simian crease), upslanting palpebral fissures, and a small mouth with protruding
tongue. Which chromosomal disorder is MOST likely?
A. Trisomy 18 (Edwards syndrome)
B. Trisomy 13 (Patau syndrome)
C. Down syndrome (Trisomy 21)
D. Turner syndrome (45,X)
**[CORRECT]** C
*Rationale: Down syndrome (trisomy 21) is characterized by hypotonia, flat facial profile,
upslanting palpebral fissures, epicanthal folds, single palmar crease (simian crease), small
mouth with protruding tongue, and increased risk of congenital heart defects (AV canal, VSD).
Trisomy 18 features clenched fists with overlapping fingers, rocker-bottom feet, and
micrognathia. Trisomy 13 features polydactyly, microphthalmia, and holoprosencephaly. Turner
syndrome features webbed neck, short stature, and coarctation of the aorta. Clinical pearl: All
newborns with suspected Down syndrome should have echocardiography due to 40-50%
incidence of CHD; developmental delay is universal but varies in severity; early intervention
programs improve outcomes.*
* *Q47 (Congenital anomalies – metabolic disorders):** A newborn on day 3 of life has poor
feeding, lethargy, and a musty odor to the urine. Newborn screening results show elevated
phenylalanine. Which dietary intervention is required?
A. Lactose-free formula
B. Phenylalanine-restricted diet with special medical formula
C. Soy-based formula
D. High-protein diet to promote growth
**[CORRECT]** B
*Rationale: Phenylketonuria (PKU) is an autosomal recessive disorder of phenylalanine
metabolism; treatment requires a lifelong phenylalanine-restricted diet with special medical
formulas that provide protein without phenylalanine; untreated PKU causes severe intellectual
disability, seizures, and behavioral problems. Lactose-free formula is for galactosemia. Soy
formula is not specific for PKU. High-protein diets worsen PKU. Clinical pearl: Newborn
screening for PKU is performed 24-48 hours after protein feeding (usually before discharge);
maternal PKU requires strict diet control before and during pregnancy to prevent fetal
teratogenic effects (microcephaly, CHD, intellectual disability).*
