Chapter 43 - Neonatal Care

1. Which term defines the period from birth to 28 days of life?
   A) Neonate
   B) Infant
   C) Newborn
   D) Toddler

A) Neonate
Explanation: The neonatal period is the first 28 days after birth. (Ch. 43)

2. What is the primary physiologic change at birth?
   A) Closure of ductus arteriosus
   B) First breath expanding lungs
   C) Placental separation
   D) Cord clamping

B) First breath expanding lungs
Explanation: The newborn’s first breath expands alveoli, initiating pulmonary circulation. (Ch. 43)

3. Which fetal structure allows blood flow from the right atrium to the left atrium?
   A) Ductus venosus
   B) Foramen ovale
   C) Ductus arteriosus
   D) Umbilical vein

B) Foramen ovale
Explanation: The foramen ovale shunts blood between atria in fetal circulation. (Ch. 43)

4. Which fetal shunt bypasses the liver?
   A) Ductus arteriosus
   B) Ductus venosus
   C) Foramen ovale
   D) Umbilical artery

B) Ductus venosus
Explanation: The ductus venosus diverts umbilical blood into the IVC. (Ch. 43)

5. Which fetal shunt bypasses the lungs?
   A) Ductus arteriosus
   B) Ductus venosus
   C) Foramen ovale
   D) Umbilical vein

A) Ductus arteriosus
Explanation: The ductus arteriosus shunts blood from pulmonary artery to aorta. (Ch. 43)

6. What closes the foramen ovale at birth?
   A) Mechanical pressure from placenta
   B) Increased left atrial pressure
   C) Drop in right atrial pressure
   D) Both B and C

D) Both B and C
Explanation: With lung expansion, left atrial pressure rises and right atrial pressure falls, closing the foramen ovale. (Ch. 43)

7. Which normal newborn respiratory rate range is correct?
   A) 10–20
   B) 20–30
   C) 30–60
   D) 60–90

C) 30–60
Explanation: Neonates normally breathe 30–60 times per minute. (Ch. 43)

8. What is the normal heart rate for a neonate?
   A) 60–100
   B) 80–120
   C) 100–180
   D) 180–200

C) 100–180
Explanation: Newborns usually have high resting heart rates averaging 120–160. (Ch. 43)

9. Which factor most contributes to neonatal heat loss?
   A) Small blood volume
   B) Large body surface area compared to mass
   C) High metabolic rate
   D) Low cardiac output

B) Large body surface area compared to mass
Explanation: Newborns lose heat rapidly because of proportionally large surface area. (Ch. 43)

10. Which method prevents heat loss in newborns?
    A) Placing under radiant warmer
    B) Drying thoroughly
    C) Skin-to-skin contact
    D) All of the above

D) All of the above
Explanation: Thermoregulation requires multiple warming strategies. (Ch. 43)

11. Which term describes a baby born before 37 weeks?
    A) Full-term
    B) Preterm
    C) Post-term
    D) Growth restricted

B) Preterm
Explanation: Preterm infants are delivered before 37 completed weeks. (Ch. 43)

12. Which term describes a baby born after 42 weeks?
    A) Full-term
    B) Post-term
    C) Preterm
    D) Low birth weight

B) Post-term
Explanation: Post-term pregnancy exceeds 42 weeks. (Ch. 43)

13. Which gestational age range defines a full-term infant?
    A) 34–37 weeks
    B) 37–42 weeks
    C) 40–44 weeks
    D) 35–40 weeks

B) 37–42 weeks
Explanation: Normal term pregnancy is 37–42 weeks. (Ch. 43)

14. What is the priority action immediately after birth?
    A) Suction nose first
    B) Dry and stimulate infant
    C) Clamp cord immediately
    D) Place under warmer only

B) Dry and stimulate infant
Explanation: Drying reduces heat loss and stimulation helps initiate respirations. (Ch. 43)

15. Which order is correct for suctioning a newborn?
    A) Nose before mouth
    B) Mouth before nose
    C) Both together
    D) Not required

B) Mouth before nose
Explanation: Suction mouth first to prevent aspiration if infant gasps. (Ch. 43)

