Low Risk Neonatal Nursing Practice Test

RNC-LRN exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Certification: Low Risk Neonatal Nursing (RNC-LRN)
Issuing Organization: National Certification Corporation (NCC)
Eligibility: Requires an active RN license and recent experience in low-risk neonatal nursing
Exam Format: Computer-based, multiple-choice questions
Exam Length: 3 hours (180 minutes)
Number of Questions: 175 (150 scored + 25 pretest/un-scored)
Passing Score: Determined by a criterion-referenced standard (exact percentage not disclosed)

- Maternal risk factors and birth history
- Fetal Anatomy and Physiology
- Fetal Assessment
- GBS screening
- Nonstress testing
- Biophysical profile
- Antepartal screening
- Cord gases
- Maternal age
- Medical Conditions
-Maternal age
-Diabetes
-Blood disorders
-Infectious diseases
- CMV
- Toxoplasmosis
- syphilis
- herpes
- hepatitis HIV
- gonorrhea
- Chlamydia
- GB
-Maternal depression

- Pregnancy Related
-Hypertensive Disorders
- Eclampsia
- HELLP syndrome
- Amniotic fluid disorders (Amniotic bands, Polyhydramnios, Oligohydramnios)
- Maternal hemorrhage
- Placental abruption
- Placenta previa
- Multiple gestations
- Chorioamnionitis
- Cord Accidents

- Maternal medications during labor and delivery (tocolytics, analgesia, anesthesia)
- Complications of Labor
- Abnormal labor patterns
- Abnormal fetal heart rate patterns (altered variability, decelerations [early, late, variable]; tachycardia, bradycardia (category I, II and III fetal heart rate tracings)
- Operative/instrument assisted birth
- Preterm/postterm
- Meconium
- Breech and other malpresentation
- Life-style and Environmental Conditions
- Substance use
- Teratogen exposure
- Medication use

- Physical and gestational age assessment Gestational Age
- Physical Characteristics, Etiologies and/or Risks and Complications of
- Preterm
- Term
- Post-term
- Late preterm
- AGA
- SGA
- LGA
- Intrauterine growth restriction
- Symmetrical
- Asymmetrical

- Physical Assessment
- Cardiac examination findings
- Heart rate, rhythms and sounds
- Point of maximal intensity
- Blood pressure
- Peripheral pulses
- Perfusion
- Color
- Respiratory Physical Assessment
- Respiratory rate and breath sounds
- Respiratory patterns
- Thorax and Chest
- Abdominal examination findings
- Stooling patterns
- Neonatal skin assessment
- Characteristics of normal neonatal skin
- Musculoskeletal assessment
- Neurological assessment

- Reflexes
- Moro
- Rooting and sucking
- Palmar grasp
- Plantar grasp
- Stepping
- Babinski
- Tonic neck
- Gag
- Anal wink reflex
- Tone
- Techniques
- Pull to sit
- Truncal tone assessment

- Head, ear, eyes, nose, mouth assessment
- Fontanelles and cranial sutures
- Neck appearance
- Ear appearance, shape and placement
- Hearing
- Nasal patency
- Symmetry of the mouth
- Evaluation of pigmentation and movement
- Evaluation of cornea/sclera
- Eye prophylaxis
- Complications/Variations
- Skull/neck variations & abnormalities
- Molding
- Cephalhematoma
- Caput succedaneum
- Craniosynostosis
- Craniotabes
- Cystic hygroma
- Pierre Robin
- Variations & abnormalities
- Conjunctivitis
- Cleft lip and palate
- Epstein’s pearls
- Natal teeth
- Choanal atresia
- Retinopathy of prematurity
- Tracheomalacia
- Micronathia

- Laboratory and Diagnostic Data
- Blood
- Glucose
- Complete blood count with differential
- Cultures
- Rh (Coombs)
- Blood gases
- Bilirubin
- Electrolytes
- Newborn screening

