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RNC-LRN practice questions

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Question 1Assessment and Physiologic Adaptation of the Newborn

Which set of findings is used to calculate a newborn's Apgar score?

  1. Heart rate, blood pressure, temperature, tone, and cry
  2. Respiratory rate, oxygen saturation, tone, color, and urine output
  3. Gestational age, weight, length, head circumference, and tone
  4. Heart rate, respiratory effort, muscle tone, reflex response, and color Correct answer.

Explanation

The Apgar score is the sum of five components-heart rate, respiratory effort, muscle tone, reflex irritability, and color-each scored 0 to 2 and totaled at 1 and 5 minutes. It is a rapid assessment of how well the newborn is adapting to extrauterine life, not a measure of gestational maturity.

Question 2Assessment and Physiologic Adaptation of the Newborn

At which times is the Apgar score routinely assigned after birth?

  1. At 1 minute and 5 minutes Correct answer.
  2. At 30 seconds and 3 minutes
  3. At 1 minute and 10 minutes
  4. At 5 minutes and 15 minutes

Explanation

The Apgar score is assigned at 1 minute to summarize the immediate response to birth and resuscitation, and again at 5 minutes to reflect the infant's ongoing adaptation. Scores may be repeated every 5 minutes up to 20 minutes if the 5-minute score remains low.

Question 3Assessment and Physiologic Adaptation of the Newborn

Brown adipose tissue, the main site of nonshivering thermogenesis in the newborn, is found primarily where?

  1. Between the scapulae, at the nape, and in the axillae Correct answer.
  2. The buttocks and lower extremities of the newborn
  3. The palms and the soles of the feet only
  4. The superficial fat of the anterior abdominal wall

Explanation

Brown fat is concentrated in the interscapular region, posterior neck, axillae, and around the great vessels and kidneys. Its rich blood supply and mitochondria allow rapid heat production through oxidation of fat when the newborn is cold.

Question 4Assessment and Physiologic Adaptation of the Newborn

Surfactant is produced by which cells, and what is its primary action?

  1. Clara cells; it stimulates the respiratory drive
  2. Type I pneumocytes; it traps inhaled particles
  3. Alveolar macrophages; it clears retained amniotic fluid
  4. Type II pneumocytes; it lowers alveolar surface tension Correct answer.

Explanation

Type II pneumocytes secrete surfactant, a phospholipid mixture that reduces surface tension at the air-liquid interface of the alveoli. This prevents alveolar collapse at end-expiration and reduces the work of breathing.

Question 5Assessment and Physiologic Adaptation of the Newborn

In a healthy term newborn, the anterior fontanel normally closes at what age?

  1. At birth in most term infants
  2. Between 9 and 18 months of age Correct answer.
  3. Between 3 and 6 years of age
  4. Between 1 and 3 months of age

Explanation

The anterior fontanel is diamond shaped and typically closes between about 9 and 18 months as the frontal and parietal bones fuse. The posterior fontanel is much smaller and usually closes within the first 2 to 3 months.

Question 6Assessment and Physiologic Adaptation of the Newborn

A 2-day-old infant has several tiny white papules on the nose and chin that do not rupture when pressed. These lesions are most likely which of the following?

  1. Seborrheic dermatitis
  2. Milia Correct answer.
  3. Erythema toxicum neonatorum
  4. Neonatal herpes simplex vesicles

Explanation

Milia are benign retention cysts of keratin that appear as 1- to 2-mm white papules on the nose and chin. They resolve spontaneously over weeks and require no treatment or squeezing.

Question 7Assessment and Physiologic Adaptation of the Newborn

The normal umbilical cord of a term newborn contains which vessels?

  1. Two arteries and two veins
  2. Two arteries and one vein Correct answer.
  3. One artery and one vein
  4. Three arteries and one vein

Explanation

The normal cord has two umbilical arteries that carry deoxygenated blood from the fetus to the placenta and one umbilical vein that returns oxygenated blood to the fetus. Finding a single artery is associated with renal and cardiac anomalies and warrants further evaluation.

Question 8Assessment and Physiologic Adaptation of the Newborn

By what time should a healthy term newborn have voided urine for the first time, if further evaluation is to be avoided?

