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Neonatal Nurse Practitioner Practice Test

NNP-BC exam Format | Course Contents | Course Outline | exam Syllabus | exam Objectives

Exam Code: NNP-BC
Exam Name: NCC Neonatal Nurse Practitioner
Exam Type: Computer-based- multiple-choice questions.
Number of Questions: 175 questions (150 scored- 25 unscored pretest questions).
Time Allotted: 3 hours (180 minutes).
Passing Score: Scaled score of 700 (on a scale of 300–900).

- Maternal History affecting the Newborn Antepartum
- Neonatal complications: maternal risk factors & complications
- gestational hypertension
- cardiac/pulmonary disease
- diabetes
- common infectious diseases
- common hematologic diseases
- placental insufficiency
- substance abuse
- medication effects
- Fetal assessment
- fetal fibronectin
- nonstress test
- biophysical profile
- ultrasound/doppler flow
- amniocentesis
- antenatal screening/quad screen
- Fetal procedures
- Intrapartum
- Fetal Heart Rate (FHR) Patterns
- Effects on the Fetus/Neonate
- tocolysis/induction
- analgesia
- anesthesia
- neuroprotective agents
- Intrapartum Complications
- amniotic fluid volume
- oligohydramnios
- polyhydramnios
- Rupture of Membranes
- premature
- prolonged
- Intrauterine Drug Exposure
- Nicotine
- Alcohol
- Prescription/nonprescription
- Illicit Drug

- Neonatal
- General appearance
- Head- eyes- nose- ears and mouth
- Neck and throat
- Chest
- Abdomen
- Spine/back
- Extremities
- Genitalia
- Musculoskeletal
- Skin
- Vital signs
- Gestational age assessment physical Characteristics of
- preterm
- term
- post-term
- AGA
- SGA
- LGA

- Associated risks/Complications of variations in gestational age
- Abnormalities of intrauterine parameters
- Behavioral assessment
- state
- Muscle movement/tone/reflexes
- Autonomic control/responses
- Neurosensory capabilities
- Neurological assessment
- Clinical Laboratory Tests
- Microbiological
- Biochemical
- Hematological
- Endocrine
- Immunologic
- Genetic

- Diagnostic studies
- Ultrasound/Doppler
- CT scan
- MRI
- X-ray/fluoroscopy
- EKG
- EEG
- Echocardiogram
- Voiding Cystourethrogram

- Techniques & Equipment
- Procedures
- bag and mask ventilation and T-piece
- LMA’s
- endotracheal intubation
- umbilical vessel and peripheral catheterization
- chest tube insertion/removal
- needle aspiration
- spinal/lumbar tap
- intraosseous access
- intravenous line placement (central/peripheral)
- blood sampling
- circumcisions - complications/contraindications

- Equipment
- cardiopulmonary monitors
- oxygenation equipment/end tidal CO2 monitoring
- invasive/non-invasive blood gas monitoring
- indwelling catheters
- incubators/radiant warmers
- ventilators
- phototherapy
- NIRS

- Family Integration
- Communication
- Family centered care
- Barriers to parent/infant interaction
- Grieving Process
- Stages of grieving and common behaviors
- Factors influencing enhancement or impediment of grief process
- Palliative care/End of life
- Parental depression
- Periviability
- Diversity- Equity and Inclusion
• Culturally supportive care

- Discharge Planning and Follow Up
- Anticipatory guidance
- Follow up screening
- Hearing
- Vision - ROP
- Developmental
- Health risks
- Discharge preparation
- Follow-up care

- Thermoregulation
- Mechanisms and management of heat transfer
- evaporation
- conduction
- convection
- radiation
- Rewarming techniques
- Mechanisms of heat production
- Temperature assessment
- Neutral thermal environment

- Resuscitation and Stabilization
- Transition to extrauterine life
- Delivery room assessment
- Techniques of resuscitation
- Indications for interventions
- Cord blood gas interpretation
- Neonatal transport

- Growth and Nutrition
- Physiology of Digestion and Absorption
- Nutritional Requirements
- Enteral Feeding
- Parenteral Nutrition
- Composition of Breast Milk/Formulas/Donor milk
- Dietary Supplementation

- Fluids and Electrolytes
- Common problems and conditions
- Fluid & Electrolyte requirements
- Insensible water loss/gain
- Central & peripheral infusion
- Acid base balance
- Fish oil emulsion (Omegaven) SMOF

