NRP 2025/2026 Comprehensive Review – Overview| 200
scenario-based, multiple-choice questions
The Neonatal Resuscitation Program (NRP) focuses on the care of newborns at birth and
immediately afterward, emphasizing rapid recognition, airway management, and effective
team-based resuscitation. It’s a cornerstone certification for nurses, physicians, midwives, and
emergency providers who manage deliveries or newborn emergencies.This comprehensive
review includes 200 scenario-based, multiple-choice questions, divided into five core sections
aligned with the 2025 AAP & AHA NRP 8th Edition Guidelines.
NRP Sections Overview
1. Section 1 – Preparation, Initial Assessment, and Thermal Management (Q1–40).
2. Section 2 – Airway Management and Effective Ventilation (Q41–80
3. Section 3 – Chest Compressions and Circulatory Support (Q81–120)
4. Section 4 – Post-Resuscitation Care and Complications (Q121–160)
5. Section 5 – Ethical Considerations, Communication, and Special Situations (Q161–200)
SECTION 1 — Preparation, Initial Assessment & Thermal Management
(Q1–40)
1. Which of the following is the first action for every newborn immediately after
birth (assuming no obvious lethal anomaly)?
A. Place on mother's chest for skin-to-skin contact only
B. Dry, provide warmth, clear airway if necessary, and stimulate (CORRECT)
C. Intubate immediately
D. Draw blood for ABG
Rationale:
The initial newborn steps are simple, rapid, and effective: drying and warming to prevent heat
loss, clear the airway if there is obvious obstruction, and stimulation to promote spontaneous
breathing. These actions alone will usually suffice for the vigorous newborn. Advanced measures
(intubation, labs) come only if the infant is not breathing or is unstable.
,2. Which item is essential to have available at every delivery for NRP readiness?
A. Neonatal stethoscope only
B. Umbilical cord clamp only
C. A working neonatal resuscitation cart with appropriately sized equipment and oxygen
source (CORRECT)
D. Portable ultrasound
Rationale:
Effective resuscitation requires a fully stocked resuscitation cart (bag-mask devices in multiple
sizes, suction, oxygen/blender, warming device, laryngoscopes, ETTs, umbilical catheters,
medications). Having organized, functioning equipment readily available reduces time to critical
interventions and improves outcomes.
3. Which newborn condition most strongly predicts the need for immediate
resuscitation?
A. Maternal diabetes
B. Meconium-stained fluid alone
C. Absence of spontaneous respirations or poor respiratory effort at birth (CORRECT)
D. Low birth weight only
Rationale:
The primary trigger for resuscitation is the infant’s clinical status—apnea, gasping, or
inadequate respiration. While maternal or obstetric risk factors increase vigilance, action is
guided by the newborn’s breathing, tone, and heart rate at birth.
4. At what point should you assess the newborn’s heart rate during initial
stabilization?
A. Only after 10 minutes
B. Immediately after initial steps (drying/stimulation) and early during resuscitation, using
auscultation or ECG if available (CORRECT)
C. After placing an umbilical catheter
D. Only if cyanosis persists
Rationale:
Heart rate (HR) is the most important indicator of neonatal well-being and response to
interventions. It should be checked early and frequently (auscultation or ECG/monitor),
because HR drives decisions (initiate PPV, start compressions) and is more reliable than color or
oxygen saturation in guiding resuscitation.
,5. Which newborn should be placed under a radiant warmer immediately after
birth?
A. Vigorous term infant who is breastfeeding well
B. Any infant who is preterm, hypothermic, or not breathing adequately (CORRECT)
C. All infants regardless of condition
D. Only infants born by cesarean delivery
Rationale:
Thermoregulation is essential: preterm or ill infants are at high risk for heat loss and
hypothermia, which worsens outcomes. Vigorous, stable term infants can be kept with the
mother (skin-to-skin). Unstable or preterm infants require immediate warming measures (radiant
warmer, plastic wrap for very preterm).
6. For an infant born at 28 weeks’ gestation, which thermal strategy is
recommended immediately after birth?
