High-Risk Pregnancy and Newborn Adaptation Practice Questions
23 free High-Risk Pregnancy and Newborn Adaptation practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A newborn born at 34 weeks’ gestation, one of the primary adaptation challenges is:
- A Fully mature surfactant production and stable lungs
- B Immature thermoregulation with risk of hypothermia
- C Over-stocked glycogen stores buffering against hypoglycemia
- D Well-coordinated sucking, swallowing, and breathing reflexes
Correct answer: Immature thermoregulation with risk of hypothermia
Preterm infants often have underdeveloped temperature regulation, making hypothermia a major adaptation challenge in newborns born at 34 weeks' gestation.
For a high-risk newborn, one of the first nursing priorities is to:
- A Delay all feeding for the first 48 hours of life
- B Promote parent-infant bonding in the incubator
- C Allow unlimited handling to maximize early stimulation
- D Forgo ambient temperature monitoring in the unit
Correct answer: Promote parent-infant bonding in the incubator
In high-risk newborn care, promoting parent-infant bonding even in NICU/incubator is important while maintaining physiologic stability.
During a high-risk pregnancy, the nurse knows that fetal surveillance with non-stress testing (NST) and biophysical profile helps to assess:
- A Only the mother's circulating glucose levels
- B Fetal well-being, including oxygenation and placental function
- C Only the mother's blood pressure and heart rate
- D The frequency of fetal bowel movements in utero
Correct answer: Fetal well-being, including oxygenation and placental function
Fetal surveillance with tests like NST and BPP in high-risk pregnancies assess fetal oxygenation and placental adequacy.
In high-risk newborn adaptation, the nurse recognises that thermoregulation is critical because:
- A Preterm infants carry an excess of insulating subcutaneous fat
- B Cold stress raises oxygen consumption, risking hypoxia and acidosis
- C Thermoregulation only becomes relevant after hospital discharge
- D Term infants reliably maintain a normal temperature on their own
Correct answer: Cold stress raises oxygen consumption, risking hypoxia and acidosis
Cold stress in newborns leads to increased oxygen demand and metabolic acidosis, highlighting the critical importance of thermoregulation.
Which maternal behavior is a modifiable risk factor for high-risk pregnancy that can influence newborn adaptation?
- A Age of 25 years
- B Smoking during pregnancy
- C Having one prior healthy infant
- D Balanced diet
Correct answer: Smoking during pregnancy
Maternal smoking is a modifiable risk factor that increases the risk of preterm birth, low birth weight, and neonatal adaptation issues.
A high-risk pregnancy involving twin gestation increases newborn adaptation issues because twins are at higher risk for:
- A Post-term delivery with macrosomia
- B Preterm birth, low birth weight and twin-to-twin transfusion
- C Higher-than-average birth weight from shared circulation
- D Delayed lung maturation with normal birth weight
Correct answer: Preterm birth, low birth weight and twin-to-twin transfusion
Twins are at increased risk of prematurity, low birth weight, and complications like twin-to-twin transfusion, affecting adaptation after birth.
What is one of the primary adaptation challenges faced by a newborn born at 34 weeks' gestation?
- A Mature surfactant production with stable breathing
- B Immature thermoregulation with risk of hypothermia
- C Over-stocked glycogen stores preventing hypoglycaemia
- D Strong coordination of sucking and swallowing
Correct answer: Immature thermoregulation with risk of hypothermia
Preterm infants often struggle with immature thermoregulation, leading to a risk of hypothermia.
What is the highest risk faced by a newborn born to a mother with gestational diabetes and weighs 4,500g?
- A Neonatal hypoglycaemia after birth
- B Hypothermia from inadequate fat stores
- C Early-onset sepsis from membrane rupture
- D Rapid maturation of all major organs
Correct answer: Neonatal hypoglycaemia after birth
Infants of diabetic mothers, especially large for gestational age, are prone to neonatal hypoglycaemia after birth.
What is one of the first nursing priorities for a high-risk newborn?
- A Delay feeding for the first 48 hours
- B Promote parent-infant bonding in the incubator
- C Allow unlimited handling to stimulate development
- D Maintain a cool environment to slow metabolism
Correct answer: Promote parent-infant bonding in the incubator
Supporting parent-infant bonding in the incubator environment is important for high-risk newborn care.
Which fetal risk is most directly associated with a pregnancy complicated by premature rupture of membranes (PROM) at 32 weeks?
- A Post-term birth with placental ageing
- B Respiratory distress syndrome from prematurity
- C Maternal-to-infant diabetes transmission
- D Macrosomia from excess fetal growth
Correct answer: Respiratory distress syndrome from prematurity
PROM leading to preterm delivery increases the risk of respiratory distress syndrome due to immature lungs.
What is an indicator of respiratory transition in a newborn?
- A Failure to breathe spontaneously after one minute
- B Pink mucous membranes, rate 60, minimal retractions
- C Absent reflexes with poor muscle tone at birth
- D Persistently closed ductus arteriosus at birth
Correct answer: Pink mucous membranes, rate 60, minimal retractions
Normal respiratory transition includes pink mucous membranes, appropriate respiratory rate, and minimal retractions.
Which maternal factor identifies a pregnancy as high risk and predisposes the newborn to adaptation issues?
