CCRN NEONATAL EXAM PRACTICE Q&A -A DOCUMENT
ONLY AIMING AT EXCELLENCE!!-2025/2026 BRAND NEW
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1. A 38-week gestation neonate presents with respiratory distress and anuria. On exam you note
hypertension, bilateral flank masses, and hypoplastic lungs. Which condition best explains this
presentation?
a) Polycystic kidney disease
b) Posterior urethral valves
c) Bilateral renal agenesis
d) Neuroblastoma
✓ CORRECT ANSWER a) Polycystic kidney disease
✓ Rationale: Bilateral flank masses, hypertension, hypoplastic lungs, and anuria in a term
infant are classic for polycystic kidney disease.
2. You are caring for a neonate born at 40 5/7 weeks weighing 5 lbs 2 oz (2,360 grams). How do
you classify this infant?
a) Preterm, appropriate for gestational age
b) Term, small for gestational age
c) Term, large for gestational age
d) Late preterm, small for gestational age
✓ CORRECT ANSWER b) Term, small for gestational age
✓ Rationale: Gestational age ≥37 weeks is term; weight <10th percentile for 40 weeks is
small for gestational age.
3. A full-term neonate at 6 hours of life has worsening hypoxemia that seems out of proportion to
their mild lung disease. You should evaluate for which condition?
a) Persistent pulmonary hypertension of the newborn
b) Surfactant deficiency
c) Diaphragmatic hernia
d) Pneumothorax
, ✓ CORRECT ANSWER a) Persistent pulmonary hypertension of the newborn
✓ Rationale: Labile oxygenation disproportionate to parenchymal lung disease suggests
PPHN with right-to-left shunting.
4. Which medication is a direct-acting vasodilator used in PPHN to relax pulmonary vessel
musculature?
a) Indomethacin
b) Nitric oxide
c) Prostacyclin
d) Sildenafil
✓ CORRECT ANSWER b) Nitric oxide
✓ Rationale: Inhaled nitric oxide selectively dilates pulmonary vessels, reducing pulmonary
vascular resistance in PPHN.
5. An infant born through thick meconium requires intubation based on which finding?
a) Meconium below the vocal cords
b) Response to stimulation and bag-mask ventilation
c) Apgar score <5 at 1 minute
d) Thick meconium visible at the cords
✓ CORRECT ANSWER b) Response to stimulation and bag-mask ventilation
✓ Rationale: Current guidelines recommend intubation only if the infant is not vigorous
(poor respiratory effort, low heart rate, poor tone) after initial stimulation.
6. A preterm infant on a ventilator develops a sudden pulmonary hemorrhage. Which preexisting
condition should you suspect?
a) Meconium aspiration syndrome
b) Patent ductus arteriosus
c) Surfactant administration
d) Pneumonia
✓ CORRECT ANSWER c) Surfactant administration
✓ Rationale: Surfactant therapy, while life-saving, increases the risk of pulmonary
hemorrhage, especially in extremely preterm infants.
,7. The nurse notes a discrepancy >10 mm Hg between upper and lower extremity blood
pressures. Which defect is most likely?
a) Aortic stenosis
b) Coarctation of the aorta
c) Patent ductus arteriosus
d) Tetralogy of Fallot
✓ CORRECT ANSWER b) Coarctation of the aorta
✓ Rationale: Coarctation causes higher BP in upper extremities compared to lower
extremities due to narrowing of the aorta.
8. A neonate at 10 hours of age is cyanotic but has no respiratory distress, normal EKG and chest
x-ray, and oxygen does not relieve cyanosis. Which defect should you suspect?
a) Transposition of the great vessels
b) Tetralogy of Fallot
c) Total anomalous pulmonary venous return
d) Truncus arteriosus
✓ CORRECT ANSWER a) Transposition of the great vessels
✓ Rationale: Cyanosis without respiratory distress and unresponsive to oxygen is classic for
transposition of the great arteries (parallel circulations).