- Cardiovascular
- Basic physiology and anatomy
- Adaptation to extrauterine life
- Complications/Variations
- Pulmonary vascular resistance
- Abnormal rhythms
- Congenital heart disease
- Patent ductus arteriosus
- Coarctation of the aorta
- Septal defects
- Tetralogy of Fallot
- Transposition of the great vessels
- Congestive heart failure
- Hypertension/Hypotension
- Shock

- Respiratory
- Basic physiology and anatomy
- Adaptation to extrauterine life
- Complications/Variations
- Air leaks
- Apnea of prematurity
- Chronic lung disease
- Pneumothorax
- Pneumomediastinum
- Pneumonia
- Respiratory distress syndrome
- Transient tachypnea of the newborn
- Persistent pulmonary hypertension
- Meconium aspiration syndrome
- Diaphragmatic hernia

- Gastrointestinal and Genitourinary
- Basic physiology and anatomy
- Complications/Variations
- Diastasis of recti muscles
- Duodenal atresia
- Bowel obstruction
- Esophageal atresia/tracheoesophageal fistula
- Imperforate anus
- Omphalocele/gastroschisis
- Umbilical hernia
- Meconium ileus/plug
- GE reflux
- Necrotizing enterocolitis
- Short gut syndrome
- Malrotation/Volvulus
- Renal function/urinary output
- Complications
- Hypospadias
- Undescended testes
- Testicular abnormalities
- Hydrocele
- Inguinal hernia
- Vaginal discharge/abnormalities
- Renal abnormalities
- Circumcision
- Postoperative care

- Musculoskeletal and Integumentary
- Musculoskeletal Complications
- Congenital hip dysplasia
- Metatarsus adductus
- Polydactyly and syndactyly
- Torticollis
- Talipes equinovarus
- Fracture
- Physiologic basis for general skin care
- Variations
- Erythema toxicum
- Milia
- hyperpigmented skin lesions
- Hemangiomas/birth marks
- Petechiae
- Cafe au lait spots
- Other skin lesions, e.g. pustules, vesicles
- Umbilical cord
- Fat necrosis
- Diaper Dermatitis

- Neurological
- Basic physiology
- Motor function
- Complications/Variations
- Seizures
- Jitteriness
- Intracranial hemorrhage (subdural)
- Intraventricular hemorrhages
- Periventricular leukomalacia
- Hydrocephalus
- Neuromuscular birth Injuries
- Brachial plexus injuries
- Facial nerve injuries
- Neural tube defects
- Therapeutic hypothermia

- Hematology and hyperbilirubinemia
- Basic physiology
- Interpret lab values (CBC; hematocrit, hemoglobin, retic, platelets, total and direct serum bilirubin, direct and indirect antibody tests)
- Complications
- Anemia (Physiologic and non-physiologic)
- Bleeding disorders
- ABO/Rh incompatibility
- Polycythemia/hyperviscosity
- Sickle Cell
- Administration of blood and blood products
- Hyperbilirubinemia
- Basic physiology
- Complications
- Jaundice
- Physiologic jaundice
- Pathologic jaundice
- Breast feeding and jaundice
- Kernicterus
- Phototherapy
- G6PD

- Genetic, Metabolic and Endocrine Genetic Disorders
- Patterns of Inheritance
- Autosomal recessive, autosomal dominant, sex linked
- Complications
- Common chromosomal abnormalities (trisomy 21, 18 & 13)
- Birth defects/congenital anomalies
- Skeletal dysplasia
- Cystic Fibrosis
- DiGeorge (22q11.2 deletion syndrome)
- Turners
- Endocrine/Metabolic
- Interpreting lab values (Calcium, phosphorus, magnesium, glucose)
- Metabolic Disorders (PKU, Thyroid, CAH, Galactosemia)
- Complications
- Hypoglycemia
- Hypocalcemia
- Rickets/metabolic bone disease
- Infant of a diabetic mother

- Resuscitation and Stabilization
- General assessment of status and need for resuscitation
- Management of resuscitation
- Airway
- Breathing
- Circulation
- Drug Therapy
- Evaluation of effectiveness of interventions
- Apgar scores
- CHD Screening