A. Drying only
B. Placing on mother's bare chest only
C. Place under radiant warmer and use plastic wrap or bag without drying, with a cap
(CORRECT)
D. Cold room to slow metabolism
Rationale:
Very preterm infants (<32 weeks) are at very high risk of evaporative heat loss. Best practice is
to avoid drying first (or limit it), place the infant in a plastic wrap/bag with a hat and under a
radiant warmer to reduce evaporative and convective loss. Maintaining normothermia is critical
to reduce morbidity and mortality.
7. Which finding at birth indicates the need for positive-pressure ventilation
(PPV)?
A. Heart rate 120 bpm and good tone
B. Weak cry but vigorous movement
C. Apnea, gasping, or HR <100/min (CORRECT)
D. Mild grunting only
Rationale:
NRP indicates PPV when the newborn is apneic or gasping, or when HR is <100 bpm, despite
, initial steps. Mild respiratory distress with adequate oxygenation may be observed or receive
low-level support; however, absent or inadequate respiratory effort requires immediate PPV to
establish lung aeration and oxygenation.
8. What is the initial fraction of inspired oxygen (FiO ₂) recommended for most
term newborns requiring resuscitation?
A. 100% oxygen always
B. Room air (21%) titrated to clinical response and SpO₂ targets (CORRECT)
C. 50% fixed
D. 80% fixed
Rationale:
For term infants, initiate resuscitation with room air (21%) and titrate oxygen to achieve
targeted preductal saturations. Starting with high FiO₂ risks hyperoxia and oxidative injury.
Blended oxygen and pulse oximetry guide FiO₂ adjustments until effective transition is achieved.
9. Which monitoring is preferred to rapidly and accurately display neonatal
heart rate during resuscitation?
A. Pulse oximetry only
B. 3-lead ECG or electrocardiography (CORRECT)
C. Stethoscope alone
D. Palpation of umbilical pulse
Rationale:
ECG provides the quickest and most accurate HR display in the delivery room, outperforming
auscultation and pulse oximetry (which may lag). When available, ECG monitoring should be
applied early to guide resuscitation decisions; pulse oximetry still needed for oxygen saturation.
10. After starting PPV, when should you reassess the heart rate to determine
effectiveness?
A. After 5 minutes only
B. After about 15–30 seconds of effective ventilation and chest rise (CORRECT)
C. Only after intubation
D. After administering epinephrine
scenario-based, multiple-choice questions
The Neonatal Resuscitation Program (NRP) focuses on the care of newborns at birth and
immediately afterward, emphasizing rapid recognition, airway management, and effective
team-based resuscitation. It’s a cornerstone certification for nurses, physicians, midwives, and
emergency providers who manage deliveries or newborn emergencies.This comprehensive
review includes 200 scenario-based, multiple-choice questions, divided into five core sections
aligned with the 2025 AAP & AHA NRP 8th Edition Guidelines.
NRP Sections Overview
1. Section 1 – Preparation, Initial Assessment, and Thermal Management (Q1–40).
2. Section 2 – Airway Management and Effective Ventilation (Q41–80
3. Section 3 – Chest Compressions and Circulatory Support (Q81–120)
4. Section 4 – Post-Resuscitation Care and Complications (Q121–160)
5. Section 5 – Ethical Considerations, Communication, and Special Situations (Q161–200)
SECTION 1 — Preparation, Initial Assessment & Thermal Management
(Q1–40)
1. Which of the following is the first action for every newborn immediately after
birth (assuming no obvious lethal anomaly)?
A. Place on mother's chest for skin-to-skin contact only
B. Dry, provide warmth, clear airway if necessary, and stimulate (CORRECT)
C. Intubate immediately
D. Draw blood for ABG
Rationale:
The initial newborn steps are simple, rapid, and effective: drying and warming to prevent heat
loss, clear the airway if there is obvious obstruction, and stimulation to promote spontaneous
breathing. These actions alone will usually suffice for the vigorous newborn. Advanced measures
(intubation, labs) come only if the infant is not breathing or is unstable.
,2. Which item is essential to have available at every delivery for NRP readiness?
A. Neonatal stethoscope only
B. Umbilical cord clamp only
C. A working neonatal resuscitation cart with appropriately sized equipment and oxygen
source (CORRECT)
D. Portable ultrasound
Rationale:
Effective resuscitation requires a fully stocked resuscitation cart (bag-mask devices in multiple
sizes, suction, oxygen/blender, warming device, laryngoscopes, ETTs, umbilical catheters,
medications). Having organized, functioning equipment readily available reduces time to critical
interventions and improves outcomes.
