NCLEX RN Neonatal Nursing Practice
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A preterm infant born at 28 weeks’ gestation is placed under a radiant
warmer immediately after birth. Which nursing action is the highest priority
to prevent insensible water loss and maintain thermoregulation?
A. Administer warmed intravenous fluids
B. Cover the infant with a plastic wrap or bag without drying
C. Place a hat on the infant’s head and wrap in a warm blanket
D. Increase the radiant warmer setpoint to 38°C
Rationale: Preterm infants, especially extremely low birth weight, experience
massive transepidermal water loss due to thin, immature skin. Covering the
entire body (including the trunk and extremities) with a polyethylene wrap or
bag immediately after birth, without drying the skin, creates a
microenvironment that traps evaporative losses and dramatically reduces
convective heat loss. Drying is avoided because evaporation consumes heat. A
hat alone is insufficient; warmed IV fluids are important but do not address
transcutaneous losses as effectively. Raising the warmer setpoint without
occlusion can lead to thermal burns and does not stop evaporative water loss.
This practice is an evidence-based standard for thermoregulation in very
preterm infants.
2. A term newborn is 2 hours old and becomes jittery, tachypneic, and
hypothermic. The blood glucose level is 35 mg/dL. The infant is awake and
able to feed orally. What is the nurse’s first action?
, A. Administer intravenous 10% dextrose bolus
B. Assist the mother to breastfeed or provide expressed breast milk
immediately
C. Give 2 mL/kg of buccal 40% dextrose gel
D. Recheck blood glucose in 30 minutes before intervening
Rationale: Asymptomatic or mildly symptomatic hypoglycemia in a term,
feeding-capable infant should be managed first with early feeding. Breast milk
or formula provides a sustained source of glucose and stimulates
gluconeogenesis. Buccal dextrose gel may be used if feeding is not possible or
glucose remains low, but feeding is preferred and noninvasive. An IV bolus is
reserved for severe, symptomatic hypoglycemia (<25 mg/dL) or inability to feed.
Waiting 30 minutes while the infant is symptomatic and hypothermic is unsafe
because prolonged neuroglycopenia can cause brain injury. Thus, immediate
feeding is the safest and most physiologic first-line intervention.
3. A nurse is assessing a 32-week gestation infant at 6 hours of age. The infant
exhibits nasal flaring, expiratory grunting, and subcostal retractions. The
respiratory rate is 72 breaths/min and oxygen saturation is 88% on room air.
Which condition does the nurse suspect?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Persistent pulmonary hypertension of the newborn
Rationale: Nasal flaring, grunting, retractions, and hypoxia within the first hours
of life in a preterm infant are classic for respiratory distress syndrome caused by
surfactant deficiency. Immature type II pneumocytes fail to produce adequate
surfactant, leading to alveolar collapse and atelectasis. Transient tachypnea
resolves faster and is common in late-preterm or term infants after cesarean
birth. Meconium aspiration would be associated with meconium-stained fluid
and occurs typically in term/post-term infants. Persistent pulmonary
hypertension may occur as a complication but is not the primary etiology; it
,presents with labile oxygenation and differential cyanosis. The timing and
preterm gestation make RDS most likely.
4. A nurse is caring for a term newborn with a large cephalohematoma after a
vacuum-assisted delivery. Which laboratory result is most important to
monitor due to the cephalohematoma?
A. Serum bilirubin level
B. Blood glucose level
C. Serum calcium level
D. White blood cell count
Rationale: A cephalohematoma is a collection of blood beneath the periosteum
of a cranial bone. As red blood cells within the hematoma break down, they
release bilirubin, placing the infant at high risk for pathologic
hyperbilirubinemia. Monitoring total serum bilirubin levels and instituting
phototherapy promptly if thresholds are met prevent kernicterus. Blood glucose,
calcium, and white blood cell count are not directly affected by a
cephalohematoma, though sepsis must be ruled out if other risk factors exist.
The key concern is increased bilirubin production from extravascular hemolysis
within the cephalohematoma.
5. A mother with a positive Group B Streptococcus (GBS) culture received
intrapartum antibiotics 2 hours before delivery. The term newborn appears
vigorous with normal vital signs. What is the appropriate management for
the infant?
