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NPS Neonatal & Pediatric Respiratory Care Exam 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100% Latest
Already Graded A+
QUESTION 1
A 28-week gestational age infant in the NICU develops respiratory
distress syndrome. Which of the following surfactant replacement
strategies has been shown in large randomized controlled trials to most
significantly reduce the combined outcome of mortality or
bronchopulmonary dysplasia when administered early versus rescue?
A) Natural animal-derived surfactant administered within 15 minutes of
birth
B) Synthetic surfactant administered within 2 hours of life
C) Natural surfactant administered as rescue therapy at 12 hours of life
D) Prophylactic surfactant in all infants less than 30 weeks regardless of
respiratory status
Answer: A
Explanation: Early administration of natural animal-derived surfactant
(within 15-30 minutes of birth) has been shown in meta-analyses to
reduce the combined outcome of mortality or BPD compared to later
rescue strategies. The prophylactic or early surfactant strategy allows
for more uniform lung aeration and prevents the development of
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atelectasis and further lung injury. While synthetic surfactants are
available, natural surfactants (beractant, calfactant, poractant alfa)
contain surfactant proteins B and C which enhance spreading and
adsorption. Prophylactic surfactant for all infants less than 30 weeks
has not been universally recommended due to the risk of unnecessary
intubation in some infants.
QUESTION 2
A 6-year-old child with status asthmaticus is receiving continuous
albuterol nebulization. The patient's heart rate increases from 140 to
180 beats per minute, and the respiratory rate decreases from 40 to 20
breaths per minute. The most appropriate next step is:
A) Discontinue the albuterol immediately
B) Continue the albuterol and monitor closely
C) Add ipratropium bromide to the nebulizer
D) Administer intravenous magnesium sulfate
Answer: B
Explanation: In status asthmaticus, the decrease in respiratory rate
from 40 to 20 breaths per minute with continued tachypnea and
tachycardia suggests improvement in airflow obstruction and work of
breathing, not impending respiratory failure. In children, respiratory
rate often decreases as airway obstruction improves because the
patient no longer needs to compensate for increased dead space
ventilation. Tachycardia is an expected side effect of beta-agonists and
is not a contraindication to continuing therapy if the patient is clinically
improving. The other options would be appropriate if the patient were
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deteriorating or not responding, but the clinical picture suggests
improvement.
QUESTION 3
A neonate with congenital diaphragmatic hernia is being managed with
high-frequency oscillatory ventilation (HFOV). Which of the following
ventilator settings would be most appropriate to optimize oxygenation
while minimizing the risk of volutrauma?
A) Mean airway pressure 18 cm H2O, amplitude 40 cm H2O, frequency
10 Hz
B) Mean airway pressure 12 cm H2O, amplitude 30 cm H2O, frequency
8 Hz
C) Mean airway pressure 22 cm H2O, amplitude 50 cm H2O, frequency
12 Hz
D) Mean airway pressure 15 cm H2O, amplitude 35 cm H2O, frequency
15 Hz
Answer: A
Explanation: In congenital diaphragmatic hernia, optimizing
oxygenation requires adequate mean airway pressure to recruit lung
volume while avoiding overdistension. The appropriate mean airway
pressure is typically higher than conventional ventilation (often 14-20
cm H2O). An amplitude of 30-45 cm H2O with a frequency of 8-12 Hz is
typical. The combination of mean airway pressure 18 cm H2O,
amplitude 40 cm H2O, and frequency 10 Hz provides adequate lung
recruitment without excessive volutrauma. Higher mean airway
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pressures (>20 cm H2O) risk barotrauma and impair venous return.
Lower settings may not adequately recruit the hypoplastic lung.
QUESTION 4
A 2-year-old child with viral bronchiolitis is admitted to the PICU. The
patient's oxygen saturation is 85% on 15 L/min high-flow nasal cannula.
The respiratory therapist notes significant subcostal retractions and
nasal flaring. Which of the following is the most appropriate next
intervention?
A) Increase the high-flow nasal cannula flow to 20 L/min
B) Initiate non-invasive positive pressure ventilation with CPAP
C) Proceed with endotracheal intubation and mechanical ventilation
D) Administer a trial of nebulized racemic epinephrine
Answer: C
Explanation: This child demonstrates signs of impending respiratory
failure despite high-flow nasal cannula at maximum support (15 L/min
is generally the maximum for pediatric high-flow). With oxygen
saturation of 85% and significant work of breathing, non-invasive
ventilation may be attempted but given the severity of hypoxemia and
signs of fatigue, the safest approach is endotracheal intubation and
mechanical ventilation. Bronchiolitis typically peaks at day 2-4 of illness,
and these patients can deteriorate rapidly. Delaying intubation when
the patient has severe hypoxemia despite maximal non-invasive support
risks cardiac arrest from hypoxemia.
