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NEONATAL NURSING EXAM 2025-2026|QUESTIONS
WITH REAL ANSWERS|100% GUARANTEED PASS
Gestational periods
- Pre-embryonic stage (first 2 weeks, fertilisation to implantation)
- Embryonic stage (3-8 weeks, formation of rudimentary organs)
- Fetal period (week 9 to birth, growth and functional development) Implantation Blastocyte attaches to the uterine wall. Trophoblast cells invade the endometrium. 50-75% implantation failure rate due to endometrial readiness Embryonic membranes Amnion: protects with fluid. Yolk sac: Early blood formation. Chorion: Contributes to placenta. Allantois: Forms part of umbilical cord.
Gastrulation and Germ layers Primitive streak forms. Ectoderm: Nervous system and skin Mesoderm: Muscles and circulatory system. Endoderm: Digestive and respiratory tracts. Placental development Maternal component: Decidua basalis Fetal component: Chorionic villi Functions: Nutrient exchange, waste removal, hormone production (hCG, progesterone). Embryonic folding Transforms a flat disc into a 3D structure, forming body cavities (thoracic, abdominal)
Intrauterine Growth Restriction Estimated fetal weight below the 10th percentile for gestational age. Caused by environment or pathological factors that hinder normal growth. SGA v IUGR SGA includes both constitutionally small and growth-restricted fetuses. IUGR implies a pathological restriction of growth. Risk factors for IUGR Maternal factors:
- smoking, malnutrition, or substance use
- chronic disease Fetal factors:
- chromosomal abnormalities (trisomies, genetic syndromes).
- Infections (TORCH, syphilis) Placental factors:
- placental insufficiency or abnormalities.
- placental infections Symmetric IUGR Proportional growth restriction
- early onset due to intrinsic factors (e.g. chromosomal anomalies, infections). Asymmetric IUGR Disproportionate growth (normal head size, smaller body)
- Late onset due to nutrient or oxygen deficiency. Screening for IUGR Symphysis-fundal height (SFH):
- measures the distance from the pubic bone to the uterine fundus Ultrasound:
- feta biometry to asses parameters like head circumference and abdominal diameter.
- doppler studies to evaluate placental blood flow.
It directs blood towards the liver, bypassing liver filtration via the ductus venosus. Where does the mixed blood from the inferior vena cava (IVC) enter? The mixed blood enters the right atrium (RA) of the heart. How does blood bypass the lungs before birth? Oxygenated blood in the right atrium is directed through the foramen ovale into the left atrium (LA). What is the pathway of blood from the left atrium after bypassing the lungs? From the LA, blood flows into the left ventricle (LV) and exits via the aorta. How does blood draining from the head and arms enter the heart? It enters via the superior vena cava (SVC) into the right atrium (RA).
What happens to blood in the right ventricle (RV) before birth? It exits via the pulmonary trunk but is shunted to the aorta through the ductus arteriosus due to high pressure in the collapsed lungs. Where is blood directed after bypassing the lungs through the ductus arteriosus? It is directed to the brain via the first three branches of the aorta. What happens to the remaining blood flowing down the abdominal aorta? It returns to the placenta for oxygenation via the umbilical arteries. Changes to circulation at birth 1st week:
- lungs expand: Pressure decreases in pulmonary circulation, altering pressure gradients in the heart. The foramen ovale closes due to increased pressure on the left side of the heart:
- its adult remnant is the fossa ovalis.
Infection vs Sepsis Infection is the presence of microorganisms in the body causing harm. Sepsis is a systemic inflammatory response to infection, potentially leading to organ dysfunction. Maternal factors for neonatal infection and sepsis
- chorioamnionitis, prolonged rupture of membranes, or maternal infection during pregnancy.
- use of invasive procedures during delivery Neonatal factors for neonatal infection and sepsis
- Prematurity, low birth weight, or congenital abnormalities.
- Lack of maternal antibody transfer in preterm births. Early vs Late Onset Sepsis EOS:
- occurs within the first 72 hours of life
- commonly associated with maternal infection and vertical transmission. LOS:
- occurs after 72 hours of life.
- often linked to environmental exposure and nosocomial infections Clinical signs of neonatal sepsis: Non-specific signs:
- respiratory: Apnoea, tachypnoea, grunting.
- cardiovascular: Tachycardia, poor perfusion.