16. Which newborn finding is normal within first minutes of life?
    A) Central cyanosis
    B) Acrocyanosis
    C) Grunting
    D) Retractions

B) Acrocyanosis
Explanation: Peripheral cyanosis is common early, but central cyanosis is abnormal. (Ch. 43)

17. What does the “A” in APGAR stand for?
    A) Activity
    B) Airway
    C) Appearance
    D) Alertness

C) Appearance
Explanation: APGAR categories are Appearance, Pulse, Grimace, Activity, Respiration. (Ch. 43)

18. What APGAR score is normal at 1 minute?
    A) 0–2
    B) 3–5
    C) 7–10
    D) 11–15

C) 7–10
Explanation: A score of 7–10 indicates normal neonatal adaptation. (Ch. 43)

19. Which APGAR category tests reflex irritability?
    A) Pulse
    B) Grimace
    C) Activity
    D) Appearance

B) Grimace
Explanation: Grimace measures response to stimulation like suctioning. (Ch. 43)

20. Which APGAR category assesses muscle tone?
    A) Appearance
    B) Pulse
    C) Activity
    D) Respiration

C) Activity
Explanation: Activity represents neonatal tone and spontaneous movement. (Ch. 43)

21. What APGAR score is given for a newborn with HR >100 bpm?
    A) 0
    B) 1
    C) 2
    D) 3

C) 2
Explanation: HR >100 bpm scores 2, <100 scores 1, absent = 0. (Ch. 43)

22. Which APGAR score is assigned for an infant with a weak cry and irregular respirations?
    A) 0
    B) 1
    C) 2
    D) 3

B) 1
Explanation: Weak or irregular breathing scores 1; absent=0, strong cry=2. (Ch. 43)

23. What is the first step in neonatal resuscitation if HR <100?
    A) Chest compressions
    B) Positive pressure ventilation
    C) Epinephrine
    D) Blow-by oxygen

B) Positive pressure ventilation
Explanation: PPV is started if HR is <100 bpm after initial steps. (Ch. 43)

24. What is the compression-to-ventilation ratio in neonatal resuscitation?
    A) 15:2
    B) 30:2
    C) 5:1
    D) 3:1

D) 3:1
Explanation: Neonates require a 3:1 ratio of compressions to ventilations. (Ch. 43)

25. At what heart rate should chest compressions be started?
    A) <100
    B) <80
    C) <60
    D) <40

C) <60
Explanation: HR <60 after 30 sec of PPV requires compressions. (Ch. 43)

26. Which technique is preferred for neonatal chest compressions?
    A) One-finger technique
    B) Two-thumb encircling hands technique
    C) Two-finger technique at xiphoid
    D) Heel of hand

B) Two-thumb encircling hands technique
Explanation: This method provides best control and blood flow. (Ch. 43)

27. Where are compressions performed on a newborn?
    A) Upper sternum
    B) Lower sternum just below nipple line
    C) Epigastric region
    D) Abdomen

B) Lower sternum just below nipple line
Explanation: Compressions should be delivered on the lower third of sternum. (Ch. 43)

28. What is the recommended compression depth in neonates?
    A) 1/2 inch
    B) 1 inch
    C) 1/3 anterior-posterior chest diameter
    D) 2 inches

C) 1/3 anterior-posterior chest diameter
Explanation: Neonatal compressions should depress chest by one-third AP diameter. (Ch. 43)

29. What is the initial ventilation rate for neonatal resuscitation?
    A) 40–60 breaths per minute
    B) 20–30
    C) 10–20
    D) 12–15

A) 40–60 breaths per minute
Explanation: PPV rate is 40–60 breaths per minute to match normal RR. (Ch. 43)

30. Which medication is indicated if HR remains <60 after compressions and ventilation?
    A) Atropine
    B) Epinephrine
    C) Sodium bicarbonate
    D) Calcium chloride

B) Epinephrine
Explanation: Epinephrine is given IV or IO if HR <60 after adequate resuscitation. (Ch. 43)

