Newborn Transition: Exam 3 - Questions with Correct Answers
100 questions
1. Fetal pulmonary vascular resistance is high because:
A. The lungs are fully aerated
B. The foramen ovale is closed
C. The fetus breathes air
D. The lungs are filled with fluid and the vessels are constricted in a low-oxygen environment
Correct Answer: D. The lungs are filled with fluid and the vessels are constricted in a
low-oxygen environment
Rationale: Fluid-filled, unexpanded lungs and low oxygen keep pulmonary vessels constricted,
directing blood through the fetal shunts. Aeration at birth lowers resistance.
2. A normal newborn respiratory pattern includes:
A. Regular breathing at 12 to 20 breaths per minute
B. Breathing only through the mouth
C. Irregular, diaphragmatic breathing at about 30 to 60 breaths per minute with brief pauses
D. Pauses longer than 20 seconds
Correct Answer: C. Irregular, diaphragmatic breathing at about 30 to 60 breaths per minute
with brief pauses
Rationale: Newborn breathing is irregular and abdominal, with short pauses typical of periodic
breathing. Adult rates, obligate mouth breathing and long apnea are not normal.
,3. Fetal hemoglobin differs from adult hemoglobin in that it:
A. Has a higher affinity for oxygen, helping the fetus extract oxygen from maternal blood
B. Has a lower affinity for oxygen
C. Cannot carry oxygen
D. Is found only in adults
Correct Answer: A. Has a higher affinity for oxygen, helping the fetus extract oxygen from
maternal blood
Rationale: Higher affinity allows oxygen transfer across the placenta. It is gradually replaced by
adult hemoglobin over the first months.
4. A newborn with a single umbilical artery should be evaluated because it may be associated
with:
A. Increased intelligence
B. Other congenital anomalies, especially renal anomalies
C. Normal development only
D. Jaundice in all cases
Correct Answer: B. Other congenital anomalies, especially renal anomalies
Rationale: A two-vessel cord can be isolated but is linked to renal, cardiac and other anomalies
in some infants, so assessment is warranted. It is not linked to intelligence or universal jaundice.
5. Functional closure of the ductus arteriosus after birth is triggered mainly by:
A. Falling oxygen levels
B. Rising prostaglandin levels
C. Rising arterial oxygen levels and falling prostaglandin levels
D. Increased pulmonary vascular resistance
Correct Answer: C. Rising arterial oxygen levels and falling prostaglandin levels
Rationale: Oxygen constricts the ductus, and loss of placental prostaglandins removes a dilating
influence. Low oxygen or high prostaglandins keep it open.
,6. Ductal-dependent congenital heart defects may not cause symptoms at birth because:
A. They are always benign
B. The ductus arteriosus is still open, maintaining blood flow until it closes days later
C. The foramen ovale stays open forever
D. They are cured by the first breath
Correct Answer: B. The ductus arteriosus is still open, maintaining blood flow until it closes
days later
Rationale: As the ductus closes, infants can suddenly become cyanotic or go into shock, which is
why pulse oximetry screening is performed. They are serious conditions.
7. A soft heart murmur heard in the first day of life may be:
A. Always a sign of serious heart disease
B. A transitional finding related to a closing ductus arteriosus, but it still requires follow-up
C. Impossible in healthy infants
D. A lung sound
Correct Answer: B. A transitional finding related to a closing ductus arteriosus, but it still
requires follow-up
Rationale: Many early murmurs are benign and disappear as shunts close, but persistent
murmurs or other signs need evaluation. They are not lung sounds.
8. Newborns born to mothers who received opioids shortly before birth may have:
A. Increased respiratory rate in all cases
B. Early closure of the ductus
C. Excess surfactant
D. Respiratory depression that delays transition
Correct Answer: D. Respiratory depression that delays transition
Rationale: Opioids cross the placenta and can depress breathing, so newborns are monitored
and supported with ventilation as needed. They do not cause the other effects.
, 9. Transporting a newborn within the hospital should include:
A. A warmed transport incubator or skin-to-skin with a parent when appropriate
B. An open bassinet in cold hallways without cover
C. Wet linens
D. No temperature monitoring
Correct Answer: A. A warmed transport incubator or skin-to-skin with a parent when
appropriate
Rationale: Transport environments must prevent heat loss. Cold, uncovered or wet conditions
increase risk.
10. Newborns are especially vulnerable to heat loss because they have:
A. A thick layer of fat
B. A small head relative to body
C. The ability to shiver effectively
D. A large body surface area relative to weight and little subcutaneous fat
Correct Answer: D. A large body surface area relative to weight and little subcutaneous fat
Rationale: Large surface area, thin skin and limited insulating fat promote heat loss. Newborns
have relatively large heads and cannot shiver effectively.
11. Heat loss by conduction occurs when the newborn:
A. Is wet after birth
B. Is placed on a cold surface such as a scale or examination table
C. Is exposed to air drafts
D. Is near a cold wall without contact
Correct Answer: B. Is placed on a cold surface such as a scale or examination table
Rationale: Direct contact with cooler objects transfers heat away. Warming surfaces and using
warmed blankets prevent conductive loss.
