NPS Neonatal & Pediatric Respiratory
Care Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified
Pass Guaranteed – A+ Graded
Content Area Overview
This actual examination reflects the specialized neonatal and pediatric respiratory care knowledge
required for success on the NBRC Neonatal/Pediatric Specialty (NPS) Examination. It is designed to
evaluate the respiratory therapist's ability to assess, manage, and treat neonatal and pediatric patients
with respiratory disorders. Questions are structured to assess recall of key concepts, application of
clinical algorithms to complex patient scenarios, and analysis of life-threatening conditions in neonatal
and pediatric critical care. This authentic question bank represents the real exams used in the course
and serves as a comprehensive resource for RRTs demonstrating mastery of neonatal/pediatric
respiratory care content for the 2026/2027 academic year.
Domain I: Competencies Shared Between Critical and General Care (80 Questions)
Q1. A 28-week gestational age neonate is born via emergency cesarean section. The RT is present at
delivery. According to NRP guidelines, what is the first step in resuscitation?
A. Intubate and ventilate immediately
B. Dry, stimulate, and position the infant, then assess breathing and heart rate
C. Administer epinephrine via umbilical vein
D. Begin chest compressions at a rate of 120 per minute
B. Dry, stimulate, and position the infant, then assess breathing and heart rate [CORRECT]
The best answer is B. This choice is correct because the NRP algorithm always starts with the basics—dry
the infant, position the head, clear the airway if needed, stimulate, and then assess respirations and
heart rate before moving to more invasive interventions.
Correct Answer: B
,Q2. A 3-year-old child with asthma presents to the emergency department with respiratory distress.
SpO₂ is 88% on room air, respiratory rate is 42, and there is marked intercostal retractions. Which
intervention is the priority?
A. Administer supplemental oxygen to maintain SpO₂ > 92%
B. Start continuous albuterol nebulization immediately
C. Obtain a chest X-ray
D. Draw arterial blood gas
A. Administer supplemental oxygen to maintain SpO₂ > 92% [CORRECT]
The best answer is A. This choice is correct because oxygenation is the first priority in any patient with
respiratory distress—before you do anything else, you need to get the SpO₂ above 92%, then you can
move on to bronchodilators and further assessment.
Correct Answer: A
Q3. A neonate born at 34 weeks gestation has a respiratory rate of 72, grunting, nasal flaring, and mild
retractions. Chest X-ray shows a "wet lung" pattern with fluid in the fissures and perihilar streaking.
What is the most likely diagnosis?
A. Neonatal Respiratory Distress Syndrome (RDS)
B. Transient Tachypnea of the Newborn (TTN)
C. Meconium Aspiration Syndrome (MAS)
D. Persistent Pulmonary Hypertension of the Newborn (PPHN)
B. Transient Tachypnea of the Newborn (TTN) [CORRECT]
The best answer is B. This choice is correct because TTN typically presents in late preterm or term
infants with tachypnea, grunting, and a "wet lung" appearance on X-ray due to delayed clearance of
fetal lung fluid—this is classic for TTN, not RDS which would show a ground-glass appearance.
Correct Answer: B
Q4. A 5-year-old child with cystic fibrosis is receiving chest physiotherapy. The RT notes the child has
thick, tenacious secretions that are difficult to mobilize. Which adjunctive therapy would be most
beneficial?
A. Increase the frequency of bronchodilator administration
B. Add dornase alfa (Pulmozyme) to break down DNA in the mucus
,C. Increase oxygen flow rate
D. Administer systemic corticosteroids
B. Add dornase alfa (Pulmozyme) to break down DNA in the mucus [CORRECT]
The best answer is B. This choice is correct because dornase alfa is a recombinant human DNase that
breaks down the DNA released from neutrophils in CF mucus, making secretions less viscous and easier
to clear—it's a cornerstone of CF airway clearance therapy.
Correct Answer: B
Q5. A neonate with a gestational age of 26 weeks is intubated and receiving mechanical ventilation.
The RT is preparing to administer surfactant. Which route of administration is correct?
A. Intravenous bolus
B. Intratracheal instillation via the endotracheal tube
C. Nebulized via aerosol mask
D. Intramuscular injection
B. Intratracheal instillation via the endotracheal tube [CORRECT]
The best answer is B. This choice is correct because surfactant replacement therapy is administered
directly into the trachea through the endotracheal tube—this allows it to reach the alveoli where it's
needed to reduce surface tension and improve lung compliance.
Correct Answer: B
Q6. A 2-year-old child is brought to the ED with sudden onset of stridor, barking cough, and low-grade
fever. The child appears anxious and is sitting in the tripod position. What is the most likely diagnosis?
