CCRN-NEONATAL QUESTIONS AND CORRECT ANSWERS
WITH DETAILED RATIONALES | LATEST VERSION PDF
Questions with Detailed Rationales | 2026/2027 Update
| Complete Exam Preparation Guide
Question 1
A 26-week gestation neonate is noted to have a sudden increase in abdominal
girth, visible bowel loops, and bloody stools on day of life 6. An abdominal X-
ray reveals pneumatosis intestinalis. What is the most appropriate initial
nursing intervention?
A) Increase the continuous infusion rate of trophic feeds
B) Initiate a stat bolus of 20 mL/kg of normal saline
C) Place the infant NPO, initiate gastric decompression, and notify the
provider
D) Administer a scheduled dose of oral ibuprofen for patent ductus arteriosus
Answer: C) Place the infant NPO, initiate gastric decompression, and
notify the provider
Rationale: The clinical presentation of abdominal distension, visible bowel
loops, bloody stools, and pneumatosis intestinalis on X-ray indicates
Necrotizing Enterocolitis (NEC). The immediate initial management is to stop
all enteral intake (NPO), decompress the stomach using an orogastric tube to
alleviate pressure, and contact the provider. Continuing feeds or giving
hyperosmolar medications like oral ibuprofen can worsen bowel ischemia or
perforation. Fluid boluses are indicated for shock, but gastric decompression
and NPO status are the immediate primary steps.
Question 2
A term infant exhibits severe respiratory distress at birth with a scaphoid
abdomen and decreased breath sounds on the left side. The nurse suspects a
,congenital diaphragmatic hernia (CDH). Which action should the nurse
immediately avoid?
A) Endotracheal intubation
B) Positive pressure ventilation via bag-valve-mask
C) Placement of an orogastric tube to low intermittent suction
D) Pre- and post-ductal oxygen saturation monitoring
Answer: B) Positive pressure ventilation via bag-valve-mask
Rationale: In an infant with a suspected congenital diaphragmatic hernia
(CDH), bag-valve-mask ventilation is strictly contraindicated because it
introduces air into the stomach and herniated bowel loops in the thoracic
cavity. This worsens lung compression, shifts the mediastinum, and
exacerbates respiratory failure. The correct approach is immediate
endotracheal intubation and placement of a large-bore orogastric tube to
decompress the gastrointestinal tract.
Question 3
Which of the following physiological changes occurs as a direct result of the
successful transition from fetal to neonatal circulation?
A) Increase in pulmonary vascular resistance and decrease in systemic
vascular resistance
B) Decrease in pulmonary vascular resistance and increase in systemic
vascular resistance
C) Increase in right atrial pressure relative to left atrial pressure
D) Continued shunting of blood from the pulmonary artery to the aorta
Answer: B) Decrease in pulmonary vascular resistance and increase in
systemic vascular resistance
Rationale: At birth, the expansion of the lungs with air and subsequent
oxygenation causes pulmonary vasodilation, leading to a dramatic drop in
pulmonary vascular resistance (PVR). Concurrently, clamping the umbilical
cord removes the low-resistance placental circuit, causing a significant
,increase in systemic vascular resistance (SVR). This causes left atrial pressure
to exceed right atrial pressure, functionally closing the foramen ovale and
reversing ductal flow until the ductus arteriosus closes.
Question 4
A neonate born at 34 weeks gestation is receiving therapeutic hypothermia
for hypoxic-ischemic encephalopathy (HIE) initiated under an approved
expanded protocol. During the cooling phase, the nurse notes a heart rate of
82 beats per minute. The infant is well-perfused with a normal blood
pressure. What is the most appropriate action?
A) Administer a stat dose of intravenous atropine
B) Initiate immediate active rewarming of the neonate
C) Document the finding as an expected physiological response to
hypothermia
D) Increase the target temperature setting on the cooling blanket by 1 degree
Celsius
Answer: C) Document the finding as an expected physiological response
to hypothermia
Rationale: Sinus bradycardia (heart rate between 70 and 100 beats per
minute) is a well-documented, expected physiological response to therapeutic
hypothermia due to the metabolic slowing induced by lower core
temperatures. If the infant remains well-perfused, has a normal blood
pressure, and shows no signs of systemic compromise, no intervention is
needed, and the finding should simply be documented. Active rewarming or
pharmacological intervention is inappropriate unless severe cardiovascular
instability occurs.