31. What is the preferred route for epinephrine in neonates?
    A) Endotracheal tube
    B) Intravenous or intraosseous
    C) Oral
    D) Subcutaneous

B) Intravenous or intraosseous
Explanation: IV/IO is preferred for accurate dosing; ETT route less reliable. (Ch. 43)

32. What is the initial concentration of oxygen used in neonatal resuscitation?
    A) 21% (room air)
    B) 40%
    C) 60%
    D) 100%

A) 21% (room air)
Explanation: Resuscitation begins with room air unless otherwise indicated. (Ch. 43)

33. Which finding is abnormal in a newborn?
    A) Acrocyanosis
    B) Central cyanosis
    C) Irregular respirations
    D) Transient tachypnea

B) Central cyanosis
Explanation: Central cyanosis indicates inadequate oxygenation. (Ch. 43)

34. What is transient tachypnea of the newborn?
    A) Respiratory distress due to retained fetal lung fluid
    B) Pneumothorax
    C) Sepsis
    D) Meconium aspiration

A) Respiratory distress due to retained fetal lung fluid
Explanation: TTN is common in C-section babies due to delayed fluid clearance. (Ch. 43)

35. Which neonatal complication results from meconium-stained fluid aspiration?
    A) Pneumothorax
    B) Respiratory distress syndrome
    C) Meconium aspiration syndrome
    D) Bronchiolitis

C) Meconium aspiration syndrome
Explanation: Meconium can block airways and impair oxygen exchange. (Ch. 43)

36. Which airway intervention is required in suspected diaphragmatic hernia?
    A) Bag-mask ventilation
    B) Endotracheal intubation without bag-mask
    C) Nasal cannula oxygen only
    D) CPAP

B) Endotracheal intubation without bag-mask
Explanation: Bag-mask ventilation can inflate stomach and worsen lung compression. (Ch. 43)

37. Which finding suggests congenital diaphragmatic hernia?
    A) Bowel sounds in chest
    B) Cyanosis
    C) Scaphoid abdomen
    D) All of the above

D) All of the above
Explanation: Bowel in chest and scaphoid abdomen are classic findings. (Ch. 43)

38. Which is the most common cause of neonatal seizures?
    A) Hypoglycemia
    B) Hypoxia
    C) Hypocalcemia
    D) Infection

B) Hypoxia
Explanation: Perinatal hypoxia/ischemia is the leading cause of neonatal seizures. (Ch. 43)

39. What is the normal blood glucose level for neonates?
    A) >20 mg/dL
    B) >40 mg/dL
    C) >60 mg/dL
    D) >80 mg/dL

B) >40 mg/dL
Explanation: Neonates should maintain blood glucose above 40 mg/dL. (Ch. 43)

40. Which symptom suggests neonatal hypoglycemia?
    A) Tremors, jitteriness
    B) Lethargy
    C) Poor feeding
    D) All of the above

D) All of the above
Explanation: Hypoglycemia presents with nonspecific symptoms requiring testing. (Ch. 43)

41. Which is the most common metabolic disorder in newborns?
    A) Hypoglycemia
    B) Hypocalcemia
    C) Acidosis
    D) Hypernatremia

A) Hypoglycemia
Explanation: Hypoglycemia is frequent, especially in infants of diabetic mothers. (Ch. 43)

42. Which congenital cardiac anomaly presents with cyanosis unrelieved by oxygen?
    A) ASD
    B) PDA
    C) Tetralogy of Fallot
    D) VSD

C) Tetralogy of Fallot
Explanation: Cyanotic heart disease does not improve with oxygen therapy. (Ch. 43)

43. Which congenital heart condition is ductal-dependent?
    A) Tetralogy of Fallot
    B) Transposition of great arteries
    C) Coarctation of aorta
    D) All of the above

D) All of the above
Explanation: Many critical defects depend on PDA to maintain circulation. (Ch. 43)

44. What is the most common cause of neonatal pneumonia?
    A) Viral infection
    B) Aspiration of amniotic fluid
    C) Bacterial infection acquired during delivery
    D) Congenital defect

C) Bacterial infection acquired during delivery
Explanation: GBS and other bacteria can cause early-onset neonatal pneumonia. (Ch. 43)

