NNP Neonatal Nurse Practitioner for Professional 2 — Questions and Answers
Question 1: A preterm infant at 28 weeks gestation presents with apnea of prematurity. Which mechanism best explains this condition?
- Immature respiratory center with decreased response to CO2 (Correct answer)
- Excessive surfactant production causing airway collapse
- Hypercalcemia depressing the respiratory drive
- Premature closure of the ductus arteriosus
Correct answer: Immature respiratory center with decreased response to CO2
Apnea of prematurity results from an immature brainstem respiratory center with blunted chemoreceptor response to CO2.
Question 2: When calculating maintenance IV fluid requirements for a VLBW infant on day of life 1, which factor most significantly increases insensible water losses?
- Phototherapy and radiant warmer use (Correct answer)
- Nasogastric tube feedings
- Prone positioning
- Continuous pulse oximetry
Correct answer: Phototherapy and radiant warmer use
Radiant warmers and phototherapy significantly increase insensible water losses through evaporation and radiation, sometimes doubling baseline requirements.
Question 3: A term neonate has a serum bilirubin of 22 mg/dL at 48 hours of life. Direct Coombs test is positive. Which condition is most likely?
- ABO incompatibility (Correct answer)
- Physiologic jaundice
- Breast milk jaundice
- Gilbert syndrome
Correct answer: ABO incompatibility
A positive direct Coombs test indicates maternal antibodies coating neonatal red blood cells, most commonly due to ABO incompatibility.
Question 4: A neonate born at 36 weeks develops hypoglycemia. After three 15-minute dextrose gel treatments fail to normalize glucose, the next best step is:
- Initiate IV dextrose infusion at 4-6 mg/kg/min (Correct answer)
- Administer glucagon 0.03 mg/kg IM
- Increase dextrose gel concentration to 40%
- Begin corticosteroid therapy
Correct answer: Initiate IV dextrose infusion at 4-6 mg/kg/min
IV dextrose infusion is indicated when oral/buccal dextrose gel fails to correct persistent hypoglycemia in a neonate.
Question 5: Which finding on cranial ultrasound in a preterm infant indicates the highest risk for long-term neurodevelopmental impairment?
- Grade IV IVH with periventricular hemorrhagic infarction (Correct answer)
- Grade I IVH confined to the germinal matrix
- Mild choroid plexus cysts
- Grade II IVH without ventricular dilation
Correct answer: Grade IV IVH with periventricular hemorrhagic infarction
Grade IV IVH with periventricular hemorrhagic infarction (PVHI) carries the highest risk of cerebral palsy and severe cognitive impairment.
Question 6: A 3-day-old term infant presents with temperature instability, poor feeding, and a WBC of 3,200 cells/µL with an I:T ratio of 0.28. Which diagnosis should be treated empirically?
- Early-onset neonatal sepsis (Correct answer)
- Physiologic leukopenia
- Transient neonatal thrombocytopenia
- Polycythemia
Correct answer: Early-onset neonatal sepsis
An elevated immature-to-total neutrophil ratio (>0.2) combined with clinical signs warrants empiric antibiotic treatment for early-onset sepsis.
Question 7: During a difficult resuscitation, the team leader notices escalating tension. Which communication technique best maintains team performance?
- Closed-loop communication with role clarity and directed task assignment (Correct answer)
- Allowing the most experienced member to work uninterrupted
- Limiting verbal updates to reduce distraction
- Assigning tasks alphabetically by team member name
Correct answer: Closed-loop communication with role clarity and directed task assignment
Closed-loop communication with clear role assignments prevents errors of omission and maintains situational awareness during high-stress neonatal resuscitation.
NNP Neonatal Nurse Practitioner for Professional 2
A preterm infant at 28 weeks gestation presents with apnea of prematurity.
Which mechanism best explains this condition?