A clinically stable preterm baby born at 30 weeks' gestation is ready to start enteral feeds. Which method is most appropriate?

Expressed breast milk by orogastric tube

Nil by mouth until 34 weeks of age

Direct breastfeeding every 2 hours

Formula feeds by bottle every 3 hours

Kangaroo mother care for a stable low birth weight baby consists mainly of:

Continuous skin-to-skin contact with exclusive breastfeeding

Care in a radiant warmer placed beside the mother

Wrapping in warm cloth and keeping in a cot

Daily oil massage followed by sunbathing

A term neonate is started on phototherapy for jaundice. Which nursing action is correct?

Cover the eyes with shields and expose skin, with a nappy only

Keep the baby fully clothed to prevent heat loss

Apply coconut oil to the skin to prevent drying

Withhold breastfeeds until phototherapy ends

A baby was born after membranes had been ruptured for 26 hours and the mother had a fever of 38.4°C in labour. At 6 hours, the baby has a respiratory rate of 72/min, a temperature of 38.1°C and poor feeding. Antibiotics have been ordered. What should the nurse do first?

Send a blood culture, then give the first antibiotic dose

Wait for the CRP report before giving antibiotics

Give the first antibiotic dose and send cultures later

Give paracetamol and recheck the temperature in 1 hour

Neonatal care and high-risk newborn

22 AIIMS NORCET (Nursing Officer) practice questions on Neonatal care and high-risk newborn, part of Paediatric Nursing. The first 22 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A clinically stable preterm baby born at 30 weeks' gestation is ready to start enteral feeds. Which method is most appropriate?
1. AExpressed breast milk by orogastric tube
2. BNil by mouth until 34 weeks of age
3. CDirect breastfeeding every 2 hours
4. DFormula feeds by bottle every 3 hours
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Answer: A · Expressed breast milk by orogastric tube
Coordinated sucking, swallowing and breathing matures at about 32-34 weeks, so babies below about 32 weeks are fed by gastric tube. Expressed breast milk is the feed of choice because it protects against infection and necrotising enterocolitis. Between about 32 and 34 weeks, feeds by cup or paladai are introduced, and direct breastfeeding follows. Kangaroo care during tube feeds supports later breastfeeding.
- B: Keeping a stable baby nil by mouth for weeks deprives it of nutrition and gut priming.
- C: A 30-week baby cannot coordinate suck and swallow for direct breastfeeding.
- D: Bottle feeding needs a mature suck and formula lacks breast milk's protection.
Question 2 · Medium
On the first day after a vacuum-assisted delivery, a baby develops a firm swelling over the right parietal bone that was not present at birth. The swelling stops sharply at the suture lines. The most likely diagnosis is:
1. ACephalhaematoma
2. BSubgaleal haemorrhage
3. CMoulding of the skull
4. DCaput succedaneum
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Answer: A · Cephalhaematoma
A cephalhaematoma is bleeding under the periosteum, so it is limited by the suture lines and usually appears a few hours after birth. It may take weeks to resolve and can increase jaundice as the blood breaks down. Caput succedaneum is oedema of the scalp, present at birth and crossing sutures. Parents are reassured, and the swelling is never aspirated because of infection risk.
- B: Subgaleal bleeding spreads freely across sutures and can cause shock.
- C: Moulding is overlapping of skull bones, not a swelling.
- D: Caput is present at birth and crosses the suture lines.
Question 3 · Easy
Kangaroo mother care for a stable low birth weight baby consists mainly of:
1. AContinuous skin-to-skin contact with exclusive breastfeeding
2. BCare in a radiant warmer placed beside the mother
3. CWrapping in warm cloth and keeping in a cot
4. DDaily oil massage followed by sunbathing
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Answer: A · Continuous skin-to-skin contact with exclusive breastfeeding
Kangaroo mother care places the nappy-clad baby upright in skin-to-skin contact on the mother's chest for as long as possible, with exclusive breastfeeding. It keeps the baby warm, improves breastfeeding and weight gain, and lowers infection and mortality. It suits stable LBW babies and can continue at home after early discharge. Fathers and other family members can also provide skin-to-skin care.
- B: A radiant warmer is equipment care, not kangaroo care.
- C: Wrapping in a cot lacks the skin-to-skin contact that defines the method.
- D: Oil massage and sunbathing are not part of kangaroo care and sunbathing risks chilling.
Question 4 · Medium
A term neonate is started on phototherapy for jaundice. Which nursing action is correct?
1. ACover the eyes with shields and expose skin, with a nappy only
2. BKeep the baby fully clothed to prevent heat loss
3. CApply coconut oil to the skin to prevent drying
4. DWithhold breastfeeds until phototherapy ends
Show answerHide answer
Answer: A · Cover the eyes with shields and expose skin, with a nappy only
Phototherapy works on the exposed skin, so the baby is nursed naked except for a small nappy, with the eyes covered to protect the retina. Position is changed regularly, temperature is checked often and breastfeeding continues on demand. Oils and lotions can cause burns under the lights and are avoided. Interruptions are kept short so the treatment is effective.
- B: Clothing blocks the light and makes phototherapy ineffective.
- C: Oils can cause skin burns under the lamps.
- D: Feeding should continue; it helps bilirubin excretion and prevents dehydration.
Question 5 · Hard
A baby was born after membranes had been ruptured for 26 hours and the mother had a fever of 38.4°C in labour. At 6 hours, the baby has a respiratory rate of 72/min, a temperature of 38.1°C and poor feeding. Antibiotics have been ordered. What should the nurse do first?
1. AWait for the CRP report before giving antibiotics
2. BSend a blood culture, then give the first antibiotic dose
3. CGive the first antibiotic dose and send cultures later