45. Which neonatal jaundice is pathologic?
    A) Appears after 24 hours
    B) Appears in first 24 hours
    C) Resolves within a week
    D) Associated with breastfeeding

B) Appears in first 24 hours
Explanation: Jaundice in the first 24 hrs suggests hemolysis or serious pathology. (Ch. 43)

46. What is kernicterus?
    A) Sepsis
    B) Brain damage from high bilirubin
    C) Neonatal seizure disorder
    D) Hypocalcemia

B) Brain damage from high bilirubin
Explanation: Severe hyperbilirubinemia can deposit in brain causing permanent injury. (Ch. 43)

47. Which type of newborn is most at risk for hypothermia?
    A) Post-term
    B) Preterm
    C) Large for gestational age
    D) Term

B) Preterm
Explanation: Preterm infants have less fat and poor thermoregulation. (Ch. 43)

48. Which intervention is most important for neonatal thermoregulation?
    A) Place in incubator or radiant warmer
    B) Cover with warm blankets only
    C) Immediate feeding
    D) Administer oxygen

A) Place in incubator or radiant warmer
Explanation: Maintaining neutral thermal environment prevents cold stress. (Ch. 43)

49. Which finding suggests neonatal pneumothorax?
    A) Asymmetrical chest movement
    B) Absent breath sounds on one side
    C) Sudden desaturation
    D) All of the above

D) All of the above
Explanation: Pneumothorax presents with asymmetric expansion and absent sounds. (Ch. 43)

50. Which procedure confirms pneumothorax?
    A) Chest X-ray
    B) Ultrasound
    C) Needle aspiration
    D) Transillumination

D) Transillumination
Explanation: Shining light through chest reveals area of trapped air; X-ray confirms. (Ch. 43)

51. Which tool is best for assessing gestational age of a newborn?
    A) APGAR score
    B) Ballard score
    C) Moro reflex
    D) Babinski reflex

B) Ballard score
Explanation: The Ballard scoring system estimates gestational age based on physical and neuromuscular signs. (Ch. 43)

52. Which newborn reflex is tested by startling the infant?
    A) Moro reflex
    B) Rooting reflex
    C) Babinski reflex
    D) Grasp reflex

A) Moro reflex
Explanation: Moro reflex is a startle reflex with symmetric arm movement. (Ch. 43)

53. Which newborn reflex is tested by stroking the cheek?
    A) Rooting reflex
    B) Moro reflex
    C) Babinski reflex
    D) Palmar grasp

A) Rooting reflex
Explanation: Rooting helps the baby find the nipple for feeding. (Ch. 43)

54. Which newborn reflex is tested by stroking the sole of the foot?
    A) Moro reflex
    B) Rooting reflex
    C) Babinski reflex
    D) Palmar grasp

C) Babinski reflex
Explanation: A normal Babinski is dorsiflexion of big toe and fanning of others. (Ch. 43)

55. Which newborn reflex is tested by placing a finger in the infant’s palm?
    A) Rooting reflex
    B) Moro reflex
    C) Babinski reflex
    D) Palmar grasp

D) Palmar grasp
Explanation: Palmar grasp is strong in neonates and disappears with age. (Ch. 43)

56. Which newborn weight is considered low birth weight?
    A) <1500 g
    B) <2500 g
    C) <3000 g
    D) <3500 g

B) <2500 g
Explanation: Birth weight below 2500 g is defined as low birth weight. (Ch. 43)

57. Which newborn weight is considered very low birth weight?
    A) <1000 g
    B) <1500 g
    C) <2000 g
    D) <2500 g

B) <1500 g
Explanation: Very low birth weight is less than 1500 g. (Ch. 43)

58. What is the normal newborn blood pressure?
    A) 40–60 / 25–40 mmHg
    B) 60–90 / 40–60 mmHg
    C) 80–100 / 50–70 mmHg
    D) 100–120 / 70–90 mmHg

A) 40–60 / 25–40 mmHg
Explanation: Neonatal BP is significantly lower than in older children. (Ch. 43)

