National Certification Corporation (NCC)
Neonatal Nurse Practitioner
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
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1. A 30-week gestation infant born by cesarean section for fetal distress
remains apneic and bradycardic. After 30 seconds of effective positive
pressure ventilation, the heart rate is 55 bpm. The neonatal nurse
practitioner should:
A. Administer epinephrine via endotracheal tube
B. Initiate chest compressions coordinated with positive pressure
ventilation
C. Insert an umbilical venous catheter for volume expansion
D. Increase peak inspiratory pressure to improve chest rise
Answer: B
Rationale: According to the Neonatal Resuscitation Program, if the heart rate
remains below 60 beats per minute after at least 30 seconds of effective positive
pressure ventilation that produces chest movement, chest compressions must be
started. Compressions are coordinated with ventilation in a 3:1 ratio.
Epinephrine is indicated only if the heart rate persists below 60 bpm after 60
seconds of coordinated compressions and ventilation with appropriate
corrective steps. Volume expansion is reserved for suspected hypovolemia, and
increasing inspiratory pressure alone does not address the profound
bradycardia.
, 2. A term infant born via vacuum-assisted delivery presents with a fluctuant,
boggy scalp swelling that crosses suture lines. Vital signs are stable. The
nurse practitioner suspects:
A. Cephalohematoma
B. Caput succedaneum
C. Subgaleal hemorrhage
D. Craniosynostosis
Answer: C
Rationale: A subgaleal hemorrhage is a collection of blood in the loose
connective tissue between the galea aponeurotica and the periosteum, allowing
it to cross suture lines and expand widely. It can be fluctuant and, if large, may
lead to hypovolemic shock. Cephalohematoma is subperiosteal and does not
cross sutures. Caput succedaneum is a serosanguinous, superficial collection that
crosses suture lines but is not fluctuant and resolves quickly. Craniosynostosis
involves premature suture fusion and does not present as an acute fluctuant
swelling.
3. A 28-week infant is 12 hours old, on CPAP of 6 cm H2O and FiO2 0.35. Blood
gas analysis shows pH 7.25, PaCO2 60 mm Hg, PaO2 65 mm Hg, HCO3 22
mEq/L. The most appropriate intervention is to:
A. Increase CPAP to 8 cm H2O
B. Administer sodium bicarbonate
C. Intubate and initiate mechanical ventilation
D. Increase FiO2 to 0.50
Answer: C
Rationale: The blood gas indicates a primary respiratory acidosis with a pH
below 7.30 and marked hypercapnia. CPAP provides continuous distending
pressure but does not guarantee adequate minute ventilation to eliminate
carbon dioxide. Increasing CPAP may improve oxygenation but is unlikely to
sufficiently reduce PaCO2. Sodium bicarbonate is contraindicated for respiratory
acidosis because the underlying problem is hypoventilation. Intubation and
,mechanical ventilation will ensure effective CO2 removal. Increasing FiO2 alone
will not correct hypercapnia.
4. A late preterm infant develops indirect hyperbilirubinemia at 72 hours of
life. Total serum bilirubin is 18 mg/dL, birth weight is 2.5 kg, the infant is
feeding well, and there is no evidence of hemolysis. Intensive phototherapy
is initiated. Which laboratory value should be monitored most closely
during therapy?
A. Direct bilirubin fraction
B. Reticulocyte count
C. Serum bilirubin levels every 4 to 6 hours
D. Serum albumin
Answer: C
Rationale: During phototherapy, serial total serum bilirubin measurement every
4 to 6 hours is essential to evaluate response and determine whether therapy
needs to be intensified or can be discontinued. Direct bilirubin fraction is
monitored when cholestasis is suspected. Reticulocyte count helps detect
hemolysis but does not guide minute-to-minute phototherapy management.
Serum albumin may be considered in extreme hyperbilirubinemia to estimate
free bilirubin but is not a routine monitoring parameter during phototherapy.
5. An infant with meconium aspiration syndrome is on conventional
mechanical ventilation. The oxygenation index (OI) is calculated as 22 while
on FiO2 1.0. The nurse practitioner should anticipate initiating which
therapy?