- Pharmacokinetics & Pharmacodynamics
- Pharmacokinetics
- distribution
- excretion
- absorption
- metabolism
- withdrawal
- Principles of administration
- dosage/interval
- route
- tolerance/weaning
- Common Drug Therapies
- Analgesia/narcotics
- Anticoagulants
- Anticonvulsants
- Antihypertensive drugs
- Antimicrobials
- biologics/immunities
- vaccinations
- Cardiovascular drugs
- vasodilators/vasopressors
- antidysrhythmia drugs
- Diuretics
- GI drugs
- antacids
- prokinetic
- proton pump inhibitors
- Inhalants
- iNO
- Neurologic agents
- anesthetics agents
- sedatives
- hypnotics
- Respiratory drugs
- bronchodilators
- respiratory stimulants
- surfactant therapy
- Steroids
- Drugs and breastfeeding
- Drug transfer
- Drug safety

- Cardiac
- Congenital Cardiac Defects
- cyanotic
- Ebstein’s Anomaly
- Tetralogy of Fallot
- truncus arteriosus
- transposition of great vessels
- total anomalous pulmonary venous return
- tricuspid atresia
- acyanotic
- ventricular septal defect
- coarctation of aorta (interrupted arch)
- atrial septal defect septal defect
- hypoplastic left heart syndrome
- endocardial cushion defect (AV canal)
- aortic stenosis
- Patent ductus arteriosus
- Congestive heart failure
- Hypertension/Hypotension
- Shock
- Dysrhythmias
- PGE’s

- Respiratory
- Respiratory distress syndrome
- Transient tachypnea
- Pneumothorax and air leaks/chylothorax
- Congenital pulmonary airway malformation (CPAM)
- Cystic pulmonary
- Apnea of prematurity
- Meconium aspiration
- Diaphragmatic eventrations
- Persistent pulmonary hypertension
- Pneumonia
- Pulmonary hemorrhage
- Pulmonary hypoplasia
- Diaphragmatic hernia
- Chronic lung disease
- Laryngeal- tracheomalacia/stenosis
- Respiratory support
- principles and methods of oxygen
- administration/ventilation
- risk factors affecting oxygenation/ventilation
- oxyhemoglobin dissociation curve
- high frequency ventilation (HFV)
- extracorporeal membrane oxygenation (ECMO)
- nitric oxide
- neurally adjusted ventilatory assist (NAVA)
- nasal intermittent positive pressure ventilation (NIPPV)
- noninvasive ventilation (NIV)

- Gastrointestinal
- Development of the GI tract
- Digestive and absorptive disorders
- diarrhea/short gut
- Disorders of suck/swallow/motility
- GERD
- cleft lip palate
- Duodenal atresia
- tracheoesophageal fistula -esophageal atresia
- small left colon syndrome
- Hirschsprung disease
- volvulus
- imperforate anus
- pyloric stenosis
- Malabsorption/maldigestion
- Diarrhea/short gut
- Anomalies/obstruction of upper and lower GI tract
- small left colon syndrome
- Hirschsprung’s disease
- Abdominal wall defects
- gastroschisis -omphalocele
- Obstructions
- Perforations
- Meconium ileus
- Tracheoesophageal fistula
- Necrotizing enterocolitis
- Inguinal hernia
- Malrotaton

- Renal/Genitourinary
- Renal vein/artery thrombosis
- Acute renal failure/insufficiency
- Polycystic/multicystic dysplastic kidneys
- Urinary outflow tract obstruction
- Testicular torsion
- Exstrophy of the bladder
- Hypospadias/epispadias
- Hydronephrosis grading system/hydroureter

- Endocrine/Metabolic
- Adrenal disorders
- Ambiguous genitalia
- Calcium disorders
- Glucose disorders
- Magnesium disorders
- Phosphorus disorders
- Pituitary disorders
- Thyroid disorders
- Infants of diabetic mothers
- Osteopenia of prematurity

- Hematopoietic
- Hematological disorders
- anemia
- polycythemia
- platelet disorders
- coagulopathies
- vitamin K deficiency
- disseminated intravascular coagulation
- factor deficiencies
- neutropenia/neutrophilia
- Rh disease and ABO incompatibility
- Blood component therapy
- Jaundice and liver disease
- Hyperbilirubinemia (direct and indirect)
- Breastmilk jaundice
- Kernicterus
- Phototherapy
- Exchange transfusion
- Biliary atresia

- Infectious Diseases
- Normal immunologic function
- Common neonatal infections
- group B streptococcal
- e-coli
- staphylococcal
- klebsiella
- enterococcus
- candidiasis
- pseudomonas
- enterovirus
- respiratory syncytial virus (RSV)
- CMV
- hepatitis B
- toxoplasmosis
- herpes
- HIV/AIDS
- chlamydia
- gonorrhea
- syphilis
- varicella
- Neonatal sepsis
- SIRS
- Meningitis
- Septic shock
- Infection control and universal precautions
- MRSA/VRSE
- Osteomyelitis

- Musculoskeletal
- Abnormalities of the skeleton
- metatarsus adductus
- achondroplasia
- Clubfoot
- Developmental dysplasia of the hip
- Spinal abnormalities
- Musculoskeletal birth injuries
- fractures
- nerve damage
- torticollis
- Aperts- crouzon- etc.