Question 5
An infant born at 25 weeks gestation is now 48 hours old. The nurse observes
fluctuating blood pressures, an active precordium, a bounding peripheral
pulse, and a new systolic murmur. The nurse suspects a patent ductus
, arteriosus (PDA). Which of the following echocardiographic findings would
confirm a hemodynamically significant PDA?
A) Right-to-left shunting across the ductus arteriosus with right ventricular
hypertrophy
B) Left-to-right shunting across the ductus arteriosus with left atrial and left
ventricular enlargement
C) Complete absence of flow through the ductus arteriosus
D) Stenosis of the main pulmonary artery branches
Answer: B) Left-to-right shunting across the ductus arteriosus with left
atrial and left ventricular enlargement
Rationale: A hemodynamically significant PDA in a preterm infant causes a
left-to-right shunt due to the higher systemic vascular resistance relative to
pulmonary vascular resistance. This creates pulmonary overcirculation,
returning excessive blood volumes to the left side of the heart, which leads to
left atrial and left ventricular enlargement or dilation. A right-to-left shunt
indicates high pulmonary pressures, characteristic of persistent pulmonary
hypertension of the newborn (PPHN), not a standard left-to-right shunting
PDA.
Question 6
A 28-week gestation infant is receiving mechanical ventilation for respiratory
distress syndrome (RDS). The nurse notes a sudden drop in oxygen
saturation, decreased breath sounds on the right side, and a shift in the
trachea to the left. Which of the following is the priority nursing action?
A) Administer a bolus of surfactant via the endotracheal tube
B) Notify the provider and prepare for chest tube insertion
C) Increase the peak inspiratory pressure on the ventilator
D) Position the infant on the left side
Answer: B) Notify the provider and prepare for chest tube insertion
WITH DETAILED RATIONALES | LATEST VERSION PDF
Questions with Detailed Rationales | 2026/2027 Update
| Complete Exam Preparation Guide
Question 1
A 26-week gestation neonate is noted to have a sudden increase in abdominal
girth, visible bowel loops, and bloody stools on day of life 6. An abdominal X-
ray reveals pneumatosis intestinalis. What is the most appropriate initial
nursing intervention?
A) Increase the continuous infusion rate of trophic feeds
B) Initiate a stat bolus of 20 mL/kg of normal saline
C) Place the infant NPO, initiate gastric decompression, and notify the
provider
D) Administer a scheduled dose of oral ibuprofen for patent ductus arteriosus
Answer: C) Place the infant NPO, initiate gastric decompression, and
notify the provider
Rationale: The clinical presentation of abdominal distension, visible bowel
loops, bloody stools, and pneumatosis intestinalis on X-ray indicates
Necrotizing Enterocolitis (NEC). The immediate initial management is to stop
all enteral intake (NPO), decompress the stomach using an orogastric tube to
alleviate pressure, and contact the provider. Continuing feeds or giving
hyperosmolar medications like oral ibuprofen can worsen bowel ischemia or
perforation. Fluid boluses are indicated for shock, but gastric decompression
and NPO status are the immediate primary steps.
Question 2
A term infant exhibits severe respiratory distress at birth with a scaphoid
abdomen and decreased breath sounds on the left side. The nurse suspects a
,congenital diaphragmatic hernia (CDH). Which action should the nurse
immediately avoid?
A) Endotracheal intubation
B) Positive pressure ventilation via bag-valve-mask
C) Placement of an orogastric tube to low intermittent suction
D) Pre- and post-ductal oxygen saturation monitoring
Answer: B) Positive pressure ventilation via bag-valve-mask
Rationale: In an infant with a suspected congenital diaphragmatic hernia
(CDH), bag-valve-mask ventilation is strictly contraindicated because it
introduces air into the stomach and herniated bowel loops in the thoracic
cavity. This worsens lung compression, shifts the mediastinum, and
exacerbates respiratory failure. The correct approach is immediate
endotracheal intubation and placement of a large-bore orogastric tube to
decompress the gastrointestinal tract.