A. High-frequency oscillatory ventilation
B. Surfactant administration
C. Inhaled nitric oxide
D. Systemic corticosteroids
Answer: C
Rationale: An oxygenation index (mean airway pressure × FiO2 × 100 / PaO2)
greater than 20 indicates severe hypoxemic respiratory failure, and inhaled nitric
oxide is indicated for persistent pulmonary hypertension of the newborn, which
, often accompanies meconium aspiration syndrome. Surfactant may be
considered but does not directly treat pulmonary hypertension. High-frequency
ventilation may be used as a rescue mode, but the presence of a high OI
mandates a targeted pulmonary vasodilator. Systemic corticosteroids are not
first-line therapy for acute PPHN.
6. A preterm infant born at 26 weeks and now 2 weeks old develops
abdominal distension, bilious gastric aspirates, and pneumatosis intestinalis
on abdominal radiograph. Blood culture is pending. Priority management
includes:
A. Immediate surgical consultation
B. Discontinue enteral feedings, start broad-spectrum antibiotics, and
provide nasogastric decompression
C. Administer indomethacin
D. Increase trophic feeds to maintain gut integrity
Answer: B
Rationale: Pneumatosis intestinalis is pathognomonic for necrotizing
enterocolitis. The immediate priorities are to make the infant nil per os, initiate
nasogastric decompression to reduce bowel distension, and administer broad-
spectrum antibiotics after obtaining cultures. Surgery is reserved for perforation
or clinical deterioration. Indomethacin is contraindicated because it may reduce
mesenteric perfusion. Increasing feeds would exacerbate the condition.
7. A newborn with critical pulmonary stenosis and ductal-dependent
pulmonary blood flow presents with cyanosis. Which medication is essential
to maintain systemic oxygenation until surgery?
A. Indomethacin
B. Prostaglandin E1 infusion
C. Milrinone
D. Furosemide
Answer: B
Rationale: In ductal-dependent pulmonary blood flow lesions such as critical
pulmonary stenosis, the ductus arteriosus provides the only source of pulmonary
Neonatal Nurse Practitioner
Examination Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 30-week gestation infant born by cesarean section for fetal distress
remains apneic and bradycardic. After 30 seconds of effective positive
pressure ventilation, the heart rate is 55 bpm. The neonatal nurse
practitioner should:
A. Administer epinephrine via endotracheal tube
B. Initiate chest compressions coordinated with positive pressure
ventilation
C. Insert an umbilical venous catheter for volume expansion
D. Increase peak inspiratory pressure to improve chest rise
Answer: B
Rationale: According to the Neonatal Resuscitation Program, if the heart rate
remains below 60 beats per minute after at least 30 seconds of effective positive
pressure ventilation that produces chest movement, chest compressions must be
started. Compressions are coordinated with ventilation in a 3:1 ratio.
Epinephrine is indicated only if the heart rate persists below 60 bpm after 60
seconds of coordinated compressions and ventilation with appropriate
corrective steps. Volume expansion is reserved for suspected hypovolemia, and
increasing inspiratory pressure alone does not address the profound
bradycardia.
, 2. A term infant born via vacuum-assisted delivery presents with a fluctuant,
boggy scalp swelling that crosses suture lines. Vital signs are stable. The
nurse practitioner suspects:
A. Cephalohematoma
B. Caput succedaneum
C. Subgaleal hemorrhage
D. Craniosynostosis
Answer: C
Rationale: A subgaleal hemorrhage is a collection of blood in the loose
connective tissue between the galea aponeurotica and the periosteum, allowing
it to cross suture lines and expand widely. It can be fluctuant and, if large, may
lead to hypovolemic shock. Cephalohematoma is subperiosteal and does not
cross sutures. Caput succedaneum is a serosanguinous, superficial collection that
crosses suture lines but is not fluctuant and resolves quickly. Craniosynostosis
involves premature suture fusion and does not present as an acute fluctuant
swelling.
