NRP Neonatal Resuscitation Program Exam — Questions and Answers

Question 1: Where should the pulse oximetry probe be placed during neonatal resuscitation to measure preductal oxygen saturation?

Right hand or wrist (Correct answer)
Either foot
Left hand or wrist
The forehead

Correct answer: Right hand or wrist

Preductal SpO2 is measured on the right hand or wrist, which receives blood from the right subclavian artery — before the ductus arteriosus joins the aorta — giving a more accurate reflection of cerebral oxygenation.

Question 2: What is the significance of a cord pH below 7.0 in the post-resuscitation assessment?

Is a normal value for preterm infants
Indicates respiratory alkalosis from hyperventilation
Requires immediate sodium bicarbonate administration
Indicates severe metabolic acidosis consistent with significant birth asphyxia (Correct answer)

Correct answer: Indicates severe metabolic acidosis consistent with significant birth asphyxia

A cord pH below 7.0 indicates severe metabolic acidosis, suggesting significant hypoxic-ischemic insult and supporting evaluation for HIE/cooling criteria.

Question 3: After administering the first dose of epinephrine IV during neonatal resuscitation, when should the next dose be given if the heart rate remains below 60 bpm?

Only after confirming UVC placement by X-ray
After 3–5 minutes (Correct answer)
After 10 minutes
After 1 minute

Correct answer: After 3–5 minutes

Epinephrine may be repeated every 3–5 minutes if the heart rate remains below 60 bpm despite continued CPR and adequate ventilation.

Question 4: Which laryngoscope blade size is used for a term newborn during neonatal intubation?

Size 0 (straight blade)
Size 2 (curved Macintosh blade)
Size 3 (curved blade)
Size 1 (straight Miller blade) (Correct answer)

Correct answer: Size 1 (straight Miller blade)

A size 1 straight (Miller) blade is used for term newborns; a size 0 blade is reserved for very preterm infants.

Question 5: What is the role of CO₂ detectors in the presence of extremely poor cardiac output?

They detect only esophageal placement accurately
They are more reliable than in normal perfusion states
They may give a false negative (no color change) even with correct tracheal placement (Correct answer)
They consistently show positive CO₂ regardless of placement

Correct answer: They may give a false negative (no color change) even with correct tracheal placement

In severe bradycardia or cardiac arrest, little CO₂ may be exhaled, causing a false-negative reading even with correct tracheal tube position.

Question 6: How is resuscitation of a newborn with a known congenital diaphragmatic hernia (CDH) modified?

Bag-mask ventilation is acceptable if face seal is good
High-flow oxygen by mask; no intubation until NICU arrival
Immediate chest compressions to reduce herniated bowel
Immediate intubation; avoid bag-mask ventilation to prevent bowel distension (Correct answer)

Correct answer: Immediate intubation; avoid bag-mask ventilation to prevent bowel distension

CDH requires immediate intubation at delivery because mask PPV inflates herniated abdominal organs, further compressing the lungs.

Question 7: After intubation, which clinical sign most reliably confirms bilateral equal lung ventilation?

Absence of gastric gurgling
Equal bilateral breath sounds in the axillae (Correct answer)
Equal chest rise visually
SpO₂ rise above 95%

Correct answer: Equal bilateral breath sounds in the axillae

Auscultation in both axillae (rather than over the chest wall) minimizes transmitted sounds and confirms equal bilateral ventilation.

Question 8: What is the purpose of a debriefing session after a neonatal resuscitation?

To provide a structured review of the resuscitation for learning, quality improvement, and team well-being (Correct answer)
To complete the formal incident report required by hospital administration
To re-train team members who made errors during the resuscitation
To assign legal responsibility for any adverse outcomes

Correct answer: To provide a structured review of the resuscitation for learning, quality improvement, and team well-being

Post-resuscitation debriefing is a structured, non-punitive review of team performance that identifies what went well, what could be improved, and supports the emotional well-being of team members involved in difficult resuscitations.

Question 9: When chest compressions are being performed, what oxygen concentration should be used for PPV?

100% oxygen (Correct answer)
21% oxygen
40% oxygen
30% oxygen

Correct answer: 100% oxygen

When chest compressions are required, FiO₂ should be increased to 100% to maximize oxygen delivery during cardiac arrest.

Question 10: When can free-flow oxygen be delivered with a self-inflating bag?

Only when attached to a reservoir bag
By opening the inlet valve
It cannot deliver free-flow oxygen reliably (Correct answer)
By holding the mask loosely over the face

Correct answer: It cannot deliver free-flow oxygen reliably

A self-inflating bag does not deliver reliable free-flow oxygen because the inlet valve remains closed unless the bag is squeezed.

Question 11: What is the correct hand position when using the E-C clamp technique for mask ventilation?