- Nutrition and Feeding
- Growth patterns (Growth curves)
- Fluid/Calorie requirements
- CHO, Fats, Proteins
- Lactation
- Anatomy and physiology of lactation
- Composition of breast milk
- Maternal nutritional needs
- Normal breastfeeding process
- Positioning
- Latch On
- Suck/swallow/sequence
- Timing (frequency and duration)
- Feeding cues
- Contraindications to breastfeeding
- Maternal Complications
- Latch on problems
- Nipple problems
- Breast engorgement
- Insufficient milk supply
- Medication effects
- Therapeutic medications
- Infection/Mastitis
- Maternal illness
- Perinatal substance abuse (TCN)
- Maternal/newborn separation
- Breast reduction/augmentation
- Newborn complications
- Drug screening
- Multiple births
- Prematurity
- Patient Education
- Breast/nipple care
- Use of supplementary/ complementary feedings
- Use of breastfeeding devices
- Expressing and storing breast milk
- Colostrum
- Complications/Contraindications
- Donor milk
- Formula feeding
- Composition of formula
- Techniques
- Special needs (e.g. cleft palate, PKU)
- Dietary Supplements (Iron, MCT, Vitamins, probiotics, Fortifiers)
- Feeding techniques
- Tube feedings
- Feeding cues
- Special Nutritional considerations
- Chronic Lung Disease (CLD)
- Prematurity
- Short Gut syndrome

- Pharmacology, Pharmacokinetics and Pharmacodynamics
- Principles of administration
- Dosage
- Route
- 5 rights of medication administration
- Blood drug levels (toxic vs therapeutic)
- Pharmacokinetics
- Common drugs used in neonates
- Vitamin K
- Antibiotics
- Antibiotics
- Anticonvulsants
- Antimicrobials
- Antiretroviral
- Immunologic agents
- Bronchodilators
- CNS stimulants (Caffeine, etc)
- Diuretics
- Drugs for NAS
- Eye prophylaxis
- Vaccines
- Pain Assessment and Management
- Signs and symptoms
- Nonpharmacological interventions
- Pharmacological interventions

- Fluid, Electrolytes and Glucose Homeostasis
- Normal fluid and electrolyte requirements
- Monitoring fluid and electrolyte status
- electrolytes
- urine output
- Parenteral nutrition (indication, composition, complications)
- Lipids
- Metabolic panel
- PICC lines or midlines
- Umbilical lines
- Hypoglycemia

- Oxygenation, non-invasive ventilation and Acid-base balance
- Oxygenation: interpretation and management
- Hypoxia/hypoxemia
- Oxygen saturation (SaO2)
- Methods of oxygenation/ventilation
- non-invasive ventilation (high flow NC, CPAP, Nasal cannula, hood)
- Blood gas: interpretation and management
- Metabolic acidosis/alkalosis
- Respiratory acidosis/alkalosis
- Mixed

- Neurodevelopmental Care
- Neurobehavioral development
- habituation
- motor organization
- sensory/interaction capabilities
- state/sleep cycles
- Environmental impact on development
- Interventions (Reducing noise, light level, diurnal patterns, handling, positioning, kangaroo care/skin to skin)
- Nonnutritive sucking
- Complications of Substance Exposure in Utero
- Alcohol
- Heroin
- Methadone
- Cocaine
- Nicotine
- Subutex
- Cannabis (marijuana)
- Prescription drug abuse
- Neonatal Abstinence Syndrome (NAS)
- Methadone
- Cocaine
- Nicotine
- Subutex
- Cannabis (marijuana)
- Prescription drug abuse

- Infection and Immunology Immune System
- Basic physiology
- Interpret laboratory values
- WBC and differential
- CRP
- Antibody function
- IgA
- IgG
- IgM
- Infection Control
- Handwashing
- Visitation
- Standards precautions
- Complications/Variations
- Neonatal sepsis
- Septic shock
- Viral and fungal infections
- AIDS/HIV
- Cytomegalovirus
- Rubella
- Hepatitis B
- Varicella
- Toxoplasmosis
- Herpes
- Human papilloma virus
- Enterovirus
- Bacterial infections
- Group B streptococcus
- Staphylococcus
- E. coli
- Sexually Transmitted infections
- Gonorrhea
- Chlamydia
- Syphilis
- Early and late onset infections

