Neonatal Resuscitation Program (NRP) Practice Questions and
Answers Rated A
Questions to ask prior to birth - -1. what is assisted delivery, breech or abnormal presentation,
expected Gestational age, (preterm <38 wks, term category II or III, maternal anesthesia, mag, or narcs,
38-41 wks or post-term >41 wks) prolapse cord, shoulder dystocia, meconium staining,
2. what is amniotic fluid color (only clear good), bleeding, placental abruption, chorioamnionitis
3. what's number of babies expected (twins mebbe
more),
4. are any additional risk factors (GDM, miscarriages, Abnormal transition signs and symptoms - -
preeclampsia, etc.) Apnea, tachypnea, bradycardia, tachycardia,
decreased muscle tone, low SpO2, hypotension
When to clamp umbilical cord - -30-60 seconds
after birth for VIGOROUS newborn Preductal SpO2 at 1 min - -60-65%
Things to look for after birth - -1. Is the baby Preductal SpO2 at 2 min - -65-70%
term, (if no, bring baby to warmer)
2. does the baby have good muscle tone,
(flaccid/extended extremities are bad) Preductal SpO2 at 3 min - -70-75%
3. is the baby breathing or crying? (if no crying,
observe chest for breathing efforts. if vigorous crying,
return to mom) Preductal SpO2 at 4 min - -75-80%
5 initial steps of care - -1. Warm, Preductal SpO2 at 5 min - -80-85%
2. position airway,
3. clear secretions if needed,
4. dry, Preductal SpO2 at 10 min - -85-95%
5. stimulate
Where to put pulse oximeter on newborn - -
Flow rate for free-flow O2 administration - -
Right hand or wrist (preductal)
10lpm
Requirements for CPAP on newborn - -HR
O2 level for free-flow O2 administration - -30%
>100bpm and spontaneous respirations
Suction setting for newborn - -80-100mmHg
Best way to determine HR - -Listen with
stethoscope on left side chest for 6 seconds, multiply
by 10
Antepartum risk factors - -gestation <36wks or
>41wks, pre-eclampsia and eclampsia, maternal
HTN, poly and oligohydramnios, fetal hydrops, If suctioning, do you suction the mouth or nose first? -
macrosomia and IGR, fetal malformations or
-Mouth
anomalies, no prenatal care.
Indications for PPV - -Apnea, gasping,
Inpartum - -Emergency c-section, vacuum
1/7
, Neonatal Resuscitation Program (NRP) Practice Questions and
Answers Rated A
HR<100bpm, SpO2 low despite free-flow O2 or lower heart rate. Stimulation will usually assist a
CPAP newborn in the required respiratory transition,
however if a newborn does not start breathing
immediately following stimulation, he/she is likely
Preparation for PPV - -Clear secretions, experiencing secondary apnea. Further stimulation
position yourself at baby's head, position baby's head will not help, and the newborn require positive-
and neck pressure ventilation.)
Rate for administering PPV breaths - -40- Which device should be readily available as a backup
60bpm or "breathe, two, three, breathe..." wherever resuscitation may be needed, in case a
compressed gas source fails? - -Self-inflating
bag
Proper PIP setting - -20-25cmH2O
(Unlike other bag-mask ventilation methods, self-
inflating bags reinflate when released due to a
pressure-release, or pop-off valve. Valves are
Proper PEEP setting - -5cmH20
typically set by the manufacturer to release at 30 to
40 cm H2O of pressure. This makes them the only
method usable when compressed gas sources are
O2 flow rate for PPV - -10lpm not available. It's important to note that for newborns
who have not yet taken their first breath, occlusion of
the pop-off valve may be necessary to generate
O2 concentration for PPV (>35wk gestation) - - sufficient pressure to inflate the nonaerated lungs.
21% However, care must be taken to avoid overinflation
and creation of a pulmonary air leak.)
O2 concentration for PPV (<35wk gestation) - -
21-30% Where should pressure be applied when performing
compressions on the newborn? - -Lower third
of the sternum
Single most important step in NRP is... - -
Ventilation of the lungs (Chest compressions on the newborn should apply
pressure to the lower one-third of the sternum,
typically in line with the nipples. Downward pressure
Meaning of "MR. SOPA" - -Mask adjustment, should be applied perpendicular to the chest wall to
reposition head, suction airway, open mouth, depress the sternum about one-third of the
pressure, alternative airway anteroposterior diameter of the chest, followed by
release of pressure to allow for refilling of the heart.