  1. Within 12 hours of birth
  2. Within 24 hours of birth Correct answer.
  3. Within 18 hours of birth
  4. Within 8 hours of birth

Explanation

Most term newborns void within the first 24 hours after birth, often much sooner. Absence of voiding by 24 hours warrants evaluation for inadequate intake, bladder outlet obstruction, or renal anomalies.

Question 9Assessment and Physiologic Adaptation of the Newborn

A newborn is placed directly on a cold, unpadded metal scale immediately after delivery. Which mechanism of heat loss is primarily involved?

  1. Convection
  2. Radiation
  3. Conduction Correct answer.
  4. Evaporation

Explanation

Conduction is heat loss through direct contact with a cooler solid surface, such as a cold scale or unheated mattress. Placing a warmed blanket between the infant and the surface reduces this loss.

Question 10Assessment and Physiologic Adaptation of the Newborn

Functional closure of the foramen ovale after birth is triggered primarily by which change?

  1. A fall in right atrial pressure relative to left atrial pressure Correct answer.
  2. Clamping of the umbilical cord with a rise in systemic vascular resistance
  3. A rise in pulmonary vascular resistance
  4. An increase in circulating prostaglandin E2

Explanation

With the first breaths, pulmonary blood flow increases and pulmonary vascular resistance falls, so less blood returns to the right atrium while pulmonary venous return raises left atrial pressure. The resulting left-to-right pressure gradient presses the septal flap closed.

Question 11Assessment and Physiologic Adaptation of the Newborn

Which change after birth promotes closure of the ductus arteriosus?

  1. An increase in pulmonary vascular resistance
  2. A rise in arterial oxygen tension Correct answer.
  3. A fall in arterial oxygen tension
  4. A rise in circulating prostaglandin E2

Explanation

After birth, increased pulmonary blood flow and oxygenation raise arterial oxygen tension, which constricts the ductal smooth muscle. Simultaneously, removal of the placenta lowers prostaglandin E2, reinforcing constriction.

Question 12Assessment and Physiologic Adaptation of the Newborn

Fetal hemoglobin enhances oxygen uptake in the newborn because it does which of the following?

  1. Releases oxygen more readily at high oxygen tensions
  2. Has a higher oxygen affinity, shifting the curve left Correct answer.
  3. Has a lower affinity for oxygen than adult hemoglobin
  4. Circulates in plasma rather than inside red blood cells

Explanation

Fetal hemoglobin binds 2,3-DPG less avidly than adult hemoglobin, so its oxygen dissociation curve is shifted to the left. This higher affinity lets the fetus and newborn capture oxygen effectively at the low partial pressures found in utero.

Question 13Assessment and Physiologic Adaptation of the Newborn

Which term newborn should receive routine blood glucose screening under common protocols?

  1. An infant of a diabetic mother who is large for gestational age Correct answer.
  2. A newborn weighing 3.5 kg with no risk factors
  3. A vigorous breastfed infant who is appropriate for gestational age
  4. An infant whose mother received epidural analgesia

Explanation

Infants of diabetic mothers, late-preterm infants, small-for-gestational-age infants, large-for-gestational-age infants, and those with perinatal stress are at risk for hypoglycemia and require glucose screening. The infant of a diabetic mother is at risk because of fetal hyperinsulinism.

Question 14Assessment and Physiologic Adaptation of the Newborn

Which finding distinguishes a cephalohematoma from caput succedaneum?

  1. It is present at birth and crosses the suture lines
  2. It consists of pitting edema of the scalp
  3. It resolves within 12 hours of birth
  4. It is bounded by suture lines and may appear after birth Correct answer.

Explanation

A cephalohematoma is a subperiosteal hemorrhage limited by the cranial sutures, so it does not cross suture lines and often becomes apparent hours after birth as it enlarges. Caput succedaneum is serosanguineous edema of the scalp present at birth that crosses suture lines and resolves within days.

Question 15Assessment and Physiologic Adaptation of the Newborn

A term newborn's birth weight plots below the 10th percentile for gestational age. How is this infant classified?

  1. Large for gestational age
  2. Macrosomic
  3. Appropriate for gestational age
  4. Small for gestational age Correct answer.

Explanation

Small for gestational age describes a birth weight below the 10th percentile for completed gestational age and sex. These infants are at higher risk for hypoglycemia, hypothermia, and polycythemia.

