NLE Newborn & Neonatal Nursing Reviewer 2026

Answer: A. 8

Step 1 – Score each APGAR component: • Appearance: Body pink, extremities blue = 1 (acrocyanosis scores 1, not 2) • Pulse: 120 bpm (above 100) = 2 • Grimace: Cries when stimulated = 2 • Activity: Active, well-flexed = 2 • Respiration: Strong cry = 2 Step 2 – Add the scores: 1 + 2 + 2 + 2 + 2 = 8 Step 3 – Interpret: A score of 7–10 indicates good adjustment and requires only routine newborn care. Why the other options are wrong: • 9 or 10 would require completely pink skin all over (Appearance = 2), but acrocyanosis was noted, so Appearance = 1 only. • 7 would mean one more component scored lower, which is not supported by the data given.

Answer: A. Begin active resuscitation immediately

Step 1 – Interpret the score: An APGAR of 0–3 indicates severe depression. The newborn is critically compromised. Step 2 – Recall the key principle: APGAR guides ongoing observation, but resuscitation decisions are based on heart rate and breathing assessment — NOT on waiting for a score. A score of 3 confirms the need for immediate intervention. Step 3 – Priority action: Active resuscitation (positive-pressure ventilation, chest compressions if HR < 60) must begin at once. Why the other options are wrong: • Waiting for the 5-minute score wastes critical time and can lead to brain damage or death. • Simply placing in a warmer and observing is insufficient for a severely depressed newborn. • Oxygen by face mask alone is insufficient; positive-pressure ventilation is needed when breathing is absent or inadequate.

Answer: A. Axillary temperature of 36.8°C

Step 1 – Recall normal newborn vital sign ranges: • Axillary temperature: 36.5–37.5°C ✔ • Heart rate: 110–160 bpm • Respiratory rate: 30–60 breaths/min • Blood glucose: above 45 mg/dL Step 2 – Evaluate each option: • 36.8°C falls within 36.5–37.5°C — NORMAL. • 95 bpm at rest is below the lower limit of 110 bpm — abnormal (bradycardia). • 70 breaths/min exceeds the upper limit of 60 breaths/min — abnormal (tachypnea), may indicate respiratory distress. • 35 mg/dL is below 45 mg/dL — hypoglycemia, requires immediate feeding and recheck. Step 3 – Conclusion: Only the axillary temperature of 36.8°C is within normal range.

Answer: A. A normal Babinski reflex

Step 1 – Identify the reflex: Stroking the lateral sole of the foot produces dorsiflexion of the great toe and fanning of the other toes — this is the Babinski reflex. Step 2 – Is it normal? In newborns and infants up to about 1 year of age, a positive Babinski reflex is NORMAL because the corticospinal tracts are not yet fully myelinated. Step 3 – Distinguish from other reflexes: • Galant reflex: stroking along the spine causes trunk incurvation (the trunk curves toward the side stroked). • Plantar grasp: pressure on the ball of the foot causes toes to curl downward (flexion), not fanning. Step 4 – Key NLE point: A positive Babinski in an ADULT is abnormal (upper motor neuron lesion), but in a newborn it is completely expected. Do not confuse the two contexts.

Answer: A. Fractured right clavicle or right brachial plexus injury

Step 1 – Recall the normal Moro reflex: A sudden stimulus (jarring or slight head drop) causes SYMMETRIC arm abduction and extension, followed by an embrace (C-shape of the thumb and index finger). Step 2 – Interpret asymmetry: If one arm does not respond while the other does, this indicates a problem with that arm's motor function — think bone or nerve injury on the non-responding side. Step 3 – Most common causes of asymmetric Moro: fractured clavicle (especially after shoulder dystocia) or Erb's palsy (brachial plexus injury, C5–C6). Step 4 – Why the other options are wrong: • An asymmetric Moro is NOT a normal variation — symmetric response is expected. • CNS depression would cause a globally decreased or absent Moro bilaterally, not unilateral absence. • The Moro reflex IS present in the first hour of life; its absence or asymmetry is significant.

Answer: A. Immediate and thorough drying of the newborn

Step 1 – Recall the four EINC/Unang Yakap time-bound steps in ORDER: 1. Immediate and thorough drying (within the first 30 seconds) 2. Early skin-to-skin contact 3. Properly timed cord clamping (after pulsations stop, ~1–3 minutes) 4. Non-separation for early breastfeeding Step 2 – Why drying comes FIRST: Drying the newborn provides tactile stimulation to initiate breathing AND prevents evaporative heat loss, addressing two life-sustaining priorities simultaneously. Step 3 – Why the other options are not first: • Skin-to-skin contact is the second step, done after drying. • Cord clamping is the third step — delayed to allow blood transfer. • Breastfeeding initiation is the fourth step, ideally within 90 minutes. Step 4 – Key point: The first bath is DELAYED at least 6 hours to protect temperature. Early routine suctioning of a vigorous newborn is discouraged by EINC.

