RNC-LRN Low-risk neonatal nursing
certification focusing on healthy newborn
assessment, development, and family
support.
Question 1
A late preterm infant born at 35 weeks gestation is being assessed in the newborn
nursery. Which finding is most indicative of the infant's physiologic immaturity?
A) Poor feeding coordination and temperature instability
B) Heart rate of 140 bpm with regular rhythm
C) Respiratory rate of 45 breaths/min with slight irregularity
D) Acrocyanosis of the hands and feet
Rationale: Late preterm infants (34-36 6/7 weeks) commonly exhibit physiologic
immaturity including poor feeding coordination, temperature instability, and
increased risk of hypoglycemia and hyperbilirubinemia. Heart rate of 140 bpm,
respiratory rate of 45 breaths/min, and acrocyanosis are normal findings in term
and late preterm newborns.
Question 2
A newborn is 4 hours old and the nurse performs a gestational age assessment
using the Ballard score. Which component is evaluated as part of the
neuromuscular maturity assessment?
A) Arm recoil
B) Skin texture
C) Plantar creases
D) Breast tissue
Rationale: The Ballard score assesses gestational age based on both physical
maturity (skin, lanugo, plantar creases, breast tissue, ear cartilage, and genitalia)
and neuromuscular maturity (posture, arm recoil, popliteal angle, scarf sign, and
,heel-to-ear). Arm recoil is a neuromuscular component, while skin texture, plantar
creases, and breast tissue are physical maturity components.
Question 3
A newborn's mother had a positive Group B Streptococcus (GBS) culture at 36
weeks gestation and received inadequate intrapartum antibiotic prophylaxis. The
nurse should prioritize which assessment?
A) Blood glucose monitoring
B) Signs of respiratory distress and sepsis
C) Bilirubin level monitoring
D) Temperature instability assessment
Rationale: Inadequate intrapartum antibiotic prophylaxis for GBS-positive
mothers increases the newborn's risk for early-onset GBS sepsis, which can present
with respiratory distress, temperature instability, apnea, and poor feeding. While
glucose, bilirubin, and temperature monitoring are important, signs of sepsis
should be the priority.
Question 4
A newborn is 1 hour old and the nurse notes that the infant's oxygen saturation is
88% on room air. Which action should the nurse take?
A) Administer supplemental oxygen and notify the healthcare provider
B) Continue to monitor; this is a normal transitional finding
C) Initiate feeding to stimulate respiratory effort
D) Place the infant in a warmer
Rationale: A normal oxygen saturation for a newborn at 1 hour of age should be
>95%. An SpO₂ of 88% indicates hypoxemia requiring evaluation. While oxygen
saturation gradually rises after birth, it should be >95% by 10 minutes of age.
Supplemental oxygen and provider notification are indicated.
Question 5
A nurse is performing a head-to-toe assessment on a 12-hour-old newborn. Which
finding should be reported to the healthcare provider?
,A) Abdominal distension with absent bowel sounds
B) Heart rate of 150 bpm
C) Respiratory rate of 50 breaths/min
D) Blood glucose of 55 mg/dL
Rationale: Abdominal distension with absent bowel sounds in a newborn may
indicate an intestinal obstruction, necrotizing enterocolitis, or sepsis. Heart rate of
150 bpm, respiratory rate of 50 breaths/min, and blood glucose of 55 mg/dL are
within normal ranges for a newborn.
Question 6
A newborn is 24 hours old and the nurse assesses the infant's skin. Which finding
is considered a normal variant?
A) Generalized petechiae
B) Erythema toxicum
C) Pustules with surrounding erythema
D) Vesicular lesions on an erythematous base
Rationale: Erythema toxicum is a benign, self-limited rash occurring in up to 50%
of newborns, typically appearing within the first few days of life as pustules on an
erythematous base. Generalized petechiae may indicate infection or
thrombocytopenia; pustules with erythema and vesicular lesions are concerning for
infection (e.g., staphylococcal or herpes).