Question 16Assessment and Physiologic Adaptation of the Newborn

Which heart rate range is considered normal for a term newborn who is awake and at rest?

  1. 110 to 160 beats per minute Correct answer.
  2. 80 to 120 beats per minute
  3. 100 to 140 beats per minute
  4. 60 to 100 beats per minute

Explanation

A term newborn's resting heart rate is typically 110 to 160 beats per minute, with brief fluctuations during crying and activity. Rates persistently below 100 while awake or above 160 at rest warrant further assessment.

Question 17Assessment and Physiologic Adaptation of the Newborn

Which pattern is most consistent with physiologic jaundice in a term breastfed newborn?

  1. Jaundice that first appears on day 10 of life
  2. Jaundice present within the first 12 hours of life
  3. Jaundice appearing on day 3 and peaking at days 3 to 5 Correct answer.
  4. Jaundice accompanied by a direct bilirubin of 4 mg/dL

Explanation

Physiologic jaundice appears after the first 24 hours, typically peaks around days 3 to 5 in term infants, and then declines as hepatic conjugation and feeding mature. Jaundice present in the first 24 hours, a direct fraction above 1 mg/dL, or onset after 2 weeks is considered pathologic until proven otherwise.

Question 18Assessment and Physiologic Adaptation of the Newborn

A 12-hour-old infant shows an asymmetric Moro reflex, with abduction and extension of the left arm but the right arm remaining flexed. This finding most suggests which of the following?

  1. Hypocalcemia requiring immediate intravenous calcium therapy
  2. A normal finding in a drowsy newborn infant
  3. A brachial plexus injury or clavicle fracture on the right Correct answer.
  4. Neonatal abstinence syndrome

Explanation

An asymmetric Moro reflex indicates a structural problem on the side that fails to respond, most often a brachial plexus injury or clavicle fracture from birth trauma. Symmetry is the expected finding in a healthy newborn.

Question 19Assessment and Physiologic Adaptation of the Newborn

Why is intramuscular vitamin K given to every newborn shortly after birth?

  1. To promote closure of the ductus arteriosus
  2. To prevent hemolytic disease of the newborn
  3. To prevent vitamin K deficiency bleeding Correct answer.
  4. To accelerate bilirubin conjugation

Explanation

Newborns have low vitamin K stores and a sterile gut that does not yet synthesize vitamin K, placing them at risk for vitamin K deficiency bleeding in the first weeks of life. A single intramuscular dose given after birth prevents this hemorrhagic disorder.

Question 20Assessment and Physiologic Adaptation of the Newborn

A term breastfed newborn loses weight in the first days of life. Loss of what percentage of birth weight is generally considered within normal limits?

  1. Up to 7% to 10% of birth weight Correct answer.
  2. Up to 3% to 4% of birth weight
  3. Up to 15% to 20% of birth weight
  4. Up to 1% to 2% of birth weight

Explanation

Term newborns commonly lose up to 7% to 10% of birth weight in the first 3 to 5 days, reflecting loss of extracellular fluid and limited intake, and regain birth weight by about 10 to 14 days. Losses beyond about 10% warrant feeding assessment and closer follow-up.

Question 21Assessment and Physiologic Adaptation of the Newborn

A 28-week preterm infant has a mean arterial blood pressure of 26 mmHg. How is this value best interpreted?

  1. It cannot be interpreted without a central venous pressure
  2. It is well above the expected value for this gestational age
  3. It approximates the gestational age in weeks and is acceptable Correct answer.
  4. It indicates hypotension requiring immediate volume expansion

Explanation

A commonly used rule of thumb is that the mean arterial pressure of a preterm infant should be at least equal to the gestational age in weeks. A value of 26 mmHg in a 28-week infant falls just below this benchmark and is assessed together with perfusion, urine output, and clinical status rather than treated on the number alone.

Question 22Assessment and Physiologic Adaptation of the Newborn

For a healthy term newborn, when should the routine newborn screening heel-stick specimen be collected?

  1. At 2 weeks of age at the first well-child visit
  2. Only if the infant develops clinical signs of disease
  3. After 24 hours of age and before hospital discharge Correct answer.
  4. Immediately after birth, before the first feeding

Explanation

Screening is best performed after 24 hours of life, once feeding has begun, to reduce false results from transient metabolic and endocrine changes of the immediate newborn period, and before discharge so results can be tracked. Early discharge specimens may need to be repeated.

