Newborn Transition: Exam 2 - Questions with Correct Answers
100 questions
1. Apical heart rate in a newborn is auscultated:
A. At the radial pulse for 15 seconds
B. At the neck only
C. Over the abdomen
D. For a full minute at the point of maximal impulse, about the fourth intercostal space left of
the sternum
Correct Answer: D. For a full minute at the point of maximal impulse, about the fourth
intercostal space left of the sternum
Rationale: The apical pulse is most accurate in newborns, and a full minute captures
irregularities. Radial pulses are difficult to feel in newborns.
2. Periodic breathing in a newborn consists of:
A. Brief pauses of less than about 20 seconds without color or heart rate change, alternating
with regular breathing
B. Pauses longer than 20 seconds with bradycardia
C. Constant gasping
D. Breathing only when crying
Correct Answer: A. Brief pauses of less than about 20 seconds without color or heart rate
change, alternating with regular breathing
Rationale: Periodic breathing is a normal immature pattern. Longer pauses with bradycardia or
desaturation define apnea.
,3. Fetal breathing movements before birth help:
A. Clear all lung fluid
B. Exchange gases
C. Develop respiratory muscles and lung growth
D. Close the ductus
Correct Answer: C. Develop respiratory muscles and lung growth
Rationale: Breathing movements in utero support lung development but do not exchange
gases. Gas exchange occurs through the placenta.
4. Newborns with Down syndrome should have cardiac evaluation because they:
A. Never have heart disease
B. Have only lung disease
C. Have closed shunts at birth
D. Have a high rate of congenital heart defects such as atrioventricular septal defects
Correct Answer: D. Have a high rate of congenital heart defects such as atrioventricular septal
defects
Rationale: About half of infants with Down syndrome have congenital heart disease, so
echocardiography is recommended. They are not free of heart disease.
5. A newborn's hemoglobin at birth is relatively high because:
A. Newborns are always dehydrated
B. The fetus adapted to a low-oxygen environment by producing more red cells and fetal
hemoglobin
C. Hemoglobin is produced by the placenta only
D. The lungs make red cells
Correct Answer: B. The fetus adapted to a low-oxygen environment by producing more red
cells and fetal hemoglobin
Rationale: Fetal hemoglobin has high oxygen affinity, and higher red cell mass compensated for
low intrauterine oxygen. Red cells are made in the bone marrow and liver, not the placenta or
lungs.
,6. The newborn's cardiac output is highly dependent on:
A. Stroke volume only
B. Blood pressure only
C. Heart rate, because stroke volume is relatively fixed
D. Lung fluid
Correct Answer: C. Heart rate, because stroke volume is relatively fixed
Rationale: Newborns increase output mainly by increasing heart rate, so bradycardia
significantly reduces perfusion. This is why heart rate is critical during resuscitation.
7. Persistent pulmonary hypertension of the newborn occurs when:
A. Pulmonary vascular resistance falls normally
B. The ductus closes immediately
C. Pulmonary vascular resistance remains high after birth, causing right-to-left shunting and
hypoxemia
D. The lungs are overinflated in all cases
Correct Answer: C. Pulmonary vascular resistance remains high after birth, causing
right-to-left shunting and hypoxemia
Rationale: Failure of the normal fall in pulmonary pressure keeps fetal shunts open with
deoxygenated blood bypassing the lungs. It is not normal transition.
8. Antenatal corticosteroids given to a mother at risk of preterm birth help the newborn
transition by:
A. Accelerating lung maturation and surfactant production
B. Closing the ductus arteriosus
C. Preventing jaundice
D. Increasing birth weight greatly
Correct Answer: A. Accelerating lung maturation and surfactant production
Rationale: Steroids reduce respiratory distress syndrome and other complications of
prematurity. They do not close the ductus, prevent jaundice or greatly increase weight.
, 9. Insensible water loss in newborns is increased by:
A. High humidity
B. Prematurity, radiant warmers, phototherapy and low humidity
C. Clothing
D. Skin-to-skin care
Correct Answer: B. Prematurity, radiant warmers, phototherapy and low humidity
Rationale: Thin skin and heat sources increase evaporative loss, so fluid needs are monitored.
Humidity and clothing reduce losses.
10. Oral dextrose gel for neonatal hypoglycemia is:
A. Given intravenously
B. Massaged into the buccal mucosa, followed by feeding, to raise glucose and support
breastfeeding
C. Injected intramuscularly
D. Given instead of all feeding
Correct Answer: B. Massaged into the buccal mucosa, followed by feeding, to raise glucose
and support breastfeeding
Rationale: Buccal dextrose gel can reduce NICU admission for hypoglycemia and supports
continued breastfeeding. It is not given by injection or as a substitute for feeding.
11. A newborn with symptomatic hypoglycemia or persistently low glucose despite feeding
usually requires:
A. Only water feeds
B. IV dextrose and close monitoring
C. Delayed feeding
D. A bath
Correct Answer: B. IV dextrose and close monitoring
Rationale: IV glucose rapidly corrects hypoglycemia and prevents brain injury. Water and
delayed feeding worsen glucose levels.