100 questions
1. Fetal pulmonary vascular resistance is high because:
A. The lungs are fully aerated
B. The foramen ovale is closed
C. The fetus breathes air
D. The lungs are filled with fluid and the vessels are constricted in a low-oxygen environment
Correct Answer: D. The lungs are filled with fluid and the vessels are constricted in a
low-oxygen environment
Rationale: Fluid-filled, unexpanded lungs and low oxygen keep pulmonary vessels constricted,
directing blood through the fetal shunts. Aeration at birth lowers resistance.
2. A normal newborn respiratory pattern includes:
A. Regular breathing at 12 to 20 breaths per minute
B. Breathing only through the mouth
C. Irregular, diaphragmatic breathing at about 30 to 60 breaths per minute with brief pauses
D. Pauses longer than 20 seconds
Correct Answer: C. Irregular, diaphragmatic breathing at about 30 to 60 breaths per minute
with brief pauses
Rationale: Newborn breathing is irregular and abdominal, with short pauses typical of periodic
breathing. Adult rates, obligate mouth breathing and long apnea are not normal.
,3. Fetal hemoglobin differs from adult hemoglobin in that it:
A. Has a higher affinity for oxygen, helping the fetus extract oxygen from maternal blood
B. Has a lower affinity for oxygen
C. Cannot carry oxygen
D. Is found only in adults
Correct Answer: A. Has a higher affinity for oxygen, helping the fetus extract oxygen from
maternal blood
Rationale: Higher affinity allows oxygen transfer across the placenta. It is gradually replaced by
adult hemoglobin over the first months.
4. A newborn with a single umbilical artery should be evaluated because it may be associated
with:
A. Increased intelligence
B. Other congenital anomalies, especially renal anomalies
C. Normal development only
D. Jaundice in all cases
Correct Answer: B. Other congenital anomalies, especially renal anomalies
Rationale: A two-vessel cord can be isolated but is linked to renal, cardiac and other anomalies
in some infants, so assessment is warranted. It is not linked to intelligence or universal jaundice.
5. Functional closure of the ductus arteriosus after birth is triggered mainly by:
A. Falling oxygen levels
B. Rising prostaglandin levels
C. Rising arterial oxygen levels and falling prostaglandin levels
D. Increased pulmonary vascular resistance
Correct Answer: C. Rising arterial oxygen levels and falling prostaglandin levels
Rationale: Oxygen constricts the ductus, and loss of placental prostaglandins removes a dilating
influence. Low oxygen or high prostaglandins keep it open.
,6. Ductal-dependent congenital heart defects may not cause symptoms at birth because:
A. They are always benign
B. The ductus arteriosus is still open, maintaining blood flow until it closes days later
C. The foramen ovale stays open forever
D. They are cured by the first breath
Correct Answer: B. The ductus arteriosus is still open, maintaining blood flow until it closes
days later
Rationale: As the ductus closes, infants can suddenly become cyanotic or go into shock, which is
why pulse oximetry screening is performed. They are serious conditions.
7. A soft heart murmur heard in the first day of life may be:
A. Always a sign of serious heart disease
B. A transitional finding related to a closing ductus arteriosus, but it still requires follow-up
C. Impossible in healthy infants
D. A lung sound
Correct Answer: B. A transitional finding related to a closing ductus arteriosus, but it still
requires follow-up
Rationale: Many early murmurs are benign and disappear as shunts close, but persistent
murmurs or other signs need evaluation. They are not lung sounds.
8. Newborns born to mothers who received opioids shortly before birth may have:
A. Increased respiratory rate in all cases
B. Early closure of the ductus
C. Excess surfactant
D. Respiratory depression that delays transition
Correct Answer: D. Respiratory depression that delays transition
Rationale: Opioids cross the placenta and can depress breathing, so newborns are monitored
and supported with ventilation as needed. They do not cause the other effects.
, 9. Transporting a newborn within the hospital should include:
A. A warmed transport incubator or skin-to-skin with a parent when appropriate
B. An open bassinet in cold hallways without cover
C. Wet linens
D. No temperature monitoring
Correct Answer: A. A warmed transport incubator or skin-to-skin with a parent when
appropriate
Rationale: Transport environments must prevent heat loss. Cold, uncovered or wet conditions
increase risk.
10. Newborns are especially vulnerable to heat loss because they have:
A. A thick layer of fat
B. A small head relative to body
C. The ability to shiver effectively
D. A large body surface area relative to weight and little subcutaneous fat
Correct Answer: D. A large body surface area relative to weight and little subcutaneous fat
Rationale: Large surface area, thin skin and limited insulating fat promote heat loss. Newborns
have relatively large heads and cannot shiver effectively.
11. Heat loss by conduction occurs when the newborn:
A. Is wet after birth
B. Is placed on a cold surface such as a scale or examination table
C. Is exposed to air drafts
D. Is near a cold wall without contact
Correct Answer: B. Is placed on a cold surface such as a scale or examination table
Rationale: Direct contact with cooler objects transfers heat away. Warming surfaces and using
warmed blankets prevent conductive loss.