59. Which statement about neonatal skin is correct?
    A) It is thicker than adult skin
    B) It regulates temperature well
    C) It is thin and poorly regulates heat
    D) It has strong barrier function

C) It is thin and poorly regulates heat
Explanation: Neonatal skin is thin, increasing heat and fluid loss. (Ch. 43)

60. Which finding is normal in a newborn’s skin?
    A) Vernix caseosa
    B) Lanugo
    C) Mongolian spots
    D) All of the above

D) All of the above
Explanation: These are common benign neonatal skin findings. (Ch. 43)

61. Which of the following is a risk factor for neonatal hypothermia?
    A) Preterm birth
    B) Wet skin
    C) Cold environment
    D) All of the above

D) All of the above
Explanation: Newborns lose heat quickly from multiple mechanisms. (Ch. 43)

62. What is cold stress in neonates?
    A) Sepsis
    B) Hypothermia leading to hypoglycemia and acidosis
    C) Hypoxia only
    D) Pulmonary embolism

B) Hypothermia leading to hypoglycemia and acidosis
Explanation: Cold stress increases oxygen demand and metabolic acidosis risk. (Ch. 43)

63. Which statement is true about neonatal circulation?
    A) Right-sided pressures are higher after birth
    B) Left atrial pressure exceeds right atrial pressure
    C) Foramen ovale remains open indefinitely
    D) Ductus arteriosus remains permanently patent

B) Left atrial pressure exceeds right atrial pressure
Explanation: This closes the foramen ovale and establishes normal circulation. (Ch. 43)

64. Which neonatal condition is most associated with surfactant deficiency?
    A) Pneumonia
    B) Respiratory distress syndrome
    C) Meconium aspiration
    D) Pneumothorax

B) Respiratory distress syndrome
Explanation: Premature infants lack surfactant, leading to alveolar collapse. (Ch. 43)

65. Which newborn finding is most concerning?
    A) Irregular respirations
    B) Periodic breathing with pauses

C) Apnea >20 sec with bradycardia
Explanation: Apnea with bradycardia is abnormal and requires intervention. (Ch. 43)

66. Which neonatal resuscitation step is most important in first 30 seconds?
    A) Airway management
    B) Drying, warming, stimulating
    C) IV access
    D) Chest compressions

B) Drying, warming, stimulating
Explanation: Initial steps focus on thermoregulation and stimulation. (Ch. 43)

67. Which sign indicates effective positive pressure ventilation in neonate?
    A) Heart rate increases
    B) Chest rises visibly
    C) Breath sounds are bilateral
    D) All of the above

D) All of the above
Explanation: Ventilation effectiveness is judged by HR increase and chest movement. (Ch. 43)

68. When should intubation be considered in neonatal resuscitation?
    A) Ineffective bag-mask ventilation
    B) Chest compressions required
    C) Diaphragmatic hernia suspected
    D) All of the above

D) All of the above
Explanation: Intubation is required for prolonged or ineffective ventilation. (Ch. 43)

69. Which is the correct ETT size for a 3 kg term newborn?
    A) 2.5 mm
    B) 3.0 mm
    C) 3.5 mm
    D) 4.0 mm

C) 3.5 mm
Explanation: Term infants (3 kg) typically need a 3.5 mm uncuffed tube. (Ch. 43)

70. Which is the correct depth for intubation of a term neonate?
    A) 6–7 cm at lips
    B) 8–9 cm at lips
    C) 10–12 cm at lips
    D) 12–14 cm at lips

B) 8–9 cm at lips
Explanation: The formula is 6 + weight (kg); for 3 kg infant = 9 cm. (Ch. 43)

71. Which airway device is contraindicated in newborns?
    A) Oropharyngeal airway
    B) Nasopharyngeal airway
    C) Laryngeal mask airway
    D) None

B) Nasopharyngeal airway
Explanation: NPAs risk trauma and are not typically used in neonates. (Ch. 43)

72. What is the most reliable sign of neonatal circulation?
    A) Color of skin
    B) Pulse oximetry
    C) Heart rate
    D) Capillary refill

