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 - 2026
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Question: 846
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. The CRP is 8 mg/L. What does the IgM level indicate, and what infection control measure
should the nurse enforce?
A. Normal immunity; continue routine care
B. Acute infection; apply contact precautions
C. Limited antibody production; enforce handwashing
D. Maternal antibody failure; limit visitation
Answer: C
Explanation: Undetectable IgM (<5 mg/dL) is normal, reflecting the infant�s inability to produce
antibodies, increasing hepatitis C risk. Strict handwashing prevents pathogen spread, critical given the
immature immune system and potential exposure.
Question: 847
A 33-year-old G3P2 woman at 38 weeks gestation with a triplet pregnancy delivers via cesarean section
due to fetal distress in Triplet C. Birth weights are Triplet A 2,600 g, Triplet B 2,400 g, and Triplet C
1,900 g. Triplet C�s hematocrit is 58%, and blood viscosity is elevated. What neonatal complication is
most likely for Triplet C?
A. Polycythemia
B. Respiratory distress syndrome
C. Hypoglycemia
D. Intrauterine growth restriction
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?
A. Switch to CPAP at 5 cm H2O with 30% FiO2
B. Increase FiO2 to 35%
C. Maintain current settings
D. Reduce flow to 0.5 L/min
Answer: C
Explanation: Normal pH (7.42), PaCO2 (36 mmHg), and adequate oxygenation (PaO2 68 mmHg, SaO2
95%) indicate stability on nasal cannula. Maintaining settings is appropriate. Increasing FiO2 or
switching to CPAP is unnecessary, and reducing flow risks hypoxemia.
Question: 849
A 35-week neonate with a history of prolonged rupture of membranes develops jittery movements and
irritability on day 2. Serum glucose is 55 mg/dL, calcium is 7.5 mg/dL, and CSF analysis shows 80
WBCs/mm� (90% neutrophils), glucose 20 mg/dL, and protein 150 mg/dL. What is the most likely
underlying condition mimicking jitteriness?
A. Hypocalcemia
B. Subdural hematoma
C. Hypoglycemia
D. Meningitis
Answer: D
Explanation: Jittery movements and irritability with CSF pleocytosis (80 WBCs/mm�), low glucose (20
mg/dL), and high protein (150 mg/dL) indicate meningitis, likely from prolonged rupture of membranes.
Normal serum glucose (55 mg/dL) rules out hypoglycemia, mild hypocalcemia (7.5 mg/dL) is unlikely to
cause this alone, and subdural hematoma would not explain the CSF findings.
Question: 850
A 34-year-old G3P2 woman at 35 weeks gestation presents with severe epigastric pain, nausea, and 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?
A. Placental abruption
B. HELLP syndrome
C. Chorioamnionitis
D. 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
A 34-year-old mother delivered a term infant 6 days ago and is taking fluoxetine 20 mg daily for
postpartum depression. The infant is exclusively breastfed, gaining 25 g/day, but exhibits irritability and
poor sleep. Fluoxetine levels in breast milk are 50 ng/mL (therapeutic range: 20�100). What is the most
likely medication effect on this infant?
A. Gastrointestinal irritation from fluoxetine
B. Reduced milk quality from maternal depression
C. Drug withdrawal from inconsistent exposure
D. Serotonin excess causing neurobehavioral changes
Answer: D
Explanation: Irritability and poor sleep with fluoxetine levels of 50 ng/mL suggest serotonin excess in the
infant via breast milk, a known side effect of SSRIs. Milk quality, withdrawal, and GI irritation are less
consistent with the infant�s normal weight gain and exposure pattern.
Question: 852
A 38-week gestation male neonate, now 3 days old, is noted to have a reducible mass in the left inguinal
canal during a bath. The neonate is asymptomatic, feeding well, and has normal bowel movements. What
is the most appropriate management for this inguinal hernia?