A. Asthma exacerbation
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
C. Croup (laryngotracheobronchitis) [CORRECT]
The best answer is C. This choice is correct because the barking cough, stridor, and low-grade fever in a
toddler are the classic triad for croup—this is a viral upper airway infection, and the presentation is very
different from the high fever and drooling you'd see with epiglottitis.
Correct Answer: C
, Q7. A neonate with suspected PPHN is being evaluated. The preductal SpO₂ is 95% and the postductal
SpO₂ is 78%. What does this finding indicate?
A. The infant has a right-to-left shunt through the ductus arteriosus
B. The infant has a left-to-right shunt
C. The pulse oximeter is malfunctioning
D. The infant has adequate oxygenation
A. The infant has a right-to-left shunt through the ductus arteriosus [CORRECT]
The best answer is A. This choice is correct because a significant preductal-postductal oxygen saturation
difference (>10%) is the hallmark of PPHN with right-to-left shunting through the ductus arteriosus—
blood is bypassing the lungs and going directly to the lower body.
Correct Answer: A
Q8. An 8-year-old child with asthma is receiving a continuous albuterol nebulizer at 15 mg/hr. The RT
notes the child's heart rate has increased from 110 to 160 bpm. What is the most appropriate action?
A. Continue the current treatment; tachycardia is an expected side effect
B. Decrease the albuterol dose and monitor closely
C. Stop all bronchodilator therapy immediately
D. Administer a beta-blocker
B. Decrease the albuterol dose and monitor closely [CORRECT]
The best answer is B. This choice is correct because while some tachycardia is expected with continuous
albuterol, a heart rate of 160 in an 8-year-old is excessive and signals the need to back off the dose
slightly while maintaining bronchodilation—this is a judgment call that balances efficacy with safety.
Correct Answer: B
Q9. A neonate born at 30 weeks gestation develops increasing oxygen requirements and bilateral
diffuse ground-glass opacities on chest X-ray. The infant is diagnosed with RDS. What is the primary
pathophysiologic defect?
A. Surfactant deficiency leading to alveolar collapse
B. Meconium obstruction of the airways
C. Pulmonary hypertension causing right-to-left shunting
D. Congenital diaphragmatic hernia
Care Exam Actual 2026/2027 – Complete
Exam-Style Questions | 100% Verified
Pass Guaranteed – A+ Graded
Content Area Overview
This actual examination reflects the specialized neonatal and pediatric respiratory care knowledge
required for success on the NBRC Neonatal/Pediatric Specialty (NPS) Examination. It is designed to
evaluate the respiratory therapist's ability to assess, manage, and treat neonatal and pediatric patients
with respiratory disorders. Questions are structured to assess recall of key concepts, application of
clinical algorithms to complex patient scenarios, and analysis of life-threatening conditions in neonatal
and pediatric critical care. This authentic question bank represents the real exams used in the course
and serves as a comprehensive resource for RRTs demonstrating mastery of neonatal/pediatric
respiratory care content for the 2026/2027 academic year.
Domain I: Competencies Shared Between Critical and General Care (80 Questions)
Q1. A 28-week gestational age neonate is born via emergency cesarean section. The RT is present at
delivery. According to NRP guidelines, what is the first step in resuscitation?
A. Intubate and ventilate immediately
B. Dry, stimulate, and position the infant, then assess breathing and heart rate
C. Administer epinephrine via umbilical vein
D. Begin chest compressions at a rate of 120 per minute
B. Dry, stimulate, and position the infant, then assess breathing and heart rate [CORRECT]
The best answer is B. This choice is correct because the NRP algorithm always starts with the basics—dry
the infant, position the head, clear the airway if needed, stimulate, and then assess respirations and
heart rate before moving to more invasive interventions.
Correct Answer: B
,Q2. A 3-year-old child with asthma presents to the emergency department with respiratory distress.
SpO₂ is 88% on room air, respiratory rate is 42, and there is marked intercostal retractions. Which
intervention is the priority?
A. Administer supplemental oxygen to maintain SpO₂ > 92%
B. Start continuous albuterol nebulization immediately
C. Obtain a chest X-ray
D. Draw arterial blood gas
A. Administer supplemental oxygen to maintain SpO₂ > 92% [CORRECT]
The best answer is A. This choice is correct because oxygenation is the first priority in any patient with
respiratory distress—before you do anything else, you need to get the SpO₂ above 92%, then you can
move on to bronchodilators and further assessment.