- Integumentary
- General skin development and care
- Disorders
- ecchymosis -epidermolysis bullosa
- hemangiomas
- ichthyosis
- subcutaneous fat necrosis
- Milia/miliara
- Hyperpigmented macule
- Erythema toxicum
- Neonatal pustular melanosis
- Auricular tags
- Petechiae
- Port wine stain
- Hyper/hypopigmentation

- Genetics
- Genetic processes
- multifactorial inheritance
- nondisjunction
- translocation
- deletion/duplication
- sex linked inheritance
- Inborn errors of metabolism
- Hyperammonemia
- Newborn Screening
- galactosemia
- cystic fibrosis
- Chromosomal abnormalities/syndromes
- Trisomy 21
- Trisomy 13
- Trisomy 18
- Turner syndrome
- Beckwith-Wiedemann syndrome
- DiGeorge syndrome
- Osteogenesis imperfecta
- Potter sequence
- VATER/VACTERL
- CHARGE

- Neurological
- Perinatal – depression/asphyxia
- Hypoxic ischemic encephalopathy
- therapeutic hypothermia
- Cranial hemorrhages
- Hydrocephalus
- Neural tube defects
- Seizures
- Jitteriness
- Periventricular leukomalacia
- Auto regulation
- Cerebral palsy
- aEEG
- Near-infrared spectroscopy (NIRS)
- Congenital neuromuscular disorders
- Craniosynostosis
- Neurodevelopmental care

- Ears- Eyes- Nose and Throat
- Eyes
- eye prophylaxis
- cataracts
- coloboma
- glaucoma
- retinopathy of prematurity
- strabismus
- conjunctivitis
- Nose
- nasolacrimal duct obstruction
- choanal atresia
- deviated septum
- Ears
- malformations
- Mouth/throat
- cleft lip and palate
- micrognathia/retrognathia
- macroglossia
- airway obstruction
- Ethical Principles
- Autonomy
- Beneficence
- Non-maleficence
- Justice
- Professional/Legal Issues
- Professional
- Regulation
- Practice
- HIPPA
- Staffing issues
- Legal liability
- Consent
- Documentation/medical records
- Negligence/malpractice
- Evidence-based practice
- Terminology
- Reliability
- Validity
- Significance
- Levels of Evidence
- Quality Improvement
- Research utilization
- Neonatal Safety
- Communication
- Interprofessional practice