A. Emergent surgical repair
B. Observation for spontaneous resolution
C. Elective repair within 1-2 months
D. 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?
A. Cystic fibrosis with autosomal recessive inheritance
B. Trisomy 21 with nondisjunction
C. Achondroplasia with autosomal dominant inheritance
D. DiGeorge syndrome with microdeletion
Answer: C
Explanation: The short limbs, large head, narrow thorax, and FGFR3 mutation confirm achondroplasia,
an autosomal dominant skeletal dysplasia, often a new mutation. Trisomy 21 lacks skeletal findings,
cystic fibrosis affects lungs and pancreas, and DiGeorge involves 22q11.2 deletion, not FGFR3.
Question: 854
A neonate is delivered at 43 weeks gestation with a birth weight of 3,400 g (25th percentile), length of 52
cm (50th percentile), and head circumference of 36 cm (50th percentile). Physical exam shows dry
cracked skin, long nails, and meconium staining. The neonate develops seizures at 12 hours. What is the
most likely classification and complication?
A. Post-term with perinatal asphyxia
B. Term with hypoglycemia
C. Late preterm with respiratory distress
D. Preterm with hypothermia
Answer: A
Explanation: At 43 weeks with post-term features (cracked skin, long nails) and AGA measurements, the
neonate is post-term. Seizures suggest perinatal asphyxia, a risk from placental dysfunction. Other
options do not align with gestation or symptoms.
Question: 855
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?
A. Monitor urine output for fluid balance
B. Increase dextrose to 12.5% in the IV fluid
C. Administer calcium gluconate 100 mg/kg IV
D. 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
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?
A. Preterm with apnea
B. Late preterm with hypocalcemia
C. Term with polycythemia
D. Post-term with jaundice
Answer: B
Explanation: At 36 weeks with AGA measurements (50th percentile) and late preterm features (soft ears),
the neonate is late preterm. Hypocalcemia (7.0 mg/dL) causes jitteriness, a common issue in late preterm
infants due to immature parathyroid function. Other options mismatch gestation or findings.
Question: 857
A term infant, now 6 days old, is receiving morphine 0.1 mg/kg/dose IV every 4 hours for postoperative
pain after a pyloromyotomy. The infant weighs 3.8 kg, and the NIPS score is 4 (moderate pain) despite
three doses. A blood level is 25 ng/mL (therapeutic: 10�40 ng/mL). What pharmacological intervention
should the nurse consider?
A. Add acetaminophen as an adjunct
B. Increase the dose to 0.15 mg/kg for better control
C. Switch to fentanyl for faster onset
D. Reduce the interval to every 3 hours
Answer: A
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?
A. Diabetes insipidus
B. Dehydration
C. Syndrome of inappropriate ADH
D. Renal tubular acidosis
Answer: B
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.
Question: 859
A nurse assesses the gag reflex in a 2-day-old neonate with a PaCO2 of 55 mmHg and HCO3 of 28
mEq/L. The reflex is present but weak. What is the most likely cause?
A. Cranial nerve damage
B. Normal variation in reflex strength
C. Metabolic alkalosis enhancing the reflex
D. Respiratory acidosis weakening the reflex
Answer: D
Explanation: PaCO2 55 mmHg and HCO3 28 mEq/L indicate respiratory acidosis with partial
compensation, which can cause lethargy and weaken reflexes like the gag. Option B is incorrect as a
weak gag is not typical.
Question: 860
A preterm infant born at 35 weeks gestation, now 5 days old, is receiving sucrose 24% orally for pain
during a venous puncture. The infant�s heart rate is 165 bpm (baseline 140), and the N-PASS score is 3
(mild pain). What nonpharmacological intervention should the nurse add?
A. Increase ambient light for distraction
B. Apply a cold pack to the site
C. Swaddle the infant during the procedure
D. 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?
A. Retained Plastibell ring
B. Necrosis from tight ring
C. Wound infection
D. Adhesion formation
Answer: B
Explanation: Delayed ring detachment with swelling and grayish discoloration suggest necrosis from a
tight Plastibell ring compromising blood flow, requiring urgent removal. Infection involves fever,
retained ring alone doesn�t cause discoloration, and adhesions form later, none matching this ischemic
picture.
