Newborn Transition: Practice Test 1 (Units 1-7) - Questions
with Correct Answers
100 questions
1. Central cyanosis in a newborn is:
A. Normal for the first week
B. Limited to the hands and feet
C. Bluish color of the lips, tongue and trunk, indicating low oxygen saturation, and requires
immediate evaluation
D. Caused by cold hands only
Correct Answer: C. Bluish color of the lips, tongue and trunk, indicating low oxygen
saturation, and requires immediate evaluation
Rationale: Central cyanosis signals hypoxemia from respiratory or cardiac causes. Peripheral
cyanosis is limited to extremities.
2. In fetal circulation, the ductus venosus allows:
A. Blood to pass from the right atrium to the left atrium
B. Oxygenated blood from the umbilical vein to bypass the liver and enter the inferior vena cava
C. Blood to pass from the pulmonary artery to the aorta
D. Blood to return to the placenta
Correct Answer: B. Oxygenated blood from the umbilical vein to bypass the liver and enter
the inferior vena cava
Rationale: The ductus venosus shunts much of the oxygen-rich placental blood past the liver
toward the heart. The foramen ovale connects the atria, the ductus arteriosus connects the
pulmonary artery to the aorta, and the umbilical arteries return blood to the placenta.
,3. Indomethacin or ibuprofen may be used in preterm infants to:
A. Keep the ductus open
B. Promote closure of a patent ductus arteriosus by inhibiting prostaglandins
C. Treat infection
D. Increase surfactant
Correct Answer: B. Promote closure of a patent ductus arteriosus by inhibiting prostaglandins
Rationale: Prostaglandin inhibition constricts the ductus. These drugs do not keep it open, treat
infection or increase surfactant.
4. Effective ventilation of the lungs at birth is the single most important factor in:
A. Preventing jaundice
B. Successful cardiopulmonary transition and neonatal resuscitation
C. Closing the anterior fontanelle
D. Passing meconium
Correct Answer: B. Successful cardiopulmonary transition and neonatal resuscitation
Rationale: Lung aeration lowers pulmonary resistance and raises oxygen, allowing heart rate to
improve. It is not related to jaundice, fontanelles or meconium.
5. Fetal lung fluid is cleared at birth mainly by:
A. Coughing alone
B. Activation of sodium channels that move fluid from the airspaces into the interstitium and
circulation, aided by labor hormones
C. Suctioning of every newborn
D. Swallowing all the fluid
Correct Answer: B. Activation of sodium channels that move fluid from the airspaces into the
interstitium and circulation, aided by labor hormones
Rationale: Catecholamines and other labor hormones stimulate sodium transport that pulls
fluid out of the alveoli, with a smaller contribution from chest compression. Routine suctioning
is no longer recommended.
,6. At birth, the first breaths help transition by:
A. Expanding the lungs, lowering pulmonary vascular resistance and increasing pulmonary
blood flow
B. Raising pulmonary vascular resistance
C. Opening the foramen ovale wider
D. Increasing lung fluid
Correct Answer: A. Expanding the lungs, lowering pulmonary vascular resistance and
increasing pulmonary blood flow
Rationale: Lung aeration and rising oxygen dilate pulmonary vessels, so blood flows to the
lungs. Resistance falls, the foramen ovale closes and lung fluid is cleared.
7. Shunting through a patent ductus arteriosus in a preterm infant after pulmonary resistance
falls is usually:
A. Right-to-left in all cases
B. Left-to-right, from the aorta to the pulmonary artery, which can cause pulmonary
overcirculation
C. Absent
D. From the liver to the lungs
Correct Answer: B. Left-to-right, from the aorta to the pulmonary artery, which can cause
pulmonary overcirculation
Rationale: As systemic pressure exceeds pulmonary pressure, blood flows from the aorta into
the lungs, which can cause heart failure in preterm infants. Right-to-left shunting occurs with
pulmonary hypertension.
, 8. Brief nasal flaring and mild retractions in the first minutes after birth that resolve within the
first hour are:
A. Often part of normal transition, but persistent signs require evaluation
B. Always signs of pneumonia
C. Signs of hypoglycemia only
D. Unrelated to breathing
Correct Answer: A. Often part of normal transition, but persistent signs require evaluation
Rationale: Some infants show transient signs while clearing lung fluid. If distress persists or
worsens, conditions such as TTN, infection or RDS must be considered.
9. During transition, a newborn's blood pressure:
A. Falls steadily to very low levels
B. Is identical to adult values
C. Gradually rises over the first days of life
D. Cannot be measured
Correct Answer: C. Gradually rises over the first days of life
Rationale: Blood pressure increases as the circulation adapts and varies with gestational age.
Newborn values are lower than adult values and can be measured with appropriate cuffs.