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NCC Low Risk Neonatal Nursing - 2025
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Question: 846
The CRP is 8 mg/L. What does the IgM level indicate, and what infection control measure the nurse enforce?
rmal immunity; continue routine care ute infection; apply contact precautions
mited antibody production; enforce handwashing ternal antibody failure; limit visitation
er: C
nation: Undetectable IgM (<5 mg/dL) is normal, reflecting the infant�s inability to produce dies, increasing hepatitis C risk. Strict handwashing prevents pathogen spread, critical given ure immune system and potential exposure.
ion: 847
year-old G3P2 woman at 38 weeks gestation with a triplet pregnancy delivers via cesarean se fetal distress in Triplet C. Birth weights are Triplet A 2,600 g, Triplet B 2,400 g, and Triple
. Triplet C�s hematocrit is 58%, and blood viscosity is elevated. What neonatal complicatio ikely for Triplet C?
ycythemia
piratory distress syndrome poglycemia
auterine growth restriction
A term infant, now 72 hours old, born to a mother with hepatitis C, weighs 3.3 kg and received no prophylaxis at birth. Labs show a WBC of 15,000/mm�, neutrophils 40%, lymphocytes 50%, and IgM <5 mg/dL.
should
1. No
2. Ac
3. Li
4. Ma
Answ Expla
antibo the
immat
Quest
A 33- ction
due to t C
1,900 g n is
most l
1. Pol
2. Res
3. Hy
4. Intr Answer: A
Explanation: In multiple gestations, Triplet C�s low weight (1,900 g) and high hematocrit (58%) suggest polycythemia, possibly from unequal placental sharing. IUGR is present but secondary, while RDS and hypoglycemia are less directly tied to these lab findings.
Question: 848
A term infant, now 48 hours old, born via emergency cesarean, is on nasal cannula at 1 L/min with an
FiO2 of 30%. The infant weighs 3.7 kg, and an ABG shows pH 7.42, PaCO2 36 mmHg, PaO2 68 mmHg, and HCO3 23 mEq/L. The SaO2 is 95%. What should the nurse do?
1. Switch to CPAP at 5 cm H2O with 30% FiO2
2. Increase FiO2 to 35%
3. Maintain current settings
4. Reduce flow to 0.5 L/min Answer: C
ndicate stability on nasal cannula. Maintaining settings is appropriate. Increasing FiO2 or ing to CPAP is unnecessary, and reducing flow risks hypoxemia.
ion: 849
week neonate with a history of prolonged rupture of membranes develops jittery movements lity on day 2. Serum glucose is 55 mg/dL, calcium is 7.5 mg/dL, and CSF analysis shows 8
/mm� (90% neutrophils), glucose 20 mg/dL, and protein 150 mg/dL. What is the most likely ying condition mimicking jitteriness?
pocalcemia bdural hematoma poglycemia ningitis
er: D
nation: Jittery movements and irritability with CSF pleocytosis (80 WBCs/mm�), low glucose
), and high protein (150 mg/dL) indicate meningitis, likely from prolonged rupture of memb serum glucose (55 mg/dL) rules out hypoglycemia, mild hypocalcemia (7.5 mg/dL) is unli his alone, and subdural hematoma would not explain the CSF findings.
ion: 850
year-old G3P2 woman at 35 weeks gestation presents with severe epigastric pain, nausea, an
Explanation: Normal pH (7.42), PaCO2 (36 mmHg), and adequate oxygenation (PaO2 68 mmHg, SaO2 95%) i
switch
Quest
A 35- and
irritabi 0
WBCs
underl
1. Hy
2. Su
3. Hy
4. Me
Answ
Expla (20
mg/dL ranes.
Normal kely to
cause t
Quest
A 34- d a
blood pressure of 165/105 mmHg. Laboratory results show a platelet count of 85,000/mm�, AST 220 U/L, ALT 250 U/L, and LDH 950 U/L. The neonate is delivered emergently via cesarean section with an umbilical artery pH of 7.16, PCO2 60 mmHg, and base deficit -13 mEq/L. What maternal condition most likely contributed to the neonatal acidosis?
1. Placental abruption
2. HELLP syndrome
3. Chorioamnionitis
4. Cord prolapse
