final questions

A newborn has central cyanosis, nasal flaring, and grunting. What is the nurse's priority action?

A. Suction the mouth and nose

B. Stimulate the newborn to cry

C. Notify the healthcare provider

D. Perform a full assessment

C@@ Central cyanosis and grunting indicate respiratory distress that requires immediate provider evaluation and oxygen support.

Which fetal shunt closes within 1-2 hours after birth?

A. Ductus arteriosus

B. Ductus venosus

C. Foramen ovale

D. Umbilical vein

C@@ The foramen ovale closes first, allowing separation of right and left atria and normal oxygenation.

Which nursing action prevents heat loss by conduction?

A. Drying the newborn thoroughly

B. Placing the newborn on a warm surface

C. Using a radiant warmer

D. Covering the newborn's head

B@@ Conduction heat loss occurs through contact with cold surfaces; placing on a pre-warmed surface prevents this.

A newborn's axillary temperature is 96.8°F (36°C). What is the best initial intervention?

A. Place under a radiant warmer

B. Begin oxygen therapy

C. Notify the provider

D. Bathe the newborn

A@@ Mild hypothermia should first be managed by external warming to prevent cold stress and hypoglycemia.

A newborn's blood glucose is 38 mg/dL. What should the nurse do first?

A. Notify the provider

B. Give IV dextrose

C. Feed the newborn

D. Recheck in 2 hours

C@@ Feeding stabilizes mild hypoglycemia and should be initiated immediately before other interventions.

A nurse observes jaundice within 6 hours of birth. What should the nurse suspect?

A. Physiologic jaundice

B. Breastfeeding jaundice

C. Pathologic jaundice

D. Late-onset jaundice

C@@ Jaundice appearing within 24 hours is abnormal and may indicate hemolytic disease or infection.

Which intervention is most important during phototherapy?

A. Keep the baby swaddled

B. Apply lotion to dry skin

C. Cover the eyes with patches

D. Limit fluid intake

C@@ Eye protection prevents retinal damage from phototherapy lights.

Which finding is expected in a healthy newborn?

A. Yellow sclera at 12 hours

B. Lanugo on shoulders

C. Temperature of 96°F

D. Grunting respirations

B@@ Fine hair (lanugo) on shoulders and back is a normal newborn finding.

A parent states, "My baby sleeps best on their stomach." What is the best response?

A. "That's fine if you use a firm mattress."

B. "Always place your baby on their back to sleep."

C. "Side-lying is safer for reflux."

D. "Try using a weighted sleep sack."

B@@ Back-sleeping reduces the risk of sudden infant death syndrome (SIDS).

A newborn has not voided in 24 hours. What should the nurse do first?

A. Increase feedings

B. Notify the provider

C. Measure rectal temperature

D. Assess for bladder distention

D@@ Assessing for bladder distention determines if urine is being retained before notifying the provider.

A mother asks why her baby needs a vitamin K shot. What is the best explanation?

A. "It prevents infection."

B. "It helps your baby digest milk."

C. "It helps your baby's blood clot properly."

D. "It prevents jaundice."

C@@ Newborns lack intestinal bacteria to produce vitamin K, needed for coagulation.

Which sign indicates respiratory distress?

A. Irregular breathing during sleep

B. Periodic breathing

C. Nasal flaring and grunting

D. Abdominal breathing

C@@ Nasal flaring and grunting are abnormal and indicate respiratory distress.

The nurse notes a bluish area on a newborn's buttocks. What should be documented?

A. Bruising

B. Mongolian spot

C. Birth injury

D. Petechiae

B@@ Mongolian spots are benign hyperpigmented areas common in darker-skinned infants.

A mother asks when her baby's umbilical cord will fall off. What should the nurse say?

A. "Usually within a few days."

B. "It should fall off in about 10-14 days."

C. "It will fall off by 1 month."

D. "It should be removed by the provider."

B@@ The cord stump typically dries, hardens, and falls off within 1-2 weeks.

Which action demonstrates correct circumcision care teaching?

A. Pull back the gauze daily

B. Apply petroleum jelly at each diaper change

C. Use baby wipes after each void

D. Remove the yellow crust when it forms

B@@ Petroleum prevents the diaper from sticking and promotes healing.

Which reflex disappears first after birth?

A. Moro reflex

B. Rooting reflex

C. Babinski reflex

D. Palmar grasp reflex

B@@ The rooting reflex disappears first, around 4-6 months of age.

A nurse suspects neonatal abstinence syndrome. Which finding supports this?

A. Hypotonia and sleepiness

B. Tremors and high-pitched cry

C. Hypothermia and pallor

D. Hypoglycemia and weak cry

B@@ Tremors, irritability, and shrill cry are classic signs of withdrawal.

Which newborn is at greatest risk for respiratory distress syndrome (RDS)?

A. 39-week infant of diabetic mother

B. 37-week infant of a healthy mother

C. 30-week premature infant

D. 41-week post-term infant

C@@ Surfactant deficiency in premature infants leads to alveolar collapse and hypoxia.

Which finding suggests necrotizing enterocolitis (NEC)?

A. Projectile vomiting

B. Abdominal distention and bloody stool

C. Hypothermia and apnea

D. Green vomitus after feeding

B@@ Abdominal distention and blood in stool are classic signs of NEC.

A preterm infant on a radiant warmer becomes tachycardic. What should the nurse check first?

A. IV line patency

B. Temperature probe placement

C. Oxygen flow rate

D. Blood glucose level

B@@ Improper probe placement may cause inaccurate readings or overheating.

Which nursing action supports development in preterm infants?

A. Continuous bright lighting

B. Cluster care and reduce noise

C. Schedule feedings every 2 hours exactly

D. Frequent handling for stimulation

B@@ Clustered care conserves energy, supports growth, and reduces stress.

A mother asks about feeding frequency. What should the nurse teach?

A. "Feed every 6 hours."

B. "Feed every 2-3 hours."

C. "Feed once the baby cries."

D. "Feed 4 times daily."

B@@ Newborns should breastfeed every 2-3 hours to maintain glucose and hydration.

Which statement indicates understanding of formula preparation?

A. "I'll microwave the bottle for 10 seconds."

B. "I'll refrigerate unused formula for 24 hours."

C. "I'll save leftover formula for the next feeding."

D. "I'll add extra water to stretch the formula."

B@@ Prepared formula should be refrigerated up to 24 hours and never microwaved or diluted.

Which sign requires immediate follow-up?

A. Irregular respirations 30-60/min

B. Axillary temperature 97.8°F

C. Grunting respirations and retractions

D. Acrocyanosis of hands and feet

C@@ Grunting and retractions indicate respiratory distress and potential hypoxia.

Which finding in a term newborn is abnormal?

A. Soft, flat fontanel

B. Jitteriness and tremors

C. Lanugo on shoulders

D. Vernix in skin folds

B@@ Jitteriness may signal hypoglycemia or withdrawal and should be evaluated.