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NCC Neonatal Nurse Practitioner - 2026
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Question: 1143
A 38-week gestation neonate is born to a mother with a history of opioid use disorder and recent
methadone maintenance. At 36 hours of life, the neonate exhibits a Finnegan score of 14, with tremors
and poor feeding. What is the most appropriate management?
A. Administer intravenous fluids and monitor
B. Initiate morphine therapy
C. Provide non-pharmacologic interventions
Answer: B
Explanation: A Finnegan score of 14 indicates severe neonatal abstinence syndrome (NAS) requiring
pharmacologic treatment. Morphine is the first-line therapy to manage withdrawal symptoms. Non-
pharmacologic interventions are insufficient for severe NAS, and intravenous fluids are not indicated
unless dehydration is present.
Question: 1144
A 32-week preterm neonate with a birth weight of 1.4 kg presents with pallor and poor feeding.
Laboratory results show hemoglobin of 8 g/dL (normal: 14-20), mean corpuscular volume (MCV) of 90
fL (normal: 100-120), and reticulocyte count of 1% (normal: 3-7%). The peripheral smear shows
microcytic, hypochromic red blood cells. Ferritin is 20 ng/mL (normal: 50-200). What is the most
appropriate treatment for this neonate�s condition?
A. Administer folic acid supplementation
B. Start oral ferrous sulfate therapy
C. Initiate packed red blood cell transfusion
Answer: C
Explanation: The neonate has iron deficiency anemia, evidenced by low hemoglobin, microcytic
hypochromic red cells, low MCV, and low ferritin. In preterm neonates, acute anemia with significant
symptoms (pallor, poor feeding) warrants packed red blood cell transfusion to rapidly correct oxygen-
carrying capacity. Oral iron therapy is not suitable for preterm infants due to immature gut absorption,
and folic acid is indicated for megaloblastic anemia, not iron deficiency.
Question: 1145
A term neonate with biliary atresia is diagnosed via intraoperative cholangiogram at 6 weeks of age. The
neonate undergoes a Kasai portoenterostomy. Postoperatively, the neonate develops cholangitis, with
fever, elevated direct bilirubin (6 mg/dL), and leukocytosis (WBC 18,000/�L). What is the most
appropriate antibiotic regimen to treat this complication?
A. Ampicillin and gentamicin
B. Ceftriaxone monotherapy
C. Piperacillin-tazobactam
Answer: C
Explanation: Cholangitis following Kasai portoenterostomy is typically caused by gram-negative bacilli
and anaerobes. Piperacillin-tazobactam provides broad-spectrum coverage, including Pseudomonas and
anaerobes, making it the preferred choice. Ampicillin and gentamicin are less effective against anaerobes.
Ceftriaxone is contraindicated in neonates due to its displacement of bilirubin from albumin, increasing
kernicterus risk.
Question: 1146
A 29-year-old G1P0 at 36 weeks gestation undergoes a Doppler ultrasound due to suspected fetal growth
restriction (FGR). The middle cerebral artery (MCA) Doppler shows a decreased pulsatility index (PI),
and the umbilical artery Doppler shows reversed end-diastolic flow (REDF). What is the most
appropriate management to optimize neonatal outcomes?
A. Plan for immediate delivery
B. Perform a biophysical profile (BPP)
C. Administer betamethasone and monitor weekly
Answer: A
Explanation: Reversed end-diastolic flow in the umbilical artery and a decreased MCA pulsatility index
(indicating brain-sparing redistribution) signify severe placental insufficiency and fetal hypoxia in FGR.
At 36 weeks, immediate delivery is indicated to prevent stillbirth or further compromise. Betamethasone
and monitoring are insufficient given the critical Doppler findings. A BPP may confirm compromise but
delays urgent delivery.
Question: 1147
A 33-week preterm neonate, appropriate for gestational age (AGA), is admitted to the NICU. On
examination, the nurse practitioner notes soft, pliable ears with minimal cartilage, sparse lanugo, and a
gelatinous, transparent skin appearance. Using the New Ballard Score, what is the estimated gestational
age based on these physical characteristics?
A. 34�36 weeks
B. 31�33 weeks
C. 28�30 weeks
Answer: C
Explanation: The New Ballard Score assesses gestational age based on physical and neuromuscular
maturity. Soft, pliable ears with minimal cartilage, sparse lanugo, and gelatinous, transparent skin are
characteristic of extreme prematurity, typically 28�30 weeks gestation. These features indicate
underdeveloped physical maturity compared to the 33-week stated age, suggesting the score aligns with
an earlier gestational age.
Question: 1148
A 36-week neonate, diagnosed prenatally with congenital pulmonary airway malformation (CPAM) via
ultrasound, is delivered via elective cesarean section. Postnatally, the neonate is asymptomatic, with
oxygen saturation of 98% on room air. Chest CT confirms a macrocystic CPAM in the left lower lobe,
measuring 4 cm. The neonatal nurse practitioner is consulted regarding management. Which approach is
most appropriate based on current evidence?
A. Immediate surgical resection of the affected lobe
B. Observation with serial imaging and outpatient follow-up
C. Start prophylactic antibiotics to prevent infection
Answer: B
