1
HESI Exit Exam Newborn Assessment
Bank: Neonatal Complications & Clinical
Monitoring
Table of Contents
Subtopic 1: Immediate Newborn Assessment – APGAR, Vital Signs, and
Transition to Extrauterine Life..........................................................................2
Subtopic 2: Neonatal Jaundice, Hypoglycemia, and Electrolyte Imbalances..10
Subtopic 3: Neonatal Respiratory Distress, TTN, and Meconium Aspiration
Syndrome.......................................................................................................19
Subtopic 4: Neonatal Infections – Sepsis, TORCH, and Group B Strep (GBS). 27
Subtopic 5: Birth Injuries, Congenital Anomalies, and Neonatal Neurological
Concerns........................................................................................................36
Subtopic 6: Thermoregulation, Hypothermia, and Hyperthermia in Neonates
.......................................................................................................................44
Subtopic 7: Newborn Feeding, Nutrition, and Signs of Feeding Complications
.......................................................................................................................52
Subtopic 8: Neonatal Hypoglycemia, Electrolyte Imbalance, and Metabolic
Disorders........................................................................................................60
Subtopic 9: Thermoregulation, Cold Stress, and Hyperthermia in Neonates. 67
Subtopic 10: Neonatal Skin, Musculoskeletal, and Birth Trauma Assessments
.......................................................................................................................75
, 2
Subtopic 1: Immediate Newborn Assessment –
APGAR, Vital Signs, and Transition to
Extrauterine Life
Questions 1–20
1. Which of the following APGAR scores requires immediate resuscitation?
A. 9
B. 3
C. 7
D. 5
Correct Answer: B. 3
Rationale: An APGAR score of 3 indicates severe distress. Scores ≤3 require
immediate resuscitation. A normal APGAR is 7–10.
2. A nurse is assessing a newborn 1 minute after birth and notes: HR 102,
slow irregular respirations, some flexion of extremities, grimace on
stimulation, and a pink body with blue extremities. What is the APGAR score?
A. 6
B. 5
C. 7
D. 4
Correct Answer: B. 5
Rationale: HR (2), Respirations (1), Muscle tone (1), Reflex irritability (1),
Color (0) = Total 5.
, 3
3. Which of the following is a normal finding in a newborn’s vital signs?
A. RR 80 breaths/min
B. HR 90 bpm
C. Temp 35.0°C (95.0°F)
D. HR 140 bpm
Correct Answer: D. HR 140 bpm
Rationale: Normal newborn HR is 120–160 bpm. RR is 30–60. Temperature
should be 36.5–37.5°C.
4. What does a bluish discoloration of the hands and feet in a newborn
signify?
A. Central cyanosis
B. Respiratory distress
C. Acrocyanosis
D. Hypoxia
Correct Answer: C. Acrocyanosis
Rationale: Acrocyanosis is common immediately after birth due to immature
circulation and is considered normal.
5. The nurse observes periodic breathing in a newborn. What is the most
appropriate action?
A. Call the physician immediately
, 4
B. Continue to monitor the newborn
C. Initiate oxygen therapy
D. Suction the airway
Correct Answer: B. Continue to monitor the newborn
Rationale: Periodic breathing (short pauses <20 sec) is normal in newborns.
Intervention is not required unless apnea occurs.
6. A nurse notes nasal flaring, intercostal retractions, and grunting in a
newborn. What does this indicate?
A. Normal adaptation
B. Respiratory distress
C. Transient tachypnea
D. Diaphragmatic hernia
Correct Answer: B. Respiratory distress
Rationale: These are classic signs of respiratory distress and should prompt
immediate evaluation.
7. The primary purpose of drying the newborn immediately after birth is to:
A. Stimulate crying
B. Promote bonding
C. Prevent heat loss
D. Clean the skin
Correct Answer: C. Prevent heat loss
HESI Exit Exam Newborn Assessment
Bank: Neonatal Complications & Clinical
Monitoring
Table of Contents
Subtopic 1: Immediate Newborn Assessment – APGAR, Vital Signs, and
Transition to Extrauterine Life..........................................................................2
Subtopic 2: Neonatal Jaundice, Hypoglycemia, and Electrolyte Imbalances..10
Subtopic 3: Neonatal Respiratory Distress, TTN, and Meconium Aspiration
Syndrome.......................................................................................................19
Subtopic 4: Neonatal Infections – Sepsis, TORCH, and Group B Strep (GBS). 27
Subtopic 5: Birth Injuries, Congenital Anomalies, and Neonatal Neurological
Concerns........................................................................................................36
Subtopic 6: Thermoregulation, Hypothermia, and Hyperthermia in Neonates
.......................................................................................................................44
Subtopic 7: Newborn Feeding, Nutrition, and Signs of Feeding Complications
.......................................................................................................................52
Subtopic 8: Neonatal Hypoglycemia, Electrolyte Imbalance, and Metabolic
Disorders........................................................................................................60
Subtopic 9: Thermoregulation, Cold Stress, and Hyperthermia in Neonates. 67
Subtopic 10: Neonatal Skin, Musculoskeletal, and Birth Trauma Assessments
.......................................................................................................................75
, 2
Subtopic 1: Immediate Newborn Assessment –
APGAR, Vital Signs, and Transition to
Extrauterine Life
Questions 1–20
1. Which of the following APGAR scores requires immediate resuscitation?
A. 9
B. 3
C. 7
D. 5
Correct Answer: B. 3
Rationale: An APGAR score of 3 indicates severe distress. Scores ≤3 require
immediate resuscitation. A normal APGAR is 7–10.
2. A nurse is assessing a newborn 1 minute after birth and notes: HR 102,
slow irregular respirations, some flexion of extremities, grimace on
stimulation, and a pink body with blue extremities. What is the APGAR score?
A. 6
B. 5
C. 7
D. 4
Correct Answer: B. 5
Rationale: HR (2), Respirations (1), Muscle tone (1), Reflex irritability (1),
Color (0) = Total 5.
, 3
3. Which of the following is a normal finding in a newborn’s vital signs?
A. RR 80 breaths/min
B. HR 90 bpm
C. Temp 35.0°C (95.0°F)
D. HR 140 bpm
Correct Answer: D. HR 140 bpm
Rationale: Normal newborn HR is 120–160 bpm. RR is 30–60. Temperature
should be 36.5–37.5°C.
4. What does a bluish discoloration of the hands and feet in a newborn
signify?
A. Central cyanosis
B. Respiratory distress
C. Acrocyanosis
D. Hypoxia
Correct Answer: C. Acrocyanosis
Rationale: Acrocyanosis is common immediately after birth due to immature
circulation and is considered normal.
5. The nurse observes periodic breathing in a newborn. What is the most
appropriate action?
A. Call the physician immediately
, 4
B. Continue to monitor the newborn
C. Initiate oxygen therapy
D. Suction the airway
Correct Answer: B. Continue to monitor the newborn
Rationale: Periodic breathing (short pauses <20 sec) is normal in newborns.
Intervention is not required unless apnea occurs.
6. A nurse notes nasal flaring, intercostal retractions, and grunting in a
newborn. What does this indicate?
A. Normal adaptation
B. Respiratory distress
C. Transient tachypnea
D. Diaphragmatic hernia
Correct Answer: B. Respiratory distress
Rationale: These are classic signs of respiratory distress and should prompt
immediate evaluation.
7. The primary purpose of drying the newborn immediately after birth is to:
A. Stimulate crying
B. Promote bonding
C. Prevent heat loss
D. Clean the skin
Correct Answer: C. Prevent heat loss