3. A 28-week infant is 12 hours old, on CPAP of 6 cm H2O and FiO2 0.35. Blood
gas analysis shows pH 7.25, PaCO2 60 mm Hg, PaO2 65 mm Hg, HCO3 22
mEq/L. The most appropriate intervention is to:
A. Increase CPAP to 8 cm H2O
B. Administer sodium bicarbonate
C. Intubate and initiate mechanical ventilation
D. Increase FiO2 to 0.50
Answer: C
Rationale: The blood gas indicates a primary respiratory acidosis with a pH
below 7.30 and marked hypercapnia. CPAP provides continuous distending
pressure but does not guarantee adequate minute ventilation to eliminate
carbon dioxide. Increasing CPAP may improve oxygenation but is unlikely to
sufficiently reduce PaCO2. Sodium bicarbonate is contraindicated for respiratory
acidosis because the underlying problem is hypoventilation. Intubation and
,mechanical ventilation will ensure effective CO2 removal. Increasing FiO2 alone
will not correct hypercapnia.
4. A late preterm infant develops indirect hyperbilirubinemia at 72 hours of
life. Total serum bilirubin is 18 mg/dL, birth weight is 2.5 kg, the infant is
feeding well, and there is no evidence of hemolysis. Intensive phototherapy
is initiated. Which laboratory value should be monitored most closely
during therapy?
A. Direct bilirubin fraction
B. Reticulocyte count
C. Serum bilirubin levels every 4 to 6 hours
D. Serum albumin
Answer: C
Rationale: During phototherapy, serial total serum bilirubin measurement every
4 to 6 hours is essential to evaluate response and determine whether therapy
needs to be intensified or can be discontinued. Direct bilirubin fraction is
monitored when cholestasis is suspected. Reticulocyte count helps detect
hemolysis but does not guide minute-to-minute phototherapy management.
Serum albumin may be considered in extreme hyperbilirubinemia to estimate
free bilirubin but is not a routine monitoring parameter during phototherapy.
5. An infant with meconium aspiration syndrome is on conventional
mechanical ventilation. The oxygenation index (OI) is calculated as 22 while
on FiO2 1.0. The nurse practitioner should anticipate initiating which
therapy?
A. High-frequency oscillatory ventilation
B. Surfactant administration
C. Inhaled nitric oxide
D. Systemic corticosteroids
Answer: C
Rationale: An oxygenation index (mean airway pressure × FiO2 × 100 / PaO2)
greater than 20 indicates severe hypoxemic respiratory failure, and inhaled nitric
oxide is indicated for persistent pulmonary hypertension of the newborn, which
, often accompanies meconium aspiration syndrome. Surfactant may be
considered but does not directly treat pulmonary hypertension. High-frequency
ventilation may be used as a rescue mode, but the presence of a high OI
mandates a targeted pulmonary vasodilator. Systemic corticosteroids are not
first-line therapy for acute PPHN.
6. A preterm infant born at 26 weeks and now 2 weeks old develops
abdominal distension, bilious gastric aspirates, and pneumatosis intestinalis
on abdominal radiograph. Blood culture is pending. Priority management
includes:
A. Immediate surgical consultation
B. Discontinue enteral feedings, start broad-spectrum antibiotics, and
provide nasogastric decompression
C. Administer indomethacin
D. Increase trophic feeds to maintain gut integrity
Answer: B
Rationale: Pneumatosis intestinalis is pathognomonic for necrotizing
enterocolitis. The immediate priorities are to make the infant nil per os, initiate
nasogastric decompression to reduce bowel distension, and administer broad-
spectrum antibiotics after obtaining cultures. Surgery is reserved for perforation
or clinical deterioration. Indomethacin is contraindicated because it may reduce
mesenteric perfusion. Increasing feeds would exacerbate the condition.
7. A newborn with critical pulmonary stenosis and ductal-dependent
pulmonary blood flow presents with cyanosis. Which medication is essential
to maintain systemic oxygenation until surgery?
A. Indomethacin
B. Prostaglandin E1 infusion
C. Milrinone
D. Furosemide
Answer: B
Rationale: In ductal-dependent pulmonary blood flow lesions such as critical
pulmonary stenosis, the ductus arteriosus provides the only source of pulmonary
