1
NPS Exam Review Actual Exam 2026/2027 |
Neonatal Pediatric Specialist Practice Questions
with Complete Solutions | NBRC Blueprint
Aligned | Pass Guaranteed - A+ Graded
SECTION 1: PATIENT DATA EVALUATION & ASSESSMENT (35 Questions)
Q1: A newborn is assessed at 1 minute after birth. Heart rate 110, respiratory effort good with
strong cry, muscle tone active motion, reflexes cry with stimulation, skin color pink with
acrocyanosis. What is the Apgar score?
A. 7
B. 8
C. 9
D. 10
Correct Answer: C. [CORRECT]
Rationale: Apgar scoring assigns 2 points for heart rate >100 bpm, 2 points for strong cry/good
respiratory effort, 2 points for active motion, 2 points for vigorous cry with stimulation, and 1
point for pink color with acrocyanosis. Total = 9. Perfect score requires completely pink skin.
Q2: A 28-week gestational age infant is born. Using the Ballard Score, which neuromuscular
finding would be expected?
A. Square window angle of 0 degrees
B. Arm recoil with immediate flexion
C. Popliteal angle of 180 degrees
D. Scarf sign with elbow crossing midline
Correct Answer: C. [CORRECT]
Rationale: Preterm infants <30 weeks demonstrate neuromuscular immaturity including
popliteal angle of 180 degrees (full extension), absent square window, minimal arm recoil, and
scarf sign with elbow easily passing beyond midline. These findings reflect hypotonia and
incomplete neuromuscular development.
,2
Q3: A 5-year-old child presents with respiratory distress. Which vital sign parameter is
ABNORMAL for this age?
A. Respiratory rate 24 breaths/min
B. Heart rate 100 bpm
C. Blood pressure 90/60 mmHg
D. Temperature 37.2°C
Correct Answer: A. [CORRECT]
Rationale: Normal respiratory rate for a 5-year-old is 20-25 breaths/min at rest. Rates >30
indicate tachypnea. Normal heart rate for this age is 75-120 bpm, blood pressure approximately
90-110/55-75 mmHg, and temperature 36.5-37.5°C. The respiratory rate of 24 is actually within
normal limits for this age (normal range 20-25), making this the borderline but acceptable
parameter. [Note: If rate were 30+, it would be abnormal]
Q4: An arterial blood gas is obtained from a 2-day-old term infant: pH 7.32, PaCO2 55 mmHg,
PaCO2 50 mmHg, HCO3 26 mEq/L, BE +1. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B. [CORRECT]
Rationale: The pH of 7.32 indicates acidemia. The elevated PaCO2 of 55 mmHg with normal
HCO3 and minimal base excess indicates uncompensated respiratory acidosis. This pattern is
common in neonates with transient tachypnea or mild respiratory distress.
Q5: A 3-year-old with severe asthma has ABG: pH 7.25, PaCO2 60 mmHg, PaO2 55 mmHg,
HCO3 24 mEq/L. What is the interpretation?
A. Acute respiratory alkalosis with hypoxemia
B. Acute respiratory acidosis with hypoxemia
C. Metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B. [CORRECT]
Rationale: pH <7.35 indicates acidosis, PaCO2 >45 mmHg confirms respiratory component,
normal HCO3 indicates acute uncompensated state, and PaO2 <60 mmHg defines hypoxemia.
This represents acute respiratory acidosis with hypoxemia, indicating severe asthma with
respiratory muscle fatigue and impending respiratory failure.
,3
Q6: A premature infant has the following chest radiograph findings: diffuse reticulogranular
pattern, air bronchograms, and low lung volumes. What is the diagnosis?
A. Meconium aspiration syndrome
B. Transient tachypnea of the newborn
C. Respiratory distress syndrome
D. Neonatal pneumonia
Correct Answer: C. [CORRECT]
Rationale: The classic triad of diffuse reticulogranular (ground-glass) appearance, air
bronchograms, and low lung volumes is pathognomonic for respiratory distress syndrome (RDS)
caused by surfactant deficiency. These findings result from diffuse microatelectasis and fluid-
filled alveoli.
Q7: Which breath sound description indicates consolidation in the right lower lobe of a pediatric
patient?
A. High-pitched musical sounds on expiration
B. Decreased breath sounds with hyperresonance to percussion
C. Bronchial breath sounds with increased tactile fremitus
D. Late inspiratory crackles that change with cough
Correct Answer: C. [CORRECT]
Rationale: Bronchial breath sounds (tubular, hollow quality) over peripheral lung fields
combined with increased tactile fremitus indicates lung consolidation. Air-filled lung normally
filters breath sounds; consolidation transmits sounds directly from bronchi to chest wall. This
distinguishes pneumonia from effusion (decreased fremitus) or obstruction.
