CCRN NEONATAL EXAM PRACTICE COMPLETELY COVERED
THROUGH QUESTIONS THAT ARE ACCURATELY SOLVED
WITH SUFFICIENT SOLUTIONS -2026 FINEST AND BRAND
NEW RELEASE-
1. A 2-day-old term neonate presents with tachypnea, grunting, and nasal flaring. Chest X-ray
shows diffuse granular opacities and air bronchograms. What is the most likely diagnosis?
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome (RDS)
C) Meconium aspiration syndrome
D) Pneumothorax
Correct answer: B) Respiratory distress syndrome (RDS)
Rationale: RDS presents with tachypnea, grunting, and X-ray findings of granular
opacities due to surfactant deficiency, most common in preterm but can occur in term with
surfactant dysfunction.
2. A neonate with severe hypoxic-ischemic encephalopathy is undergoing therapeutic
hypothermia. What core temperature is the target during the cooling phase?
A) 35.5–36.0°C
B) 33.0–34.0°C
C) 32.0–33.0°C
D) 36.5–37.0°C
Correct answer: B) 33.0–34.0°C
Rationale: Therapeutic hypothermia for HIE targets core temperature 33–34°C for 72
hours to reduce cerebral metabolic demand and prevent secondary injury.
3. A 3-day-old infant with jaundice has a total serum bilirubin of 22 mg/dL. The direct bilirubin
is 1.5 mg/dL. What is the priority nursing intervention?
A) Encourage oral feeding every 2 hours
B) Prepare for double-volume exchange transfusion
,C) Discontinue phototherapy
D) Administer IV albumin
Correct answer: B) Prepare for double-volume exchange transfusion
Rationale: Term infant with TSB >20–25 mg/dL is at risk for kernicterus; exchange
transfusion rapidly lowers bilirubin and prevents neurological damage.
4. A 1-hour-old neonate born via meconium-stained amniotic fluid is depressed with poor
respiratory effort, heart rate 80 bpm, and limp tone. What is the first step in resuscitation?
A) Intubate and suction meconium
B) Initial steps: warm, position, clear airway, stimulate, and if not breathing, begin PPV
C) Administer epinephrine via endotracheal tube
D) Start chest compressions
Correct answer: B) Initial steps: warm, position, clear airway, stimulate, and if not
breathing, begin PPV
Rationale: NRP guidelines no longer recommend routine intubation for meconium unless
infant is depressed; initial steps and PPV come first for apnea.
5. A preterm infant on high-frequency oscillatory ventilation develops sudden hypotension,
abdominal distension, and bloody stools. What condition should be suspected first?
A) Spontaneous intestinal perforation
B) Necrotizing enterocolitis (NEC)
C) Malrotation with volvulus
D) Hirschsprung disease
Correct answer: B) Necrotizing enterocolitis (NEC)
Rationale: Sudden abdominal distension, bloody stools, and instability in a preterm infant
on HFOV are classic for NEC until proven otherwise.
6. A neonate with congenital diaphragmatic hernia is on inhaled nitric oxide for persistent
pulmonary hypertension. Which finding indicates a positive response to iNO?
A) Mean airway pressure decreases
B) Oxygen saturation increases and need for oxygenation support decreases
,C) Heart rate drops below 100 bpm
D) PaCO2 rises to 60 mmHg
Correct answer: B) Oxygen saturation increases and need for oxygenation support
decreases
Rationale: iNO selectively vasodilates pulmonary vessels; a positive response improves
oxygenation and allows reduction of FiO2 and vasopressor support.
7. A 5-day-old infant with unrepaired tetralogy of Fallot has a hypercyanotic spell with crying.
What is the priority action?
A) Administer furosemide
B) Place infant in knee-chest position and give 100% oxygen
C) Start a dopamine drip
D) Prepare for immediate cardiac catheterization
Correct answer: B) Place infant in knee-chest position and give 100% oxygen
Rationale: Knee-chest position increases systemic vascular resistance, reduces right-to-left
shunting, and improves pulmonary blood flow during a Tet spell.
8. A term neonate has persistent hypoglycemia requiring IV dextrose infusion rates above 12
mg/kg/min. Labs show low insulin, low ketones, and low cortisol. What is the most likely
diagnosis?
