Barkley Neonatal Nurse Practitioner
(NNP) Certification Review 2026/2027:
Complete 250-Q Practice Test Bank with
Verified Answers & Detailed Rationales |
NCC-Aligned | 100% Pass Guarantee
SECTION 1: GENERAL ASSESSMENT & NEONATAL PHYSICAL EXAM (Questions 1-45)
Question 1
A new parent asks the nurse why the 36-hour-old newborn has a yellow skin tint. What
should the nurse explain to the parent?
A) The newborn's liver is not functioning as well as it should
B) The yellow color indicates possible brain damage
C) The infant's bowels are not excreting bilirubin
D) The color is a sign of physiologic jaundice, a normal finding
Correct Answer: D
Rationale: Physiologic jaundice typically appears between 24-72 hours of life as a result
of normal neonatal hyperbilirubinemia. The newborn's immature liver leads to a
temporary elevation of unconjugated bilirubin. This is a normal, self-limiting process in
most healthy term newborns.
Question 2
At birth, a newborn weighed 6 pounds, 12 ounces. Three days later, the newborn weighs
5 pounds, 10 ounces. What conclusion should the nurse draw regarding this newborn's
weight?
A) This weight loss is within normal limits
B) This weight gain is within normal limits
C) This weight loss is excessive
D) This weight gain is excessive
,Correct Answer: C
Rationale: A 5-7% weight loss is considered normal for breastfed infants (up to 10% for
some). This represents a loss of over 1 pound (approximately 16-17% of birth weight),
which is excessive. This significant weight loss warrants evaluation of feeding adequacy,
hydration status, and potential underlying pathology.
Question 3
The nurse is completing an initial assessment of the newborn. The newborn's ears
appear to be parallel to the outer and inner canthus of the eye. How does the nurse
document the ear placement?
A) Low set
B) High set
C) A normal position
D) Facial paralysis
Correct Answer: C
Rationale: Normal ear placement is when the top of the pinna aligns with the outer
canthus of the eye. Low-set ears may be associated with genetic syndromes or renal
anomalies. Documentation of normal ear placement is important for establishing a
baseline.
Question 4
A new parent is concerned about a mass on the newborn's head. The nurse assesses this
to be a cephalohematoma based on what characteristic?
A) The mass just appeared
B) The mass is on one side of the head and does not cross suture lines
C) The head is boggy and crosses suture lines
D) The mass increases when the infant cries
Correct Answer: B
Rationale: Cephalohematoma is a subperiosteal collection of blood that does not cross
suture lines. It typically appears 24-48 hours after birth and resolves over weeks to
,months. A mass that crosses suture lines is consistent with caput succedaneum, which is
subcutaneous edema.
Question 5
What condition can result from a long, difficult labor and is characterized by a localized,
soft area on the newborn's head?
A) Caput succedaneum
B) Molding
C) Depressed fontanelles
D) Cephalohematoma
Correct Answer: A
Rationale: Caput succedaneum is a localized, soft, edematous swelling of the scalp that
crosses suture lines and is present at birth. It is caused by pressure during labor and
typically resolves within 24-48 hours. Cephalohematoma, in contrast, is subperiosteal
and appears hours after birth.
Question 6
During an assessment of a 12-hour-old newborn, the nurse notices pale pink spots on
the nape of the neck. How does the nurse document this finding?
A) Nevus vasculosus
B) Mongolian spots
C) Nevus flammeus
D) Telangiectatic nevi
Correct Answer: D
Rationale: Telangiectatic nevi (also called "stork bites" or "angel kisses") are pale pink to
red, flat, vascular birthmarks commonly found on the nape of the neck, eyelids, and
glabella. They are benign and typically fade with age.
, Question 7
How would the nurse elicit a rooting reflex in a newborn?
A) Gently rub a finger on the side of the newborn's cheek
B) Put a finger into the palm of the newborn's hand and wait for them to grab on
C) Put a gloved finger into the newborn's mouth and stimulate the roof
D) Grab both arms, pulling upward, and let them go, watching for a startle response
bilaterally
Correct Answer: A
Rationale: The rooting reflex is elicited by stroking the side of the newborn's cheek. The
infant will turn their head toward the stimulus with an open mouth. This reflex aids in
breastfeeding and is present at birth.
Question 8
The nurse notices that a 6-hour-old newborn patient's urethral opening is on the dorsal
side of the penis. The nurse knows that this is called what?
A) Hypospadias
B) Epispadias
C) Phimosis
D) Unispadias
Correct Answer: B
Rationale: Epispadias is a congenital anomaly where the urethral opening is located on
the dorsal (upper) surface of the penis. Hypospadias is when the opening is on the
ventral (lower) surface. Epispadias is often associated with bladder exstrophy.
Question 9
The nurse is completing a gestational assessment on a newborn whose parent was
treated for preeclampsia during labor. The neonate is demonstrating "frog-like"
posturing. The nurse knows this is likely due to what medication during labor?