9. To pass pulse oximetry screening for critical congenital heart disease, which thresholds are
required?
a) ≥95% in right hand and foot with ≤3% variance
b) <95% in either extremity with >5% variance
c) 90-94% in right hand with any variance
d) 100% in both extremities
✓ CORRECT ANSWER a) ≥95% in right hand and foot with ≤3% variance
✓ Rationale: CCHD screen passes if oxygen saturation ≥95% in either lower extremity and
difference between right hand and foot is ≤3% after 24 hours of age.
, 10. Which four defects make up tetralogy of Fallot?
a) Pulmonary stenosis, VSD, right ventricular hypertrophy, overriding aorta
b) Aortic stenosis, ASD, left ventricular hypertrophy, overriding pulmonary artery
c) Tricuspid atresia, VSD, right ventricular hypoplasia, overriding aorta
d) Pulmonary atresia, ASD, right ventricular hypertrophy, overriding aorta
✓ CORRECT ANSWER a) Pulmonary stenosis, VSD, right ventricular hypertrophy,
overriding aorta
✓ Rationale: Tetralogy of Fallot includes these four structural abnormalities leading to
right-to-left shunting.
11. A 38-week neonate is 1 hour old, born in the ER parking lot. Rectal temperature is 95°F
(35°C). Cold stress predisposes this infant to which complication?
a) Increased oxygen consumption and hypoxia
b) Hyperglycemia
c) Metabolic alkalosis
d) Decreased metabolic rate
✓ CORRECT ANSWER a) Increased oxygen consumption and hypoxia
✓ Rationale: Cold stress increases metabolic rate and oxygen demand, leading to hypoxia,
metabolic acidosis, and hypoglycemia.
12. Which finding is expected in a neonate whose mother received magnesium sulfate during
labor?
a) Hypertonia
b) Hypotonia
c) Hyperreflexia
d) Seizures
✓ CORRECT ANSWER b) Hypotonia
✓ Rationale: Magnesium sulfate crosses the placenta and can cause neonatal hypotonia,
respiratory depression, and decreased reflexes.
13. The most common cause of hyperthermia in a newborn is:
ONLY AIMING AT EXCELLENCE!!-2025/2026 BRAND NEW
RELEASE-
1. A 38-week gestation neonate presents with respiratory distress and anuria. On exam you note
hypertension, bilateral flank masses, and hypoplastic lungs. Which condition best explains this
presentation?
a) Polycystic kidney disease
b) Posterior urethral valves
c) Bilateral renal agenesis
d) Neuroblastoma
✓ CORRECT ANSWER a) Polycystic kidney disease
✓ Rationale: Bilateral flank masses, hypertension, hypoplastic lungs, and anuria in a term
infant are classic for polycystic kidney disease.
2. You are caring for a neonate born at 40 5/7 weeks weighing 5 lbs 2 oz (2,360 grams). How do
you classify this infant?
a) Preterm, appropriate for gestational age
b) Term, small for gestational age
c) Term, large for gestational age
d) Late preterm, small for gestational age
✓ CORRECT ANSWER b) Term, small for gestational age
✓ Rationale: Gestational age ≥37 weeks is term; weight <10th percentile for 40 weeks is
small for gestational age.
3. A full-term neonate at 6 hours of life has worsening hypoxemia that seems out of proportion to
their mild lung disease. You should evaluate for which condition?
a) Persistent pulmonary hypertension of the newborn
b) Surfactant deficiency
c) Diaphragmatic hernia
d) Pneumothorax
, ✓ CORRECT ANSWER a) Persistent pulmonary hypertension of the newborn
✓ Rationale: Labile oxygenation disproportionate to parenchymal lung disease suggests
PPHN with right-to-left shunting.
4. Which medication is a direct-acting vasodilator used in PPHN to relax pulmonary vessel
musculature?
a) Indomethacin
b) Nitric oxide
c) Prostacyclin
d) Sildenafil
✓ CORRECT ANSWER b) Nitric oxide
✓ Rationale: Inhaled nitric oxide selectively dilates pulmonary vessels, reducing pulmonary
vascular resistance in PPHN.