C) Heart rate
Explanation: HR is the most important indicator of neonatal status. (Ch. 43)

73. Which site is preferred for umbilical vein catheterization?
    A) Umbilical artery
    B) Umbilical vein
    C) Femoral vein
    D) Jugular vein

B) Umbilical vein
Explanation: Umbilical vein access provides reliable route for meds and fluids. (Ch. 43)

74. Which volume of fluid bolus is given for neonatal hypovolemia?
    A) 5 mL/kg
    B) 10 mL/kg
    C) 20 mL/kg
    D) 30 mL/kg

B) 10 mL/kg
Explanation: Neonatal fluid resuscitation is typically 10 mL/kg isotonic fluid. (Ch. 43)

75. Which is the drug of choice for neonatal resuscitation?
    A) Epinephrine
    B) Atropine
    C) Amiodarone
    D) Calcium

A) Epinephrine
Explanation: Epinephrine is used if HR <60 after compressions and ventilation. (Ch. 43)

76. Which concentration of epinephrine is used in neonates?
    A) 1:1,000
    B) 1:10,000
    C) 1:100,000
    D) 1:1

B) 1:10,000
Explanation: Neonatal resuscitation uses 0.01–0.03 mg/kg of 1:10,000 epinephrine. (Ch. 43)

77. Which glucose solution is used to treat neonatal hypoglycemia?
    A) D50
    B) D25
    C) D10
    D) D5

C) D10
Explanation: D10W is safest; concentrated dextrose can damage veins. (Ch. 43)

78. What is the initial dose of D10 for neonatal hypoglycemia?
    A) 2 mL/kg
    B) 4 mL/kg
    C) 5 mL/kg
    D) 10 mL/kg

A) 2 mL/kg
Explanation: D10 at 2 mL/kg is given to correct hypoglycemia. (Ch. 43)

79. Which infection is most common cause of neonatal sepsis?
    A) Group B Streptococcus
    B) E. coli
    C) Staphylococcus aureus
    D) Klebsiella

A) Group B Streptococcus
Explanation: GBS is the leading cause of early-onset neonatal sepsis. (Ch. 43)

80. Which finding is most concerning for neonatal sepsis?
    A) Hypothermia
    B) Tachypnea
    C) Poor feeding
    D) All of the above

D) All of the above
Explanation: Neonatal sepsis presents nonspecifically with subtle signs. (Ch. 43)

81. Which lab test best screens for neonatal hypoglycemia?
    A) Serum insulin
    B) Point-of-care blood glucose
    C) Serum calcium
    D) Blood culture

B) Point-of-care blood glucose
Explanation: Rapid bedside glucose testing is used in neonates at risk. (Ch. 43)

82. Which condition is most associated with neonatal seizures?
    A) Hypoxia
    B) Hypoglycemia
    C) Hypocalcemia
    D) All of the above

D) All of the above
Explanation: Multiple metabolic and hypoxic causes may trigger seizures. (Ch. 43)

83. Which medication is first-line for neonatal seizures?
    A) Lorazepam
    B) Midazolam
    C) Phenobarbital
    D) Diazepam

C) Phenobarbital
Explanation: Phenobarbital is the drug of choice for neonatal seizures. (Ch. 43)

84. Which neonatal complication is caused by persistent ductus arteriosus?
    A) Hypoxia
    B) Pulmonary overcirculation and CHF
    C) Sepsis
    D) Hypoglycemia

B) Pulmonary overcirculation and CHF
Explanation: PDA causes excess blood flow to lungs and heart failure. (Ch. 43)

85. Which congenital heart defect is most common?
    A) VSD
    B) ASD
    C) Tetralogy of Fallot
    D) Coarctation of aorta

A) VSD
Explanation: Ventricular septal defect is the most common congenital heart defect. (Ch. 43)

86. Which neonatal condition requires prostaglandin infusion?
    A) PDA
    B) Ductal-dependent heart lesions
    C) VSD
    D) ASD

B) Ductal-dependent heart lesions
Explanation: Prostaglandin E1 keeps ductus arteriosus open until surgery. (Ch. 43)