Answer: A. After cord pulsations have stopped, approximately 1–3 minutes after birth

Step 1 – EINC recommends delayed cord clamping: wait until the cord stops pulsating, which occurs approximately 1–3 minutes after birth. Step 2 – Rationale: Delayed clamping allows blood to transfer from the placenta to the newborn, significantly improving iron stores and reducing the risk of anemia in infancy. Step 3 – Why early clamping (immediate/15 seconds) is discouraged: Cutting the cord immediately interrupts placental blood transfer, depriving the newborn of an estimated 80–100 mL of blood. Step 4 – Why waiting for placenta delivery is too long: By the time the placenta delivers, the beneficial blood transfer window has already passed and there is no added benefit. Step 5 – Clinical note: In a non-vigorous newborn needing immediate resuscitation, the cord may need to be clamped earlier to allow resuscitative efforts — clinical judgment applies.

Answer: A. Conduction

Step 1 – Define each mechanism: • Conduction: heat loss through DIRECT CONTACT with a cooler solid surface. • Convection: heat loss to moving AIR or liquid (e.g., drafts, air conditioning). • Radiation: heat loss to a nearby cold OBJECT without contact (e.g., cold window, outer wall). • Evaporation: heat loss as MOISTURE vaporizes from skin (e.g., wet newborn after delivery). Step 2 – Apply: The newborn is in DIRECT contact with the metal scale → this is conduction. Step 3 – Prevention of conduction heat loss: Pre-warm blankets, scales, examination tables, hands, and any surfaces the baby touches. Step 4 – Why the others are wrong: • Convection requires moving air, not a solid surface. • Radiation does not require contact; the object must be nearby but not touching. • Evaporation involves moisture on the skin turning into vapor. Memory tip: 'Conduction = Contact.'

Answer: A. To prevent vitamin K–deficiency bleeding (hemorrhagic disease of the newborn)

Step 1 – Why is the newborn at risk? The newborn's gut is sterile at birth — it has no intestinal bacteria yet to synthesize vitamin K. Without vitamin K, clotting factors II, VII, IX, and X cannot be activated, putting the baby at risk for spontaneous bleeding. Step 2 – The medication: Vitamin K1 (phytonadione) 0.5–1 mg (usually 1 mg) is given IM into the vastus lateralis muscle ONCE to prevent hemorrhagic disease of the newborn. Step 3 – Why the other options are wrong: • Ophthalmia neonatorum prevention = erythromycin 0.5% ophthalmic ointment, NOT vitamin K. • Hepatitis B passive immunity = Hepatitis B immunoglobulin (HBIG), not vitamin K. • Vitamin K activates existing clotting factors — it does not stimulate the liver to produce new ones immediately; it enables carboxylation of clotting factors already present.

Answer: A. Between 24 and 72 hours after birth

Step 1 – RA 9288 requirement: The heel-prick blood sample should be collected ideally when the newborn is 24–72 hours old. Step 2 – Why not earlier than 24 hours? The disorders screened (e.g., PKU, CAH, galactosemia) depend on feeding-related metabolite accumulation. If drawn before 24 hours, some metabolites have not yet built up to detectable levels, and the result may be falsely normal. Step 3 – If drawn before 24 hours: The test must be REPEATED after the baby is at least 24 hours old. Step 4 – Why not 7 days or later? Early detection allows treatment BEFORE irreversible intellectual disability or organ damage occurs — delay defeats the purpose of screening. Step 5 – Nurse's role: Inform parents, obtain consent, collect the sample correctly on filter paper, and ensure follow-up for results.

Answer: B. Less than 1,500 grams

Step 1 — Recall the weight classifications: Low Birth Weight (LBW) is under 2,500 g; Very Low Birth Weight (VLBW) is under 1,500 g; and Extremely Low Birth Weight (ELBW) is under 1,000 g. Step 2 — The question asks specifically about VLBW, which is the middle category. Step 3 — Option A (under 1,000 g) describes ELBW, not VLBW. Option C (under 2,000 g) is not a standard classification. Option D (under 2,500 g) describes LBW, the broadest category. Step 4 — Therefore, VLBW is correctly defined as a birth weight of less than 1,500 grams.

Answer: B. Deficiency of surfactant

Step 1 — Surfactant is a phospholipid produced by Type II pneumocytes in the fetal lung. It reduces surface tension in the alveoli, preventing them from collapsing after each breath. Step 2 — Preterm infants are born before adequate surfactant production is complete (approximately 34–35 weeks). Step 3 — Without enough surfactant, alveoli collapse at end-expiration (atelectasis), causing the infant to work very hard to breathe with each breath — leading to the classic signs of RDS. Step 4 — Option A describes TTN (retained fetal fluid). Option C describes a cause of neonatal sepsis. Option D is meconium aspiration syndrome — a different condition. Step 5 — The definitive cause of RDS is surfactant deficiency.