Neonatal RDS occurs when surfactant deficiency causes alveolar collapse, decreased lung compliance, ventilation-perfusion mismatch, hypoxemia, and increased work of breathing. The infant may develop tachypnea, nasal flaring, grunting, retractions, cyanosis, and rising oxygen needs. RDS often presents early after birth; one consensus description defines neonatal RDS as respiratory distress within the first 6 hours of life with supportive radiographic features such as low lung volumes, reticulogranular pattern, and air bronchograms. When alveoli collapse repeatedly, the infant must reopen them with each breath. This repetitive opening and closing increases fatigue and can worsen lung injury. If escalating oxygen and pressure are required, the infant is at risk for complications such as pneumothorax, pulmonary interstitial emphysema, bronchopulmonary dysplasia, and prolonged mechanical ventilation. Exogenous surfactant replaces or supplements the missing surfactant. It lowers surface tension, improves alveolar recruitment, increases lung compliance, improves gas exchange, and reduces the risk of air leak and mortality in RDS. For NCLEX-RN (Canada), items rarely announce the topic in the first sentence. Anchor to objective data, trajectory, and the safest next step for the role named in the...