NRP EXAM QUESTIONS AND ANSWERS
Version A+ Guaranteed EXAM with
Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Overview and Principles of Neonatal Resuscitation
2. Preparation for Resuscitation
3. Initial Steps of Newborn Care
4. Use of Resuscitation Devices for Positive-Pressure Ventilation
5. Alternative Airways (Endotracheal Tube and Laryngeal Mask)
6. Chest Compressions
7. Medications in Neonatal Resuscitation
8. Resuscitation of the Preterm Newborn
9. Special Considerations and Ethics
1. A neonate is born at 34 weeks gestation via emergency cesarean section due to fetal distress.
Upon delivery, the infant is apneic and limp. After initial steps, heart rate is 50 bpm. Which of
the following is the most appropriate next intervention?
A. Administer a bolus of normal saline.
B. Begin chest compressions coordinated with positive-pressure ventilation (PPV).
, C. Immediately intubate and administer epinephrine.
D. Increase the oxygen concentration to 100%.
CORRECT ANSWER : B
Rationale: In neonatal resuscitation, if the heart rate remains below 60 bpm after at least 30
seconds of PPV through an alternative airway, chest compressions are indicated. Saline (A) is
for suspected hypovolemia, and epinephrine (C) is indicated only if HR remains <60 bpm after
coordinated CPR and ventilation. Increasing oxygen (D) is not the priority over mechanical
support.
2. During resuscitation, you are using a T-piece resuscitator. You note that the chest is not moving
and the oxygen saturation is not rising despite appropriate head positioning. What is the most
immediate action?
A. Increase the peak inspiratory pressure (PIP) to 40 cm H2O.
B. Perform the MR. SOPA corrective steps to ensure an effective seal and airway.
C. Immediately place an endotracheal tube.
D. Start chest compressions.
CORRECT ANSWER : B
Rationale: Before escalating to an advanced airway or compressions, the nurse must ensure the
current ventilation method is effective using the MR. SOPA sequence (Mask adjustment,
Reposition airway, Suction, Open mouth, Pressure increase, Alternative airway). Increasing
pressure (A) without troubleshooting the seal risks pneumothorax, and invasive procedures (C)
are not immediate priorities.
3. A term newborn has a heart rate of 80 bpm after 30 seconds of effective PPV. Which of the
following is the next best step?
A. Begin chest compressions.
B. Check for signs of effective ventilation (MR. SOPA) and continue PPV.
C. Administer epinephrine via the umbilical vein.
D. Terminate resuscitation efforts.
CORRECT ANSWER : B
, Rationale: If the heart rate is between 60 and 100 bpm, the priority is to ensure that ventilation
is being delivered effectively. Chest compressions are only required when the heart rate remains
below 60 bpm after effective ventilation. Epinephrine is not indicated unless the heart rate is
below 60 after adequate ventilation and compressions.
4. You are preparing for the delivery of a newborn with known gastroschisis. Which of the
following is a priority during the initial stabilization?
A. Immediately place the infant in a prone position.
B. Place the infant in a sterile bowel bag up to the axilla to minimize heat and fluid loss.
C. Attempt to reduce the bowel into the abdominal cavity manually.
D. Delay all resuscitation efforts until the surgeon arrives.
CORRECT ANSWER : B
Rationale: Gastroschisis results in exposed viscera, leading to significant heat and fluid loss. A
sterile bowel bag is the standard of care to protect the organs and maintain thermoregulation.
Reducing the bowel (C) can cause ischemia, and resuscitation (D) must proceed regardless of
surgical arrival.
5. A neonate requires epinephrine after a prolonged resuscitation. What is the recommended route
and dosage for intravenous administration?
A. 0.1 mg/kg; umbilical artery.
B. 0.01 to 0.03 mg/kg; umbilical vein.
C. 0.05 mg/kg; endotracheal tube.
D. 0.1 mg/kg; intramuscular.
CORRECT ANSWER : B
Rationale: The recommended intravenous dose for neonatal epinephrine is 0.01 to 0.03 mg/kg.
The umbilical vein is the preferred route for rapid access. Higher doses (A) are potentially
harmful, and endotracheal dosing (C) is generally discouraged due to unpredictable absorption.
6. Which finding is the most reliable indicator of effective chest compressions?
A. A palpable brachial pulse.
B. An increase in the infant’s heart rate toward 100 bpm.
, C. A visible chest rise with each compression.
D. An improvement in peripheral perfusion (capillary refill).
CORRECT ANSWER : B
Rationale: The primary goal of chest compressions is to provide cardiac output and coronary
perfusion; an increasing heart rate is the most objective clinical sign that this goal is being met.
Pulses (A) are often unreliable in neonates, and chest rise (C) is a sign of ventilation, not
compression efficacy.
7. A newborn at 28 weeks gestation is delivered. What is the most appropriate oxygen
concentration to initiate PPV?
A. 100%
B. 21% to 30%
C. 50%
D. 100% with high-flow CPAP.
CORRECT ANSWER : B
Rationale: Current neonatal resuscitation guidelines recommend starting with low oxygen
concentrations (21% for term, 21-30% for preterm) to avoid hyperoxia. High concentrations (A,
C, D) can lead to oxidative stress in the premature lung.
8. When coordinating chest compressions and ventilation, what is the correct ratio of events per
minute?
A. 1 compression to 3 ventilations.
B. 3 compressions to 1 ventilation (90 compressions and 30 breaths per minute).
C. 15 compressions to 2 ventilations.
D. Continuous compressions with asynchronous ventilation.
CORRECT ANSWER : B
Rationale: The standard ratio is 3:1 to ensure that both cardiac and respiratory support are
provided adequately, resulting in 120 total events per minute. Other ratios (A, C, D) are either
inefficient for neonatal physiology or represent adult resuscitation protocols.