A. Obtain a complete blood count, blood culture, and start empiric
antibiotics
B. Observe the infant for a minimum of 48 hours for signs of sepsis
C. Obtain a single C-reactive protein at 12 hours of life
D. Discharge home at 24 hours if feeding well
Rationale: Current guidelines recommend that well-appearing term infants born
to GBS-positive mothers who received intrapartum antibiotic prophylaxis (IAP)
≥4 hours before delivery require no special workup and can be observed for 48
hours. If IAP was given less than 4 hours before delivery, the infant should be
, observed for at least 48 hours and evaluated if signs develop. If the mother
received IAP less than 2 hours before birth, a limited evaluation (CBC, blood
culture) and observation for 48 hours are recommended. In this scenario,
inadequate duration (2 hours) of IAP makes enhanced observation for 48 hours
necessary; empiric antibiotics are not indicated for asymptomatic vigorous
newborns. Thus, observation for at least 48 hours is correct.
6. A nurse is providing phototherapy to a preterm infant with
hyperbilirubinemia. Which nursing intervention is essential to prevent
complications during therapy?
A. Apply opaque eye shields loosely to allow partial visual stimulation
B. Ensure eye shields are correctly placed and monitor for skin breakdown
daily
C. Discontinue phototherapy during feeding times to promote bonding
D. Maintain the infant in a supine position at all times
Rationale: During phototherapy, the infant’s eyes must be protected from retinal
damage with correctly fitting opaque eye shields that do not compress the eyes
or nares. The shields must be removed at least every 2–4 hours during feeds and
care to assess the eyes for infection, corneal abrasion, or drainage. Skin is
exposed to maximize bilirubin isomerization; only the diaper is left on.
Discontinuing phototherapy for feeds reduces its effectiveness and can prolong
therapy. The position should be changed frequently to expose all skin surfaces.
Preventing eye and skin complications is a critical safety measure.
7. A term infant born via planned cesarean section without labor at 39 weeks
presents with tachypnea (respiratory rate 100 breaths/min), mild
retractions, and oxygen saturation 94% on room air at 2 hours of life. Chest
radiograph shows prominent perihilar streaking and fluid in the fissures.
What is the most likely diagnosis?
A. Meconium aspiration syndrome
B. Transient tachypnea of the newborn
C. Congenital pneumonia
D. Spontaneous pneumothorax
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A preterm infant born at 28 weeks’ gestation is placed under a radiant
warmer immediately after birth. Which nursing action is the highest priority
to prevent insensible water loss and maintain thermoregulation?
A. Administer warmed intravenous fluids
B. Cover the infant with a plastic wrap or bag without drying
C. Place a hat on the infant’s head and wrap in a warm blanket
D. Increase the radiant warmer setpoint to 38°C
Rationale: Preterm infants, especially extremely low birth weight, experience
massive transepidermal water loss due to thin, immature skin. Covering the
entire body (including the trunk and extremities) with a polyethylene wrap or
bag immediately after birth, without drying the skin, creates a
microenvironment that traps evaporative losses and dramatically reduces
convective heat loss. Drying is avoided because evaporation consumes heat. A
hat alone is insufficient; warmed IV fluids are important but do not address
transcutaneous losses as effectively. Raising the warmer setpoint without
occlusion can lead to thermal burns and does not stop evaporative water loss.
This practice is an evidence-based standard for thermoregulation in very
preterm infants.
2. A term newborn is 2 hours old and becomes jittery, tachypneic, and
hypothermic. The blood glucose level is 35 mg/dL. The infant is awake and
able to feed orally. What is the nurse’s first action?
, A. Administer intravenous 10% dextrose bolus
B. Assist the mother to breastfeed or provide expressed breast milk
immediately
C. Give 2 mL/kg of buccal 40% dextrose gel
D. Recheck blood glucose in 30 minutes before intervening
Rationale: Asymptomatic or mildly symptomatic hypoglycemia in a term,
feeding-capable infant should be managed first with early feeding. Breast milk
or formula provides a sustained source of glucose and stimulates
gluconeogenesis. Buccal dextrose gel may be used if feeding is not possible or
glucose remains low, but feeding is preferred and noninvasive. An IV bolus is
reserved for severe, symptomatic hypoglycemia (<25 mg/dL) or inability to feed.
Waiting 30 minutes while the infant is symptomatic and hypothermic is unsafe
because prolonged neuroglycopenia can cause brain injury. Thus, immediate
feeding is the safest and most physiologic first-line intervention.