Two fingers press the mask; palm lifts the chin
Thumb and index finger form a 'C' on the mask; remaining fingers form an 'E' under the jaw (Correct answer)
Index finger on top of mask; four fingers under the jaw
All five fingers grip the mask tightly

Correct answer: Thumb and index finger form a 'C' on the mask; remaining fingers form an 'E' under the jaw

The E-C technique uses the thumb and index finger in a 'C' to hold the mask and the remaining three fingers in an 'E' to lift the jaw.

Question 12: What is the correct landmark for intraosseous needle insertion in a neonate?

The lateral surface of the femur, 1 cm above the lateral condyle
The posterior surface of the calcaneus at the heel
The iliac crest, just posterior to the anterior superior iliac spine
The flat, medial surface of the proximal tibia, approximately 1–2 cm below the tibial tuberosity (Correct answer)

Correct answer: The flat, medial surface of the proximal tibia, approximately 1–2 cm below the tibial tuberosity

The preferred site for IO insertion in neonates is the flat, medial surface of the proximal tibia, approximately 1–2 cm distal (below) to the tibial tuberosity — a site with minimal overlying tissue and a broad, flat marrow cavity.

Question 13: What is therapeutic hypothermia and when is it indicated after neonatal resuscitation?

Cooling to 30°C in all infants who required intubation
Cooling to 33–34°C for 72 hours in ≥36-week infants with moderate–severe HIE (Correct answer)
Hypothermia initiated in the delivery room for all infants needing compressions
Mild cooling to 36°C for all asphyxiated infants

Correct answer: Cooling to 33–34°C for 72 hours in ≥36-week infants with moderate–severe HIE

Therapeutic hypothermia (33–34°C for 72 hours) is indicated for ≥36-week infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE).

Question 14: Which of the following is a contraindication to umbilical venous catheter insertion?

Omphalocele, gastroschisis, or omphalitis (Correct answer)
Birth weight less than 1 kg
Gestational age less than 28 weeks
Need for simultaneous chest compressions

Correct answer: Omphalocele, gastroschisis, or omphalitis

Conditions such as omphalocele, gastroschisis, and omphalitis are contraindications to UVC placement, as they involve anomalies or infection of the umbilical region that prevent safe catheter insertion.

Question 15: What is 'gentle' chest rise in the context of PPV for preterm infants, and why is it important?

Slight, visible chest rise described as a gentle movement of the chest — indicates appropriate tidal volume without overdistension (Correct answer)
Chest movement barely perceptible — any visible movement indicates excessive tidal volume
Vigorous chest expansion to ensure adequate tidal volume delivery
Chest rise equivalent to that seen in a normal adult breath

Correct answer: Slight, visible chest rise described as a gentle movement of the chest — indicates appropriate tidal volume without overdistension

NRP recommends aiming for slight, visible chest rise ('a gentle wiggle') during PPV for preterm infants. Excessive chest rise indicates high tidal volumes that risk volutrauma and BPD.

Question 16: What is the normal saline flush volume recommended after giving epinephrine through an umbilical venous catheter in a neonate?

5 mL
0.1 mL
0.5–1 mL (Correct answer)
2–3 mL

Correct answer: 0.5–1 mL

After administering epinephrine via UVC, a flush of 0.5–1 mL of normal saline is recommended to ensure the full drug dose reaches the circulation.

Question 17: Which three questions should be answered at every birth to determine if resuscitation may be needed?

Gestational age, weight, and heart rate
Weight, Apgar score, and oxygen saturation
Gestational age, tone, and breathing/crying (Correct answer)
Heart rate, color, and temperature

Correct answer: Gestational age, tone, and breathing/crying

The NRP initial assessment asks: Is the baby term gestation, has good muscle tone, and is breathing or crying?

Question 18: What is the recommended initial glucose infusion rate (GIR) to prevent hypoglycemia in a post-resuscitation neonate?

10–12 mg/kg/min
4–6 mg/kg/min of dextrose (Correct answer)
1–2 mg/kg/min
Only oral glucose is recommended

Correct answer: 4–6 mg/kg/min of dextrose

A GIR of 4–6 mg/kg/min replicates hepatic glucose production and maintains euglycemia in neonates unable to feed orally.

Question 19: In which clinical scenario would it be appropriate to use 100% oxygen during neonatal resuscitation despite NRP's standard recommendation to start at lower FiO2?

A term infant with SpO2 of 60% at 1 minute
A preterm infant at 28 weeks needing intubation
An infant receiving CPR for heart rate below 60 bpm despite PPV (Correct answer)
Any infant whose Apgar score is below 5 at 1 minute

Correct answer: An infant receiving CPR for heart rate below 60 bpm despite PPV

NRP recommends considering 100% oxygen during active CPR for heart rate below 60 bpm, as the priority in cardiac arrest is maximizing oxygen delivery. Wean as quickly as possible once circulation is restored.

