NSG 3500 EXAM 4 STUDY GUIDE - PRACTICE QUESTIONS
COMPLETE WITH 100% VERIFIED ANSWERS
1. A nurse is assessing a newborn's vital signs. Which heart rate would be within
the normal range for a term newborn?
A) 90 beats per minute
B) 145 beats per minute ✓
C) 170 beats per minute
D) 80 beats per minute
Explanation: The normal newborn heart rate is 110-160 beats per minute. 145
falls within this range, while 90 and 80 are bradycardic and 170 is tachycardic for a
newborn.
2. A newborn has a respiratory rate of 65 breaths per minute. How should the
nurse document this finding?
A) Normal finding
B) Bradypnea
C) Tachypnea ✓
D) Apnea
Explanation: Tachypnea in a newborn is defined as a respiratory rate greater than
60 breaths per minute. A rate of 65 exceeds this threshold and should be
documented as tachypnea.
3. The nurse is assessing a newborn's blood pressure. Which reading would be
expected for a newborn weighing 2,500 grams?
A) 50/35 mmHg
,B) 60/35 mmHg ✓
C) 51/40 mmHg
D) 65/40 mmHg
Explanation: For a newborn weighing 2,000-3,000 grams, the expected blood
pressure is 60/35 mmHg. 50/35 mmHg is for newborns <2000g, and 51/40 mmHg
is for newborns >3000g.
4. A newborn's blood glucose level is 35 mg/dL. What action should the nurse
take?
A) Document as a normal finding
B) Notify the healthcare provider immediately ✓
C) Recheck in 4 hours
D) Offer the infant water
Explanation: Normal newborn blood glucose is 40-60 mg/dL. A level of 35 mg/dL
is below normal and requires immediate notification of the healthcare provider
for intervention.
5. The nurse is assessing a newborn and notes small white papules on the
infant's face that resemble pimples. How should the nurse document this
finding?
A) Vernix
B) Lanugo
C) Milia ✓
D) Epstein pearls
Explanation: Milia (also called milk spots) are small white papules or sebaceous
cysts on an infant's face that resemble pimples. They are a normal finding and
require no treatment.
,6. A preterm newborn is noted to have a large amount of white biofilm covering
the skin, particularly in the axillary and genital areas. The nurse recognizes this
as:
A) Milia
B) Vernix ✓
C) Lanugo
D) Mongolian spots
Explanation: Vernix is a white naturally occurring biofilm that covers the skin of
newborns. Large amounts are associated with preterm infants, as term infants
have usually shed most of it.
7. The nurse observes fine, downy hair on a newborn's back and shoulders. This
finding is documented as:
A) Milia
B) Vernix
C) Lanugo ✓
D) Telangiectatic nevi
Explanation: Lanugo is fine, downy hair noted on an infant's back, shoulders, and
head. Large amounts are associated with preterm infants.
8. A nurse assessing a newborn of Asian descent notes a grayish-blue area on
the infant's buttocks. What is the most appropriate action?
A) Report suspected child abuse
B) Document as a Mongolian spot ✓
C) Apply warm compresses
D) Notify the healthcare provider for biopsy
Explanation: Mongolian spots are benign areas that appear gray, dark, blue, or
purple, commonly located on the back/buttocks. They are common in infants of
, Asian, Mediterranean, Latin American, and African descent and should be
documented to prevent confusion with bruises.
9. A newborn has a red birthmark at the nape of the neck. The nurse correctly
identifies this as:
A) Mongolian spot
B) Milia
C) Telangiectatic nevus (stork bite) ✓
D) Hemangioma
Explanation: Telangiectatic nevus, also known as a "stork bite" or "angel kiss," is a
red birthmark often seen at the nape of the neck. It can also occur on the face
between the eyebrows, eyelids, nose, or upper lip.
10. During assessment, the nurse palpates whitish hardened nodules on a
newborn's gums. What is this finding?
A) Milia
B) Epstein pearls ✓
C) Natal teeth
D) Cysts
Explanation: Epstein pearls are whitish hardened nodules on the gums or roof of
the mouth. They are benign and typically resolve on their own without
intervention.
11. The nurse performs a red reflex test on a newborn. Which finding indicates a
normal result?
