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NEONATAL RESUSCITATION PROGRAM (NRP)
CERTIFICATION EXAM | 2026/2027 EDITION |
VERIFIED QUESTIONS WITH DETAILED
ANSWERS AND RATIONALES | BRAND NEW!
1. A 34-week gestation infant is delivered via emergency cesarean
section due to placental abruption. The infant is limp, apneic, and has
a heart rate of 80 bpm. The team has completed the initial steps and is
preparing for positive pressure ventilation. According to NRP
guidelines, what is the most appropriate initial oxygen concentration
for this preterm infant?
A. 100% oxygen
B. 21% to 30% oxygen
C. 40% to 60% oxygen
D. 60% to 80% oxygen
B. 21% to 30% oxygen
Expert Explanation: NRP guidelines recommend initiating resuscitation
of preterm infants (less than 35 weeks gestation) with a low oxygen
concentration of 21% to 30%, titrating upward based on preductal SpO2
targets. Initiating with 100% oxygen is associated with oxidative injury
in preterm infants.
2. During a pre-birth huddle for a delivery at 39 weeks gestation, the
obstetric team reports meconium-stained amniotic fluid. The fetal
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heart rate tracing shows late decelerations. Which of the following is
the most appropriate equipment preparation for this delivery?
A. Prepare only a bulb syringe for suctioning
B. Prepare a meconium aspirator and endotracheal tube for intubation
C. Prepare a radiant warmer, PPV device, pulse oximeter, and suction
equipment with a 10F or 12F catheter
D. Prepare only for routine newborn care
C. Prepare a radiant warmer, PPV device, pulse oximeter, and suction
equipment with a 10F or 12F catheter
Expert Explanation: Meconium-stained fluid with fetal heart rate
abnormalities constitutes a risk factor requiring full resuscitation
preparation. The presence of meconium alone does not mandate
intubation for tracheal suctioning, but all standard resuscitation
equipment must be immediately available. A 10F or 12F suction catheter
is appropriate for clearing the airway.
3. A term newborn is delivered and placed on the mother's chest. At
30 seconds of life, the infant is noted to be grunting with nasal flaring
and intercostal retractions. The heart rate is 120 bpm. What is the
most appropriate next step?
A. Begin positive pressure ventilation immediately
B. Provide free-flow oxygen and continue observation
C. Perform endotracheal intubation
D. Begin chest compressions
B. Provide free-flow oxygen and continue observation
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Expert Explanation: This infant is demonstrating signs of respiratory
distress but has a heart rate above 100 bpm and is breathing
spontaneously. The appropriate intervention is to provide free-flow
oxygen and monitor closely. Positive pressure ventilation is indicated for
apnea, gasping, or heart rate below 100 bpm.
4. A preterm infant at 28 weeks gestation is born and requires positive
pressure ventilation. The team is using a T-piece resuscitator. What is
the recommended initial inspiratory pressure for this infant?
A. 10-15 cm H2O
B. 20-25 cm H2O
C. 30-35 cm H2O
D. 40-45 cm H2O
B. 20-25 cm H2O
Expert Explanation: Initial peak inspiratory pressure for preterm infants
is typically 20-25 cm H2O, though some references suggest starting at
15-20 cm H2O for very preterm infants. Pressure should be adjusted
based on chest rise and heart rate response. The goal is to achieve
adequate ventilation without causing lung injury.
5. During positive pressure ventilation, the team notices that the
newborn's chest is not rising adequately. The heart rate remains
below 100 bpm. According to the MR. SOPA corrective steps, which
action should be taken first?
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A. Increase the ventilation rate
B. Reposition the head and open the airway
C. Insert an orogastric tube
D. Increase the inspiratory pressure
B. Reposition the head and open the airway
Expert Explanation: The MR. SOPA corrective steps are applied in
sequence when ventilation is ineffective: Mask adjustment, Reposition
head, Suction mouth and nose, Open mouth, Pressure increase,
Alternative airway. Repositioning the head to ensure a patent airway is
the first corrective action after mask adjustment.
6. A term newborn has received effective positive pressure ventilation
for 30 seconds. The heart rate is now 40 bpm. Chest compressions are
initiated. What is the correct compression-to-ventilation ratio for
neonatal resuscitation?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations
C. 3 compressions to 1 ventilation
D. 5 compressions to 1 ventilation
C. 3 compressions to 1 ventilation
Expert Explanation: The neonatal resuscitation compression-to-
ventilation ratio is 3:1, meaning 3 compressions followed by 1
ventilation, delivered at a rate of 90 compressions and 30 ventilations
per minute (120 total events per minute).