A) Hyperinsulinism
B) Pituitary deficiency or adrenal insufficiency
C) Glycogen storage disease
D) Beckwith-Wiedemann syndrome
Correct answer: B) Pituitary deficiency or adrenal insufficiency
Rationale: Hypoglycemia with low ketones and low cortisol suggests cortisol deficiency
(adrenal or pituitary); hyperinsulinism would show high insulin.
9. A neonate with hypoxic-ischemic encephalopathy is on therapeutic hypothermia. During
rewarming, which complication is most important to monitor?
A) Hypothermia rebound
, B) Hyperthermia and seizures
C) Bradycardia
D) Hypotension
Correct answer: B) Hyperthermia and seizure
Rationale: Rewarming too quickly or overshooting normothermia can cause cerebral
hyperthermia and trigger seizures; rewarm slowly over 4–6 hours.
10. A preterm infant receiving caffeine citrate for apnea of prematurity develops tachycardia and
jitteriness. What is the most likely cause?
A) Caffeine toxicity
B) Therapeutic caffeine level with expected side effects
C) Sepsis
D) Hypoglycemia
Correct answer: B) Therapeutic caffeine level with expected side effects
Rationale: Caffeine citrate commonly causes mild tachycardia and jitteriness at
therapeutic levels; toxicity would cause vomiting and seizures.
11. A 2-week-old infant with CHD awaiting surgery has poor weight gain despite 24 kcal/oz
formula. What is the most appropriate nutritional intervention?
A) Switch to maternal breast milk only
B) Increase caloric density to 27–30 kcal/oz with modular additives
C) Start total parenteral nutrition
D) Restrict fluids to 100 mL/kg/day
Correct answer: B) Increase caloric density to 27–30 kcal/oz with modular additives
Rationale: Infants with heart failure need high-calorie, fluid-restricted feeds; 27–30 kcal/oz
supports growth without volume overload.
12. A neonate with meconium aspiration syndrome is on conventional ventilation with high
oxygen requirements. Which therapy is most likely to improve oxygenation?
A) Surfactant administration
THROUGH QUESTIONS THAT ARE ACCURATELY SOLVED
WITH SUFFICIENT SOLUTIONS -2026 FINEST AND BRAND
NEW RELEASE-
1. A 2-day-old term neonate presents with tachypnea, grunting, and nasal flaring. Chest X-ray
shows diffuse granular opacities and air bronchograms. What is the most likely diagnosis?
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome (RDS)
C) Meconium aspiration syndrome
D) Pneumothorax
Correct answer: B) Respiratory distress syndrome (RDS)
Rationale: RDS presents with tachypnea, grunting, and X-ray findings of granular
opacities due to surfactant deficiency, most common in preterm but can occur in term with
surfactant dysfunction.
2. A neonate with severe hypoxic-ischemic encephalopathy is undergoing therapeutic
hypothermia. What core temperature is the target during the cooling phase?
A) 35.5–36.0°C
B) 33.0–34.0°C
C) 32.0–33.0°C
D) 36.5–37.0°C
Correct answer: B) 33.0–34.0°C
Rationale: Therapeutic hypothermia for HIE targets core temperature 33–34°C for 72
hours to reduce cerebral metabolic demand and prevent secondary injury.
3. A 3-day-old infant with jaundice has a total serum bilirubin of 22 mg/dL. The direct bilirubin
is 1.5 mg/dL. What is the priority nursing intervention?
A) Encourage oral feeding every 2 hours
B) Prepare for double-volume exchange transfusion
,C) Discontinue phototherapy
D) Administer IV albumin
Correct answer: B) Prepare for double-volume exchange transfusion
Rationale: Term infant with TSB >20–25 mg/dL is at risk for kernicterus; exchange
transfusion rapidly lowers bilirubin and prevents neurological damage.
4. A 1-hour-old neonate born via meconium-stained amniotic fluid is depressed with poor
respiratory effort, heart rate 80 bpm, and limp tone. What is the first step in resuscitation?