Question 20: What volume expander is recommended for neonatal hypovolemia during resuscitation?

Normal saline (0.9% NaCl) at 10 mL/kg IV over 5–10 minutes (Correct answer)
5% albumin at 20 mL/kg
Lactated Ringer's at 20 mL/kg bolus
D10W at 2 mL/kg

Correct answer: Normal saline (0.9% NaCl) at 10 mL/kg IV over 5–10 minutes

Normal saline at 10 mL/kg administered IV over 5–10 minutes is the recommended volume expander in neonatal resuscitation.

Question 21: Which of the following scenarios would most support continuing resuscitative efforts rather than withholding or withdrawing them, according to NRP ethical guidance?

A term infant following a cord prolapse who has been without cardiac activity for 45 minutes prior to delivery
A confirmed gestational age of 22 weeks with no antenatal steroids and no fetal heart tones for 20 minutes
A term infant with a confirmed diagnosis of anencephaly made prior to delivery
A 28-week infant with Apgar score of 2 at one minute who has not yet responded to positive pressure ventilation (Correct answer)

Correct answer: A 28-week infant with Apgar score of 2 at one minute who has not yet responded to positive pressure ventilation

A 28-week infant who has not yet responded to initial PPV still has substantial survival potential and has not exhausted resuscitative efforts — continuation is warranted. The other scenarios involve conditions (anencephaly, prolonged asystole, pre-viable age without signs of life) that NRP identifies as appropriate indications for withholding or discontinuing efforts.

Question 22: What is the recommended oxygen concentration to begin PPV for a term newborn?

21% (room air) (Correct answer)
40% oxygen
100% oxygen
30% oxygen

Correct answer: 21% (room air)

Resuscitation of term newborns should begin with 21% oxygen (room air), increasing as needed based on pulse oximetry.

Question 23: Which finding during PPV suggests a pneumothorax has occurred?

Gastric distension with good chest rise
Increasing SpO₂ with rising heart rate
Bilateral equal breath sounds with poor chest rise
Decreased breath sounds on one side and worsening bradycardia (Correct answer)

Correct answer: Decreased breath sounds on one side and worsening bradycardia

A pneumothorax typically presents with asymmetric breath sounds, unilateral chest hyperexpansion, and hemodynamic deterioration.

Question 24: How should oxygen concentration be adjusted if SpO₂ remains above the target range during PPV?

Maintain the same FiO₂ and increase pressure
Increase FiO₂ to 100% immediately
Decrease the FiO₂ in 10% increments (Correct answer)
Discontinue oxygen entirely

Correct answer: Decrease the FiO₂ in 10% increments

If SpO₂ exceeds the target range, FiO₂ should be reduced in 10% steps while monitoring the oximeter to avoid hyperoxia.

Question 25: Why is a preterm infant at increased risk for intraventricular hemorrhage (IVH) during delivery room resuscitation?

Preterm infants have a larger brain volume that is more susceptible to pressure
Preterm infants receive more medication during resuscitation, which increases bleeding risk
Preterm infants have thinner skull bones that allow external compression during delivery
Preterm infants have fragile germinal matrix vessels that are vulnerable to fluctuations in cerebral blood flow (Correct answer)

Correct answer: Preterm infants have fragile germinal matrix vessels that are vulnerable to fluctuations in cerebral blood flow

Preterm infants have a highly vascularized germinal matrix adjacent to the lateral ventricles. These immature vessels lack the structural support and autoregulatory capacity of mature vessels, making them vulnerable to rupture from abrupt changes in cerebral blood flow and pressure.

Question 26: What role does surfactant play in neonatal lung transition at birth?

Surfactant is produced only after the first breath
Surfactant increases alveolar surface tension to promote drainage of lung fluid
Surfactant primarily transports oxygen across the alveolar membrane
Surfactant reduces alveolar surface tension, preventing alveolar collapse and facilitating FRC (Correct answer)

Correct answer: Surfactant reduces alveolar surface tension, preventing alveolar collapse and facilitating FRC

Surfactant, produced by type II pneumocytes, reduces alveolar surface tension, preventing alveolar collapse (atelectasis) at end-expiration and reducing the work of breathing needed to establish and maintain FRC.

Question 27: In the context of neonatal resuscitation, what is the principle of 'non-maleficence'?

Document every intervention to protect the team from liability
Always provide the maximum level of resuscitation available
Avoid interventions that are more likely to cause harm than benefit (Correct answer)
Ensure family members are present during all resuscitation efforts

Correct answer: Avoid interventions that are more likely to cause harm than benefit

Non-maleficence means 'do no harm.' In neonatal resuscitation, this principle guides decisions about when aggressive interventions may cause more suffering than benefit, especially in extreme prematurity or lethal anomalies.