NEONATAL RESUSCITATION PROGRAM (NRP)
CERTIFICATION EXAM | 2026/2027 EDITION |
VERIFIED QUESTIONS WITH DETAILED
ANSWERS AND RATIONALES | BRAND NEW!
1. A 34-week gestation infant is delivered via emergency cesarean
section due to placental abruption. The infant is limp, apneic, and has
a heart rate of 80 bpm. The team has completed the initial steps and is
preparing for positive pressure ventilation. According to NRP
guidelines, what is the most appropriate initial oxygen concentration
for this preterm infant?
A. 100% oxygen
B. 21% to 30% oxygen
C. 40% to 60% oxygen
D. 60% to 80% oxygen
B. 21% to 30% oxygen
Expert Explanation: NRP guidelines recommend initiating resuscitation
of preterm infants (less than 35 weeks gestation) with a low oxygen
concentration of 21% to 30%, titrating upward based on preductal SpO2
targets. Initiating with 100% oxygen is associated with oxidative injury
in preterm infants.
2. During a pre-birth huddle for a delivery at 39 weeks gestation, the
obstetric team reports meconium-stained amniotic fluid. The fetal
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heart rate tracing shows late decelerations. Which of the following is
the most appropriate equipment preparation for this delivery?
A. Prepare only a bulb syringe for suctioning
B. Prepare a meconium aspirator and endotracheal tube for intubation
C. Prepare a radiant warmer, PPV device, pulse oximeter, and suction
equipment with a 10F or 12F catheter
D. Prepare only for routine newborn care
C. Prepare a radiant warmer, PPV device, pulse oximeter, and suction
equipment with a 10F or 12F catheter
Expert Explanation: Meconium-stained fluid with fetal heart rate
abnormalities constitutes a risk factor requiring full resuscitation
preparation. The presence of meconium alone does not mandate
intubation for tracheal suctioning, but all standard resuscitation
equipment must be immediately available. A 10F or 12F suction catheter
is appropriate for clearing the airway.
3. A term newborn is delivered and placed on the mother's chest. At
30 seconds of life, the infant is noted to be grunting with nasal flaring
and intercostal retractions. The heart rate is 120 bpm. What is the
most appropriate next step?
A. Begin positive pressure ventilation immediately
B. Provide free-flow oxygen and continue observation
C. Perform endotracheal intubation
D. Begin chest compressions
B. Provide free-flow oxygen and continue observation
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Expert Explanation: This infant is demonstrating signs of respiratory
distress but has a heart rate above 100 bpm and is breathing
spontaneously. The appropriate intervention is to provide free-flow
oxygen and monitor closely. Positive pressure ventilation is indicated for
apnea, gasping, or heart rate below 100 bpm.
4. A preterm infant at 28 weeks gestation is born and requires positive
pressure ventilation. The team is using a T-piece resuscitator. What is
the recommended initial inspiratory pressure for this infant?
A. 10-15 cm H2O
B. 20-25 cm H2O
C. 30-35 cm H2O
D. 40-45 cm H2O
B. 20-25 cm H2O
Expert Explanation: Initial peak inspiratory pressure for preterm infants
is typically 20-25 cm H2O, though some references suggest starting at
15-20 cm H2O for very preterm infants. Pressure should be adjusted
based on chest rise and heart rate response. The goal is to achieve
adequate ventilation without causing lung injury.
5. During positive pressure ventilation, the team notices that the
newborn's chest is not rising adequately. The heart rate remains
below 100 bpm. According to the MR. SOPA corrective steps, which
action should be taken first?
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A. Increase the ventilation rate
B. Reposition the head and open the airway
C. Insert an orogastric tube
D. Increase the inspiratory pressure
B. Reposition the head and open the airway
Expert Explanation: The MR. SOPA corrective steps are applied in
sequence when ventilation is ineffective: Mask adjustment, Reposition
head, Suction mouth and nose, Open mouth, Pressure increase,
Alternative airway. Repositioning the head to ensure a patent airway is
the first corrective action after mask adjustment.
6. A term newborn has received effective positive pressure ventilation
for 30 seconds. The heart rate is now 40 bpm. Chest compressions are
initiated. What is the correct compression-to-ventilation ratio for
neonatal resuscitation?
A. 15 compressions to 2 ventilations
B. 30 compressions to 2 ventilations
C. 3 compressions to 1 ventilation
D. 5 compressions to 1 ventilation
C. 3 compressions to 1 ventilation
Expert Explanation: The neonatal resuscitation compression-to-
ventilation ratio is 3:1, meaning 3 compressions followed by 1
ventilation, delivered at a rate of 90 compressions and 30 ventilations
per minute (120 total events per minute).