Question 7
A newborn is being assessed for gestational age. Which physical characteristic is
consistent with a preterm infant?
A) Absent or sparse lanugo
B) Abundant lanugo
C) Deep plantar creases covering the entire sole
D) Breast tissue ≥5 mm
Rationale: Preterm infants typically have abundant lanugo (fine hair) covering the
body, which decreases with advancing gestational age. Sparse lanugo, deep plantar
creases, and well-developed breast tissue are characteristic of more mature, term
infants.
, Question 8
A newborn's birth weight is 2,500 g (5 lb 8 oz). The nurse should classify this
infant as:
A) Low birth weight
B) Very low birth weight
C) Extremely low birth weight
D) Normal birth weight
Rationale: Low birth weight (LBW) is defined as a birth weight less than 2,500 g
(5 lb 8 oz). Very low birth weight (VLBW) is less than 1,500 g, and extremely low
birth weight (ELBW) is less than 1,000 g. Normal birth weight is 2,500-4,000 g.
Question 9
A newborn is 48 hours old and the nurse notes that the infant's urine is dark and
concentrated. Which assessment should the nurse perform?
A) Assess for signs of dehydration and evaluate feeding adequacy
B) Notify the healthcare provider immediately
C) Obtain a urine culture
D) Administer intravenous fluids
Rationale: Dark, concentrated urine in a newborn may indicate dehydration due to
inadequate feeding. The nurse should assess for signs of dehydration (sunken
fontanelle, dry mucous membranes, decreased skin turgor, weight loss >10%) and
evaluate feeding adequacy. If dehydration is confirmed, further intervention may
be needed.
Question 10
A newborn is 2 hours old and the nurse notes that the infant's respiratory rate is 70
breaths/min with grunting and nasal flaring. Which action should the nurse take
first?
A) Administer oxygen and notify the healthcare provider
B) Assess the infant's blood glucose
certification focusing on healthy newborn
assessment, development, and family
support.
Question 1
A late preterm infant born at 35 weeks gestation is being assessed in the newborn
nursery. Which finding is most indicative of the infant's physiologic immaturity?
A) Poor feeding coordination and temperature instability
B) Heart rate of 140 bpm with regular rhythm
C) Respiratory rate of 45 breaths/min with slight irregularity
D) Acrocyanosis of the hands and feet
Rationale: Late preterm infants (34-36 6/7 weeks) commonly exhibit physiologic
immaturity including poor feeding coordination, temperature instability, and
increased risk of hypoglycemia and hyperbilirubinemia. Heart rate of 140 bpm,
respiratory rate of 45 breaths/min, and acrocyanosis are normal findings in term
and late preterm newborns.
Question 2
A newborn is 4 hours old and the nurse performs a gestational age assessment
using the Ballard score. Which component is evaluated as part of the
neuromuscular maturity assessment?
A) Arm recoil
B) Skin texture
C) Plantar creases
D) Breast tissue
Rationale: The Ballard score assesses gestational age based on both physical
maturity (skin, lanugo, plantar creases, breast tissue, ear cartilage, and genitalia)
and neuromuscular maturity (posture, arm recoil, popliteal angle, scarf sign, and
,heel-to-ear). Arm recoil is a neuromuscular component, while skin texture, plantar
creases, and breast tissue are physical maturity components.
Question 3
A newborn's mother had a positive Group B Streptococcus (GBS) culture at 36
weeks gestation and received inadequate intrapartum antibiotic prophylaxis. The
nurse should prioritize which assessment?
A) Blood glucose monitoring
B) Signs of respiratory distress and sepsis
C) Bilirubin level monitoring
D) Temperature instability assessment
Rationale: Inadequate intrapartum antibiotic prophylaxis for GBS-positive
mothers increases the newborn's risk for early-onset GBS sepsis, which can present
with respiratory distress, temperature instability, apnea, and poor feeding. While
glucose, bilirubin, and temperature monitoring are important, signs of sepsis
should be the priority.