3. Which newborn condition most strongly predicts the need for immediate
resuscitation?
A. Maternal diabetes
B. Meconium-stained fluid alone
C. Absence of spontaneous respirations or poor respiratory effort at birth (CORRECT)
D. Low birth weight only
Rationale:
The primary trigger for resuscitation is the infant’s clinical status—apnea, gasping, or
inadequate respiration. While maternal or obstetric risk factors increase vigilance, action is
guided by the newborn’s breathing, tone, and heart rate at birth.
4. At what point should you assess the newborn’s heart rate during initial
stabilization?
A. Only after 10 minutes
B. Immediately after initial steps (drying/stimulation) and early during resuscitation, using
auscultation or ECG if available (CORRECT)
C. After placing an umbilical catheter
D. Only if cyanosis persists
Rationale:
Heart rate (HR) is the most important indicator of neonatal well-being and response to
interventions. It should be checked early and frequently (auscultation or ECG/monitor),
because HR drives decisions (initiate PPV, start compressions) and is more reliable than color or
oxygen saturation in guiding resuscitation.
,5. Which newborn should be placed under a radiant warmer immediately after
birth?
A. Vigorous term infant who is breastfeeding well
B. Any infant who is preterm, hypothermic, or not breathing adequately (CORRECT)
C. All infants regardless of condition
D. Only infants born by cesarean delivery
Rationale:
Thermoregulation is essential: preterm or ill infants are at high risk for heat loss and
hypothermia, which worsens outcomes. Vigorous, stable term infants can be kept with the
mother (skin-to-skin). Unstable or preterm infants require immediate warming measures (radiant
warmer, plastic wrap for very preterm).
6. For an infant born at 28 weeks’ gestation, which thermal strategy is
recommended immediately after birth?
A. Drying only
B. Placing on mother's bare chest only
C. Place under radiant warmer and use plastic wrap or bag without drying, with a cap
(CORRECT)
D. Cold room to slow metabolism
Rationale:
Very preterm infants (<32 weeks) are at very high risk of evaporative heat loss. Best practice is
to avoid drying first (or limit it), place the infant in a plastic wrap/bag with a hat and under a
radiant warmer to reduce evaporative and convective loss. Maintaining normothermia is critical
to reduce morbidity and mortality.
7. Which finding at birth indicates the need for positive-pressure ventilation
(PPV)?
A. Heart rate 120 bpm and good tone
B. Weak cry but vigorous movement
C. Apnea, gasping, or HR <100/min (CORRECT)
D. Mild grunting only
Rationale:
NRP indicates PPV when the newborn is apneic or gasping, or when HR is <100 bpm, despite
, initial steps. Mild respiratory distress with adequate oxygenation may be observed or receive
low-level support; however, absent or inadequate respiratory effort requires immediate PPV to
establish lung aeration and oxygenation.
8. What is the initial fraction of inspired oxygen (FiO ₂) recommended for most
term newborns requiring resuscitation?
A. 100% oxygen always
B. Room air (21%) titrated to clinical response and SpO₂ targets (CORRECT)
C. 50% fixed
D. 80% fixed
Rationale:
For term infants, initiate resuscitation with room air (21%) and titrate oxygen to achieve
targeted preductal saturations. Starting with high FiO₂ risks hyperoxia and oxidative injury.
Blended oxygen and pulse oximetry guide FiO₂ adjustments until effective transition is achieved.
9. Which monitoring is preferred to rapidly and accurately display neonatal
heart rate during resuscitation?
A. Pulse oximetry only
B. 3-lead ECG or electrocardiography (CORRECT)
C. Stethoscope alone
D. Palpation of umbilical pulse
Rationale:
ECG provides the quickest and most accurate HR display in the delivery room, outperforming
auscultation and pulse oximetry (which may lag). When available, ECG monitoring should be
applied early to guide resuscitation decisions; pulse oximetry still needed for oxygen saturation.
10. After starting PPV, when should you reassess the heart rate to determine
effectiveness?
A. After 5 minutes only
B. After about 15–30 seconds of effective ventilation and chest rise (CORRECT)
C. Only after intubation
D. After administering epinephrine