3. A nurse is assessing a 32-week gestation infant at 6 hours of age. The infant
exhibits nasal flaring, expiratory grunting, and subcostal retractions. The
respiratory rate is 72 breaths/min and oxygen saturation is 88% on room air.
Which condition does the nurse suspect?
A. Transient tachypnea of the newborn
B. Meconium aspiration syndrome
C. Respiratory distress syndrome
D. Persistent pulmonary hypertension of the newborn
Rationale: Nasal flaring, grunting, retractions, and hypoxia within the first hours
of life in a preterm infant are classic for respiratory distress syndrome caused by
surfactant deficiency. Immature type II pneumocytes fail to produce adequate
surfactant, leading to alveolar collapse and atelectasis. Transient tachypnea
resolves faster and is common in late-preterm or term infants after cesarean
birth. Meconium aspiration would be associated with meconium-stained fluid
and occurs typically in term/post-term infants. Persistent pulmonary
hypertension may occur as a complication but is not the primary etiology; it
,presents with labile oxygenation and differential cyanosis. The timing and
preterm gestation make RDS most likely.
4. A nurse is caring for a term newborn with a large cephalohematoma after a
vacuum-assisted delivery. Which laboratory result is most important to
monitor due to the cephalohematoma?
A. Serum bilirubin level
B. Blood glucose level
C. Serum calcium level
D. White blood cell count
Rationale: A cephalohematoma is a collection of blood beneath the periosteum
of a cranial bone. As red blood cells within the hematoma break down, they
release bilirubin, placing the infant at high risk for pathologic
hyperbilirubinemia. Monitoring total serum bilirubin levels and instituting
phototherapy promptly if thresholds are met prevent kernicterus. Blood glucose,
calcium, and white blood cell count are not directly affected by a
cephalohematoma, though sepsis must be ruled out if other risk factors exist.
The key concern is increased bilirubin production from extravascular hemolysis
within the cephalohematoma.
5. A mother with a positive Group B Streptococcus (GBS) culture received
intrapartum antibiotics 2 hours before delivery. The term newborn appears
vigorous with normal vital signs. What is the appropriate management for
the infant?
A. Obtain a complete blood count, blood culture, and start empiric
antibiotics
B. Observe the infant for a minimum of 48 hours for signs of sepsis
C. Obtain a single C-reactive protein at 12 hours of life
D. Discharge home at 24 hours if feeding well
Rationale: Current guidelines recommend that well-appearing term infants born
to GBS-positive mothers who received intrapartum antibiotic prophylaxis (IAP)
≥4 hours before delivery require no special workup and can be observed for 48
hours. If IAP was given less than 4 hours before delivery, the infant should be
, observed for at least 48 hours and evaluated if signs develop. If the mother
received IAP less than 2 hours before birth, a limited evaluation (CBC, blood
culture) and observation for 48 hours are recommended. In this scenario,
inadequate duration (2 hours) of IAP makes enhanced observation for 48 hours
necessary; empiric antibiotics are not indicated for asymptomatic vigorous
newborns. Thus, observation for at least 48 hours is correct.
6. A nurse is providing phototherapy to a preterm infant with
hyperbilirubinemia. Which nursing intervention is essential to prevent
complications during therapy?
A. Apply opaque eye shields loosely to allow partial visual stimulation
B. Ensure eye shields are correctly placed and monitor for skin breakdown
daily
C. Discontinue phototherapy during feeding times to promote bonding
D. Maintain the infant in a supine position at all times
Rationale: During phototherapy, the infant’s eyes must be protected from retinal
damage with correctly fitting opaque eye shields that do not compress the eyes
or nares. The shields must be removed at least every 2–4 hours during feeds and
care to assess the eyes for infection, corneal abrasion, or drainage. Skin is
exposed to maximize bilirubin isomerization; only the diaper is left on.
Discontinuing phototherapy for feeds reduces its effectiveness and can prolong
therapy. The position should be changed frequently to expose all skin surfaces.
Preventing eye and skin complications is a critical safety measure.
7. A term infant born via planned cesarean section without labor at 39 weeks
presents with tachypnea (respiratory rate 100 breaths/min), mild
retractions, and oxygen saturation 94% on room air at 2 hours of life. Chest
radiograph shows prominent perihilar streaking and fluid in the fissures.
What is the most likely diagnosis?
A. Meconium aspiration syndrome
B. Transient tachypnea of the newborn
C. Congenital pneumonia
D. Spontaneous pneumothorax