87. Which condition is suspected if cyanosis does not improve with oxygen?
    A) Pneumonia
    B) Congenital heart disease
    C) Pneumothorax
    D) Sepsis

B) Congenital heart disease
Explanation: Cyanotic congenital heart disease does not respond to O₂. (Ch. 43)

88. Which neonatal GI emergency presents with bilious vomiting?
    A) Necrotizing enterocolitis
    B) Malrotation with volvulus
    C) GERD
    D) Pyloric stenosis

B) Malrotation with volvulus
Explanation: Bilious emesis in neonates indicates possible bowel obstruction. (Ch. 43)

89. Which neonatal GI condition presents with projectile non-bilious vomiting?
    A) Malrotation
    B) Pyloric stenosis
    C) Necrotizing enterocolitis
    D) GERD

B) Pyloric stenosis
Explanation: Hypertrophic pyloric stenosis causes projectile non-bilious emesis. (Ch. 43)

90. Which finding suggests necrotizing enterocolitis?
    A) Bilious vomiting
    B) Abdominal distension
    C) Bloody stools
    D) All of the above

D) All of the above
Explanation: NEC presents with GI bleeding, distension, and shock. (Ch. 43)

91. Which neonatal infection is prevented by erythromycin eye ointment?
    A) HIV
    B) Rubella
    C) Gonorrhea and chlamydia
    D) CMV

C) Gonorrhea and chlamydia
Explanation: Eye ointment prevents ophthalmia neonatorum. (Ch. 43)

92. Which newborn condition is most likely if jaundice appears within first 24 hrs?
    A) Physiologic jaundice
    B) Hemolytic disease
    C) Breast milk jaundice
    D) Transient jaundice

B) Hemolytic disease
Explanation: Early jaundice suggests pathologic hemolysis. (Ch. 43)

93. Which bilirubin level increases risk of kernicterus?
    A) >5 mg/dL
    B) >10 mg/dL
    C) >20 mg/dL
    D) >25 mg/dL

C) >20 mg/dL
Explanation: Severe hyperbilirubinemia >20 mg/dL risks brain damage. (Ch. 43)

94. Which therapy treats significant neonatal jaundice?
    A) IV fluids only
    B) Phototherapy
    C) Oxygen
    D) Antibiotics

B) Phototherapy
Explanation: Blue light phototherapy reduces bilirubin levels. (Ch. 43)

95. Which additional therapy may be needed in severe hyperbilirubinemia?
    A) Exchange transfusion
    B) Epinephrine
    C) Surfactant
    D) Steroids

A) Exchange transfusion
Explanation: Exchange transfusion removes bilirubin and maternal antibodies. (Ch. 43)

96. Which newborn finding is normal and benign?
    A) Jaundice in first 12 hrs
    B) Lanugo
    C) Central cyanosis
    D) Seizures

B) Lanugo
Explanation: Lanugo (fine hair) is common, especially in preterm infants. (Ch. 43)

97. Which finding is most concerning in newborn with hypothermia?
    A) Acrocyanosis
    B) Apnea and bradycardia
    C) Pink trunk
    D) Jitteriness

B) Apnea and bradycardia
Explanation: Hypothermia can cause cardiorespiratory collapse in neonates. (Ch. 43)

98. Which glucose level defines neonatal hypoglycemia?
    A) <20 mg/dL
    B) <30 mg/dL
    C) <40 mg/dL
    D) <50 mg/dL

C) <40 mg/dL
Explanation: Glucose below 40 mg/dL is considered hypoglycemia in newborns. (Ch. 43)

99. Which newborn is most at risk for hypoglycemia?
    A) Infant of diabetic mother
    B) Preterm infant
    C) Small for gestational age
    D) All of the above

D) All of the above
Explanation: Multiple neonatal groups are at high risk for hypoglycemia. (Ch. 43)

100. Which neonatal finding is associated with hypoglycemia?
     A) Tremors
     B) Lethargy
     C) Poor feeding
     D) All of the above

D) All of the above
Explanation: Hypoglycemia presents with nonspecific symptoms, requiring testing. (Ch. 43)