Question 23Assessment and Physiologic Adaptation of the Newborn

Umbilical cord blood gases are obtained after a concerning delivery. Which vessel best reflects fetal acid-base status?

  1. Either vessel, because the values are equivalent
  2. The maternal radial artery
  3. The umbilical vein, because it carries oxygenated blood
  4. The umbilical artery, which reflects fetal status Correct answer.

Explanation

The umbilical artery carries blood from the fetus back to the placenta, so its values reflect the fetus's own acid-base status. Umbilical venous values reflect placental function and are generally higher in pH and oxygen.

Question 24Assessment and Physiologic Adaptation of the Newborn

A newborn's axillary temperature is 35.4 °C (95.7 °F). How is this finding classified?

  1. Normal newborn temperature
  2. Moderate hypothermia Correct answer.
  3. Hyperthermia
  4. Cold stress

Explanation

Axillary temperatures of 36.0 to 36.4 °C represent cold stress, 32.0 to 35.9 °C represent moderate hypothermia, and values below 32.0 °C represent severe hypothermia. A reading of 35.4 °C therefore falls in the moderate hypothermia range and requires rewarming and evaluation for causes.

Question 25Assessment and Physiologic Adaptation of the Newborn

Which statement about neonatal pain assessment tools such as the PIPP and NIPS is accurate?

  1. They use a single indicator, usually heart rate
  2. They combine facial expression, cry, and heart rate changes Correct answer.
  3. They are validated only for infants under 30 weeks
  4. They rely on the infant's self-report of pain

Explanation

Validated neonatal pain scales combine behavioral indicators such as brow action, eye squeeze, and cry with physiologic indicators such as heart rate, oxygen saturation, and breathing pattern. Because infants cannot self-report, multidimensional scoring is needed to guide comfort measures.

Question 26Assessment and Physiologic Adaptation of the Newborn

The Apgar score is calculated from which five signs?

  1. Heart rate, temperature, muscle tone, reflex irritability, and color
  2. Heart rate, respiratory effort, blood pressure, reflex irritability, and color
  3. Heart rate, respiratory effort, muscle tone, reflex irritability, and color Correct answer.
  4. Respiratory effort, muscle tone, blood pressure, oxygen saturation, and color

Explanation

The Apgar score rates heart rate, respiratory effort, muscle tone, reflex irritability, and color, each from 0 to 2, for a maximum of 10. Blood pressure, temperature, and oxygen saturation are not components of the score, although they are part of a full newborn assessment.

Question 27Assessment and Physiologic Adaptation of the Newborn

A newborn is limp and apneic immediately after delivery. Which statement about the Apgar score in this situation is accurate?

  1. The score should be deferred until the infant is stable enough to score above 7.
  2. A score of 0 to 3 at 1 minute reliably predicts long-term neurologic outcome.
  3. Resuscitation begins at once; the score is a standardized description of status rather than a trigger for intervention. Correct answer.
  4. The score must be calculated before any resuscitative steps are taken.

Explanation

Resuscitation is initiated immediately based on the infant's respirations, heart rate, and tone; Apgar scoring is assigned at fixed intervals and never delays intervention. The score summarizes condition and response to resuscitation, and a low 1-minute score alone does not predict later neurologic outcome.

Question 28Assessment and Physiologic Adaptation of the Newborn

The New Ballard Score estimates gestational age from which combination of assessments?

  1. Maternal menstrual history and first-trimester ultrasound
  2. Neuromuscular and physical maturity signs examined after birth Correct answer.
  3. Head circumference and chest circumference ratios
  4. Birth weight and length plotted on a growth curve

Explanation

The New Ballard Score combines neuromuscular criteria (such as posture, square window, and scarf sign) with physical criteria (such as skin, lanugo, and plantar creases) to estimate gestational age when dates are uncertain. Growth measurements alone describe size, not maturity.

Question 29Assessment and Physiologic Adaptation of the Newborn

During a predischarge examination, the red reflex cannot be elicited in either eye of a term newborn and a white pupillary reflex is seen. How should this be interpreted?