Explanation: Asymptomatic neonates with CPAM, particularly macrocystic lesions, are often managed
conservatively with observation and serial imaging due to the potential for spontaneous regression.
Surgical resection is reserved for symptomatic cases or those with complications like recurrent infections.
Prophylactic antibiotics are not routinely indicated without evidence of infection.
Question: 1149
A 30-week preterm neonate develops a bowel perforation secondary to necrotizing enterocolitis. Post-
resection, the neonatal nurse practitioner notes a serum sodium of 128 mEq/L and a urine output of 0.5
mL/kg/h. What is the most likely cause of these findings, and what is the appropriate intervention?
A. Syndrome of inappropriate antidiuretic hormone; fluid restriction
B. Renal failure; initiate dialysis
C. Third-space fluid losses; isotonic fluid bolus
Answer: C
Explanation: Bowel perforation in NEC leads to third-space fluid losses into the peritoneal cavity,
causing hyponatremia and oliguria from hypovolemia. An isotonic fluid bolus (e.g., normal saline) is
required to restore intravascular volume. SIADH would cause hyponatremia but not oliguria, and renal
failure is less likely without other signs.
Question: 1150
A term neonate, delivered vaginally after a prolonged second stage of labor, is apneic and limp at birth.
The delivery room team initiates resuscitation per NRP guidelines, including drying, stimulation, and
PPV with a T-piece resuscitator at 20 cm H2O pressure and 5 cm H2O PEEP. After 30 seconds, the
neonate�s heart rate is 80 bpm, but oxygen saturation (SpO2) is 60% at 1 minute of life. The pre-ductal
SpO2 target at 1 minute is 60�65%. What is the most appropriate next step to support the neonate�s
transition to extrauterine life?
A. Continue PPV with current settings
B. Administer supplemental oxygen at 30%
C. Intubate and initiate mechanical ventilation
Answer: A
Explanation: The neonate�s SpO2 of 60% at 1 minute aligns with the NRP target range of 60�65%,
indicating appropriate oxygenation for this stage of transition. The heart rate of 80 bpm is improving but
not yet optimal (>100 bpm), suggesting that continuing PPV with current settings is appropriate to
support ventilation and oxygenation. Supplemental oxygen is not indicated unless SpO2 falls below the
target range. Intubation is reserved for cases of ineffective PPV, prolonged apnea, or other complications
not present here.
Question: 1151
A 36-week neonate, born via cesarean section, presents with mild respiratory distress and oxygen
saturation of 94% on room air. Chest X-ray shows perihilar streaking, suggestive of transient tachypnea
of the newborn. The neonatal nurse practitioner notes a maternal history of gestational diabetes. Which
laboratory value should be monitored closely due to the risk of secondary complications?
A. Serum glucose levels
B. Serum calcium levels
C. Serum potassium levels
Answer: A
Explanation: Neonates born to mothers with gestational diabetes are at risk for hypoglycemia, which can
exacerbate respiratory distress in transient tachypnea of the newborn. Monitoring serum glucose levels is
critical to prevent secondary complications. Calcium and potassium are less directly related to this
scenario.
Question: 1152
A 26-week gestation neonate (800 grams) is in a servo-controlled incubator set to maintain a skin
temperature of 36.5�C. The Neonatal Nurse Practitioner observes that the incubator�s air temperature
fluctuates between 34�C and 37�C, and the neonate�s core temperature drops to 35.8�C. Lab values show
pH 7.28, PaCO2 50 mmHg, and base deficit -6 mEq/L. Which factor is most likely contributing to the
neonate�s hypothermia, and what should the Neonatal Nurse Practitioner adjust?
A. Conduction; place a warmed mattress under the neonate
B. Radiation; add a reflective heat shield to the incubator
C. Evaporation; increase incubator humidity to 80%
Answer: C
Explanation: The neonate�s hypothermia, acidotic pH, and elevated PaCO2 suggest cold stress, likely due
to evaporative heat loss in the incubator. At 26 weeks, the neonate�s thin skin and high surface area
increase transepidermal water loss, especially if humidity is suboptimal (typically <80% for extreme
preterm infants). Increasing humidity to 80% reduces evaporative losses, stabilizing temperature.
Conductive losses are minimal in a double-walled incubator, and radiation losses are less likely without
specific environmental cues (e.g., cold walls).
Question: 1153
A 35-week preterm neonate in the NICU develops widespread flaccid bullae and erosions on the
extremities on day 5 of life. Nikolsky�s sign is positive, and a skin biopsy reveals intraepidermal
cleavage. The nurse practitioner suspects epidermolysis bullosa (EB). Which subtype of EB is most
likely based on the clinical and histological findings, and what is the primary management focus?
A. Dystrophic EB; surgical debridement of lesions
B. Junctional EB; meticulous wound care and infection prevention
C. Simplex EB; systemic corticosteroids
Answer: B
Explanation: Junctional epidermolysis bullosa is characterized by flaccid bullae, positive Nikolsky�s sign,
and intraepidermal cleavage, often presenting in preterm neonates. Meticulous wound care and infection
prevention are critical due to the fragility of the skin and risk of sepsis. Dystrophic EB involves deeper