10. Cold stress affects cardiopulmonary transition by:
A. Increasing oxygen consumption and pulmonary vasoconstriction, worsening hypoxia
B. Improving oxygenation
C. Closing the foramen ovale permanently
D. Increasing surfactant
Correct Answer: A. Increasing oxygen consumption and pulmonary vasoconstriction,
worsening hypoxia
Rationale: Hypothermia increases metabolic demand and can trigger persistent fetal
circulation. Keeping the newborn warm supports transition.
with Correct Answers
100 questions
1. Central cyanosis in a newborn is:
A. Normal for the first week
B. Limited to the hands and feet
C. Bluish color of the lips, tongue and trunk, indicating low oxygen saturation, and requires
immediate evaluation
D. Caused by cold hands only
Correct Answer: C. Bluish color of the lips, tongue and trunk, indicating low oxygen
saturation, and requires immediate evaluation
Rationale: Central cyanosis signals hypoxemia from respiratory or cardiac causes. Peripheral
cyanosis is limited to extremities.
2. In fetal circulation, the ductus venosus allows:
A. Blood to pass from the right atrium to the left atrium
B. Oxygenated blood from the umbilical vein to bypass the liver and enter the inferior vena cava
C. Blood to pass from the pulmonary artery to the aorta
D. Blood to return to the placenta
Correct Answer: B. Oxygenated blood from the umbilical vein to bypass the liver and enter
the inferior vena cava
Rationale: The ductus venosus shunts much of the oxygen-rich placental blood past the liver
toward the heart. The foramen ovale connects the atria, the ductus arteriosus connects the
pulmonary artery to the aorta, and the umbilical arteries return blood to the placenta.
,3. Indomethacin or ibuprofen may be used in preterm infants to:
A. Keep the ductus open
B. Promote closure of a patent ductus arteriosus by inhibiting prostaglandins
C. Treat infection
D. Increase surfactant
Correct Answer: B. Promote closure of a patent ductus arteriosus by inhibiting prostaglandins
Rationale: Prostaglandin inhibition constricts the ductus. These drugs do not keep it open, treat
infection or increase surfactant.
4. Effective ventilation of the lungs at birth is the single most important factor in:
A. Preventing jaundice
B. Successful cardiopulmonary transition and neonatal resuscitation
C. Closing the anterior fontanelle
D. Passing meconium
Correct Answer: B. Successful cardiopulmonary transition and neonatal resuscitation
Rationale: Lung aeration lowers pulmonary resistance and raises oxygen, allowing heart rate to
improve. It is not related to jaundice, fontanelles or meconium.
5. Fetal lung fluid is cleared at birth mainly by:
A. Coughing alone
B. Activation of sodium channels that move fluid from the airspaces into the interstitium and
circulation, aided by labor hormones
C. Suctioning of every newborn
D. Swallowing all the fluid
Correct Answer: B. Activation of sodium channels that move fluid from the airspaces into the
interstitium and circulation, aided by labor hormones
Rationale: Catecholamines and other labor hormones stimulate sodium transport that pulls
fluid out of the alveoli, with a smaller contribution from chest compression. Routine suctioning
is no longer recommended.
,6. At birth, the first breaths help transition by:
A. Expanding the lungs, lowering pulmonary vascular resistance and increasing pulmonary
blood flow
B. Raising pulmonary vascular resistance
C. Opening the foramen ovale wider
D. Increasing lung fluid
Correct Answer: A. Expanding the lungs, lowering pulmonary vascular resistance and
increasing pulmonary blood flow
Rationale: Lung aeration and rising oxygen dilate pulmonary vessels, so blood flows to the
lungs. Resistance falls, the foramen ovale closes and lung fluid is cleared.
7. Shunting through a patent ductus arteriosus in a preterm infant after pulmonary resistance
falls is usually:
A. Right-to-left in all cases
B. Left-to-right, from the aorta to the pulmonary artery, which can cause pulmonary
overcirculation
C. Absent
D. From the liver to the lungs
Correct Answer: B. Left-to-right, from the aorta to the pulmonary artery, which can cause
pulmonary overcirculation
Rationale: As systemic pressure exceeds pulmonary pressure, blood flows from the aorta into
the lungs, which can cause heart failure in preterm infants. Right-to-left shunting occurs with
pulmonary hypertension.
, 8. Brief nasal flaring and mild retractions in the first minutes after birth that resolve within the
first hour are:
A. Often part of normal transition, but persistent signs require evaluation
B. Always signs of pneumonia
C. Signs of hypoglycemia only
D. Unrelated to breathing
Correct Answer: A. Often part of normal transition, but persistent signs require evaluation
Rationale: Some infants show transient signs while clearing lung fluid. If distress persists or
worsens, conditions such as TTN, infection or RDS must be considered.
9. During transition, a newborn's blood pressure:
A. Falls steadily to very low levels
B. Is identical to adult values
C. Gradually rises over the first days of life
D. Cannot be measured
Correct Answer: C. Gradually rises over the first days of life
Rationale: Blood pressure increases as the circulation adapts and varies with gestational age.
Newborn values are lower than adult values and can be measured with appropriate cuffs.
10. Cold stress affects cardiopulmonary transition by:
A. Increasing oxygen consumption and pulmonary vasoconstriction, worsening hypoxia
B. Improving oxygenation
C. Closing the foramen ovale permanently
D. Increasing surfactant
Correct Answer: A. Increasing oxygen consumption and pulmonary vasoconstriction,
worsening hypoxia
Rationale: Hypothermia increases metabolic demand and can trigger persistent fetal
circulation. Keeping the newborn warm supports transition.