- gastrointestinal: Feed intolerance, vomiting, abdominal distension
- neurological: lethargy, irritability, seizures. Management of neonatal sepsis Diagnosis:
- blood cultures, complete blood count (CBC), and C-reactive protein (CRP)
- lumbar puncture if meningitis is suspected Treatment:
- broad spectrum antibiotics initiated promptly.
Why are the Barlow and Ortolani manoeuvres important in assessing hip dysplasia? Crucial for early detection of developmental dysplasia of the hips as they attempt to either dislocate or reduce a dislocated subluxated hip Inborn errors of metabolism (IEM) IEMS are genetic disorders that disrupt normal metabolic processes due to enzyme deficiencies. These disorders often lead to the accumulation of toxic substances or the deficiency of essential compounds. Symptoms:
- vomiting
- poor feeding and weight gain.
- lethargy, seizures, or encephalopathy. Challenges:
- non-specific presentation
- symptoms often delayed. Newborn screening for IEM History: developed by Dr. Robert Guthrie in the 1960s
Process: performed at 48-72 hours after birth using a heel prick. Blood is applied to a filter card and analysed for metabolic disorders. Benefits: enables early detection and intervention, improving outcomes Common IEM conditions screened in Australia
- Phenylketonuria (PKU)
- Congenital hypothyroidism
- Cystic fibrosis.
- Medium-chain acyl-CoA dehydrogenase deficiency (MCADD).
- Galactosaemia. Management of IEM
- dietary modifications
- enzyme replacement therapy
- regular monitoring and specialist consultations
- multidisciplinary care teams support long-term management and quality of life.
Mechanisms of heat loss in newborns
- Convection: heat loss to cooler surrounding air.
- Evaporation: heat loss as moisture evaporates from the skin
- Conduction: direct heat transfer to cold surfaces
- Radiation: heat loss to nearby cooler objects without direct contact. Risk factors for hypothermia Prematurity: limited brown fat reserves. Thin skin with higher permeability. Delivery environment:
- cool rooms or exposure to drafts. Inadequate interventions:
- delayed drying or wrapping after birth. Measuring neonatal temperature Preferred method: Axillary measurement as it is non-invasive and accurate for newborns.
Thermal protection strategies Maintaining a warm birthing area, free from drafts. Dry the baby immediately after birth to prevent evaporative heat loss. use pre-warmed blankets and a hat to retain heat. For preterm infants, use polyethylene wraps to minimise heat loss. Employ humidified incubators for preterm infants to maintain temperature and hydration. Provide heated respiratory support to reduce heat loss from breathing. Normoglycaemia Refers to the normal concentration of sugar in blood.
- Glucose is the primary energy source for the fetus.
- In utero, glucose is entirely derived from the mother, with levels fluctuating based on maternal glucose.
- At birth, there is a sudden cessation of nutrient supply, requiring the newborn to:
- mobilise glucose and fatty acids from its own stores to meet energy demands. Immature physiology
- Midazolam; provides sedation and amnesia during procedures. Has r/o hypotension and prolonged sedation.
- Antibiotics (e.g. Ampicillin, Gentamicin)
- treat infections like sepsis or meningitis
- monitor for nephrotoxicity and ototoxicity/
- Surfactant
- treats RDS by improving alveolar function
- Administered via ETT or feeding tube. Neonatal vaccinations
- Vitamin K - given to all babies, prevents Vit K deficiency bleeding. Administered IM at birth
- Hep B - prevents chronic liver disease caused by Hep B
- first dose given before hospital discharge. FCC principles
- listening and respecting families
- flexibility in care routines
- sharing clear and consistent information
- providing emotional and practical support
- collaborative care planning
- recognising and building on family strengths Practical applications of neurodevelopmental care (NDC)
- Minimize alarms and reduce bright lighting in the NICU.
- Cue-based care: Recognize and respond to stress cues from the neonate. Cluster care activities to minimize disruptions.
- Positioning: Use swaddling or nesting to provide boundaries and comfort.
- Parental involvement: Teach parents to understand and respond to their baby's cues Transient Tachypnea of the newborn (TTN) TTN is a self-limiting condition caused by delayed clearance of fetal lung fluid. It typically resolves within 24-72 hrs post-birth. Risk factors include c-section birth, male sex, prematurity or late preterm birth and maternal conditions such as diabetes or asthma.