cleavage and scarring, while simplex EB is less severe and not typically managed with corticosteroids.
Question: 1154
In a busy NICU, a neonatal nurse practitioner is addressing a neonatal safety concern involving
medication errors during high-acuity handoffs. A root cause analysis reveals that incomplete verbal
handoffs contribute to 60% of errors. The Neonatal Nurse Practitioner proposes a standardized handoff
tool using the SBAR (Situation, Background, Assessment, Recommendation) format. After
implementation, a post-intervention audit shows a 95% adherence rate. What is the absolute risk
reduction (ARR) for incomplete handoffs?
A. 35%
B. 55%
C. 95%
Answer: B
Explanation: ARR is calculated as the difference between the control event rate (pre-intervention
incomplete handoff rate, 60%) and the experimental event rate (post-intervention incomplete handoff rate,
100% - 95% = 5%). ARR = 60% - 5% = 55%. This represents the absolute reduction in incomplete
handoffs due to the SBAR tool.
Question: 1155
A 34-week preterm infant with a history of transient tachypnea of the newborn (TTN) is being discharged
at 38 weeks corrected age. The infant is on full oral feeds and has gained 25 g/day over the past week.
During discharge counseling, the neonatal nurse practitioner discusses safe sleep practices to reduce the
risk of SIDS. Which anticipatory guidance is most accurate?
A. Recommend a firm mattress and back sleeping, avoiding soft bedding
B. Advise parents to use a wedge to elevate the infant�s head during sleep
C. Suggest co-sleeping to monitor breathing closely
Answer: A
Explanation: Safe sleep practices to reduce SIDS risk include using a firm mattress, placing the infant on
their back, and avoiding soft bedding or loose objects. Wedges are not recommended due to suffocation
risks, and co-sleeping increases SIDS risk.
Question: 1156
A 5-day-old neonate with tricuspid atresia presents with cyanosis (SpO2 68%), poor feeding, and a heart
rate of 180 bpm. Echocardiography shows a hypoplastic right ventricle and an ASD. Laboratory values
include a hemoglobin of 18 g/dL and a hematocrit of 54%. The neonate is started on PGE1. What is the
most critical nursing intervention to prevent complications from polycythemia in this neonate?
A. Administer aspirin 5 mg/kg PO daily
B. Initiate supplemental oxygen
C. Ensure adequate hydration
Answer: C
Explanation: Polycythemia in tricuspid atresia results from chronic hypoxia, increasing blood viscosity
and the risk of thromboembolism. Ensuring adequate hydration reduces viscosity and prevents thrombotic
complications. Aspirin is not routinely used in neonates for this purpose. Supplemental oxygen may
improve SpO2 but does not address polycythemia directly.
Question: 1157
A 34-week preterm neonate is diagnosed with Beckwith-Wiedemann syndrome based on clinical findings
of macrosomia, hemihypertrophy, and an elevated alpha-fetoprotein level. The neonate�s abdominal
ultrasound reveals visceromegaly, and the neonate is at increased risk for Wilms tumor. Which of the
following is the most appropriate screening protocol to monitor for malignancy in this neonate?
A. Abdominal ultrasound every 3 months until age 8 years
B. Annual CT scan of the abdomen
C. Serum alpha-fetoprotein levels annually
Answer: A
Explanation: Neonates with Beckwith-Wiedemann syndrome are at increased risk for embryonal tumors,
particularly Wilms tumor and hepatoblastoma, due to imprinting defects on chromosome 11p15. The
recommended screening protocol includes abdominal ultrasound every 3 months until age 8 years to
detect tumors early, as this imaging modality is non-invasive and effective. Annual CT scans expose the
neonate to unnecessary radiation, and while alpha-fetoprotein levels are monitored, they are typically
checked every 6-12 weeks, not annually, and are not the primary screening method.
Question: 1158
A term neonate with a TSB of 21 mg/dL at 72 hours of life is receiving intensive phototherapy. The
direct bilirubin is 0.8 mg/dL, and the neonate has a positive direct Coombs test, indicating ABO
incompatibility. The hemoglobin is 12 g/dL. After 12 hours, the TSB is 20 mg/dL, and the neonate is
clinically stable. What is the most appropriate adjunctive therapy to reduce the need for exchange
transfusion?
A. Administer phenobarbital 5 mg/kg/day
B. Initiate IVIG at 1 g/kg
C. Perform an albumin infusion at 1 g/kg
Answer: B
Explanation: In ABO incompatibility with persistent hyperbilirubinemia despite phototherapy, IVIG at 1
g/kg reduces hemolysis by blocking Fc receptors, lowering bilirubin production. Phenobarbital is used for
Crigler-Najjar syndrome, not ABO incompatibility. Albumin infusion is not standard for this indication.
Question: 1159
A 29-week preterm neonate exhibits jitteriness and poor feeding. The mother used SSRIs during
pregnancy. Serum glucose is 48 mg/dL, calcium is 8.8 mg/dL, and aEEG is normal. What is the most
appropriate management?
A. Administer calcium gluconate for hypocalcemia
B. Initiate phenobarbital for suspected seizures
C. Observe for SSRI withdrawal and provide supportive care
Answer: C
Explanation: Jitteriness with SSRI exposure and normal labs/aEEG suggests withdrawal. Supportive care