Correct Answer: A
Q3. A neonate born at 34 weeks gestation has a respiratory rate of 72, grunting, nasal flaring, and mild
retractions. Chest X-ray shows a "wet lung" pattern with fluid in the fissures and perihilar streaking.
What is the most likely diagnosis?
A. Neonatal Respiratory Distress Syndrome (RDS)
B. Transient Tachypnea of the Newborn (TTN)
C. Meconium Aspiration Syndrome (MAS)
D. Persistent Pulmonary Hypertension of the Newborn (PPHN)
B. Transient Tachypnea of the Newborn (TTN) [CORRECT]
The best answer is B. This choice is correct because TTN typically presents in late preterm or term
infants with tachypnea, grunting, and a "wet lung" appearance on X-ray due to delayed clearance of
fetal lung fluid—this is classic for TTN, not RDS which would show a ground-glass appearance.
Correct Answer: B
Q4. A 5-year-old child with cystic fibrosis is receiving chest physiotherapy. The RT notes the child has
thick, tenacious secretions that are difficult to mobilize. Which adjunctive therapy would be most
beneficial?
A. Increase the frequency of bronchodilator administration
B. Add dornase alfa (Pulmozyme) to break down DNA in the mucus
,C. Increase oxygen flow rate
D. Administer systemic corticosteroids
B. Add dornase alfa (Pulmozyme) to break down DNA in the mucus [CORRECT]
The best answer is B. This choice is correct because dornase alfa is a recombinant human DNase that
breaks down the DNA released from neutrophils in CF mucus, making secretions less viscous and easier
to clear—it's a cornerstone of CF airway clearance therapy.
Correct Answer: B
Q5. A neonate with a gestational age of 26 weeks is intubated and receiving mechanical ventilation.
The RT is preparing to administer surfactant. Which route of administration is correct?
A. Intravenous bolus
B. Intratracheal instillation via the endotracheal tube
C. Nebulized via aerosol mask
D. Intramuscular injection
B. Intratracheal instillation via the endotracheal tube [CORRECT]
The best answer is B. This choice is correct because surfactant replacement therapy is administered
directly into the trachea through the endotracheal tube—this allows it to reach the alveoli where it's
needed to reduce surface tension and improve lung compliance.
Correct Answer: B
Q6. A 2-year-old child is brought to the ED with sudden onset of stridor, barking cough, and low-grade
fever. The child appears anxious and is sitting in the tripod position. What is the most likely diagnosis?
A. Asthma exacerbation
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
C. Croup (laryngotracheobronchitis) [CORRECT]
The best answer is C. This choice is correct because the barking cough, stridor, and low-grade fever in a
toddler are the classic triad for croup—this is a viral upper airway infection, and the presentation is very
different from the high fever and drooling you'd see with epiglottitis.
Correct Answer: C
, Q7. A neonate with suspected PPHN is being evaluated. The preductal SpO₂ is 95% and the postductal
SpO₂ is 78%. What does this finding indicate?
A. The infant has a right-to-left shunt through the ductus arteriosus
B. The infant has a left-to-right shunt
C. The pulse oximeter is malfunctioning
D. The infant has adequate oxygenation
A. The infant has a right-to-left shunt through the ductus arteriosus [CORRECT]
The best answer is A. This choice is correct because a significant preductal-postductal oxygen saturation
difference (>10%) is the hallmark of PPHN with right-to-left shunting through the ductus arteriosus—
blood is bypassing the lungs and going directly to the lower body.
Correct Answer: A
Q8. An 8-year-old child with asthma is receiving a continuous albuterol nebulizer at 15 mg/hr. The RT
notes the child's heart rate has increased from 110 to 160 bpm. What is the most appropriate action?
A. Continue the current treatment; tachycardia is an expected side effect
B. Decrease the albuterol dose and monitor closely
C. Stop all bronchodilator therapy immediately
D. Administer a beta-blocker
B. Decrease the albuterol dose and monitor closely [CORRECT]
The best answer is B. This choice is correct because while some tachycardia is expected with continuous
albuterol, a heart rate of 160 in an 8-year-old is excessive and signals the need to back off the dose
slightly while maintaining bronchodilation—this is a judgment call that balances efficacy with safety.
Correct Answer: B
Q9. A neonate born at 30 weeks gestation develops increasing oxygen requirements and bilateral
diffuse ground-glass opacities on chest X-ray. The infant is diagnosed with RDS. What is the primary
pathophysiologic defect?
A. Surfactant deficiency leading to alveolar collapse
B. Meconium obstruction of the airways
C. Pulmonary hypertension causing right-to-left shunting
D. Congenital diaphragmatic hernia