A) Fentanyl in the epidural
B) Penicillin for treatment of group B strep infection
(NNP) Certification Review 2026/2027:
Complete 250-Q Practice Test Bank with
Verified Answers & Detailed Rationales |
NCC-Aligned | 100% Pass Guarantee
SECTION 1: GENERAL ASSESSMENT & NEONATAL PHYSICAL EXAM (Questions 1-45)
Question 1
A new parent asks the nurse why the 36-hour-old newborn has a yellow skin tint. What
should the nurse explain to the parent?
A) The newborn's liver is not functioning as well as it should
B) The yellow color indicates possible brain damage
C) The infant's bowels are not excreting bilirubin
D) The color is a sign of physiologic jaundice, a normal finding
Correct Answer: D
Rationale: Physiologic jaundice typically appears between 24-72 hours of life as a result
of normal neonatal hyperbilirubinemia. The newborn's immature liver leads to a
temporary elevation of unconjugated bilirubin. This is a normal, self-limiting process in
most healthy term newborns.
Question 2
At birth, a newborn weighed 6 pounds, 12 ounces. Three days later, the newborn weighs
5 pounds, 10 ounces. What conclusion should the nurse draw regarding this newborn's
weight?
A) This weight loss is within normal limits
B) This weight gain is within normal limits
C) This weight loss is excessive
D) This weight gain is excessive
,Correct Answer: C
Rationale: A 5-7% weight loss is considered normal for breastfed infants (up to 10% for
some). This represents a loss of over 1 pound (approximately 16-17% of birth weight),
which is excessive. This significant weight loss warrants evaluation of feeding adequacy,
hydration status, and potential underlying pathology.
Question 3
The nurse is completing an initial assessment of the newborn. The newborn's ears
appear to be parallel to the outer and inner canthus of the eye. How does the nurse
document the ear placement?
A) Low set
B) High set
C) A normal position
D) Facial paralysis
Correct Answer: C
Rationale: Normal ear placement is when the top of the pinna aligns with the outer
canthus of the eye. Low-set ears may be associated with genetic syndromes or renal
anomalies. Documentation of normal ear placement is important for establishing a
baseline.
Question 4
A new parent is concerned about a mass on the newborn's head. The nurse assesses this
to be a cephalohematoma based on what characteristic?
A) The mass just appeared
B) The mass is on one side of the head and does not cross suture lines
C) The head is boggy and crosses suture lines
D) The mass increases when the infant cries
Correct Answer: B
Rationale: Cephalohematoma is a subperiosteal collection of blood that does not cross
suture lines. It typically appears 24-48 hours after birth and resolves over weeks to
,months. A mass that crosses suture lines is consistent with caput succedaneum, which is
subcutaneous edema.
Question 5
What condition can result from a long, difficult labor and is characterized by a localized,
soft area on the newborn's head?
A) Caput succedaneum
B) Molding
C) Depressed fontanelles
D) Cephalohematoma
Correct Answer: A
Rationale: Caput succedaneum is a localized, soft, edematous swelling of the scalp that
crosses suture lines and is present at birth. It is caused by pressure during labor and
typically resolves within 24-48 hours. Cephalohematoma, in contrast, is subperiosteal
and appears hours after birth.
Question 6
During an assessment of a 12-hour-old newborn, the nurse notices pale pink spots on
the nape of the neck. How does the nurse document this finding?
A) Nevus vasculosus
B) Mongolian spots
C) Nevus flammeus
D) Telangiectatic nevi
Correct Answer: D
Rationale: Telangiectatic nevi (also called "stork bites" or "angel kisses") are pale pink to
red, flat, vascular birthmarks commonly found on the nape of the neck, eyelids, and
glabella. They are benign and typically fade with age.
, Question 7
How would the nurse elicit a rooting reflex in a newborn?
A) Gently rub a finger on the side of the newborn's cheek
B) Put a finger into the palm of the newborn's hand and wait for them to grab on
C) Put a gloved finger into the newborn's mouth and stimulate the roof
D) Grab both arms, pulling upward, and let them go, watching for a startle response
bilaterally
Correct Answer: A
Rationale: The rooting reflex is elicited by stroking the side of the newborn's cheek. The
infant will turn their head toward the stimulus with an open mouth. This reflex aids in
breastfeeding and is present at birth.
Question 8
The nurse notices that a 6-hour-old newborn patient's urethral opening is on the dorsal
side of the penis. The nurse knows that this is called what?
A) Hypospadias
B) Epispadias
C) Phimosis
D) Unispadias
Correct Answer: B
Rationale: Epispadias is a congenital anomaly where the urethral opening is located on
the dorsal (upper) surface of the penis. Hypospadias is when the opening is on the
ventral (lower) surface. Epispadias is often associated with bladder exstrophy.
Question 9
The nurse is completing a gestational assessment on a newborn whose parent was
treated for preeclampsia during labor. The neonate is demonstrating "frog-like"
posturing. The nurse knows this is likely due to what medication during labor?
A) Fentanyl in the epidural
B) Penicillin for treatment of group B strep infection