Answer: B
Explanation: The maternal symptoms (epigastric pain, hypertension) and labs (thrombocytopenia, elevated liver enzymes, high LDH) indicate HELLP syndrome, a severe preeclampsia variant. This condition causes placental insufficiency, leading to fetal hypoxia and acidosis (pH 7.16, base deficit -13 mEq/L). Placental abruption involves bleeding, chorioamnionitis requires infection signs, and cord prolapse causes variable decelerations, not this pattern.
Question: 851
year-old mother delivered a term infant 6 days ago and is taking fluoxetine 20 mg daily for rtum depression. The infant is exclusively breastfed, gaining 25 g/day, but exhibits irritabilit leep. Fluoxetine levels in breast milk are 50 ng/mL (therapeutic range: 20�100). What is the
edication effect on this infant?
strointestinal irritation from fluoxetine duced milk quality from maternal depression ug withdrawal from inconsistent exposure
otonin excess causing neurobehavioral changes er: D
nation: Irritability and poor sleep with fluoxetine levels of 50 ng/mL suggest serotonin excess ia breast milk, a known side effect of SSRIs. Milk quality, withdrawal, and GI irritation are
tent with the infant�s normal weight gain and exposure pattern.
ion: 852
week gestation male neonate, now 3 days old, is noted to have a reducible mass in the left in uring a bath. The neonate is asymptomatic, feeding well, and has normal bowel movements ost appropriate management for this inguinal hernia?
ergent surgical repair
servation for spontaneous resolution ctive repair within 1-2 months
A 34-
postpa y and
poor s most
likely m
1. Ga
2. Re
3. Dr
4. Ser Answ
Expla in the
infant v less
consis
Quest
A 38- guinal
canal d . What
is the m
1. Em
2. Ob
3. Ele
4. Manual reduction and truss application Answer: C
Explanation: A reducible inguinal hernia in an asymptomatic neonate does not require emergent surgery but should be repaired electively within 1-2 months to prevent incarceration, a risk due to the patent processus vaginalis. Observation alone is insufficient, and trusses are not standard care. Timing balances risk and surgical readiness.
Question: 853
A 34-week preterm neonate presents with short limbs, a large head with frontal bossing, and a narrow thorax on X-ray. The neonate develops respiratory distress, and skeletal survey confirms rhizomelic shortening and metaphyseal flaring. Genetic testing reveals an FGFR3 mutation. What is the most likely diagnosis and its inheritance pattern?
1. Cystic fibrosis with autosomal recessive inheritance
2. Trisomy 21 with nondisjunction
3. Achondroplasia with autosomal dominant inheritance
er: C
nation: The short limbs, large head, narrow thorax, and FGFR3 mutation confirm achondropl osomal dominant skeletal dysplasia, often a new mutation. Trisomy 21 lacks skeletal finding ibrosis affects lungs and pancreas, and DiGeorge involves 22q11.2 deletion, not FGFR3.
ion: 854
nate is delivered at 43 weeks gestation with a birth weight of 3,400 g (25th percentile), lengt 0th percentile), and head circumference of 36 cm (50th percentile). Physical exam shows dry skin, long nails, and meconium staining. The neonate develops seizures at 12 hours. What
ikely classification and complication?
-term with perinatal asphyxia m with hypoglycemia
preterm with respiratory distress term with hypothermia
er: A
nation: At 43 weeks with post-term features (cracked skin, long nails) and AGA measuremen is post-term. Seizures suggest perinatal asphyxia, a risk from placental dysfunction. Other do not align with gestation or symptoms.
ion: 855
DiGeorge syndrome with microdeletion Answ
Expla asia,
an aut s,
cystic f
Quest
A neo h of 52
cm (5
cracked is the
most l
1. Post