Question: 862
A 34-week preterm neonate presents with holoprosencephaly, polydactyly, and a midline facial cleft.
Karyotype analysis shows 47,XY,+13, and the neonate develops apnea requiring ventilation. What is the
most appropriate family counseling point regarding recurrence risk?
A. High risk due to autosomal recessive inheritance
B. Recurrence risk is low due to sporadic nondisjunction
C. Moderate risk due to parental translocation
D. No risk as it�s a de novo mutation
Answer: B
Explanation: The features (holoprosencephaly, polydactyly, midline cleft) and karyotype 47,XY,+13
confirm Trisomy 13, typically a sporadic nondisjunction event with low recurrence risk (<1%) unless a
parental translocation is identified (not suggested here). Recessive inheritance and de novo mutation
mischaracterize this condition.
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?
A. Abnormal response indicating upper motor neuron dysfunction
B. Hypocalcemia-induced exaggeration of the reflex
C. Normal finding for a neonate of this age
D. 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.
Question: 864
A 33-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 about the
composition of formula compared to breast milk. Lab results show infant iron at 55 �g/dL (normal: 60�
170). What should the nurse explain?
A. Formula lacks antibodies found in breast milk
B. Formula has higher iron to prevent anemia
C. Formula contains more fat than breast milk
D. Formula is lower in carbohydrates
Answer: B
Explanation: Low iron (55 �g/dL) and normal weight gain (25 g/day) highlight a nutritional gap. Formula
is fortified with higher iron than breast milk to prevent anemia, a key compositional difference.
Antibodies, fat, and carbs vary, but iron is most relevant here.
Question: 865
A 28-year-old G1P0 woman at 39 weeks gestation undergoes a cord gas analysis at delivery due to
prolonged second stage labor. The umbilical artery pH is 7.10, PCO2 is 60 mmHg, and base deficit is -15
mEq/L. The neonate�s Apgar scores are 5 at 1 minute and 7 at 5 minutes. What is the most likely
neonatal complication?
A. Cerebral palsy
B. Hypoxic-ischemic encephalopathy
C. Respiratory distress syndrome
D. 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?
A. Hold the next dose and notify the provider
B. Adjust the dose downward due to reduced clearance
C. Increase the dosing interval to 36 hours
D. Continue the current regimen and recheck in 24 hours
Answer: A
Explanation: A trough level of 2.5 �g/mL exceeds the therapeutic range, indicating accumulation due to
immature renal clearance in a 72-hour-old infant. Holding the dose and notifying the provider prevents
toxicity, aligning with pharmacokinetic monitoring of blood drug levels. Adjusting without consultation,
altering intervals arbitrarily, or continuing risks harm.
Question: 867
A term neonate born to a mother with a history of unexplained stillbirth presents on day 4 with pallor,
hematocrit of 30%, hemoglobin of 10 g/dL, reticulocyte count of 12%, and total bilirubin of 16 mg/dL
(direct 0.6 mg/dL). DAT is negative. What is the most likely underlying condition?
A. Fetal-maternal hemorrhage
B. Physiologic anemia
C. Hereditary spherocytosis
D. Sickle cell disease
Answer: A
Explanation: The pallor, anemia (hematocrit 30%, hemoglobin 10 g/dL), high reticulocyte count (12%),
and unconjugated hyperbilirubinemia (15.4 mg/dL) with a negative DAT and maternal history of
stillbirth suggest fetal-maternal hemorrhage causing acute blood loss. Hereditary spherocytosis would
likely have a positive DAT or spherocytes, physiologic anemia occurs later, and sickle cell disease 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?
A. Pathologic fractures
B. Cataracts
C. Adrenal insufficiency
D. 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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