  1. An expected finding in a newborn who is drowsy and has not yet fed
  2. A benign finding that can be rechecked at the 2-month well visit
  3. An abnormal finding requiring prompt ophthalmologic evaluation Correct answer.
  4. A normal variant caused by residual vernix over the cornea

Explanation

A red reflex should be present bilaterally in every newborn; absence or a white reflex (leukocoria) may indicate congenital cataract, retinoblastoma, or other serious ocular disease and warrants urgent specialist evaluation. Drowsiness does not abolish a normal red reflex.

Question 30Assessment and Physiologic Adaptation of the Newborn

The Ortolani and Barlow maneuvers are performed on a newborn to assess for which condition?

  1. Congenital muscular torticollis
  2. Developmental dysplasia of the hip Correct answer.
  3. Coarctation of the aorta
  4. Spinal dysraphism at the lumbosacral junction

Explanation

The Ortolani maneuver relocates a dislocated femoral head and the Barlow maneuver attempts to dislocate a subluxable hip, together screening for developmental dysplasia of the hip. Coarctation is assessed by femoral pulses and blood pressure, not hip maneuvers.

Question 31Assessment and Physiologic Adaptation of the Newborn

A 6-hour-old term newborn has repeated 4-second pauses in breathing, each followed by regular respirations; he remains pink with a normal heart rate. How should this be interpreted?

  1. Periodic breathing, a common and benign newborn pattern Correct answer.
  2. Septic apnea that requires immediate antibiotics
  3. Apnea of prematurity that requires caffeine therapy
  4. Respiratory distress syndrome that requires surfactant

Explanation

Brief respiratory pauses of less than about 20 seconds without bradycardia or desaturation are termed periodic breathing and are common in healthy term newborns. Apnea is pathologic when pauses exceed 20 seconds or are accompanied by bradycardia, cyanosis, or desaturation.

Question 32Assessment and Physiologic Adaptation of the Newborn

Which respiratory rate range is normal for a term newborn who is quietly awake?

  1. 10 to 30 breaths per minute
  2. 30 to 60 breaths per minute Correct answer.
  3. 60 to 90 breaths per minute
  4. 90 to 120 breaths per minute

Explanation

Term newborns normally breathe about 30 to 60 times per minute, and rates are counted for a full minute because the pattern is irregular. Rates persistently above 60 after the first hour of life suggest respiratory distress or tachypnea and require evaluation.

Question 33Assessment and Physiologic Adaptation of the Newborn

Which combination of factors most directly initiates the newborn's first breath at delivery?

  1. Rising fetal oxygen tension before the cord is clamped
  2. Closure of the ductus venosus and foramen ovale
  3. Expansion of the chest wall with surfactant release
  4. Hypoxia, hypercapnia, and sensory stimulation at delivery Correct answer.

Explanation

The first breath is triggered by the mild asphyxia of delivery (falling oxygen, rising carbon dioxide and hydrogen ion), together with cold, touch, and chest recoil after passage through the birth canal. Surfactant lowers surface tension so that subsequent breaths require less pressure.

Question 34Assessment and Physiologic Adaptation of the Newborn

Nonshivering thermogenesis in the newborn depends primarily on which tissue?

  1. Skeletal muscle shivering under voluntary control
  2. Subcutaneous white adipose tissue of the abdomen
  3. Brown fat over the scapulae and mediastinum Correct answer.
  4. Hepatic glycogen stores mobilized by glucagon

Explanation

Brown adipose tissue, located around the scapulae, mediastinum, and kidneys, is rich in mitochondria and is oxidized locally to produce heat without shivering. Term newborns have limited ability to shiver, making this mechanism especially important.

Question 35Assessment and Physiologic Adaptation of the Newborn

Which statement best defines the neutral thermal environment for a newborn?

  1. Skin temperature is kept below 36 degrees C to limit insensible water loss
  2. The infant is warmed until the skin becomes vasodilated and flushed
  3. Oxygen consumption and energy expenditure are minimal while core temperature remains normal Correct answer.
  4. Core temperature is maintained by permitting mild cooling to conserve oxygen

Explanation

The neutral thermal environment is the range of environmental temperature at which the infant maintains a normal core temperature with the lowest possible oxygen consumption and metabolic rate. It conserves energy for growth and reduces the risk of cold stress.

