NNP Cheat Sheet 2026

The 30 highest-yield NNP facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. What is the primary mechanism by which phototherapy reduces serum bilirubin levels? → Converts unconjugated bilirubin to water-soluble photoisomers excreted without conjugation
2. A neonate has a serum glucose of 300 mg/dL on day 2 of TPN. What is the first step in management? → Reduce the dextrose concentration in TPN and recheck glucose
3. A premature infant in the NICU benefits most from which developmental care principle to reduce stress? → Clustering care activities and providing containment/nesting
4. What is the mechanism of action of phenytoin in treating neonatal seizures? → Blocks voltage-gated sodium channels to stabilize neuronal membranes
5. Which condition is associated with elevated DIRECT (conjugated) bilirubin in a neonate and requires further workup for cholestasis? → Biliary atresia
6. A neonate receiving intensive phototherapy has a TSB that rises by 1 mg/dL in 6 hours despite treatment. What is the MOST appropriate next action? → Begin intravenous immunoglobulin (IVIG) therapy
7. Which finding on neonatal MRI is most predictive of adverse neurodevelopmental outcomes after HIE? → Basal ganglia and thalamic injury on diffusion-weighted imaging
8. A neonate presents with jitteriness and irritability at 24 hours of age. Mother has a history of opioid use disorder. What condition is most likely? → Neonatal opioid withdrawal syndrome (NOWS)
9. Which intervention has been shown to reduce the incidence and severity of IVH in premature neonates? → Antenatal corticosteroids administered to the mother
10. Which of the following is the greatest technique to swiftly remove air from the chest cavity in the case of a baby with pneumothorax symptoms? → Using a needle and syringe
11. What is the recommended caloric intake to support adequate growth in a stable premature neonate? → 110-130 kcal/kg/day
12. Which antibiotic combination is the standard empiric therapy for early-onset neonatal sepsis in the US? → Ampicillin and gentamicin
13. Which of the following maternal blood types places a neonate at highest risk for significant ABO hemolytic disease? → Type O mother with type A or B infant
14. Total parenteral nutrition (TPN) in neonates typically starts with which amino acid concentration to promote anabolism? → 3-4 g/kg/day starting on day 1
15. Which reversal agent is used for opioid-induced respiratory depression in a neonate? → Naloxone
16. A neonate is being evaluated for exchange transfusion. Which of the following is an absolute indication for emergency exchange transfusion? → Signs of acute bilirubin encephalopathy (ABE) with rapidly rising TSB
17. A VLBW neonate has a serum sodium of 128 mEq/L on day 3 of life with urine output of 6 mL/kg/hr. What is the most likely cause? → Excessive free water administration (dilutional hyponatremia)
18. Why is erythromycin eye ointment applied to neonates at birth in the US? → Prophylaxis against Neisseria gonorrhoeae ophthalmia neonatorum
19. Which chest X-ray finding is classic for respiratory distress syndrome (RDS) in a premature neonate? → Diffuse ground-glass appearance with air bronchograms
20. What is the primary mechanism by which prostaglandin E1 (PGE1) helps a ductal-dependent lesion? → Maintains or reopens the ductus arteriosus
21. What is the blood glucose threshold below which treatment is recommended for a symptomatic neonate in the US per AAP guidelines? → 50 mg/dL
22. What volume of blood is used for a double-volume exchange transfusion in a neonate? → 160 mL/kg
23. Dexamethasone given postnatally for BPD carries a significant risk of: → Neurodevelopmental impairment and GI perforation
24. What is the primary risk associated with chloramphenicol use in neonates? → Gray baby syndrome due to immature hepatic metabolism
25. A neonate has an arterial blood gas showing pH 7.15, PaCO2 40, HCO3 14. What drug treatment addresses the underlying metabolic cause? → Sodium bicarbonate (cautiously for severe metabolic acidosis)
26. Intraventricular hemorrhage (IVH) is most commonly graded using which system in neonates? → Papile grading system (Grades I-IV)
27. Kangaroo care (skin-to-skin holding) in the NICU has been shown to provide which benefit? → Stabilize temperature, heart rate, and improve breastfeeding outcomes
28. High-frequency oscillatory ventilation (HFOV) is preferred in which neonatal condition? → Pulmonary interstitial emphysema (PIE)
29. Which type of blood product is MOST appropriate for exchange transfusion in a neonate with Rh hemolytic disease? → O-negative irradiated CMV-negative red blood cells reconstituted with AB plasma
30. A neonate of a diabetic mother is at increased risk for hypoglycemia primarily because of: → Fetal hyperinsulinism from chronic fetal hyperglycemia