A) Intubate and suction meconium
B) Initial steps: warm, position, clear airway, stimulate, and if not breathing, begin PPV
C) Administer epinephrine via endotracheal tube
D) Start chest compressions
Correct answer: B) Initial steps: warm, position, clear airway, stimulate, and if not
breathing, begin PPV
Rationale: NRP guidelines no longer recommend routine intubation for meconium unless
infant is depressed; initial steps and PPV come first for apnea.
5. A preterm infant on high-frequency oscillatory ventilation develops sudden hypotension,
abdominal distension, and bloody stools. What condition should be suspected first?
A) Spontaneous intestinal perforation
B) Necrotizing enterocolitis (NEC)
C) Malrotation with volvulus
D) Hirschsprung disease
Correct answer: B) Necrotizing enterocolitis (NEC)
Rationale: Sudden abdominal distension, bloody stools, and instability in a preterm infant
on HFOV are classic for NEC until proven otherwise.
6. A neonate with congenital diaphragmatic hernia is on inhaled nitric oxide for persistent
pulmonary hypertension. Which finding indicates a positive response to iNO?
A) Mean airway pressure decreases
B) Oxygen saturation increases and need for oxygenation support decreases
,C) Heart rate drops below 100 bpm
D) PaCO2 rises to 60 mmHg
Correct answer: B) Oxygen saturation increases and need for oxygenation support
decreases
Rationale: iNO selectively vasodilates pulmonary vessels; a positive response improves
oxygenation and allows reduction of FiO2 and vasopressor support.
7. A 5-day-old infant with unrepaired tetralogy of Fallot has a hypercyanotic spell with crying.
What is the priority action?
A) Administer furosemide
B) Place infant in knee-chest position and give 100% oxygen
C) Start a dopamine drip
D) Prepare for immediate cardiac catheterization
Correct answer: B) Place infant in knee-chest position and give 100% oxygen
Rationale: Knee-chest position increases systemic vascular resistance, reduces right-to-left
shunting, and improves pulmonary blood flow during a Tet spell.
8. A term neonate has persistent hypoglycemia requiring IV dextrose infusion rates above 12
mg/kg/min. Labs show low insulin, low ketones, and low cortisol. What is the most likely
diagnosis?
A) Hyperinsulinism
B) Pituitary deficiency or adrenal insufficiency
C) Glycogen storage disease
D) Beckwith-Wiedemann syndrome
Correct answer: B) Pituitary deficiency or adrenal insufficiency
Rationale: Hypoglycemia with low ketones and low cortisol suggests cortisol deficiency
(adrenal or pituitary); hyperinsulinism would show high insulin.
9. A neonate with hypoxic-ischemic encephalopathy is on therapeutic hypothermia. During
rewarming, which complication is most important to monitor?
A) Hypothermia rebound
, B) Hyperthermia and seizures
C) Bradycardia
D) Hypotension
Correct answer: B) Hyperthermia and seizure
Rationale: Rewarming too quickly or overshooting normothermia can cause cerebral
hyperthermia and trigger seizures; rewarm slowly over 4–6 hours.
10. A preterm infant receiving caffeine citrate for apnea of prematurity develops tachycardia and
jitteriness. What is the most likely cause?
A) Caffeine toxicity
B) Therapeutic caffeine level with expected side effects
C) Sepsis
D) Hypoglycemia
Correct answer: B) Therapeutic caffeine level with expected side effects
Rationale: Caffeine citrate commonly causes mild tachycardia and jitteriness at
therapeutic levels; toxicity would cause vomiting and seizures.
11. A 2-week-old infant with CHD awaiting surgery has poor weight gain despite 24 kcal/oz
formula. What is the most appropriate nutritional intervention?
A) Switch to maternal breast milk only
B) Increase caloric density to 27–30 kcal/oz with modular additives
C) Start total parenteral nutrition
D) Restrict fluids to 100 mL/kg/day
Correct answer: B) Increase caloric density to 27–30 kcal/oz with modular additives
Rationale: Infants with heart failure need high-calorie, fluid-restricted feeds; 27–30 kcal/oz
supports growth without volume overload.
12. A neonate with meconium aspiration syndrome is on conventional ventilation with high
oxygen requirements. Which therapy is most likely to improve oxygenation?
A) Surfactant administration