Question 3
Which of the following physiological changes occurs as a direct result of the
successful transition from fetal to neonatal circulation?
A) Increase in pulmonary vascular resistance and decrease in systemic
vascular resistance
B) Decrease in pulmonary vascular resistance and increase in systemic
vascular resistance
C) Increase in right atrial pressure relative to left atrial pressure
D) Continued shunting of blood from the pulmonary artery to the aorta
Answer: B) Decrease in pulmonary vascular resistance and increase in
systemic vascular resistance
Rationale: At birth, the expansion of the lungs with air and subsequent
oxygenation causes pulmonary vasodilation, leading to a dramatic drop in
pulmonary vascular resistance (PVR). Concurrently, clamping the umbilical
cord removes the low-resistance placental circuit, causing a significant
,increase in systemic vascular resistance (SVR). This causes left atrial pressure
to exceed right atrial pressure, functionally closing the foramen ovale and
reversing ductal flow until the ductus arteriosus closes.
Question 4
A neonate born at 34 weeks gestation is receiving therapeutic hypothermia
for hypoxic-ischemic encephalopathy (HIE) initiated under an approved
expanded protocol. During the cooling phase, the nurse notes a heart rate of
82 beats per minute. The infant is well-perfused with a normal blood
pressure. What is the most appropriate action?
A) Administer a stat dose of intravenous atropine
B) Initiate immediate active rewarming of the neonate
C) Document the finding as an expected physiological response to
hypothermia
D) Increase the target temperature setting on the cooling blanket by 1 degree
Celsius
Answer: C) Document the finding as an expected physiological response
to hypothermia
Rationale: Sinus bradycardia (heart rate between 70 and 100 beats per
minute) is a well-documented, expected physiological response to therapeutic
hypothermia due to the metabolic slowing induced by lower core
temperatures. If the infant remains well-perfused, has a normal blood
pressure, and shows no signs of systemic compromise, no intervention is
needed, and the finding should simply be documented. Active rewarming or
pharmacological intervention is inappropriate unless severe cardiovascular
instability occurs.
Question 5
An infant born at 25 weeks gestation is now 48 hours old. The nurse observes
fluctuating blood pressures, an active precordium, a bounding peripheral
pulse, and a new systolic murmur. The nurse suspects a patent ductus
, arteriosus (PDA). Which of the following echocardiographic findings would
confirm a hemodynamically significant PDA?
A) Right-to-left shunting across the ductus arteriosus with right ventricular
hypertrophy
B) Left-to-right shunting across the ductus arteriosus with left atrial and left
ventricular enlargement
C) Complete absence of flow through the ductus arteriosus
D) Stenosis of the main pulmonary artery branches
Answer: B) Left-to-right shunting across the ductus arteriosus with left
atrial and left ventricular enlargement
Rationale: A hemodynamically significant PDA in a preterm infant causes a
left-to-right shunt due to the higher systemic vascular resistance relative to
pulmonary vascular resistance. This creates pulmonary overcirculation,
returning excessive blood volumes to the left side of the heart, which leads to
left atrial and left ventricular enlargement or dilation. A right-to-left shunt
indicates high pulmonary pressures, characteristic of persistent pulmonary
hypertension of the newborn (PPHN), not a standard left-to-right shunting
PDA.
Question 6
A 28-week gestation infant is receiving mechanical ventilation for respiratory
distress syndrome (RDS). The nurse notes a sudden drop in oxygen
saturation, decreased breath sounds on the right side, and a shift in the
trachea to the left. Which of the following is the priority nursing action?
A) Administer a bolus of surfactant via the endotracheal tube
B) Notify the provider and prepare for chest tube insertion
C) Increase the peak inspiratory pressure on the ventilator
D) Position the infant on the left side
Answer: B) Notify the provider and prepare for chest tube insertion