and observation are appropriate. Calcium is normal, and phenobarbital is unnecessary without seizures.
Question: 1160
A 35-week preterm neonate, born via cesarean section, requires PPV in the delivery room due to apnea.
After 60 seconds of effective PPV, the heart rate is 70 bpm, and SpO2 is 75% (target: 70�75%). The
team suspects persistent pulmonary hypertension of the newborn (PPHN). Which intervention is most
likely to address the underlying pathophysiology of PPHN in this scenario?
A. Administer inhaled nitric oxide via endotracheal tube
B. Start dopamine infusion
C. Increase oxygen to 100% during PPV
Answer: C
Explanation: PPHN is characterized by persistent constriction of pulmonary vasculature, leading to
hypoxemia. Increasing oxygen to 100% during PPV can promote pulmonary vasodilation and improve
oxygenation, which is critical in the acute setting of resuscitation. Inhaled nitric oxide is a targeted
therapy for PPHN but is typically initiated in a NICU setting, not during delivery room resuscitation.
Dopamine is not a first-line treatment for PPHN-related hypoxemia.
Question: 1161
A NICU serves a diverse population, including a 33-week neonate whose parents speak limited English
and request a traditional herbal remedy for jaundice. The Neonatal Nurse Practitioner must balance
cultural sensitivity with evidence-based practice. Which action best upholds the principle of beneficence
while ensuring safe care, considering the neonate�s bilirubin level of 18 mg/dL?
A. Explain the risks of untested remedies and recommend phototherapy alone
B. Allow the herbal remedy alongside phototherapy to respect cultural preferences
C. Administer the herbal remedy under medical supervision
Answer: A
Explanation: Beneficence prioritizes the neonate�s well-being. A bilirubin level of 18 mg/dL requires
evidence-based phototherapy to prevent kernicterus, per AAP guidelines. Explaining the risks of untested
herbal remedies ensures safe care while respecting cultural dialogue, aligning with ANA ethical
standards. Allowing or administering the remedy risks delaying effective treatment, compromising
beneficence, as herbal remedies lack evidence in neonatal jaundice management.
Question: 1162
A term neonate with a karyotype of 45,XO presents with lymphedema, a webbed neck, and a bicuspid
aortic valve on echocardiogram, consistent with Turner syndrome. The neonate�s growth hormone levels
are normal, but her IGF-1 level is low at 30 ng/mL (normal: 50-150 ng/mL). Which of the following is
the most appropriate intervention to address the neonate�s growth concerns in the long term?
A. Growth hormone therapy
B. Monitor growth without intervention
C. Vitamin D supplementation
Answer: A
Explanation: The neonate�s diagnosis of Turner syndrome, confirmed by a 45,XO karyotype, is
associated with short stature due to SHOX gene haploinsufficiency, as evidenced by the low IGF-1 level
despite normal growth hormone levels. Growth hormone therapy is recommended to Excellerate final adult
height in girls with Turner syndrome, typically started in early childhood but planned for in neonates
with confirmed diagnosis. Monitoring without intervention risks suboptimal growth, and vitamin D
supplementation is unrelated to the growth concerns in this context.
Question: 1163
A 30-week preterm neonate in the NICU develops a temperature of 38.5�C, lethargy, and poor feeding on
day 7 of life. Laboratory results show a white blood cell count of 22,000/mm�, C-reactive protein of 15
mg/L, and a blood culture pending. Lumbar puncture reveals cerebrospinal fluid with 50 white blood
cells/mm� (80% neutrophils), glucose of 30 mg/dL, and protein of 150 mg/dL. Which antibiotic regimen
is most appropriate for suspected neonatal sepsis and meningitis?
A. Vancomycin 15 mg/kg every 12 hours and ceftazidime 50 mg/kg every 12 hours
B. Ampicillin 100 mg/kg/day and gentamicin 4 mg/kg every 24 hours
C. Ampicillin 100 mg/kg/day and cefotaxime 100 mg/kg/day
Answer: C
Explanation: The neonate�s presentation and CSF findings suggest late-onset neonatal sepsis with
meningitis, likely caused by group B Streptococcus or gram-negative organisms. Ampicillin and
cefotaxime provide broad-spectrum coverage for these pathogens, with cefotaxime preferred over
gentamicin for meningitis due to better CSF penetration. Vancomycin and ceftazidime are used for
resistant organisms, but there is no indication of methicillin-resistant Staphylococcus aureus or
Pseudomonas in this scenario.
Question: 1164
A 26-week gestational age neonate with necrotizing enterocolitis is in critical condition, limiting parental
access due to frequent medical interventions. The parents express frustration over their inability to bond
with their infant. Which intervention best addresses this barrier to parent-infant interaction while
maintaining medical stability?
A. Postpone all parental interactions until the infant is medically stable
B. Allow brief parental visits during stable periods with nurse supervision
C. Provide a video feed of the infant to the parents� waiting area
Answer: B
Explanation: Allowing brief, supervised parental visits during stable periods balances medical needs with
opportunities for bonding, addressing the barrier to interaction. Postponing all interactions exacerbates