4. DGive paracetamol and recheck the temperature in 1 hour
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Answer: B · Send a blood culture, then give the first antibiotic dose
Prolonged rupture of membranes and maternal fever are risk factors for early-onset sepsis, and this baby has signs of it. A blood culture is drawn before the first antibiotic dose, because antibiotics can make the culture negative, and the first dose is then given without delay. Treatment is not held for CRP results. Fever control alone treats a symptom and loses valuable time.
- A: Waiting for CRP delays treatment of a baby with clear signs of sepsis.
- C: Antibiotics given first can sterilise the blood and make the culture falsely negative.
- D: Paracetamol hides the fever but does not treat the infection.
Question 6 · Easy
A newborn weighing less than 1500 g at birth, whatever the gestation, is classified as:
1. AVery low birth weight
2. BLow birth weight
3. CSmall for gestational age
4. DExtremely low birth weight
Answer and explanation in LearnFree account
Question 7 · Easy
Erb's palsy after a difficult delivery results from injury to which nerve roots?
1. AC3 and C4
2. BT2 and T3
3. CC8 and T1
4. DC5 and C6
Answer and explanation in LearnFree account
Question 8 · Medium
Neonatal sepsis that begins within the first 72 hours of life is most often caused by organisms acquired from:
1. APoor care of the umbilical cord stump
2. BThe hands of health care workers in the nursery
3. CContaminated feeding bottles at home
4. DThe mother's genital tract during labour
Answer and explanation in LearnFree account
Question 9 · Hard
At 1 minute, a newborn has a heart rate of 110/min, slow irregular breathing, some flexion of the limbs, a grimace on suction and a pink body with blue hands and feet. What is the Apgar score?
1. A5
2. B7
3. C6
4. D8
Answer and explanation in LearnFree account
Question 10 · Medium
In neonatal resuscitation, chest compressions are coordinated with ventilation in a ratio of:
1. A5 compressions to 1 breath
2. B3 compressions to 1 breath
3. C30 compressions to 2 breaths
4. D15 compressions to 2 breaths
Answer and explanation in LearnFree account
Question 11 · Easy
A newborn's axillary temperature is 36.2°C. By the WHO classification, this is:
1. AModerate hypothermia
2. BSevere hypothermia
3. CNormal temperature
4. DCold stress
Answer and explanation in LearnFree account
Question 12 · Medium
After a delivery complicated by shoulder dystocia, a newborn moves the right arm less, the Moro reflex is weaker on the right, and crepitus is felt over the right clavicle. The most likely injury is:
1. AErb's palsy
2. BDislocation of the shoulder
3. CFracture of the clavicle
4. DKlumpke's palsy
Answer and explanation in LearnFree account
Question 13 · Medium
A nurse places an unclothed newborn directly on a cold weighing scale without a cloth. By which mechanism is the baby losing heat?
1. AConduction
2. BEvaporation
3. CRadiation
4. DConvection
Answer and explanation in LearnFree account
Question 14 · Easy
The recommended dose of vitamin K for a term newborn weighing 3 kg is:
1. A1 mg intramuscularly
2. B10 mg orally
3. C0.5 mg intravenously
4. D5 mg intramuscularly
Answer and explanation in LearnFree account
Question 15 · Hard
A neonate is being resuscitated. After 60 seconds of well-coordinated chest compressions and ventilation with 100% oxygen through an endotracheal tube, the heart rate is still 50/min. What is the next step?
1. AIncrease the compression rate to 120 per minute
2. BStop compressions and reassess after 5 minutes
3. CGive epinephrine through an umbilical venous catheter
4. DGive sodium bicarbonate through a peripheral vein
Answer and explanation in LearnFree account
Question 16 · Easy
Jaundice that is first visible in a newborn within 24 hours of birth is regarded as:
1. ABreast milk jaundice
2. BPathological until proved otherwise
3. CPhysiological and self-limiting
4. DNormal if the baby feeds well
Answer and explanation in LearnFree account
Question 17 · Medium
Why is the daily fluid intake of a neonate often increased during phototherapy?
1. APhototherapy reduces breast milk production
2. BBilirubin is excreted only in a large urine volume
3. CThe lamps cause a high fever in most babies
4. DInsensible water loss through the skin increases
Answer and explanation in LearnFree account
Question 18 · Hard
A 2.0 kg preterm baby is jittery at 4 hours of age. Blood glucose is 30 mg/dL (unit threshold for hypoglycaemia: below 45 mg/dL). What should the nurse prepare to give first, as ordered?
1. AOral glucose water and recheck in an hour
2. B10% dextrose 2 mL/kg IV, then an infusion
3. CFormula feed and recheck glucose the next day
4. D25% dextrose 2 mL/kg IV as a single bolus
Answer and explanation in LearnFree account
Question 19 · Easy
During positive pressure ventilation of a newborn with a bag and mask, the recommended rate is:
1. A12-20 breaths per minute
2. B20-30 breaths per minute
3. C80-100 breaths per minute
4. D40-60 breaths per minute
Answer and explanation in LearnFree account
Question 20 · Medium
A term baby is born limp and is not breathing after being warmed, dried and stimulated. The heart rate is 80/min. What should the nurse do next?
1. AStart bag-and-mask ventilation within the first minute
2. BContinue rubbing the back and flicking the soles
3. CGive free-flow oxygen and observe for 5 minutes
4. DBegin chest compressions at a ratio of 3:1
Answer and explanation in LearnFree account
Question 21 · Hard
A term baby boy has jaundice at 20 hours of age. Mother's blood group is O positive; the baby's is A positive. Baby's haemoglobin is 14.5 g/dL, the direct Coombs test is weakly positive and there is no swelling of the scalp. What is the most likely cause?
1. APhysiological jaundice
2. BABO incompatibility
3. CBreast milk jaundice
4. DRh isoimmunisation
Answer and explanation in LearnFree account
Question 22 · Hard
A 3 kg neonate with severe haemolytic jaundice needs a double-volume exchange transfusion. Taking the neonatal blood volume as 85 mL/kg, what volume of blood should the nurse prepare?
1. A170 mL
2. B600 mL
3. C510 mL
4. D255 mL
Answer and explanation in LearnFree account