Question 4
A newborn is 1 hour old and the nurse notes that the infant's oxygen saturation is
88% on room air. Which action should the nurse take?
A) Administer supplemental oxygen and notify the healthcare provider
B) Continue to monitor; this is a normal transitional finding
C) Initiate feeding to stimulate respiratory effort
D) Place the infant in a warmer
Rationale: A normal oxygen saturation for a newborn at 1 hour of age should be
>95%. An SpO₂ of 88% indicates hypoxemia requiring evaluation. While oxygen
saturation gradually rises after birth, it should be >95% by 10 minutes of age.
Supplemental oxygen and provider notification are indicated.
Question 5
A nurse is performing a head-to-toe assessment on a 12-hour-old newborn. Which
finding should be reported to the healthcare provider?
,A) Abdominal distension with absent bowel sounds
B) Heart rate of 150 bpm
C) Respiratory rate of 50 breaths/min
D) Blood glucose of 55 mg/dL
Rationale: Abdominal distension with absent bowel sounds in a newborn may
indicate an intestinal obstruction, necrotizing enterocolitis, or sepsis. Heart rate of
150 bpm, respiratory rate of 50 breaths/min, and blood glucose of 55 mg/dL are
within normal ranges for a newborn.
Question 6
A newborn is 24 hours old and the nurse assesses the infant's skin. Which finding
is considered a normal variant?
A) Generalized petechiae
B) Erythema toxicum
C) Pustules with surrounding erythema
D) Vesicular lesions on an erythematous base
Rationale: Erythema toxicum is a benign, self-limited rash occurring in up to 50%
of newborns, typically appearing within the first few days of life as pustules on an
erythematous base. Generalized petechiae may indicate infection or
thrombocytopenia; pustules with erythema and vesicular lesions are concerning for
infection (e.g., staphylococcal or herpes).
Question 7
A newborn is being assessed for gestational age. Which physical characteristic is
consistent with a preterm infant?
A) Absent or sparse lanugo
B) Abundant lanugo
C) Deep plantar creases covering the entire sole
D) Breast tissue ≥5 mm
Rationale: Preterm infants typically have abundant lanugo (fine hair) covering the
body, which decreases with advancing gestational age. Sparse lanugo, deep plantar
creases, and well-developed breast tissue are characteristic of more mature, term
infants.
, Question 8
A newborn's birth weight is 2,500 g (5 lb 8 oz). The nurse should classify this
infant as:
A) Low birth weight
B) Very low birth weight
C) Extremely low birth weight
D) Normal birth weight
Rationale: Low birth weight (LBW) is defined as a birth weight less than 2,500 g
(5 lb 8 oz). Very low birth weight (VLBW) is less than 1,500 g, and extremely low
birth weight (ELBW) is less than 1,000 g. Normal birth weight is 2,500-4,000 g.
Question 9
A newborn is 48 hours old and the nurse notes that the infant's urine is dark and
concentrated. Which assessment should the nurse perform?
A) Assess for signs of dehydration and evaluate feeding adequacy
B) Notify the healthcare provider immediately
C) Obtain a urine culture
D) Administer intravenous fluids
Rationale: Dark, concentrated urine in a newborn may indicate dehydration due to
inadequate feeding. The nurse should assess for signs of dehydration (sunken
fontanelle, dry mucous membranes, decreased skin turgor, weight loss >10%) and
evaluate feeding adequacy. If dehydration is confirmed, further intervention may
be needed.
Question 10
A newborn is 2 hours old and the nurse notes that the infant's respiratory rate is 70
breaths/min with grunting and nasal flaring. Which action should the nurse take
first?
A) Administer oxygen and notify the healthcare provider
B) Assess the infant's blood glucose