100 questions
1. Apical heart rate in a newborn is auscultated:
A. At the radial pulse for 15 seconds
B. At the neck only
C. Over the abdomen
D. For a full minute at the point of maximal impulse, about the fourth intercostal space left of
the sternum
Correct Answer: D. For a full minute at the point of maximal impulse, about the fourth
intercostal space left of the sternum
Rationale: The apical pulse is most accurate in newborns, and a full minute captures
irregularities. Radial pulses are difficult to feel in newborns.
2. Periodic breathing in a newborn consists of:
A. Brief pauses of less than about 20 seconds without color or heart rate change, alternating
with regular breathing
B. Pauses longer than 20 seconds with bradycardia
C. Constant gasping
D. Breathing only when crying
Correct Answer: A. Brief pauses of less than about 20 seconds without color or heart rate
change, alternating with regular breathing
Rationale: Periodic breathing is a normal immature pattern. Longer pauses with bradycardia or
desaturation define apnea.
,3. Fetal breathing movements before birth help:
A. Clear all lung fluid
B. Exchange gases
C. Develop respiratory muscles and lung growth
D. Close the ductus
Correct Answer: C. Develop respiratory muscles and lung growth
Rationale: Breathing movements in utero support lung development but do not exchange
gases. Gas exchange occurs through the placenta.
4. Newborns with Down syndrome should have cardiac evaluation because they:
A. Never have heart disease
B. Have only lung disease
C. Have closed shunts at birth
D. Have a high rate of congenital heart defects such as atrioventricular septal defects
Correct Answer: D. Have a high rate of congenital heart defects such as atrioventricular septal
defects
Rationale: About half of infants with Down syndrome have congenital heart disease, so
echocardiography is recommended. They are not free of heart disease.
5. A newborn's hemoglobin at birth is relatively high because:
A. Newborns are always dehydrated
B. The fetus adapted to a low-oxygen environment by producing more red cells and fetal
hemoglobin
C. Hemoglobin is produced by the placenta only
D. The lungs make red cells
Correct Answer: B. The fetus adapted to a low-oxygen environment by producing more red
cells and fetal hemoglobin
Rationale: Fetal hemoglobin has high oxygen affinity, and higher red cell mass compensated for
low intrauterine oxygen. Red cells are made in the bone marrow and liver, not the placenta or
lungs.
,6. The newborn's cardiac output is highly dependent on:
A. Stroke volume only
B. Blood pressure only
C. Heart rate, because stroke volume is relatively fixed
D. Lung fluid
Correct Answer: C. Heart rate, because stroke volume is relatively fixed
Rationale: Newborns increase output mainly by increasing heart rate, so bradycardia
significantly reduces perfusion. This is why heart rate is critical during resuscitation.
7. Persistent pulmonary hypertension of the newborn occurs when:
A. Pulmonary vascular resistance falls normally
B. The ductus closes immediately
C. Pulmonary vascular resistance remains high after birth, causing right-to-left shunting and
hypoxemia
D. The lungs are overinflated in all cases
Correct Answer: C. Pulmonary vascular resistance remains high after birth, causing
right-to-left shunting and hypoxemia
Rationale: Failure of the normal fall in pulmonary pressure keeps fetal shunts open with
deoxygenated blood bypassing the lungs. It is not normal transition.
8. Antenatal corticosteroids given to a mother at risk of preterm birth help the newborn
transition by:
A. Accelerating lung maturation and surfactant production
B. Closing the ductus arteriosus
C. Preventing jaundice
D. Increasing birth weight greatly
Correct Answer: A. Accelerating lung maturation and surfactant production
Rationale: Steroids reduce respiratory distress syndrome and other complications of
prematurity. They do not close the ductus, prevent jaundice or greatly increase weight.
, 9. Insensible water loss in newborns is increased by:
A. High humidity
B. Prematurity, radiant warmers, phototherapy and low humidity
C. Clothing
D. Skin-to-skin care
Correct Answer: B. Prematurity, radiant warmers, phototherapy and low humidity
Rationale: Thin skin and heat sources increase evaporative loss, so fluid needs are monitored.
Humidity and clothing reduce losses.
10. Oral dextrose gel for neonatal hypoglycemia is:
A. Given intravenously
B. Massaged into the buccal mucosa, followed by feeding, to raise glucose and support
breastfeeding
C. Injected intramuscularly
D. Given instead of all feeding
Correct Answer: B. Massaged into the buccal mucosa, followed by feeding, to raise glucose
and support breastfeeding
Rationale: Buccal dextrose gel can reduce NICU admission for hypoglycemia and supports
continued breastfeeding. It is not given by injection or as a substitute for feeding.
11. A newborn with symptomatic hypoglycemia or persistently low glucose despite feeding
usually requires:
A. Only water feeds
B. IV dextrose and close monitoring
C. Delayed feeding
D. A bath
Correct Answer: B. IV dextrose and close monitoring
Rationale: IV glucose rapidly corrects hypoglycemia and prevents brain injury. Water and
delayed feeding worsen glucose levels.
