ATI Maternal Newborn High-Risk Care 2026 |Questions |Answers
|Rationales
1. A nurse is assessing a newborn for Neonatal Abstinence Syndrome (NAS).
Which of the following findings should the nurse expect?
A. Increased deep tendon reflexes
B. Hypotonia
C. Lethargy
D. Decreased muscle tone
Answer: A
Rationale: Neonatal Abstinence Syndrome typically presents with signs of CNS irritability,
such as hypertonicity and increased deep tendon reflexes.
2. Which intervention is most appropriate for a newborn receiving
phototherapy for hyperbilirubinemia?
A. Apply baby lotion to the skin every 4 hours
B. Feed the newborn every 4 to 6 hours
C. Ensure the eyes are covered with an opaque mask
D. Dress the newborn in a lightweight t-shirt
Answer: C
Rationale: An opaque mask is essential to protect the newborn’s retinas from damage
caused by the high-intensity light of phototherapy.
,3. A nurse is caring for a preterm newborn with Respiratory Distress Syndrome
(RDS). What is the primary cause of this condition?
A. Excessive amniotic fluid in the lungs
B. Inadequate surfactant production
C. Premature closure of the ductus arteriosus
D. Meconium aspiration
Answer: B
Rationale: RDS is caused by a deficiency in surfactant, which is necessary to reduce surface
tension in the alveoli and prevent collapse during expiration.
4. Which clinical finding is a common sign of hypoglycemia in a Large for
Gestational Age (LGA) infant?
A. Jitteriness and tremors
B. Fever
C. Persistent crying
D. Hypertonia
Answer: A
Rationale: Hypoglycemia in newborns often presents as jitteriness, tremors, hypotonia, or
seizures due to low blood glucose levels affecting CNS function.
5. A nurse is monitoring a newborn with sepsis. Which of the following is an
early sign of neonatal infection?
A. Temperature instability
B. Hyperthermia
C. Tachycardia
D. Hypertension
Answer: A
Rationale: Temperature instability (either hypothermia or hyperthermia) is a classic early
sign of sepsis in a newborn, though hypothermia is more common.
, 6. Which assessment finding should the nurse expect in a post-term newborn?
A. Abundant vernix caseosa
B. Leathery, cracked, and peeling skin
C. Short, soft fingernails
D. Smooth, thin skin with visible veins
Answer: B
Rationale: Post-term newborns often have dry, peeling, and parchment-like skin because
the vernix has disappeared and the placenta is less efficient at the end of pregnancy.
7. A nurse is caring for a newborn who has meconium aspiration syndrome.
Which complication is this infant at highest risk for?
A. Hypoglycemia
B. Persistent pulmonary hypertension
C. Polycythemia
D. Necrotizing enterocolitis
Answer: B
Rationale: Meconium aspiration can lead to severe respiratory distress and persistent
pulmonary hypertension of the newborn (PPHN).
8. What is the goal of the ‘Neutral Thermal Environment’ in the care of a
preterm infant?
A. To increase the newborn’s basal metabolic rate
B. To minimize oxygen and calorie consumption
C. To promote rapid weight gain through sweating
D. To keep the newborn’s skin temperature at 38 degrees Celsius
Answer: B
Rationale: A neutral thermal environment helps the newborn maintain a normal body
temperature with minimal metabolic demands and oxygen consumption.
|Rationales
1. A nurse is assessing a newborn for Neonatal Abstinence Syndrome (NAS).
Which of the following findings should the nurse expect?
A. Increased deep tendon reflexes
B. Hypotonia
C. Lethargy
D. Decreased muscle tone
Answer: A
Rationale: Neonatal Abstinence Syndrome typically presents with signs of CNS irritability,
such as hypertonicity and increased deep tendon reflexes.
2. Which intervention is most appropriate for a newborn receiving
phototherapy for hyperbilirubinemia?
A. Apply baby lotion to the skin every 4 hours
B. Feed the newborn every 4 to 6 hours
C. Ensure the eyes are covered with an opaque mask
D. Dress the newborn in a lightweight t-shirt
Answer: C
Rationale: An opaque mask is essential to protect the newborn’s retinas from damage
caused by the high-intensity light of phototherapy.
,3. A nurse is caring for a preterm newborn with Respiratory Distress Syndrome
(RDS). What is the primary cause of this condition?
A. Excessive amniotic fluid in the lungs
B. Inadequate surfactant production
C. Premature closure of the ductus arteriosus
D. Meconium aspiration
Answer: B
Rationale: RDS is caused by a deficiency in surfactant, which is necessary to reduce surface
tension in the alveoli and prevent collapse during expiration.
4. Which clinical finding is a common sign of hypoglycemia in a Large for
Gestational Age (LGA) infant?
A. Jitteriness and tremors
B. Fever
C. Persistent crying
D. Hypertonia
Answer: A
Rationale: Hypoglycemia in newborns often presents as jitteriness, tremors, hypotonia, or
seizures due to low blood glucose levels affecting CNS function.
5. A nurse is monitoring a newborn with sepsis. Which of the following is an
early sign of neonatal infection?
A. Temperature instability
B. Hyperthermia
C. Tachycardia
D. Hypertension
Answer: A
Rationale: Temperature instability (either hypothermia or hyperthermia) is a classic early
sign of sepsis in a newborn, though hypothermia is more common.
, 6. Which assessment finding should the nurse expect in a post-term newborn?
A. Abundant vernix caseosa
B. Leathery, cracked, and peeling skin
C. Short, soft fingernails
D. Smooth, thin skin with visible veins
Answer: B
Rationale: Post-term newborns often have dry, peeling, and parchment-like skin because
the vernix has disappeared and the placenta is less efficient at the end of pregnancy.
7. A nurse is caring for a newborn who has meconium aspiration syndrome.
Which complication is this infant at highest risk for?
A. Hypoglycemia
B. Persistent pulmonary hypertension
C. Polycythemia
D. Necrotizing enterocolitis
Answer: B
Rationale: Meconium aspiration can lead to severe respiratory distress and persistent
pulmonary hypertension of the newborn (PPHN).
8. What is the goal of the ‘Neutral Thermal Environment’ in the care of a
preterm infant?
A. To increase the newborn’s basal metabolic rate
B. To minimize oxygen and calorie consumption
C. To promote rapid weight gain through sweating
D. To keep the newborn’s skin temperature at 38 degrees Celsius
Answer: B
Rationale: A neutral thermal environment helps the newborn maintain a normal body
temperature with minimal metabolic demands and oxygen consumption.