Question 28: After successful resuscitation, when can PPV be discontinued?

When heart rate exceeds 100 bpm and the infant breathes spontaneously (Correct answer)
When SpO₂ reaches 100%
After exactly 10 minutes of PPV
When color is fully pink

Correct answer: When heart rate exceeds 100 bpm and the infant breathes spontaneously

PPV can be gradually weaned when the heart rate is above 100 bpm and the infant is making sustained spontaneous breathing efforts.

Question 29: What is the preferred technique for chest compressions during neonatal resuscitation?

Two-thumb encircling technique (Correct answer)
One-hand technique
Heel-of-hand technique
Two-finger technique

Correct answer: Two-thumb encircling technique

The two-thumb encircling technique generates higher peak systolic pressures and is preferred over the two-finger technique.

Question 30: A neonate is successfully resuscitated but subsequently develops signs consistent with severe hypoxic-ischemic encephalopathy with a very poor prognosis. According to NRP ethical guidance, the most appropriate next step is:

Immediately withdraw all support without consulting the family
Continue all aggressive interventions indefinitely regardless of prognosis
Meet with the family to discuss redirection of care to comfort-focused goals (Correct answer)
Transfer the infant to another institution where more aggressive care will be provided

Correct answer: Meet with the family to discuss redirection of care to comfort-focused goals

NRP acknowledges that resuscitation decisions are not irreversible. When prognosis becomes clearer after initial stabilization, clinicians are expected to reassess goals of care with the family and may appropriately redirect toward comfort-focused or palliative care when continued intervention is not in the infant's best interest.

Question 31: What happens to pulse oximetry accuracy if the probe is placed on the newborn before connecting it to the oximeter?

Probe placement order does not affect measurement accuracy
The probe should be connected to the oximeter first, then applied to the infant, for faster signal acquisition (Correct answer)
The probe must warm the skin before being connected to the oximeter
The oximeter will immediately read the correct SpO2

Correct answer: The probe should be connected to the oximeter first, then applied to the infant, for faster signal acquisition

NRP recommends connecting the probe to the oximeter before applying it to the infant, which significantly speeds up signal acquisition and reduces the time to first reliable SpO2 reading.

Question 32: At what heart rate should chest compressions be initiated in a newborn?

Below 100 bpm immediately
Below 60 bpm after 30 seconds of effective PPV (Correct answer)
Below 60 bpm before starting PPV
Below 80 bpm after any PPV

Correct answer: Below 60 bpm after 30 seconds of effective PPV

Chest compressions are started when the heart rate remains below 60 bpm after at least 30 seconds of effective PPV.

Question 33: What is the correct technique for holding the laryngoscope during neonatal intubation?

In the left hand with the blade angled 45°
In the right hand with fingers around the blade
In both hands for stability
In the left hand, blade down, with the handle vertical (Correct answer)

Correct answer: In the left hand, blade down, with the handle vertical

The laryngoscope is held in the left hand with the blade pointing down, allowing the right hand to insert the ETT.

Question 34: What is the recommended approach for delayed cord clamping (DCC) in a preterm infant who requires immediate resuscitation in the delivery room?

DCC should always be performed for a minimum of 3 minutes in preterm infants
DCC of at least 30–60 seconds may be considered if the infant can be stabilized at the bedside; individualize based on clinical condition (Correct answer)
DCC is only beneficial for infants greater than 32 weeks and is not recommended for very preterm infants
DCC is absolutely contraindicated in any preterm infant requiring resuscitation

Correct answer: DCC of at least 30–60 seconds may be considered if the infant can be stabilized at the bedside; individualize based on clinical condition

For preterm infants requiring resuscitation, DCC of 30–60 seconds may be performed if initial stabilization can be done at the bedside. If the infant is severely compromised and immediate resuscitation is critical, the decision must be individualized.

Question 35: Which ethical principle most directly underlies the NRP guidance to focus on the 'best interest of the infant' when making resuscitation decisions?

Autonomy
Justice
Veracity
Beneficence (Correct answer)

Correct answer: Beneficence

Beneficence — acting in the best interest of the patient — is the primary ethical principle guiding NRP resuscitation decisions. While parental autonomy is respected, the overriding framework asks what will genuinely benefit the newborn.

NRP Neonatal Resuscitation Program Exam

The NRP examination assesses healthcare professionals on neonatal resuscitation knowledge per the AAP/AHA 8th Edition curriculum, covering initial assessment, positive pressure ventilation, airway management, chest compressions, medication administration, and team-based resuscitation skills.

Questions

90 min

Time Limit

80%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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