5. An infant born through thick meconium requires intubation based on which finding?
a) Meconium below the vocal cords
b) Response to stimulation and bag-mask ventilation
c) Apgar score <5 at 1 minute
d) Thick meconium visible at the cords
✓ CORRECT ANSWER b) Response to stimulation and bag-mask ventilation
✓ Rationale: Current guidelines recommend intubation only if the infant is not vigorous
(poor respiratory effort, low heart rate, poor tone) after initial stimulation.
6. A preterm infant on a ventilator develops a sudden pulmonary hemorrhage. Which preexisting
condition should you suspect?
a) Meconium aspiration syndrome
b) Patent ductus arteriosus
c) Surfactant administration
d) Pneumonia
✓ CORRECT ANSWER c) Surfactant administration
✓ Rationale: Surfactant therapy, while life-saving, increases the risk of pulmonary
hemorrhage, especially in extremely preterm infants.
,7. The nurse notes a discrepancy >10 mm Hg between upper and lower extremity blood
pressures. Which defect is most likely?
a) Aortic stenosis
b) Coarctation of the aorta
c) Patent ductus arteriosus
d) Tetralogy of Fallot
✓ CORRECT ANSWER b) Coarctation of the aorta
✓ Rationale: Coarctation causes higher BP in upper extremities compared to lower
extremities due to narrowing of the aorta.
8. A neonate at 10 hours of age is cyanotic but has no respiratory distress, normal EKG and chest
x-ray, and oxygen does not relieve cyanosis. Which defect should you suspect?
a) Transposition of the great vessels
b) Tetralogy of Fallot
c) Total anomalous pulmonary venous return
d) Truncus arteriosus
✓ CORRECT ANSWER a) Transposition of the great vessels
✓ Rationale: Cyanosis without respiratory distress and unresponsive to oxygen is classic for
transposition of the great arteries (parallel circulations).
9. To pass pulse oximetry screening for critical congenital heart disease, which thresholds are
required?
a) ≥95% in right hand and foot with ≤3% variance
b) <95% in either extremity with >5% variance
c) 90-94% in right hand with any variance
d) 100% in both extremities
✓ CORRECT ANSWER a) ≥95% in right hand and foot with ≤3% variance
✓ Rationale: CCHD screen passes if oxygen saturation ≥95% in either lower extremity and
difference between right hand and foot is ≤3% after 24 hours of age.
, 10. Which four defects make up tetralogy of Fallot?
a) Pulmonary stenosis, VSD, right ventricular hypertrophy, overriding aorta
b) Aortic stenosis, ASD, left ventricular hypertrophy, overriding pulmonary artery
c) Tricuspid atresia, VSD, right ventricular hypoplasia, overriding aorta
d) Pulmonary atresia, ASD, right ventricular hypertrophy, overriding aorta
✓ CORRECT ANSWER a) Pulmonary stenosis, VSD, right ventricular hypertrophy,
overriding aorta
✓ Rationale: Tetralogy of Fallot includes these four structural abnormalities leading to
right-to-left shunting.
11. A 38-week neonate is 1 hour old, born in the ER parking lot. Rectal temperature is 95°F
(35°C). Cold stress predisposes this infant to which complication?
a) Increased oxygen consumption and hypoxia
b) Hyperglycemia
c) Metabolic alkalosis
d) Decreased metabolic rate
✓ CORRECT ANSWER a) Increased oxygen consumption and hypoxia
✓ Rationale: Cold stress increases metabolic rate and oxygen demand, leading to hypoxia,
metabolic acidosis, and hypoglycemia.
12. Which finding is expected in a neonate whose mother received magnesium sulfate during
labor?
a) Hypertonia
b) Hypotonia
c) Hyperreflexia
d) Seizures
✓ CORRECT ANSWER b) Hypotonia
✓ Rationale: Magnesium sulfate crosses the placenta and can cause neonatal hypotonia,
respiratory depression, and decreased reflexes.
13. The most common cause of hyperthermia in a newborn is:
