Into which site is intramuscular vitamin K given to a term newborn?

Rectus femoris on the front of the thigh

Dorsogluteal muscle of the buttock

A term baby receiving positive-pressure ventilation by mask has a heart rate of 80/min and the chest is not moving. The nurse should first:

Readjust the mask seal and reposition the head

Start chest compressions at a 3:1 ratio

Give adrenaline through the umbilical vein

Change to 100% oxygen and keep the same ventilation

At 26 hours, a term baby's congenital heart disease pulse oximetry screen reads 97% in the right hand and 93% in the foot. What should the nurse do?

Repeat the screen in about 1 hour

Record a pass, since both are above 90%

Record a pass, since the hand reads 95%

Refer at once for an echocardiogram

A 3-day-old breastfed baby is jaundiced to the abdomen. The baby feeds about 5 times in 24 hours, has 2 wet nappies a day and has lost 9% of birth weight. What should the nurse do?

Support breastfeeding 8 to 12 times in 24 hours

Give glucose water between feeds

Stop breastfeeding for 48 hours

Place the baby in sunlight by a window

A 4-day-old breastfed boy is brought back with deep jaundice and pallor. His grandmother had stored his clothes with mothballs. Results: haemoglobin 120 g/L (190 g/L at birth), total bilirubin 340 µmol/L (20 mg/dL), mostly unconjugated, DAT negative. Mother and baby are both group A positive. What is the most likely cause?

Haemolysis from G6PD deficiency

ABO haemolytic disease of the newborn

Newborn assessment and care

36 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Newborn assessment and care, part of Maternal and Newborn Nursing. The first 25 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 · Easy
Into which site is intramuscular vitamin K given to a term newborn?
1. AVastus lateralis of the thigh
2. BDeltoid of the upper arm
3. CRectus femoris on the front of the thigh
4. DDorsogluteal muscle of the buttock
Show answerHide answer
Answer: A · Vastus lateralis of the thigh
The vastus lateralis, on the anterolateral thigh, is the best-developed muscle in a newborn and is away from major nerves and vessels. Vitamin K is given there soon after birth, usually 1 mg for a term baby, to prevent vitamin K deficiency bleeding. The same site is used for the birth dose of hepatitis B vaccine, in the other thigh if both are given together. A 5/8-inch (16 mm) needle is usual.
- B: The newborn deltoid is too small for an intramuscular injection.
- C: The rectus femoris lies near the femoral vessels and nerve and is not the preferred newborn site.
- D: The dorsogluteal site risks the sciatic nerve and the muscle is undeveloped until walking.
Question 2 · Medium
A term baby receiving positive-pressure ventilation by mask has a heart rate of 80/min and the chest is not moving. The nurse should first:
1. AStart chest compressions at a 3:1 ratio
2. BReadjust the mask seal and reposition the head
3. CGive adrenaline through the umbilical vein
4. DChange to 100% oxygen and keep the same ventilation
Show answerHide answer
Answer: B · Readjust the mask seal and reposition the head
Chest movement shows that ventilation is effective, and effective ventilation is the most important step in newborn resuscitation. If the chest is not moving, the ventilation corrective steps (MR SOPA) are used: Mask adjustment and Reposition of the head first, then Suction, Open the mouth, Pressure increase and an Alternative airway. Compressions and adrenaline only help once the lungs are inflated. The heart rate usually rises quickly once ventilation works.
- A: Compressions are for a heart rate below 60 after 30 seconds of ventilation that moves the chest.
- C: Adrenaline is for a heart rate still below 60 despite effective ventilation and compressions.
- D: More oxygen does not help if no air is reaching the lungs.
Question 3 · Medium
At 26 hours, a term baby's congenital heart disease pulse oximetry screen reads 97% in the right hand and 93% in the foot. What should the nurse do?
1. ARecord a pass, since both are above 90%
2. BRepeat the screen in about 1 hour
3. CRecord a pass, since the hand reads 95%
4. DRefer at once for an echocardiogram
Show answerHide answer
Answer: B · Repeat the screen in about 1 hour
The screen passes when either limb reads 95% or more and the hand-foot difference is 3% or less. A reading below 90% in either limb is an immediate fail. Here the difference is 4%, so the screen is repeated in about an hour; a second result of the same kind is a fail and needs a doctor's review and echocardiography. The screen detects critical lesions that depend on the ductus, which can be missed on examination.
- A: Both readings above 90% is not enough; the difference must be 3% or less.
- C: A hand reading of 95% passes only when the difference is also 3% or less.
- D: An immediate referral is for any reading below 90% or a repeat that still fails.
Question 4 · Medium
A 3-day-old breastfed baby is jaundiced to the abdomen. The baby feeds about 5 times in 24 hours, has 2 wet nappies a day and has lost 9% of birth weight. What should the nurse do?
1. AGive glucose water between feeds
2. BStop breastfeeding for 48 hours
3. CSupport breastfeeding 8 to 12 times in 24 hours
4. DPlace the baby in sunlight by a window
Show answerHide answer
Answer: C · Support breastfeeding 8 to 12 times in 24 hours
Few feeds and few wet nappies point to low milk intake, which slows the passage of meconium and increases the reabsorption of bilirubin from the gut (suboptimal intake or breastfeeding jaundice). The answer is more effective breastfeeding, with help with latch, 8 to 12 feeds a day and expressed milk if needed. Bilirubin is measured against the hour-specific chart. Supplements are used only when medically indicated.
- A: Glucose water gives few calories and does not speed bilirubin excretion.
- B: Stopping breastfeeding is not needed and harms milk supply.
- D: Window sunlight is uncontrolled, causes overheating or sunburn and is not a treatment.
Question 5 · Hard
A 4-day-old breastfed boy is brought back with deep jaundice and pallor. His grandmother had stored his clothes with mothballs. Results: haemoglobin 120 g/L (190 g/L at birth), total bilirubin 340 µmol/L (20 mg/dL), mostly unconjugated, DAT negative. Mother and baby are both group A positive. What is the most likely cause?
1. AHaemolysis from G6PD deficiency
2. BBiliary atresia
3. CBreast milk jaundice
4. DABO haemolytic disease of the newborn
Show answerHide answer
Answer: A · Haemolysis from G6PD deficiency
A falling haemoglobin with high unconjugated bilirubin shows haemolysis, and a negative DAT means it is not antibody-mediated. Naphthalene in mothballs is a classic oxidant trigger in G6PD deficiency, which is common in Gulf populations and usually affects boys, since the gene is on the X chromosome. The baby needs urgent intensive phototherapy, possible exchange transfusion, and removal of the trigger. The family is taught which substances to avoid.
- B: Biliary atresia raises conjugated bilirubin, with pale stools and dark urine.
- C: Breast milk jaundice starts later, peaks around 2 weeks and causes no haemolysis or fall in haemoglobin.
- D: ABO disease needs a group O mother and a group A or B baby, and the DAT is usually positive.
Question 6 · Easy
In a healthy term baby, physiological jaundice usually reaches its peak:
1. AWithin the first 24 hours
2. BOn day 10 to 14 of life
3. COn day 3 to 5 of life
4. DAt about 4 to 6 weeks
Answer and explanation in LearnFree account
Question 7 · Easy
A newborn's APGAR score at 5 minutes is 6. According to neonatal resuscitation guidance, the score should next be recorded:
1. AHourly for the first 4 hours of life
2. BOnce more at 30 minutes of age
3. CEvery 15 minutes until the score reaches 10
4. DEvery 5 minutes, up to 20 minutes of age
Answer and explanation in LearnFree account
Question 8 · Medium
A 3-day-old baby has been under phototherapy for 12 hours and now passes frequent, loose, greenish stools. This most likely shows:
1. AInfective gastroenteritis needing isolation
2. BLactose intolerance needing a formula change
3. COverheating caused by the lamps
4. DBilirubin being cleared through the gut
Answer and explanation in LearnFree account
Question 9 · Hard
A newborn's findings are recorded twice. At 1 minute: heart rate 70/min, no breathing, limp, no response to a nasal catheter, blue and pale all over. At 5 minutes: heart rate 130/min, crying strongly, active movement, sneezing on suction, pink body with blue hands and feet. Which pair of APGAR scores is correct?
1. A2 at 1 minute and 8 at 5 minutes
2. B1 at 1 minute and 9 at 5 minutes
3. C0 at 1 minute and 9 at 5 minutes
4. D1 at 1 minute and 10 at 5 minutes
Answer and explanation in LearnFree account
Question 10 · Easy
A term baby born at 39 weeks needs positive-pressure ventilation. The oxygen concentration to start with is:
1. A30%
2. B100%
3. C60%
4. D21%
Answer and explanation in LearnFree account
Question 11 · Medium
A 4.0 kg baby of a mother with diabetes has a glucose of 2.2 mmol/L (40 mg/dL) at 2 hours. He is pink, feeding and not jittery. The unit's threshold is 2.6 mmol/L (47 mg/dL). The best action is to:
1. AGive 40% dextrose gel to the inner cheek, breastfeed, then recheck
2. BStart an IV bolus of 25% dextrose through a peripheral line
3. CRecheck the glucose in 4 hours before taking any action
4. DGive 10 mL of 5% glucose water from a bottle, then recheck
Answer and explanation in LearnFree account
Question 12 · Medium
A 2-hour-old term baby has an axillary temperature of 35.8 °C after being left uncovered under air conditioning. The nurse checks blood glucose because cold stress:
1. AUses up glucose to fuel brown fat heat production
2. BBlocks the release of insulin from the pancreas
3. CCauses glucose to be lost in the urine
4. DStops the liver from storing any glycogen
Answer and explanation in LearnFree account
Question 13 · Easy
Flat blue-grey patches over the sacrum and buttocks of a healthy newborn of Arab or Asian descent are most likely:
1. ABruising from trauma during the birth
2. BInfantile haemangiomas
3. CCongenital dermal melanocytosis
4. DPetechiae from low platelets
Answer and explanation in LearnFree account
Question 14 · Medium
A mother asks how to care for her baby's umbilical cord stump at home. The nurse should advise her to:
1. AClean it with surgical spirit at every nappy change
2. BApply a little oil each day to keep it soft
3. CKeep it clean and dry, folding the nappy below it
4. DCover it with a firm bandage until it drops off
Answer and explanation in LearnFree account
Question 15 · Medium
Which of these newborns needs routine blood glucose monitoring in the first hours of life?
1. AA 3.1 kg term baby with caput succedaneum
2. BA 3.3 kg term baby with erythema toxicum
3. CA 3.5 kg term baby with acrocyanosis at 2 hours
4. DA 4.4 kg baby of a mother with gestational diabetes
Answer and explanation in LearnFree account
Question 16 · Medium
A 2-day-old baby in the neonatal unit is about to receive a red cell transfusion, and the newborn screening card has not been taken. The nurse should:
1. AWait until 7 days after the transfusion to collect it
2. BDraw the screening sample from the transfusion line
3. CTake the screening sample before the transfusion
4. DOmit the screen, as transfused babies are exempt
Answer and explanation in LearnFree account
Question 17 · Hard
A nurse is caring for four newborns. Which baby should be assessed first?
1. AA 3-hour-old with blue hands and feet, heart rate 150
2. BA 30-hour-old with yellow skin on the face only
3. CA 2-day-old with a blotchy red rash on the trunk
4. DA 16-hour-old with yellow skin on the face and chest
Answer and explanation in LearnFree account
Question 18 · Hard
A 3.5 kg newborn needs IV adrenaline during resuscitation. The prescription is 0.02 mg/kg, using adrenaline 0.1 mg/mL (1 mg in 10 mL). What volume is drawn up?
1. A1.75 mL
2. B0.07 mL
3. C7 mL
4. D0.7 mL
Answer and explanation in LearnFree account
Question 19 · Easy
What is the normal respiratory rate of a healthy term newborn at rest?
1. A12 to 20 breaths per minute
2. B60 to 100 breaths per minute
3. C20 to 30 breaths per minute
4. D30 to 60 breaths per minute
Answer and explanation in LearnFree account
Question 20 · Medium
A 4-day-old baby with marked jaundice is waiting for a bilirubin result. Which finding should the nurse report at once as a possible sign of acute bilirubin encephalopathy?
1. AHigh-pitched cry with arching of the neck and back
2. BYellow colour of the sclera and the face
3. CSkin that blanches yellow when gently pressed
4. DLoose green stools after starting phototherapy
Answer and explanation in LearnFree account
Question 21 · Hard
A 50-hour-old term baby is due for discharge. Findings: white spots on the nose, slight swelling of both breasts, a little blood-stained mucus from the vagina, no meconium passed since birth and mild abdominal distension. Which finding should the nurse report?
1. ABlood-stained mucus from the vagina
2. BWhite spots on the nose
3. CNo meconium passed since birth
4. DSwelling of both breasts
Answer and explanation in LearnFree account
Question 22 · Easy
When filling the circles on a newborn screening blood-spot card, the nurse should:
1. ABuild up each spot with several small layered drops
2. BApply one large drop to each circle from one side
3. CDry the card quickly on a heater or in sunlight
4. DFill each circle by touching both sides of the paper
Answer and explanation in LearnFree account
Question 23 · Medium
A term baby is born through thick meconium-stained fluid and is limp and not breathing. According to the 2020 guidelines, the team should:
1. ASuction the mouth and nose while the head is on the perineum
2. BDo the initial steps and start PPV, with no routine tracheal suction
3. CIntubate and suction the trachea before giving any breaths
4. DWait for the neonatologist before starting any steps
Answer and explanation in LearnFree account
Question 24 · Easy
To read pre-ductal oxygen saturation during newborn resuscitation, the pulse oximeter probe is placed on the:
1. ALeft foot
2. BLeft hand or wrist
3. CRight hand or wrist
4. DRight foot
Answer and explanation in LearnFree account
Question 25 · Hard
At 3 minutes after birth, a term baby who needed brief stimulation is now breathing regularly with a heart rate of 140/min. The pre-ductal SpO2 on room air is 73%. What is the correct action?
1. AStart positive-pressure ventilation using 21% oxygen now
2. BGive free-flow oxygen at 100% by mask
3. CStart CPAP with 40% oxygen at once
4. DKeep monitoring, as this is within the 3-minute target
Answer and explanation in LearnFree account