Version A+ Guaranteed EXAM with
Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Overview and Principles of Neonatal Resuscitation
2. Preparation for Resuscitation
3. Initial Steps of Newborn Care
4. Use of Resuscitation Devices for Positive-Pressure Ventilation
5. Alternative Airways (Endotracheal Tube and Laryngeal Mask)
6. Chest Compressions
7. Medications in Neonatal Resuscitation
8. Resuscitation of the Preterm Newborn
9. Special Considerations and Ethics
1. A neonate is born at 34 weeks gestation via emergency cesarean section due to fetal distress.
Upon delivery, the infant is apneic and limp. After initial steps, heart rate is 50 bpm. Which of
the following is the most appropriate next intervention?
A. Administer a bolus of normal saline.
B. Begin chest compressions coordinated with positive-pressure ventilation (PPV).
, C. Immediately intubate and administer epinephrine.
D. Increase the oxygen concentration to 100%.
CORRECT ANSWER : B
Rationale: In neonatal resuscitation, if the heart rate remains below 60 bpm after at least 30
seconds of PPV through an alternative airway, chest compressions are indicated. Saline (A) is
for suspected hypovolemia, and epinephrine (C) is indicated only if HR remains <60 bpm after
coordinated CPR and ventilation. Increasing oxygen (D) is not the priority over mechanical
support.
2. During resuscitation, you are using a T-piece resuscitator. You note that the chest is not moving
and the oxygen saturation is not rising despite appropriate head positioning. What is the most
immediate action?
A. Increase the peak inspiratory pressure (PIP) to 40 cm H2O.
B. Perform the MR. SOPA corrective steps to ensure an effective seal and airway.
C. Immediately place an endotracheal tube.
D. Start chest compressions.
CORRECT ANSWER : B
Rationale: Before escalating to an advanced airway or compressions, the nurse must ensure the
current ventilation method is effective using the MR. SOPA sequence (Mask adjustment,
Reposition airway, Suction, Open mouth, Pressure increase, Alternative airway). Increasing
pressure (A) without troubleshooting the seal risks pneumothorax, and invasive procedures (C)
are not immediate priorities.
3. A term newborn has a heart rate of 80 bpm after 30 seconds of effective PPV. Which of the
following is the next best step?
A. Begin chest compressions.
B. Check for signs of effective ventilation (MR. SOPA) and continue PPV.
C. Administer epinephrine via the umbilical vein.
D. Terminate resuscitation efforts.
CORRECT ANSWER : B
, Rationale: If the heart rate is between 60 and 100 bpm, the priority is to ensure that ventilation
is being delivered effectively. Chest compressions are only required when the heart rate remains
below 60 bpm after effective ventilation. Epinephrine is not indicated unless the heart rate is
below 60 after adequate ventilation and compressions.
4. You are preparing for the delivery of a newborn with known gastroschisis. Which of the
following is a priority during the initial stabilization?
A. Immediately place the infant in a prone position.
B. Place the infant in a sterile bowel bag up to the axilla to minimize heat and fluid loss.
C. Attempt to reduce the bowel into the abdominal cavity manually.
D. Delay all resuscitation efforts until the surgeon arrives.
CORRECT ANSWER : B
Rationale: Gastroschisis results in exposed viscera, leading to significant heat and fluid loss. A
sterile bowel bag is the standard of care to protect the organs and maintain thermoregulation.
Reducing the bowel (C) can cause ischemia, and resuscitation (D) must proceed regardless of
surgical arrival.
5. A neonate requires epinephrine after a prolonged resuscitation. What is the recommended route
and dosage for intravenous administration?
A. 0.1 mg/kg; umbilical artery.
B. 0.01 to 0.03 mg/kg; umbilical vein.
C. 0.05 mg/kg; endotracheal tube.
D. 0.1 mg/kg; intramuscular.
CORRECT ANSWER : B
Rationale: The recommended intravenous dose for neonatal epinephrine is 0.01 to 0.03 mg/kg.
The umbilical vein is the preferred route for rapid access. Higher doses (A) are potentially
harmful, and endotracheal dosing (C) is generally discouraged due to unpredictable absorption.
6. Which finding is the most reliable indicator of effective chest compressions?
A. A palpable brachial pulse.
B. An increase in the infant’s heart rate toward 100 bpm.
, C. A visible chest rise with each compression.
D. An improvement in peripheral perfusion (capillary refill).
CORRECT ANSWER : B
Rationale: The primary goal of chest compressions is to provide cardiac output and coronary
perfusion; an increasing heart rate is the most objective clinical sign that this goal is being met.
Pulses (A) are often unreliable in neonates, and chest rise (C) is a sign of ventilation, not
compression efficacy.
7. A newborn at 28 weeks gestation is delivered. What is the most appropriate oxygen
concentration to initiate PPV?
A. 100%
B. 21% to 30%
C. 50%
D. 100% with high-flow CPAP.
CORRECT ANSWER : B
Rationale: Current neonatal resuscitation guidelines recommend starting with low oxygen
concentrations (21% for term, 21-30% for preterm) to avoid hyperoxia. High concentrations (A,
C, D) can lead to oxidative stress in the premature lung.
8. When coordinating chest compressions and ventilation, what is the correct ratio of events per
minute?
A. 1 compression to 3 ventilations.
B. 3 compressions to 1 ventilation (90 compressions and 30 breaths per minute).
C. 15 compressions to 2 ventilations.
D. Continuous compressions with asynchronous ventilation.
CORRECT ANSWER : B
Rationale: The standard ratio is 3:1 to ensure that both cardiac and respiratory support are
provided adequately, resulting in 120 total events per minute. Other ratios (A, C, D) are either
inefficient for neonatal physiology or represent adult resuscitation protocols.