2. Ter
3. Late
4. Pre
Answ
Expla ts, the
neonate options
Quest
A term infant, now 72 hours old, presents with lethargy and a glucose of 28 mg/dL (normal: >50). The infant weighs 3.5 kg, and the nurse starts D10W at 80 mL/kg/day via a peripheral IV. A metabolic panel shows sodium 134 mEq/L (normal: 135�145) and calcium 7.8 mg/dL (normal: 8.5�10.5). What should the nurse prioritize?
1. Monitor urine output for fluid balance
2. Increase dextrose to 12.5% in the IV fluid
3. Administer calcium gluconate 100 mg/kg IV
4. Request a sodium bolus to correct hyponatremia
Answer: C
Explanation: Hypocalcemia (7.8 mg/dL) with severe hypoglycemia (28 mg/dL) and lethargy requires urgent calcium correction to prevent complications like seizures. Glucose is addressed, urine monitoring is secondary, and mild hyponatremia (134 mEq/L) doesn�t need a bolus.
Question: 856
term with apnea
preterm with hypocalcemia m with polycythemia
-term with jaundice
er: B
nation: At 36 weeks with AGA measurements (50th percentile) and late preterm features (sof onate is late preterm. Hypocalcemia (7.0 mg/dL) causes jitteriness, a common issue in late p due to immature parathyroid function. Other options mismatch gestation or findings.
ion: 857
infant, now 6 days old, is receiving morphine 0.1 mg/kg/dose IV every 4 hours for postope fter a pyloromyotomy. The infant weighs 3.8 kg, and the NIPS score is 4 (moderate pain) de oses. A blood level is 25 ng/mL (therapeutic: 10�40 ng/mL). What pharmacological interve the nurse consider?
acetaminophen as an adjunct
rease the dose to 0.15 mg/kg for better control itch to fentanyl for faster onset
duce the interval to every 3 hours
er: A
A neonate born at 36 weeks gestation weighs 2,500 g (50th percentile), with a length of 46 cm (50th percentile) and head circumference of 32 cm (50th percentile). Physical exam shows soft ears, minimal lanugo, and a calcium level of 7.0 mg/dL at 24 hours with jitteriness. What is the most likely classification and complication?
1. Pre
2. Late
3. Ter
4. Post
Answ
Expla t ears),
the ne reterm
infants
Quest
A term rative
pain a spite
three d ntion
should
1. Add
2. Inc
3. Sw
4. Re
Answ
Explanation: A NIPS score of 4 with a therapeutic level (25 ng/mL) suggests inadequate pain control. Adding acetaminophen enhances analgesia without escalating opioid risks. Increasing dose or frequency risks toxicity, and switching to fentanyl is unnecessary with morphine�s efficacy.
Question: 858
A 36-week gestation male neonate, now 7 days old, has a urine output of 0.6 mL/kg/hour and a serum sodium of 150 mEq/L. The neonate is on formula feeds and has no edema. Ultrasound shows normal kidneys. What is the most likely cause of this renal function alteration?
1. Diabetes insipidus
2. Dehydration
3. Syndrome of inappropriate ADH
4. Renal tubular acidosis Answer: B
ion: 859
nurse assesses the gag reflex in a 2-day-old neonate with a PaCO2 of 55 mmHg and HCO3 of 2 The reflex is present but weak. What is the most likely cause?
nial nerve damage
rmal variation in reflex strength tabolic alkalosis enhancing the reflex spiratory acidosis weakening the reflex
er: D
nation: PaCO2 55 mmHg and HCO3 28 mEq/L indicate respiratory acidosis with partial nsation, which can cause lethargy and weaken reflexes like the gag. Option B is incorrect as ag is not typical.
ion: 860
erm infant born at 35 weeks gestation, now 5 days old, is receiving sucrose 24% orally for p a venous puncture. The infant�s heart rate is 165 bpm (baseline 140), and the N-PASS scor ain). What nonpharmacological intervention should the nurse add?
rease ambient light for distraction
