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MATERNAL-NEWBORN NCLEX RN 2025-2026 | SAUNDERS
9TH ED CHAPTER 28 | NEWBORN CARE, APGAR &
NEONATAL COMPLICATIONS | REAL NGN 140 QUESTIONS
A+ GUARANTEED PASS
Question 1 (SATA)
A newborn’s APGAR score at 1 minute is 5. Which nursing interventions are
appropriate? (Select all that apply.)
A. Begin positive pressure ventilation
B. Dry and stimulate the newborn
C. Place the newborn skin-to-skin immediately
D. Apply pulse oximetry to monitor oxygenation
E. Start chest compressions immediately
Correct Answers: A, B, D
Rationale:
An APGAR score of 5 indicates moderate distress requiring drying and
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stimulation and positive pressure ventilation to assist oxygenation. Pulse
oximetry is also indicated to monitor status. Chest compressions are reserved for
HR <60, and skin-to-skin is delayed until stable.
Question 2 (SATA)
A nurse is assessing a term newborn 1 hour after birth. Which respiratory
findings require immediate intervention? (Select all that apply.)
A. Respiratory rate 36/min
B. Nasal flaring
C. Grunting
D. Intercostal retractions
E. Periodic breathing
Correct Answers: B, C, D
Rationale:
Nasal flaring, grunting, and retractions are classic signs of respiratory distress
syndrome (RDS). Respiratory rate 36/min and periodic breathing are normal
transitional patterns in healthy newborns.
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Question 3 (SATA)
A newborn at 10 minutes of life has acrocyanosis, is crying vigorously, and has a
HR 140 bpm. Which actions are appropriate? (Select all that apply.)
A. Place the newborn under a radiant warmer
B. Apply 100% oxygen via mask
C. Continue routine newborn care
D. Initiate chest compressions
E. Document the findings as expected
Correct Answers: A, C, E
Rationale:
Acrocyanosis is normal in the first 24 hours due to immature circulation.
Routine care includes keeping the newborn warm and documenting findings.
Oxygen and compressions are unnecessary without central cyanosis or
bradycardia.
Question 4 (SATA)
A preterm newborn is noted to have grunting, nasal flaring, and intercostal
retractions. Which interventions are priority? (Select all that apply.)
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A. Place under a radiant warmer
B. Initiate oxygen therapy per protocol
C. Stimulate to cry vigorously
D. Notify the healthcare provider immediately
E. Feed the newborn 10 mL of formula
Correct Answers: A, B, D
Rationale:
Respiratory distress in a preterm infant requires thermal support, oxygen
therapy, and provider notification. Feeding is delayed to reduce aspiration risk,
and vigorous stimulation may worsen distress.
Question 5 (SATA)
A nurse is caring for a large for gestational age (LGA) newborn of a diabetic
mother. Which findings suggest hypoglycemia? (Select all that apply.)
A. Jitteriness
B. Lethargy
C. High-pitched cry
D. Poor feeding
E. Temperature 99.0°F (37.2°C)
MATERNAL-NEWBORN NCLEX RN 2025-2026 | SAUNDERS
9TH ED CHAPTER 28 | NEWBORN CARE, APGAR &
NEONATAL COMPLICATIONS | REAL NGN 140 QUESTIONS
A+ GUARANTEED PASS
Question 1 (SATA)
A newborn’s APGAR score at 1 minute is 5. Which nursing interventions are
appropriate? (Select all that apply.)
A. Begin positive pressure ventilation
B. Dry and stimulate the newborn
C. Place the newborn skin-to-skin immediately
D. Apply pulse oximetry to monitor oxygenation
E. Start chest compressions immediately
Correct Answers: A, B, D
Rationale:
An APGAR score of 5 indicates moderate distress requiring drying and
, 2
stimulation and positive pressure ventilation to assist oxygenation. Pulse
oximetry is also indicated to monitor status. Chest compressions are reserved for
HR <60, and skin-to-skin is delayed until stable.
Question 2 (SATA)
A nurse is assessing a term newborn 1 hour after birth. Which respiratory
findings require immediate intervention? (Select all that apply.)
A. Respiratory rate 36/min
B. Nasal flaring
C. Grunting
D. Intercostal retractions
E. Periodic breathing
Correct Answers: B, C, D
Rationale:
Nasal flaring, grunting, and retractions are classic signs of respiratory distress
syndrome (RDS). Respiratory rate 36/min and periodic breathing are normal
transitional patterns in healthy newborns.
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Question 3 (SATA)
A newborn at 10 minutes of life has acrocyanosis, is crying vigorously, and has a
HR 140 bpm. Which actions are appropriate? (Select all that apply.)
A. Place the newborn under a radiant warmer
B. Apply 100% oxygen via mask
C. Continue routine newborn care
D. Initiate chest compressions
E. Document the findings as expected
Correct Answers: A, C, E
Rationale:
Acrocyanosis is normal in the first 24 hours due to immature circulation.
Routine care includes keeping the newborn warm and documenting findings.
Oxygen and compressions are unnecessary without central cyanosis or
bradycardia.
Question 4 (SATA)
A preterm newborn is noted to have grunting, nasal flaring, and intercostal
retractions. Which interventions are priority? (Select all that apply.)
, 4
A. Place under a radiant warmer
B. Initiate oxygen therapy per protocol
C. Stimulate to cry vigorously
D. Notify the healthcare provider immediately
E. Feed the newborn 10 mL of formula
Correct Answers: A, B, D
Rationale:
Respiratory distress in a preterm infant requires thermal support, oxygen
therapy, and provider notification. Feeding is delayed to reduce aspiration risk,
and vigorous stimulation may worsen distress.
Question 5 (SATA)
A nurse is caring for a large for gestational age (LGA) newborn of a diabetic
mother. Which findings suggest hypoglycemia? (Select all that apply.)
A. Jitteriness
B. Lethargy
C. High-pitched cry
D. Poor feeding
E. Temperature 99.0°F (37.2°C)