emotional distress and hinders attachment, while a video feed, though supportive, does not facilitate
direct physical or emotional connection.
Question: 1165
A term neonate presents with pulmonary hypoplasia, bilateral renal agenesis, and potter facies, consistent
with Potter sequence. The neonate�s chest X-ray shows small lung fields, and the arterial blood gas
reveals pH 7.22, PaCO2 60 mmHg, and HCO3- 24 mEq/L. The neonate is intubated and on synchronized
intermittent mandatory ventilation (SIMV). Which of the following is the most appropriate adjustment to
the ventilator settings to address the respiratory acidosis?
A. Increase peak inspiratory pressure to 35 cmH2O
B. Comfort care with no ventilator adjustments
C. Increase respiratory rate to 60 breaths/min
Answer: B
Explanation: Potter sequence with bilateral renal agenesis results in severe pulmonary hypoplasia, leading
to inadequate gas exchange, as seen in the respiratory acidosis and small lung fields on X-ray. The
prognosis is fatal due to the inability to sustain ventilation. Adjusting ventilator settings, such as
increasing peak inspiratory pressure or respiratory rate, is unlikely to Excellerate outcomes and may cause
harm. Comfort care with no further ventilator adjustments is the most appropriate approach, focusing on
family support.
Question: 1166
A neonate undergoes newborn screening, which reveals an elevated phenylalanine level of 15 mg/dL
(normal: <2 mg/dL), suggestive of phenylketonuria (PKU). The neonatal nurse practitioner confirms the
diagnosis with repeat testing and initiates a low-phenylalanine diet. What is the primary goal of this
dietary intervention?
A. Prevent neurotoxicity from phenylalanine accumulation
B. Promote tyrosine synthesis
C. Reduce homogentisic acid production
Answer: A
Explanation: In PKU, phenylalanine accumulation is neurotoxic, leading to intellectual disability if
untreated. A low-phenylalanine diet prevents this by limiting substrate intake. Tyrosine supplementation
may be needed but is not the primary goal. Homogentisic acid is unrelated to PKU.
Question: 1167
A term neonate undergoes surgical repair for Hirschsprung disease, confirmed by rectal biopsy showing
absent ganglion cells. Postoperatively, the infant develops abdominal distension and fever. An abdominal
X-ray shows air-fluid levels and dilated loops of bowel. What is the most likely complication, and what
is the immediate nursing action?
A. Administer broad-spectrum antibiotics
B. Reposition the infant to relieve pressure
C. Notify the surgical team for suspected obstruction
Answer: C
Explanation: Postoperative Hirschsprung disease patients are at risk for enterocolitis or obstruction.
Abdominal distension, fever, and X-ray findings suggest a bowel obstruction, possibly due to stricture or
residual aganglionic segment. Immediate notification of the surgical team is critical for evaluation and
potential intervention. Antibiotics may follow, but surgical assessment is the priority. Repositioning does
not address the obstruction.
Question: 1168
A 30-week preterm neonate with a suspected methicillin-resistant Staphylococcus aureus (MRSA)
infection is prescribed vancomycin and gentamicin. The Neonatal Nurse Practitioner must monitor for
synergistic antimicrobial effects and potential toxicities. Given gentamicin�s nephrotoxic potential, the
neonate�s baseline serum creatinine is 0.9 mg/dL, and the estimated GFR is 25 mL/min/1.73 m�. After 72
hours, the gentamicin peak level is 8 mcg/mL (target: 5�10 mcg/mL), and the trough is 2.5 mcg/mL
(target: <2 mcg/mL). What is the most appropriate adjustment to the gentamicin regimen?
A. Increase the dose to 5 mg/kg every 24 hours
B. Discontinue gentamicin and switch to clindamycin
C. Extend the dosing interval to every 36 hours
Answer: C
Explanation: The elevated gentamicin trough (2.5 mcg/mL) indicates reduced clearance, likely due to the
neonate�s immature renal function (low GFR). Extending the dosing interval to every 36 hours allows
more time for drug clearance, reducing the risk of nephrotoxicity while maintaining therapeutic peak
levels. Increasing the dose risks further toxicity, and switching to clindamycin is unnecessary as the
current regimen is appropriate for MRSA coverage when adjusted properly.
Question: 1169
A term neonate with a history of polyhydramnios presents with excessive oral secretions and choking
during the first feed. A chest radiograph shows a coiled nasogastric tube in the proximal esophagus and
gas in the stomach. The neonatal nurse practitioner suspects tracheoesophageal fistula (TEF). What is the
most likely type of TEF, and what is the initial management?
A. Proximal esophageal atresia with distal TEF; surgical consultation
B. H-type TEF; initiate enteral feeds cautiously
C. Isolated esophageal atresia; place a gastrostomy tube
Answer: A
Explanation: The presentation of excessive secretions, choking, and a radiograph showing a coiled NG
tube with distal bowel gas is classic for esophageal atresia with a distal tracheoesophageal fistula (Type
C, the most common form). Immediate surgical consultation is required for repair, along with supportive
care (e.g., suctioning, IV fluids). Enteral feeds are contraindicated, and isolated atresia would show no
distal gas.
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