Neonatal care and high-risk newborn

A clinically stable preterm baby born at 30 weeks' gestation is ready to start enteral feeds. Which method is most appropriate?

On the first day after a vacuum-assisted delivery, a baby develops a firm swelling over the right parietal bone that was not present at birth. The swelling stops sharply at the suture lines. The most likely diagnosis is:

Kangaroo mother care for a stable low birth weight baby consists mainly of:

A term neonate is started on phototherapy for jaundice. Which nursing action is correct?

A baby was born after membranes had been ruptured for 26 hours and the mother had a fever of 38.4°C in labour. At 6 hours, the baby has a respiratory rate of 72/min, a temperature of 38.1°C and poor feeding. Antibiotics have been ordered. What should the nurse do first?

A newborn weighing less than 1500 g at birth, whatever the gestation, is classified as:

Erb's palsy after a difficult delivery results from injury to which nerve roots?

Neonatal sepsis that begins within the first 72 hours of life is most often caused by organisms acquired from:

At 1 minute, a newborn has a heart rate of 110/min, slow irregular breathing, some flexion of the limbs, a grimace on suction and a pink body with blue hands and feet. What is the Apgar score?

In neonatal resuscitation, chest compressions are coordinated with ventilation in a ratio of:

A newborn's axillary temperature is 36.2°C. By the WHO classification, this is:

After a delivery complicated by shoulder dystocia, a newborn moves the right arm less, the Moro reflex is weaker on the right, and crepitus is felt over the right clavicle. The most likely injury is:

A nurse places an unclothed newborn directly on a cold weighing scale without a cloth. By which mechanism is the baby losing heat?

The recommended dose of vitamin K for a term newborn weighing 3 kg is:

A neonate is being resuscitated. After 60 seconds of well-coordinated chest compressions and ventilation with 100% oxygen through an endotracheal tube, the heart rate is still 50/min. What is the next step?

Jaundice that is first visible in a newborn within 24 hours of birth is regarded as:

Why is the daily fluid intake of a neonate often increased during phototherapy?

A 2.0 kg preterm baby is jittery at 4 hours of age. Blood glucose is 30 mg/dL (unit threshold for hypoglycaemia: below 45 mg/dL). What should the nurse prepare to give first, as ordered?

During positive pressure ventilation of a newborn with a bag and mask, the recommended rate is:

A term baby is born limp and is not breathing after being warmed, dried and stimulated. The heart rate is 80/min. What should the nurse do next?

A term baby boy has jaundice at 20 hours of age. Mother's blood group is O positive; the baby's is A positive. Baby's haemoglobin is 14.5 g/dL, the direct Coombs test is weakly positive and there is no swelling of the scalp. What is the most likely cause?

A 3 kg neonate with severe haemolytic jaundice needs a double-volume exchange transfusion. Taking the neonatal blood volume as 85 mL/kg, what volume of blood should the nurse prepare?