Q8: A 6-month-old infant has the following pulse oximetry readings: preductal SpO2 95%,
postductal SpO2 82%. What condition does this differential cyanosis suggest?
A. Coarctation of the aorta
B. Persistent pulmonary hypertension of the newborn
C. Tetralogy of Fallot
D. Ventricular septal defect
Correct Answer: B. [CORRECT]
Rationale: Preductal SpO2 > postductal SpO2 by >10% indicates right-to-left shunting at the
ductus arteriosus level, characteristic of persistent pulmonary hypertension (PPHN).
, 4
Deoxygenated blood shunts from pulmonary artery through patent ductus to descending aorta.
This pattern requires immediate intervention for pulmonary vasodilation.
Q9: Capnography monitoring shows an EtCO2 of 25 mmHg in a ventilated neonate. Which
condition is most likely?
A. Hypoventilation
B. Hyperventilation
C. Pulmonary embolism
D. Cardiac arrest
Correct Answer: B. [CORRECT]
Rationale: EtCO2 of 25 mmHg is below normal (35-45 mmHg), indicating hypocapnia from
hyperventilation. This may cause cerebral vasoconstriction and reduced cerebral blood flow in
neonates. The gradient between PaCO2 and EtCO2 should be monitored; an increased gradient
suggests dead space ventilation or pulmonary embolism.
Q10: Which laboratory finding is most consistent with sepsis in a neonate?
A. WBC 25,000/mm³ with 30% neutrophils, 5% bands
B. WBC 8,000/mm³ with 80% neutrophils, 15% bands
C. Platelet count 250,000/mm³
D. CRP <0.5 mg/L
Correct Answer: B. [CORRECT]
Rationale: Neonatal sepsis often presents with normal or low WBC count with left shift (high
neutrophil percentage and increased band forms). Total WBC may be normal (8,000) but the
95% total neutrophil count with 15% bands indicates severe left shift and depletion of storage
pool. Thrombocytopenia (<100,000) and elevated CRP also support sepsis.
Q11: A pulmonary function test in a 10-year-old with cystic fibrosis shows FEV1/FVC ratio of
65%, FEV1 70% predicted, and FVC 85% predicted. What pattern is present?
A. Restrictive defect
B. Obstructive defect
C. Mixed defect
D. Normal spirometry
Correct Answer: B. [CORRECT]
Rationale: FEV1/FVC ratio <70% indicates airflow obstruction. The disproportionate reduction
NPS Exam Review Actual Exam 2026/2027 |
Neonatal Pediatric Specialist Practice Questions
with Complete Solutions | NBRC Blueprint
Aligned | Pass Guaranteed - A+ Graded
SECTION 1: PATIENT DATA EVALUATION & ASSESSMENT (35 Questions)
Q1: A newborn is assessed at 1 minute after birth. Heart rate 110, respiratory effort good with
strong cry, muscle tone active motion, reflexes cry with stimulation, skin color pink with
acrocyanosis. What is the Apgar score?
A. 7
B. 8
C. 9
D. 10
Correct Answer: C. [CORRECT]
Rationale: Apgar scoring assigns 2 points for heart rate >100 bpm, 2 points for strong cry/good
respiratory effort, 2 points for active motion, 2 points for vigorous cry with stimulation, and 1
point for pink color with acrocyanosis. Total = 9. Perfect score requires completely pink skin.
Q2: A 28-week gestational age infant is born. Using the Ballard Score, which neuromuscular
finding would be expected?
A. Square window angle of 0 degrees
B. Arm recoil with immediate flexion
C. Popliteal angle of 180 degrees
D. Scarf sign with elbow crossing midline
Correct Answer: C. [CORRECT]
Rationale: Preterm infants <30 weeks demonstrate neuromuscular immaturity including
popliteal angle of 180 degrees (full extension), absent square window, minimal arm recoil, and
scarf sign with elbow easily passing beyond midline. These findings reflect hypotonia and
incomplete neuromuscular development.
,2
Q3: A 5-year-old child presents with respiratory distress. Which vital sign parameter is
ABNORMAL for this age?
A. Respiratory rate 24 breaths/min
B. Heart rate 100 bpm
C. Blood pressure 90/60 mmHg
D. Temperature 37.2°C
Correct Answer: A. [CORRECT]
Rationale: Normal respiratory rate for a 5-year-old is 20-25 breaths/min at rest. Rates >30
indicate tachypnea. Normal heart rate for this age is 75-120 bpm, blood pressure approximately
90-110/55-75 mmHg, and temperature 36.5-37.5°C. The respiratory rate of 24 is actually within
normal limits for this age (normal range 20-25), making this the borderline but acceptable
parameter. [Note: If rate were 30+, it would be abnormal]
Q4: An arterial blood gas is obtained from a 2-day-old term infant: pH 7.32, PaCO2 55 mmHg,
PaCO2 50 mmHg, HCO3 26 mEq/L, BE +1. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Correct Answer: B. [CORRECT]
Rationale: The pH of 7.32 indicates acidemia. The elevated PaCO2 of 55 mmHg with normal
HCO3 and minimal base excess indicates uncompensated respiratory acidosis. This pattern is
common in neonates with transient tachypnea or mild respiratory distress.