Explanation: Low urine output with hypernatremia and normal kidneys suggest dehydration, likely from inadequate fluid intake or losses, common in preterms transitioning to feeds. Diabetes insipidus causes dilute urine, SIADH causes hyponatremia, and renal tubular acidosis involves acidosis, none aligning with this presentation.
Quest
A 8
mEq/L.
1. Cra
2. No
3. Me
4. Re
Answ Expla
compe a
weak g
Quest
A pret ain
during e is 3
(mild p
1. Inc
2. Apply a cold pack to the site
3. Swaddle the infant during the procedure
4. Delay the puncture for 30 minutes Answer: C
Explanation: A score of 3 with tachycardia (165 bpm) indicates mild pain despite sucrose. Swaddling enhances comfort and reduces stress, complementing sucrose. Cold packs numb but don�t soothe, light increases distress, and delay doesn�t address immediate pain.
Question: 861
A 38-week gestation male neonate, now 3 days old, undergoes circumcision with a Plastibell device. On day 7, the parents note the ring has not fallen off, and the penis is swollen with a grayish discoloration. What is the most likely postoperative complication requiring intervention?
1. Retained Plastibell ring
2. Necrosis from tight ring
3. Wound infection
er: B
nation: Delayed ring detachment with swelling and grayish discoloration suggest necrosis fro lastibell ring compromising blood flow, requiring urgent removal. Infection involves fever, d ring alone doesn�t cause discoloration, and adhesions form later, none matching this ische
ion: 862
week preterm neonate presents with holoprosencephaly, polydactyly, and a midline facial cle type analysis shows 47,XY,+13, and the neonate develops apnea requiring ventilation. What ppropriate family counseling point regarding recurrence risk?
gh risk due to autosomal recessive inheritance currence risk is low due to sporadic nondisjunction derate risk due to parental translocation
risk as it�s a de novo mutation er: B
nation: The features (holoprosencephaly, polydactyly, midline cleft) and karyotype 47,XY,+1 confirm Trisomy 13, typically a sporadic nondisjunction event with low recurrence risk (<1%) unl al translocation is identified (not suggested here). Recessive inheritance and de novo mutatio
aracterize this condition.
Adhesion formation Answ
Expla m a
tight P
retaine mic
picture.
Quest
A 34- ft.
Karyo is the
most a
1. Hi
2. Re
3. Mo
4. No
Answ
Expla 3
ess a
parent n
misch
Question: 863
During a neurological exam, a nurse strokes the sole of a 3-day-old neonate�s foot from heel to toe in an inverted �J� pattern. The big toe dorsiflexes, and the other toes fan outward bilaterally. The neonate�s serum ionized calcium is 4.0 mg/dL (normal: 4.4-5.2 mg/dL), and magnesium is 1.8 mg/dL. How should the nurse interpret this Babinski reflex finding?
1. Abnormal response indicating upper motor neuron dysfunction
2. Hypocalcemia-induced exaggeration of the reflex
3. Normal finding for a neonate of this age
4. Potential spinal cord injury requiring imaging Answer: C
Explanation: A positive Babinski reflex (dorsiflexion of the big toe with fanning of others) is normal in neonates up to 12-24 months due to immature corticospinal tracts. The slightly low ionized calcium (4.0 mg/dL) may cause neuromuscular irritability, but it does not alter the Babinski reflex�s expected presence in a 3-day-old.
year-old mother delivered a term infant 6 days ago and is supplementing breastfeeding with formula due to perceived low supply. The infant�s weight gain is 25 g/day, and the mother asks ab
sition of formula compared to breast milk. Lab results show infant iron at 55 �g/dL (normal hat should the nurse explain?
mula lacks antibodies found in breast milk mula has higher iron to prevent anemia mula contains more fat than breast milk mula is lower in carbohydrates
