Galen NSG 3500 Exam 4 | Nursing Research & EBP (2026) Actual
Q&A PDF
1. The nurse is assessing a newborn at 1 minute and 5 minutes after birth. The newborn has a
heart rate of 110 bpm, a loud cry, some flexion of the extremities, sneezing in response to a
bulb syringe, and a pink body with blue extremities. Which APGAR score should the nurse assign
at the 1-minute mark?
A) 6
B) 7
C) 8
D) 9
Correct Answer: 8
Rationale: The APGAR score evaluates five categories: heart rate, respiratory effort, muscle
tone, reflex irritability, and color. This infant scores 2 points for heart rate (>100 bpm), 2 points
for respiratory effort (loud cry), 1 point for muscle tone (some flexion), 2 points for reflex
irritability (sneezing), and 1 point for color (acrocyanosis). Total score = 2+2+1+2+1 = 8.
2. The nurse observes a bluish discoloration on the hands and feet of a newborn 2 hours after
birth. The rest of the infant's body is pink. How should the nurse interpret this finding?
A) A sign of a cardiac abnormality
B) A normal finding known as acrocyanosis
C) Indicative of respiratory distress
D) A symptom of cold stress
Correct Answer: A normal finding known as acrocyanosis
,Rationale: Acrocyanosis is a normal finding in newborns during the first 24-48 hours of life. It
results from immature peripheral circulation and is characterized by bluish discoloration of the
hands and feet while the trunk remains pink. It is not a sign of cardiac or respiratory
compromise.
3. A term newborn delivered by elective cesarean section is at increased risk for transient
tachypnea of the newborn (TTN). The nurse understands this is primarily due to which factor?
A) Immature surfactant production
B) Lack of the mechanical thoracic squeeze during passage through the birth canal
C) Maternal diabetes during pregnancy
D) Meconium aspiration during delivery
Correct Answer: Lack of the mechanical thoracic squeeze during passage through the birth canal
Rationale: During vaginal delivery, the fetal chest is compressed, expelling lung fluid. This
“thoracic squeeze” is absent in cesarean deliveries, leading to delayed clearance of fetal lung
fluid and TTN. Surfactant deficiency causes respiratory distress syndrome (RDS), not TTN.
4. The nurse is teaching new parents about the factors that stimulate a newborn's first breath.
Which factor is considered chemical?
A) The drop in ambient temperature upon delivery
B) Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
C) The thoracic squeeze during a vaginal birth
D) Tactile stimulation from drying the infant
Correct Answer: Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
Rationale: Chemical factors are the most critical stimulants for the first breath. Falling oxygen
levels (hypoxia), rising carbon dioxide (hypercarbia), and falling pH (acidosis) stimulate the
,medullary respiratory center. The other options are thermal, mechanical, and sensory factors,
respectively.
5. A nurse is assessing a newborn and notes a heart rate of 160-180 bpm immediately after
birth. The nurse understands that this is:
A) A sign of respiratory distress
B) A normal initial heart rate that will decrease to 120-160 bpm within 30 minutes
C) A symptom of hypoglycemia
D) An indication of congenital heart disease
Correct Answer: A normal initial heart rate that will decrease to 120-160 bpm within 30 minutes
Rationale: The initial heart rate is elevated due to birth stress and catecholamine surge, then
stabilizes as the newborn adapts to extrauterine life. The normal newborn heart rate range is
110-160 bpm.
6. The nurse is assessing a newborn's temperature regulation. The nurse understands that
newborns primarily produce heat through which mechanism?
A) Shivering
B) Metabolism of brown adipose tissue (brown fat)
C) Sweating
D) Peripheral vasodilation
Correct Answer: Metabolism of brown adipose tissue (brown fat)
Rationale: Newborns cannot shiver to maintain warmth. They metabolize brown adipose tissue
(brown fat) through non-shivering thermogenesis to generate heat.
, 7. A nurse is providing discharge teaching to parents of a newborn. Which instruction is most
important to prevent heat loss?
A) Bathe the newborn immediately after birth
B) Keep the newborn uncovered to allow for observation
C) Dry the newborn's head and place a cap on the baby
D) Keep the newborn in a cool room
Correct Answer: Dry the newborn's head and place a cap on the baby
Rationale: The newborn's head is a significant source of heat loss. Drying the head and placing a
cap on the baby helps minimize heat loss. Other interventions include skin-to-skin contact,
wrapping in warm blankets, and using a radiant warmer.
8. A newborn has a bilirubin level of 8 mg/dL at 12 hours of age. The nurse notes jaundice to the
face and chest. This jaundice is most likely:
A) Physiologic jaundice
B) Pathologic jaundice requiring phototherapy
C) Caused by a cephalohematoma
D) A sign of biliary atresia
Correct Answer: Pathologic jaundice requiring phototherapy
Rationale: Jaundice appearing within the first 24 hours of life is considered pathologic. A
bilirubin level of 8 mg/dL at 12 hours is above the phototherapy threshold for many term
newborns, indicating the need for intervention. Physiologic jaundice typically appears after 24
hours.
9. The nurse is assessing a newborn for signs of respiratory distress. Which finding is most
concerning?