- A Maternal age 28 with no chronic health conditions
- B Maternal pre-eclampsia with placental insufficiency
- C Well-balanced maternal vegetarian diet in pregnancy
- D Full-term pregnancy with uncomplicated spontaneous labour
Correct answer: Maternal pre-eclampsia with placental insufficiency
Pre-eclampsia causes placental insufficiency and fetal compromise, leading to a high-risk pregnancy and newborn adaptation issues.
What does periodic breathing in a preterm infant indicate?
- A A normal maturity pattern needing no follow-up
- B Immature respiratory control common in preterm infants
- C A reliable early sign of intracranial haemorrhage
- D A benign finding identical to true apnoea spells
Correct answer: Immature respiratory control common in preterm infants
Periodic breathing is a common sign of immature respiratory control in preterm infants, requiring monitoring.
What does fetal surveillance with non-stress testing (NST) and biophysical profile help to assess in high-risk pregnancies?
- A Maternal blood glucose control during pregnancy
- B Fetal well-being including oxygenation and placental function
- C Maternal blood pressure and cardiac output trends
- D Fetal bowel-movement frequency before delivery
Correct answer: Fetal well-being including oxygenation and placental function
NST and BPP monitor fetal well-being, including oxygenation and placental function in high-risk pregnancies.
Which intervention is important in caring for a newborn who is small for gestational age (SGA)?
- A Place in a cool crib to stimulate brown-fat metabolism
- B Monitor for hypoglycaemia, keep thermally neutral, feed adequately
- C Delay all feeding until 24 hours after birth
- D Restrict parental feeding to once every six hours
Correct answer: Monitor for hypoglycaemia, keep thermally neutral, feed adequately
Interventions for SGA infants focus on monitoring hypoglycaemia, maintaining thermal stability, and ensuring proper nutrition.
Why is thermoregulation critical in the adaptation of high-risk newborns?
- A Excess subcutaneous fat insulating preterm infants
- B Cold stress raises oxygen use, causing hypoxia and acidosis
- C Thermoregulation becomes relevant only after discharge
- D Term infants reliably self-maintain a normal temperature
Correct answer: Cold stress raises oxygen use, causing hypoxia and acidosis
Cold stress can lead to increased oxygen demand, hypoxia, and metabolic acidosis, especially in high-risk or premature infants.
What is one of the earliest signs of neonatal sepsis in a high-risk newborn?
- A Isolated tachycardia and tachypnoea without other signs
- B Temperature instability, lethargy and poor feeding
- C A late-onset rash appearing on the trunk
- D Excessive weight gain over the first days
Correct answer: Temperature instability, lethargy and poor feeding
Signs of sepsis in high-risk neonates may include hypothermia, lethargy, and feeding intolerance.
Which sign suggests neonatal hypoglycaemia in a newborn of a diabetic mother?
- A Blood glucose of 80 mg/dL at two hours of age
- B Jitteriness, irritability, lethargy and cyanosis early on
- C Hyperactivity with a vigorous high-pitched cry
- D A steady respiratory rate of 30 breaths per minute
Correct answer: Jitteriness, irritability, lethargy and cyanosis early on
Neonatal hypoglycaemia in infants of diabetic mothers may present with tremors, irritability, lethargy, and cyanosis.
Why does a high-risk pregnancy involving twin gestation increase newborn adaptation issues?
- A Post-term delivery with macrosomia
- B Preterm birth, low birth weight and twin-to-twin transfusion
- C Higher-than-average birth weight from shared circulation
- D Delayed lung maturation with normal birth weight
Correct answer: Preterm birth, low birth weight and twin-to-twin transfusion
Twins are at higher risk of preterm birth, low birth weight, and complications like twin-to-twin transfusion syndrome.
How should a high-risk newborn be assessed for adaptation in the cardiovascular system in the first hour of life?
- A Apical pulse alone, expecting it above 200 bpm
- B Capillary refill, heart rate, blood pressure and murmurs
- C Skin colour and peripheral pulses only, omitting rate
- D Respiratory effort alone, without circulatory checks
Correct answer: Capillary refill, heart rate, blood pressure and murmurs
Assessment of cardiovascular adaptation includes monitoring heart rate, capillary refill, blood pressure, and checking for murmurs.
Why does a newborn born at 28 weeks require assisted ventilation?
- A Excess surfactant flooding the immature alveoli
- B Insufficient surfactant causing respiratory distress syndrome
- C Fully developed diaphragmatic and intercostal control
- D Over-mature alveolar structure resisting expansion
Correct answer: Insufficient surfactant causing respiratory distress syndrome
Premature infants often lack sufficient surfactant, leading to respiratory distress syndrome (RDS) and the need for assisted ventilation.
What is an adaptation issue a baby born post-term (42 weeks) may face?
- A Over-abundant vernix coating the post-term skin
- B Placental insufficiency, meconium aspiration and hypoglycaemia
- C Immediately mature lung function at delivery
- D Reduced risk of birth asphyxia compared with term
Correct answer: Placental insufficiency, meconium aspiration and hypoglycaemia
Post-term infants are at risk of placental insufficiency, meconium aspiration, hypoglycaemia, and other adaptation issues.
What should be included in discharge education for a mother of a high-risk newborn?
- A Reassure that no follow-up is needed once discharged
- B Teach warning signs (hypoglycaemia, temperature, feeding, infection) and follow-up
- C Limit teaching to diapering and bathing technique only
- D Cover maternal recovery alone, omitting the infant's risks
Correct answer: Teach warning signs (hypoglycaemia, temperature, feeding, infection) and follow-up
Discharge education for high-risk newborns should cover key adaptation concerns and stress the importance of follow-up care.