Question 36Assessment and Physiologic Adaptation of the Newborn

By what time after birth does a healthy term newborn typically pass the first meconium stool?

  1. At about 12 hours, immediately after the first feeding
  2. Between 3 and 5 days of life
  3. Within the first 24 to 48 hours Correct answer.
  4. Within the first 2 hours only

Explanation

Most term newborns pass meconium within the first 24 to 48 hours after birth, and failure to do so warrants evaluation for obstruction, Hirschsprung disease, or other pathology. The stool then transitions through greenish transitional stools to yellow seedy milk stools over several days.

Question 37Assessment and Physiologic Adaptation of the Newborn

A term newborn is being screened for critical congenital heart disease with pulse oximetry before discharge. Which set of readings should prompt further evaluation?

  1. 100% in the right hand and 97% in the right foot
  2. 95% in the right hand and 96% in the left foot
  3. 92% in the right hand and 89% in the left foot Correct answer.
  4. 98% in the right hand and 98% in either foot

Explanation

Screening fails if any measurement is below 90%, if both readings fall between 90% and 94%, or if the difference between the right hand and foot exceeds 3%. A foot saturation of 89% meets immediate-fail criteria and requires prompt echocardiographic evaluation.

Question 38Assessment and Physiologic Adaptation of the Newborn

A term infant's hemoglobin is 15 g/dL at birth and 10.5 g/dL at 10 weeks of age while growing well and feeding normally. Which explanation best accounts for this change?

  1. Marrow suppression by maternal antibodies crossing the placenta
  2. Iron deficiency from inadequate dietary iron intake
  3. Physiologic anemia from reduced erythropoietin after birth Correct answer.
  4. Hemolytic disease of the newborn from ABO incompatibility

Explanation

After birth, higher arterial oxygen content and a shift toward adult hemoglobin suppress erythropoietin, so red cell production falls and hemoglobin declines. In term infants the nadir is roughly 9 to 11 g/dL at 6 to 12 weeks, then production resumes; this is physiologic, not pathologic.

Question 39Assessment and Physiologic Adaptation of the Newborn

A term infant delivered by elective cesarean section without labor develops a respiratory rate of 90 breaths per minute with nasal flaring and mild retractions soon after birth; the findings resolve within 24 hours with supportive care. Which condition does this most likely represent?

  1. Meconium aspiration syndrome
  2. Respiratory distress syndrome
  3. Persistent pulmonary hypertension of the newborn
  4. Transient tachypnea of the newborn Correct answer.

Explanation

Transient tachypnea of the newborn results from delayed clearance of fetal lung fluid and is more common after cesarean delivery without labor; it produces early tachypnea that resolves over 24 to 72 hours with supportive care. Surfactant deficiency, meconium aspiration, and pulmonary hypertension produce more severe or persistent disease.

Question 40Assessment and Physiologic Adaptation of the Newborn

A term newborn is placed skin-to-skin and the umbilical cord is clamped 2 minutes after birth rather than immediately. Which effect is expected?

  1. Higher blood volume and increased iron stores in early infancy Correct answer.
  2. Lower circulating blood volume and lower hematocrit at 24 hours
  3. Immediate functional closure of the ductus arteriosus
  4. An increased risk of respiratory distress syndrome

Explanation

Delayed cord clamping allows placental transfusion, raising neonatal blood volume by roughly a quarter to a third and improving iron stores through the first months of life. The tradeoff is a modest increase in jaundice risk, which is monitored rather than used to avoid delayed clamping in vigorous term infants.

Question 41Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

An infant born to a mother with poorly controlled gestational diabetes is at greatest risk for which finding in the first few hours after birth?

  1. Metabolic alkalosis
  2. Hypernatremia
  3. Hypoglycemia Correct answer.
  4. Hyperkalemia

Explanation

Maternal hyperglycemia drives fetal hyperinsulinemia, and insulin levels remain elevated after the cord is cut while the glucose supply stops. This mismatch produces hypoglycemia, often within the first 1 to 2 hours of life, so early glucose screening is required.

Question 42Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

A woman at 39 weeks' gestation with a positive group B streptococcus rectovaginal culture is in active labor. Which management is recommended?