Q&A PDF
1. The nurse is assessing a newborn at 1 minute and 5 minutes after birth. The newborn has a
heart rate of 110 bpm, a loud cry, some flexion of the extremities, sneezing in response to a
bulb syringe, and a pink body with blue extremities. Which APGAR score should the nurse assign
at the 1-minute mark?
A) 6
B) 7
C) 8
D) 9
Correct Answer: 8
Rationale: The APGAR score evaluates five categories: heart rate, respiratory effort, muscle
tone, reflex irritability, and color. This infant scores 2 points for heart rate (>100 bpm), 2 points
for respiratory effort (loud cry), 1 point for muscle tone (some flexion), 2 points for reflex
irritability (sneezing), and 1 point for color (acrocyanosis). Total score = 2+2+1+2+1 = 8.
2. The nurse observes a bluish discoloration on the hands and feet of a newborn 2 hours after
birth. The rest of the infant's body is pink. How should the nurse interpret this finding?
A) A sign of a cardiac abnormality
B) A normal finding known as acrocyanosis
C) Indicative of respiratory distress
D) A symptom of cold stress
Correct Answer: A normal finding known as acrocyanosis
,Rationale: Acrocyanosis is a normal finding in newborns during the first 24-48 hours of life. It
results from immature peripheral circulation and is characterized by bluish discoloration of the
hands and feet while the trunk remains pink. It is not a sign of cardiac or respiratory
compromise.
3. A term newborn delivered by elective cesarean section is at increased risk for transient
tachypnea of the newborn (TTN). The nurse understands this is primarily due to which factor?
A) Immature surfactant production
B) Lack of the mechanical thoracic squeeze during passage through the birth canal
C) Maternal diabetes during pregnancy
D) Meconium aspiration during delivery
Correct Answer: Lack of the mechanical thoracic squeeze during passage through the birth canal
Rationale: During vaginal delivery, the fetal chest is compressed, expelling lung fluid. This
“thoracic squeeze” is absent in cesarean deliveries, leading to delayed clearance of fetal lung
fluid and TTN. Surfactant deficiency causes respiratory distress syndrome (RDS), not TTN.
4. The nurse is teaching new parents about the factors that stimulate a newborn's first breath.
Which factor is considered chemical?
A) The drop in ambient temperature upon delivery
B) Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
C) The thoracic squeeze during a vaginal birth
D) Tactile stimulation from drying the infant
Correct Answer: Hypoxia, hypercarbia, and acidosis from the clamping of the umbilical cord
Rationale: Chemical factors are the most critical stimulants for the first breath. Falling oxygen
levels (hypoxia), rising carbon dioxide (hypercarbia), and falling pH (acidosis) stimulate the
,medullary respiratory center. The other options are thermal, mechanical, and sensory factors,
respectively.
5. A nurse is assessing a newborn and notes a heart rate of 160-180 bpm immediately after
birth. The nurse understands that this is:
A) A sign of respiratory distress
B) A normal initial heart rate that will decrease to 120-160 bpm within 30 minutes
C) A symptom of hypoglycemia
D) An indication of congenital heart disease
Correct Answer: A normal initial heart rate that will decrease to 120-160 bpm within 30 minutes
Rationale: The initial heart rate is elevated due to birth stress and catecholamine surge, then
stabilizes as the newborn adapts to extrauterine life. The normal newborn heart rate range is
110-160 bpm.
6. The nurse is assessing a newborn's temperature regulation. The nurse understands that
newborns primarily produce heat through which mechanism?
A) Shivering
B) Metabolism of brown adipose tissue (brown fat)
C) Sweating
D) Peripheral vasodilation
Correct Answer: Metabolism of brown adipose tissue (brown fat)
Rationale: Newborns cannot shiver to maintain warmth. They metabolize brown adipose tissue
(brown fat) through non-shivering thermogenesis to generate heat.
, 7. A nurse is providing discharge teaching to parents of a newborn. Which instruction is most
important to prevent heat loss?
A) Bathe the newborn immediately after birth
B) Keep the newborn uncovered to allow for observation
C) Dry the newborn's head and place a cap on the baby
D) Keep the newborn in a cool room
Correct Answer: Dry the newborn's head and place a cap on the baby
Rationale: The newborn's head is a significant source of heat loss. Drying the head and placing a
cap on the baby helps minimize heat loss. Other interventions include skin-to-skin contact,
wrapping in warm blankets, and using a radiant warmer.
8. A newborn has a bilirubin level of 8 mg/dL at 12 hours of age. The nurse notes jaundice to the
face and chest. This jaundice is most likely:
A) Physiologic jaundice
B) Pathologic jaundice requiring phototherapy
C) Caused by a cephalohematoma
D) A sign of biliary atresia
Correct Answer: Pathologic jaundice requiring phototherapy
Rationale: Jaundice appearing within the first 24 hours of life is considered pathologic. A
bilirubin level of 8 mg/dL at 12 hours is above the phototherapy threshold for many term
newborns, indicating the need for intervention. Physiologic jaundice typically appears after 24
hours.
9. The nurse is assessing a newborn for signs of respiratory distress. Which finding is most
concerning?
