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NNP-BC® Practice Questions – Original Questions 1-175 with
Answers and Detailed Rationales UPDATED!!!
1. A 28-week gestation infant is delivered via emergency
cesarean section for fetal bradycardia. The infant is apneic
with a heart rate of 70 bpm. The neonatal nurse practitioner
should:
A) Begin chest compressions immediately
B) Initiate positive pressure ventilation with 21-30% oxygen
C) Administer epinephrine
D) Intubate immediately
Answer: B) Initiate positive pressure ventilation with 21-30%
oxygen
Rationale: According to NRP guidelines, if the infant is
apneic or gasping with a heart rate below 100 bpm, positive
pressure ventilation should be initiated within the first
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minute of life. The initial FiO2 for a preterm infant should be
21-30%, titrated to target saturations. Chest compressions
are started only after 30 seconds of effective PPV if HR
remains <60 bpm. Epinephrine is given if HR remains <60
bpm after compressions and ventilation. Intubation may be
needed but PPV is the first step.
2. A 32-week gestation infant is 2 hours old and has a
respiratory rate of 70 breaths per minute, grunting, nasal
flaring, and intercostal retractions. Oxygen saturation is 88%
on room air. The most likely diagnosis is:
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome
C) Meconium aspiration syndrome
D) Congenital pneumonia
Answer: B) Respiratory distress syndrome
Rationale: RDS is caused by surfactant deficiency in preterm
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infants. Classic signs include tachypnea, grunting, nasal
flaring, and retractions, with hypoxemia. It typically presents
within the first hours of life. TTN is more common in late
preterm/term infants after cesarean delivery. Meconium
aspiration occurs in term/post-term infants. Congenital
pneumonia may present similarly but is less common than
RDS in preterm infants.
3. A 26-week gestation infant is receiving mechanical
ventilation. The neonatal nurse practitioner notes a sudden
decrease in oxygen saturation from 92% to 78%, decreased
breath sounds on the right side, and shift of the point of
maximal impulse to the left. The most likely cause is:
A) Left-sided pneumothorax
B) Right-sided pneumothorax
C) Endotracheal tube dislodgement into the right mainstem
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bronchus
D) Pulmonary hemorrhage
Answer: B) Right-sided pneumothorax
Rationale: Decreased breath sounds on the right with PMI
shift to the left indicates a right-sided pneumothorax with
tension physiology. This is a medical emergency requiring
immediate intervention (needle aspiration or chest tube
placement). ET tube dislodgement into the right mainstem
would cause decreased breath sounds on the left.
Pulmonary hemorrhage presents with bloody secretions and
bilateral findings.
4. A 30-week gestation infant is receiving mechanical
ventilation for RDS. The neonatal nurse practitioner is
considering surfactant administration. The mechanism of
action of surfactant is:
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NNP-BC® Practice Questions – Original Questions 1-175 with
Answers and Detailed Rationales UPDATED!!!
1. A 28-week gestation infant is delivered via emergency
cesarean section for fetal bradycardia. The infant is apneic
with a heart rate of 70 bpm. The neonatal nurse practitioner
should:
A) Begin chest compressions immediately
B) Initiate positive pressure ventilation with 21-30% oxygen
C) Administer epinephrine
D) Intubate immediately
Answer: B) Initiate positive pressure ventilation with 21-30%
oxygen
Rationale: According to NRP guidelines, if the infant is
apneic or gasping with a heart rate below 100 bpm, positive
pressure ventilation should be initiated within the first
1|Page
, Page |2
minute of life. The initial FiO2 for a preterm infant should be
21-30%, titrated to target saturations. Chest compressions
are started only after 30 seconds of effective PPV if HR
remains <60 bpm. Epinephrine is given if HR remains <60
bpm after compressions and ventilation. Intubation may be
needed but PPV is the first step.
2. A 32-week gestation infant is 2 hours old and has a
respiratory rate of 70 breaths per minute, grunting, nasal
flaring, and intercostal retractions. Oxygen saturation is 88%
on room air. The most likely diagnosis is:
A) Transient tachypnea of the newborn
B) Respiratory distress syndrome
C) Meconium aspiration syndrome
D) Congenital pneumonia
Answer: B) Respiratory distress syndrome
Rationale: RDS is caused by surfactant deficiency in preterm
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infants. Classic signs include tachypnea, grunting, nasal
flaring, and retractions, with hypoxemia. It typically presents
within the first hours of life. TTN is more common in late
preterm/term infants after cesarean delivery. Meconium
aspiration occurs in term/post-term infants. Congenital
pneumonia may present similarly but is less common than
RDS in preterm infants.
3. A 26-week gestation infant is receiving mechanical
ventilation. The neonatal nurse practitioner notes a sudden
decrease in oxygen saturation from 92% to 78%, decreased
breath sounds on the right side, and shift of the point of
maximal impulse to the left. The most likely cause is:
A) Left-sided pneumothorax
B) Right-sided pneumothorax
C) Endotracheal tube dislodgement into the right mainstem
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bronchus
D) Pulmonary hemorrhage
Answer: B) Right-sided pneumothorax
Rationale: Decreased breath sounds on the right with PMI
shift to the left indicates a right-sided pneumothorax with
tension physiology. This is a medical emergency requiring
immediate intervention (needle aspiration or chest tube
placement). ET tube dislodgement into the right mainstem
would cause decreased breath sounds on the left.
Pulmonary hemorrhage presents with bloody secretions and
bilateral findings.
4. A 30-week gestation infant is receiving mechanical
ventilation for RDS. The neonatal nurse practitioner is
considering surfactant administration. The mechanism of
action of surfactant is:
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