  1. Oral amoxicillin given at discharge
  2. Elective cesarean birth before labor
  3. Vaginal chlorhexidine cleansing
  4. Intravenous penicillin during labor Correct answer.

Explanation

Intrapartum intravenous penicillin is given to colonized women in labor to reduce vertical transmission and early-onset GBS disease. Antibiotics given after birth or by non-intravenous routes do not provide the needed intrapartum protection.

Question 43Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

Which maternal intrapartum finding most strongly suggests chorioamnionitis?

  1. Maternal heart rate of 80 beats/min
  2. Maternal fever with uterine tenderness Correct answer.
  3. Clear amniotic fluid at rupture
  4. Fetal heart rate of 130 beats/min

Explanation

Intra-amniotic infection classically presents with maternal fever plus uterine tenderness, foul-smelling fluid, or maternal tachycardia. These signs reflect infection of the membranes and fluid, which places the newborn at risk for sepsis and pneumonia.

Question 44Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

A newborn delivered at 32 weeks' gestation is at increased risk for which condition?

  1. Polycythemia
  2. Respiratory distress syndrome Correct answer.
  3. Persistent pulmonary hypertension
  4. Meconium aspiration syndrome

Explanation

Preterm birth interrupts surfactant production, so the immature lung has high surface tension and tends to collapse. This produces respiratory distress syndrome, which is the hallmark complication of prematurity.

Question 45Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

Maternal cigarette smoking during pregnancy most consistently increases the risk of which neonatal outcome?

  1. Post-term birth
  2. Neonatal hyperbilirubinemia
  3. Macrosomia
  4. Low birth weight Correct answer.

Explanation

Nicotine and carbon monoxide reduce uteroplacental blood flow and fetal oxygen delivery, which restricts growth. Smoking is therefore a leading modifiable cause of low birth weight and intrauterine growth restriction.

Question 46Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

A pregnancy that continues beyond 42 weeks' gestation is most associated with which finding?

  1. Meconium-stained amniotic fluid Correct answer.
  2. Hyperinsulinemia
  3. Polyhydramnios
  4. Reduced need for fetal surveillance

Explanation

Post-term placentas become less efficient and amniotic fluid volume falls, so the fetus may pass meconium in utero. This raises the risk of meconium aspiration syndrome and of umbilical cord compression from oligohydramnios.

Question 47Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

Twins are more likely than singletons to be born at which gestational age?

  1. At exactly 37 weeks
  2. At 39 to 40 weeks
  3. After 42 weeks
  4. Before 37 weeks Correct answer.

Explanation

Multiple gestation increases uterine distention and the risk of preterm labor and preterm rupture of membranes. As a result, a large proportion of twins are born before 37 weeks' gestation.

Question 48Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

A mother with severe preeclampsia delivers a growth-restricted infant. Which placental process best explains the fetal growth restriction?

  1. Fetal hyperinsulinemia
  2. Chronic maternal hyperglycemia
  3. Uteroplacental insufficiency Correct answer.
  4. Placental chorioangioma

Explanation

Preeclampsia is characterized by abnormal placentation and vasoconstriction that reduce blood flow through the uteroplacental circulation. The resulting nutrient and oxygen deficit restricts fetal growth.

Question 49Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

A neonate whose mother received magnesium sulfate for preeclampsia is most likely to show which finding after birth?

  1. Hyperthermia and tachycardia
  2. Hyperreflexia and jitteriness
  3. Hypotonia and respiratory depression Correct answer.
  4. Polycythemia and hypertension

Explanation

Magnesium sulfate crosses the placenta and depresses neuromuscular transmission in the fetus and newborn. The resulting hypotonia and respiratory depression are usually transient but may require monitoring and support.

Question 50Antepartum, Intrapartum, and Maternal-Fetal Factors Affecting the Newborn

Which finding is most characteristic of symmetric (proportional) fetal growth restriction?

  1. Early global growth restriction from a chromosomal anomaly Correct answer.
  2. Brain sparing with a normal head circumference
  3. Asymmetric growth with head sparing
  4. Growth restriction beginning in the third trimester

Explanation

Symmetric growth restriction begins early in gestation and affects all organs, including the brain, so head circumference and length are proportionally reduced. Chromosomal abnormalities and congenital infections are typical causes.