Q5: A 3-year-old with severe asthma has ABG: pH 7.25, PaCO2 60 mmHg, PaO2 55 mmHg,
HCO3 24 mEq/L. What is the interpretation?
A. Acute respiratory alkalosis with hypoxemia
B. Acute respiratory acidosis with hypoxemia
C. Metabolic acidosis with respiratory compensation
D. Mixed respiratory and metabolic acidosis
Correct Answer: B. [CORRECT]
Rationale: pH <7.35 indicates acidosis, PaCO2 >45 mmHg confirms respiratory component,
normal HCO3 indicates acute uncompensated state, and PaO2 <60 mmHg defines hypoxemia.
This represents acute respiratory acidosis with hypoxemia, indicating severe asthma with
respiratory muscle fatigue and impending respiratory failure.
,3
Q6: A premature infant has the following chest radiograph findings: diffuse reticulogranular
pattern, air bronchograms, and low lung volumes. What is the diagnosis?
A. Meconium aspiration syndrome
B. Transient tachypnea of the newborn
C. Respiratory distress syndrome
D. Neonatal pneumonia
Correct Answer: C. [CORRECT]
Rationale: The classic triad of diffuse reticulogranular (ground-glass) appearance, air
bronchograms, and low lung volumes is pathognomonic for respiratory distress syndrome (RDS)
caused by surfactant deficiency. These findings result from diffuse microatelectasis and fluid-
filled alveoli.
Q7: Which breath sound description indicates consolidation in the right lower lobe of a pediatric
patient?
A. High-pitched musical sounds on expiration
B. Decreased breath sounds with hyperresonance to percussion
C. Bronchial breath sounds with increased tactile fremitus
D. Late inspiratory crackles that change with cough
Correct Answer: C. [CORRECT]
Rationale: Bronchial breath sounds (tubular, hollow quality) over peripheral lung fields
combined with increased tactile fremitus indicates lung consolidation. Air-filled lung normally
filters breath sounds; consolidation transmits sounds directly from bronchi to chest wall. This
distinguishes pneumonia from effusion (decreased fremitus) or obstruction.
Q8: A 6-month-old infant has the following pulse oximetry readings: preductal SpO2 95%,
postductal SpO2 82%. What condition does this differential cyanosis suggest?
A. Coarctation of the aorta
B. Persistent pulmonary hypertension of the newborn
C. Tetralogy of Fallot
D. Ventricular septal defect
Correct Answer: B. [CORRECT]
Rationale: Preductal SpO2 > postductal SpO2 by >10% indicates right-to-left shunting at the
ductus arteriosus level, characteristic of persistent pulmonary hypertension (PPHN).
, 4
Deoxygenated blood shunts from pulmonary artery through patent ductus to descending aorta.
This pattern requires immediate intervention for pulmonary vasodilation.
Q9: Capnography monitoring shows an EtCO2 of 25 mmHg in a ventilated neonate. Which
condition is most likely?
A. Hypoventilation
B. Hyperventilation
C. Pulmonary embolism
D. Cardiac arrest
Correct Answer: B. [CORRECT]
Rationale: EtCO2 of 25 mmHg is below normal (35-45 mmHg), indicating hypocapnia from
hyperventilation. This may cause cerebral vasoconstriction and reduced cerebral blood flow in
neonates. The gradient between PaCO2 and EtCO2 should be monitored; an increased gradient
suggests dead space ventilation or pulmonary embolism.
Q10: Which laboratory finding is most consistent with sepsis in a neonate?
A. WBC 25,000/mm³ with 30% neutrophils, 5% bands
B. WBC 8,000/mm³ with 80% neutrophils, 15% bands
C. Platelet count 250,000/mm³
D. CRP <0.5 mg/L
Correct Answer: B. [CORRECT]
Rationale: Neonatal sepsis often presents with normal or low WBC count with left shift (high
neutrophil percentage and increased band forms). Total WBC may be normal (8,000) but the
95% total neutrophil count with 15% bands indicates severe left shift and depletion of storage
pool. Thrombocytopenia (<100,000) and elevated CRP also support sepsis.
Q11: A pulmonary function test in a 10-year-old with cystic fibrosis shows FEV1/FVC ratio of
65%, FEV1 70% predicted, and FVC 85% predicted. What pattern is present?
A. Restrictive defect
B. Obstructive defect
C. Mixed defect
D. Normal spirometry
Correct Answer: B. [CORRECT]
Rationale: FEV1/FVC ratio <70% indicates airflow obstruction. The disproportionate reduction