er: B
nation: Low iron (55 �g/dL) and normal weight gain (25 g/day) highlight a nutritional gap. F fied with higher iron than breast milk to prevent anemia, a key compositional difference. odies, fat, and carbs vary, but iron is most relevant here.
ion: 865
year-old G1P0 woman at 39 weeks gestation undergoes a cord gas analysis at delivery due to ged second stage labor. The umbilical artery pH is 7.10, PCO2 is 60 mmHg, and base defici The neonate�s Apgar scores are 5 at 1 minute and 7 at 5 minutes. What is the most likely
al complication?
ebral palsy
poxic-ischemic encephalopathy
Question: 864
A 33-
out the
compo : 60�
170). W
1. For
2. For
3. For
4. For Answ
Expla ormula
is forti Antib
Quest
A 28-
prolon t is -15
mEq/L. neonat
1. Cer
2. Hy
3. Respiratory distress syndrome
4. Seizures Answer: B
Explanation: Severe acidosis (pH 7.10, base deficit -15 mEq/L) and low Apgar scores indicate perinatal asphyxia, increasing the risk of hypoxic-ischemic encephalopathy. Cerebral palsy is a long-term outcome, not an immediate complication. Respiratory distress and seizures may occur but are secondary to HIE.
Question: 866
A term infant, now 72 hours old, is being treated for suspected neonatal sepsis with intravenous gentamicin. The ordered dose is 4 mg/kg every 24 hours, and the infant weighs 3.2 kg. The nurse administers 12.8 mg at 0800, but a trough level drawn at 0700 the next day is 2.5 �g/mL (therapeutic: 0.5�2 �g/mL; toxic: >2 �g/mL). What pharmacokinetic principle should guide the nurse�s next action?
1. Hold the next dose and notify the provider
2. Adjust the dose downward due to reduced clearance
3. Increase the dosing interval to 36 hours
er: A
nation: A trough level of 2.5 �g/mL exceeds the therapeutic range, indicating accumulation d ure renal clearance in a 72-hour-old infant. Holding the dose and notifying the provider prev y, aligning with pharmacokinetic monitoring of blood drug levels. Adjusting without consult
intervals arbitrarily, or continuing risks harm.
ion: 867
neonate born to a mother with a history of unexplained stillbirth presents on day 4 with pal ocrit of 30%, hemoglobin of 10 g/dL, reticulocyte count of 12%, and total bilirubin of 16 mg
0.6 mg/dL). DAT is negative. What is the most likely underlying condition?
al-maternal hemorrhage ysiologic anemia editary spherocytosis kle cell disease
er: A
nation: The pallor, anemia (hematocrit 30%, hemoglobin 10 g/dL), high reticulocyte count (1 conjugated hyperbilirubinemia (15.4 mg/dL) with a negative DAT and maternal history of th suggest fetal-maternal hemorrhage causing acute blood loss. Hereditary spherocytosis wo ave a positive DAT or spherocytes, physiologic anemia occurs later, and sickle cell disease
Continue the current regimen and recheck in 24 hours Answ
Expla ue to
immat ents
toxicit ation,
altering
Quest
A term lor,
hemat /dL
(direct
1. Fet
2. Ph
3. Her
4. Sic Answ
Expla 2%),
and un
stillbir uld
likely h would
show HbSS on screening.
Question: 868
A 34-week preterm infant, now 10 days old, has a serum calcium of 6.3 mg/dL, phosphorus of 8.8 mg/dL, and alkaline phosphatase of 480 U/L. The infant is on TPN with minimal enteral feeds. What is a potential consequence if this condition persists?
1. Pathologic fractures
2. Cataracts
3. Adrenal insufficiency
4. Hepatomegaly Answer: A
Explanation: The infant�s hypocalcemia (6.3 mg/dL), hyperphosphatemia (8.8 mg/dL), and elevated alkaline phosphatase (480 U/L) indicate metabolic bone disease of prematurity. If untreated, poor bone mineralization can lead to pathologic fractures, a significant consequence in preterm infants with prolonged TPN use.

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