A) White reflex
B) Red reflex ✓
C) Absent reflex
D) Yellow reflex
COMPLETE WITH 100% VERIFIED ANSWERS
1. A nurse is assessing a newborn's vital signs. Which heart rate would be within
the normal range for a term newborn?
A) 90 beats per minute
B) 145 beats per minute ✓
C) 170 beats per minute
D) 80 beats per minute
Explanation: The normal newborn heart rate is 110-160 beats per minute. 145
falls within this range, while 90 and 80 are bradycardic and 170 is tachycardic for a
newborn.
2. A newborn has a respiratory rate of 65 breaths per minute. How should the
nurse document this finding?
A) Normal finding
B) Bradypnea
C) Tachypnea ✓
D) Apnea
Explanation: Tachypnea in a newborn is defined as a respiratory rate greater than
60 breaths per minute. A rate of 65 exceeds this threshold and should be
documented as tachypnea.
3. The nurse is assessing a newborn's blood pressure. Which reading would be
expected for a newborn weighing 2,500 grams?
A) 50/35 mmHg
,B) 60/35 mmHg ✓
C) 51/40 mmHg
D) 65/40 mmHg
Explanation: For a newborn weighing 2,000-3,000 grams, the expected blood
pressure is 60/35 mmHg. 50/35 mmHg is for newborns <2000g, and 51/40 mmHg
is for newborns >3000g.
4. A newborn's blood glucose level is 35 mg/dL. What action should the nurse
take?
A) Document as a normal finding
B) Notify the healthcare provider immediately ✓
C) Recheck in 4 hours
D) Offer the infant water
Explanation: Normal newborn blood glucose is 40-60 mg/dL. A level of 35 mg/dL
is below normal and requires immediate notification of the healthcare provider
for intervention.
5. The nurse is assessing a newborn and notes small white papules on the
infant's face that resemble pimples. How should the nurse document this
finding?
A) Vernix
B) Lanugo
C) Milia ✓
D) Epstein pearls
Explanation: Milia (also called milk spots) are small white papules or sebaceous
cysts on an infant's face that resemble pimples. They are a normal finding and
require no treatment.
,6. A preterm newborn is noted to have a large amount of white biofilm covering
the skin, particularly in the axillary and genital areas. The nurse recognizes this
as:
A) Milia
B) Vernix ✓
C) Lanugo
D) Mongolian spots
Explanation: Vernix is a white naturally occurring biofilm that covers the skin of
newborns. Large amounts are associated with preterm infants, as term infants
have usually shed most of it.
7. The nurse observes fine, downy hair on a newborn's back and shoulders. This
finding is documented as:
A) Milia
B) Vernix
C) Lanugo ✓
D) Telangiectatic nevi
Explanation: Lanugo is fine, downy hair noted on an infant's back, shoulders, and
head. Large amounts are associated with preterm infants.
8. A nurse assessing a newborn of Asian descent notes a grayish-blue area on
the infant's buttocks. What is the most appropriate action?
A) Report suspected child abuse
B) Document as a Mongolian spot ✓
C) Apply warm compresses
D) Notify the healthcare provider for biopsy
Explanation: Mongolian spots are benign areas that appear gray, dark, blue, or
purple, commonly located on the back/buttocks. They are common in infants of
, Asian, Mediterranean, Latin American, and African descent and should be
documented to prevent confusion with bruises.
9. A newborn has a red birthmark at the nape of the neck. The nurse correctly
identifies this as:
A) Mongolian spot
B) Milia
C) Telangiectatic nevus (stork bite) ✓
D) Hemangioma
Explanation: Telangiectatic nevus, also known as a "stork bite" or "angel kiss," is a
red birthmark often seen at the nape of the neck. It can also occur on the face
between the eyebrows, eyelids, nose, or upper lip.
10. During assessment, the nurse palpates whitish hardened nodules on a
newborn's gums. What is this finding?
A) Milia
B) Epstein pearls ✓
C) Natal teeth
D) Cysts
Explanation: Epstein pearls are whitish hardened nodules on the gums or roof of
the mouth. They are benign and typically resolve on their own without
intervention.
11. The nurse performs a red reflex test on a newborn. Which finding indicates a
normal result?
A) White reflex
B) Red reflex ✓
C) Absent reflex
D) Yellow reflex