Providers should avoid direct pressure to the xiphoid,
If a baby does not begin breathing in response to which can result in liver injury.)
stimulation, you should assume they are in _______
apnea. - -Secondary
During resuscitation of a newborn, you've establish
(At the initiation of respiratory compromise, newborns adequate ventilation with an endotracheal tube and
experience an initial period of attempted rapid your colleague has begun chest compressions for a
breathing followed by primary apnea. Primary apnea heart rate under 60 bpm. Nevertheless, after 60
results in a reduced oxygen saturation, resulting in a seconds, the heart rate has not increased. What is
the most appropriate next step in management? -
2/7
Answers Rated A
Questions to ask prior to birth - -1. what is assisted delivery, breech or abnormal presentation,
expected Gestational age, (preterm <38 wks, term category II or III, maternal anesthesia, mag, or narcs,
38-41 wks or post-term >41 wks) prolapse cord, shoulder dystocia, meconium staining,
2. what is amniotic fluid color (only clear good), bleeding, placental abruption, chorioamnionitis
3. what's number of babies expected (twins mebbe
more),
4. are any additional risk factors (GDM, miscarriages, Abnormal transition signs and symptoms - -
preeclampsia, etc.) Apnea, tachypnea, bradycardia, tachycardia,
decreased muscle tone, low SpO2, hypotension
When to clamp umbilical cord - -30-60 seconds
after birth for VIGOROUS newborn Preductal SpO2 at 1 min - -60-65%
Things to look for after birth - -1. Is the baby Preductal SpO2 at 2 min - -65-70%
term, (if no, bring baby to warmer)
2. does the baby have good muscle tone,
(flaccid/extended extremities are bad) Preductal SpO2 at 3 min - -70-75%
3. is the baby breathing or crying? (if no crying,
observe chest for breathing efforts. if vigorous crying,
return to mom) Preductal SpO2 at 4 min - -75-80%
5 initial steps of care - -1. Warm, Preductal SpO2 at 5 min - -80-85%
2. position airway,
3. clear secretions if needed,
4. dry, Preductal SpO2 at 10 min - -85-95%
5. stimulate
Where to put pulse oximeter on newborn - -
Flow rate for free-flow O2 administration - -
Right hand or wrist (preductal)
10lpm
Requirements for CPAP on newborn - -HR
O2 level for free-flow O2 administration - -30%
>100bpm and spontaneous respirations
Suction setting for newborn - -80-100mmHg
Best way to determine HR - -Listen with
stethoscope on left side chest for 6 seconds, multiply
by 10
Antepartum risk factors - -gestation <36wks or
>41wks, pre-eclampsia and eclampsia, maternal
HTN, poly and oligohydramnios, fetal hydrops, If suctioning, do you suction the mouth or nose first? -
macrosomia and IGR, fetal malformations or
-Mouth
anomalies, no prenatal care.
Indications for PPV - -Apnea, gasping,
Inpartum - -Emergency c-section, vacuum
1/7
, Neonatal Resuscitation Program (NRP) Practice Questions and
Answers Rated A
HR<100bpm, SpO2 low despite free-flow O2 or lower heart rate. Stimulation will usually assist a
CPAP newborn in the required respiratory transition,
however if a newborn does not start breathing
immediately following stimulation, he/she is likely
Preparation for PPV - -Clear secretions, experiencing secondary apnea. Further stimulation
position yourself at baby's head, position baby's head will not help, and the newborn require positive-
and neck pressure ventilation.)
Rate for administering PPV breaths - -40- Which device should be readily available as a backup
60bpm or "breathe, two, three, breathe..." wherever resuscitation may be needed, in case a
compressed gas source fails? - -Self-inflating
bag
Proper PIP setting - -20-25cmH2O
(Unlike other bag-mask ventilation methods, self-
inflating bags reinflate when released due to a
pressure-release, or pop-off valve. Valves are
Proper PEEP setting - -5cmH20
typically set by the manufacturer to release at 30 to
40 cm H2O of pressure. This makes them the only
method usable when compressed gas sources are
O2 flow rate for PPV - -10lpm not available. It's important to note that for newborns
who have not yet taken their first breath, occlusion of
the pop-off valve may be necessary to generate
O2 concentration for PPV (>35wk gestation) - - sufficient pressure to inflate the nonaerated lungs.
21% However, care must be taken to avoid overinflation
and creation of a pulmonary air leak.)
O2 concentration for PPV (<35wk gestation) - -
21-30% Where should pressure be applied when performing
compressions on the newborn? - -Lower third
of the sternum
Single most important step in NRP is... - -
Ventilation of the lungs (Chest compressions on the newborn should apply
pressure to the lower one-third of the sternum,
typically in line with the nipples. Downward pressure
Meaning of "MR. SOPA" - -Mask adjustment, should be applied perpendicular to the chest wall to
reposition head, suction airway, open mouth, depress the sternum about one-third of the
pressure, alternative airway anteroposterior diameter of the chest, followed by
release of pressure to allow for refilling of the heart.
Providers should avoid direct pressure to the xiphoid,
If a baby does not begin breathing in response to which can result in liver injury.)
stimulation, you should assume they are in _______
apnea. - -Secondary
During resuscitation of a newborn, you've establish
(At the initiation of respiratory compromise, newborns adequate ventilation with an endotracheal tube and
experience an initial period of attempted rapid your colleague has begun chest compressions for a
breathing followed by primary apnea. Primary apnea heart rate under 60 bpm. Nevertheless, after 60
results in a reduced oxygen saturation, resulting in a seconds, the heart rate has not increased. What is
the most appropriate next step in management? -
2/7