11 more Newborn assessment and care questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Maternal and Newborn Nursing

Newborn assessment and care

Into which site is intramuscular vitamin K given to a term newborn?

A term baby receiving positive-pressure ventilation by mask has a heart rate of 80/min and the chest is not moving. The nurse should first:

At 26 hours, a term baby's congenital heart disease pulse oximetry screen reads 97% in the right hand and 93% in the foot. What should the nurse do?

A 3-day-old breastfed baby is jaundiced to the abdomen. The baby feeds about 5 times in 24 hours, has 2 wet nappies a day and has lost 9% of birth weight. What should the nurse do?

In a healthy term baby, physiological jaundice usually reaches its peak:

A newborn's APGAR score at 5 minutes is 6. According to neonatal resuscitation guidance, the score should next be recorded:

A 3-day-old baby has been under phototherapy for 12 hours and now passes frequent, loose, greenish stools. This most likely shows:

A term baby born at 39 weeks needs positive-pressure ventilation. The oxygen concentration to start with is:

A 4.0 kg baby of a mother with diabetes has a glucose of 2.2 mmol/L (40 mg/dL) at 2 hours. He is pink, feeding and not jittery. The unit's threshold is 2.6 mmol/L (47 mg/dL). The best action is to:

A 2-hour-old term baby has an axillary temperature of 35.8 °C after being left uncovered under air conditioning. The nurse checks blood glucose because cold stress:

Flat blue-grey patches over the sacrum and buttocks of a healthy newborn of Arab or Asian descent are most likely:

A mother asks how to care for her baby's umbilical cord stump at home. The nurse should advise her to:

Which of these newborns needs routine blood glucose monitoring in the first hours of life?

A 2-day-old baby in the neonatal unit is about to receive a red cell transfusion, and the newborn screening card has not been taken. The nurse should:

A nurse is caring for four newborns. Which baby should be assessed first?

A 3.5 kg newborn needs IV adrenaline during resuscitation. The prescription is 0.02 mg/kg, using adrenaline 0.1 mg/mL (1 mg in 10 mL). What volume is drawn up?

What is the normal respiratory rate of a healthy term newborn at rest?

A 4-day-old baby with marked jaundice is waiting for a bilirubin result. Which finding should the nurse report at once as a possible sign of acute bilirubin encephalopathy?

A 50-hour-old term baby is due for discharge. Findings: white spots on the nose, slight swelling of both breasts, a little blood-stained mucus from the vagina, no meconium passed since birth and mild abdominal distension. Which finding should the nurse report?

When filling the circles on a newborn screening blood-spot card, the nurse should:

A term baby is born through thick meconium-stained fluid and is limp and not breathing. According to the 2020 guidelines, the team should:

To read pre-ductal oxygen saturation during newborn resuscitation, the pulse oximeter probe is placed on the:

At 3 minutes after birth, a term baby who needed brief stimulation is now breathing regularly with a heart rate of 140/min. The pre-ductal SpO2 on room air is 73%. What is the correct action?