NPS Neonatal & Pediatric Respiratory Care Exam 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100% Latest
Already Graded A+
QUESTION 1
A 28-week gestational age infant in the NICU develops respiratory
distress syndrome. Which of the following surfactant replacement
strategies has been shown in large randomized controlled trials to most
significantly reduce the combined outcome of mortality or
bronchopulmonary dysplasia when administered early versus rescue?
A) Natural animal-derived surfactant administered within 15 minutes of
birth
B) Synthetic surfactant administered within 2 hours of life
C) Natural surfactant administered as rescue therapy at 12 hours of life
D) Prophylactic surfactant in all infants less than 30 weeks regardless of
respiratory status
Answer: A
Explanation: Early administration of natural animal-derived surfactant
(within 15-30 minutes of birth) has been shown in meta-analyses to
reduce the combined outcome of mortality or BPD compared to later
rescue strategies. The prophylactic or early surfactant strategy allows
for more uniform lung aeration and prevents the development of
,2|Page
atelectasis and further lung injury. While synthetic surfactants are
available, natural surfactants (beractant, calfactant, poractant alfa)
contain surfactant proteins B and C which enhance spreading and
adsorption. Prophylactic surfactant for all infants less than 30 weeks
has not been universally recommended due to the risk of unnecessary
intubation in some infants.
QUESTION 2
A 6-year-old child with status asthmaticus is receiving continuous
albuterol nebulization. The patient's heart rate increases from 140 to
180 beats per minute, and the respiratory rate decreases from 40 to 20
breaths per minute. The most appropriate next step is:
A) Discontinue the albuterol immediately
B) Continue the albuterol and monitor closely
C) Add ipratropium bromide to the nebulizer
D) Administer intravenous magnesium sulfate
Answer: B
Explanation: In status asthmaticus, the decrease in respiratory rate
from 40 to 20 breaths per minute with continued tachypnea and
tachycardia suggests improvement in airflow obstruction and work of
breathing, not impending respiratory failure. In children, respiratory
rate often decreases as airway obstruction improves because the
patient no longer needs to compensate for increased dead space
ventilation. Tachycardia is an expected side effect of beta-agonists and
is not a contraindication to continuing therapy if the patient is clinically
improving. The other options would be appropriate if the patient were
,3|Page
deteriorating or not responding, but the clinical picture suggests
improvement.
QUESTION 3
A neonate with congenital diaphragmatic hernia is being managed with
high-frequency oscillatory ventilation (HFOV). Which of the following
ventilator settings would be most appropriate to optimize oxygenation
while minimizing the risk of volutrauma?
A) Mean airway pressure 18 cm H2O, amplitude 40 cm H2O, frequency
10 Hz
B) Mean airway pressure 12 cm H2O, amplitude 30 cm H2O, frequency
8 Hz
C) Mean airway pressure 22 cm H2O, amplitude 50 cm H2O, frequency
12 Hz
D) Mean airway pressure 15 cm H2O, amplitude 35 cm H2O, frequency
15 Hz
Answer: A
Explanation: In congenital diaphragmatic hernia, optimizing
oxygenation requires adequate mean airway pressure to recruit lung
volume while avoiding overdistension. The appropriate mean airway
pressure is typically higher than conventional ventilation (often 14-20
cm H2O). An amplitude of 30-45 cm H2O with a frequency of 8-12 Hz is
typical. The combination of mean airway pressure 18 cm H2O,
amplitude 40 cm H2O, and frequency 10 Hz provides adequate lung
recruitment without excessive volutrauma. Higher mean airway
, 4|Page
pressures (>20 cm H2O) risk barotrauma and impair venous return.
Lower settings may not adequately recruit the hypoplastic lung.
QUESTION 4
A 2-year-old child with viral bronchiolitis is admitted to the PICU. The
patient's oxygen saturation is 85% on 15 L/min high-flow nasal cannula.
The respiratory therapist notes significant subcostal retractions and
nasal flaring. Which of the following is the most appropriate next
intervention?
A) Increase the high-flow nasal cannula flow to 20 L/min
B) Initiate non-invasive positive pressure ventilation with CPAP
C) Proceed with endotracheal intubation and mechanical ventilation
D) Administer a trial of nebulized racemic epinephrine
Answer: C
Explanation: This child demonstrates signs of impending respiratory
failure despite high-flow nasal cannula at maximum support (15 L/min
is generally the maximum for pediatric high-flow). With oxygen
saturation of 85% and significant work of breathing, non-invasive
ventilation may be attempted but given the severity of hypoxemia and
signs of fatigue, the safest approach is endotracheal intubation and
mechanical ventilation. Bronchiolitis typically peaks at day 2-4 of illness,
and these patients can deteriorate rapidly. Delaying intubation when
the patient has severe hypoxemia despite maximal non-invasive support
risks cardiac arrest from hypoxemia.
