NNP Neonatal Nurse Practitioner for Professional 3 — Questions and Answers
Question 1: A 30-week infant on mechanical ventilation develops sudden deterioration with decreased breath sounds on the left and shift of the cardiac impulse to the right. The priority intervention is:
- Emergent needle thoracentesis at the second intercostal space midclavicular line (Correct answer)
- Increase PEEP by 2 cm H2O
- Obtain a stat chest X-ray before any intervention
- Administer adenosine IV
Correct answer: Emergent needle thoracentesis at the second intercostal space midclavicular line
Sudden deterioration with unilateral decreased breath sounds and cardiac shift indicates tension pneumothorax requiring immediate needle decompression.
Question 2: When initiating total parenteral nutrition (TPN) in a VLBW infant, which amino acid intake on day 1 best supports positive nitrogen balance?
- 3.5 g/kg/day (Correct answer)
- 0.5 g/kg/day
- 1.0 g/kg/day
- 5.0 g/kg/day
Correct answer: 3.5 g/kg/day
Early aggressive amino acid intake of 3–4 g/kg/day from day 1 promotes positive nitrogen balance and reduces catabolism in VLBW infants.
Question 3: A term infant is diagnosed with persistent pulmonary hypertension (PPHN). After failing to respond to 100% oxygen, which pharmacologic agent is the first-line treatment?
- Inhaled nitric oxide (iNO) (Correct answer)
- IV sildenafil
- Oral bosentan
- Systemic epinephrine
Correct answer: Inhaled nitric oxide (iNO)
Inhaled nitric oxide is the first-line selective pulmonary vasodilator approved for PPHN in term and near-term infants.
Question 4: A preterm infant receiving gentamicin for sepsis has a trough level of 2.8 mcg/mL (goal <1 mcg/mL). Which action is most appropriate?
- Extend the dosing interval and recheck trough before next dose (Correct answer)
- Increase the dose to achieve higher peak levels
- Discontinue gentamicin and switch to tobramycin
- Continue current regimen and recheck in 48 hours
Correct answer: Extend the dosing interval and recheck trough before next dose
Elevated trough gentamicin levels indicate accumulation and nephrotoxicity/ototoxicity risk, requiring interval extension until trough normalizes.
Question 5: Which of the following best describes the mechanism by which hypothermia therapy reduces brain injury after hypoxic-ischemic encephalopathy (HIE)?
- Suppresses glutamate-mediated excitotoxicity and apoptotic cascades in the latent phase (Correct answer)
- Directly reverses neuronal ischemia by restoring ATP production
- Eliminates seizure activity by reducing cortical excitability
- Prevents cerebral edema by inducing osmotic diuresis
Correct answer: Suppresses glutamate-mediated excitotoxicity and apoptotic cascades in the latent phase
Cooling interrupts the secondary energy failure phase by suppressing glutamate release, apoptotic signaling, and free radical production.
Question 6: A neonate born to a mother with poorly controlled type 1 diabetes has a hematocrit of 72% at 4 hours of life. The infant is asymptomatic. The most appropriate management is:
- Partial exchange transfusion with normal saline (Correct answer)
- IV fluid hydration alone and repeat hematocrit in 4 hours
- Immediate phlebotomy of 10 mL/kg
- Observation only with feeding encouragement
Correct answer: Partial exchange transfusion with normal saline
Symptomatic polycythemia or a hematocrit ≥65-70% with risk factors warrants partial exchange transfusion to reduce hyperviscosity.
Question 7: A family requests withdrawal of life-sustaining treatment for their 24-week infant after 3 weeks of maximal support with ongoing deterioration. The NNP's ethical priority is to:
- Facilitate a family meeting with the palliative care team to align goals of care with family values (Correct answer)
- Defer the decision entirely to the attending neonatologist
- Continue current treatment while awaiting ethics committee review
- Document the family's request and take no further action
Correct answer: Facilitate a family meeting with the palliative care team to align goals of care with family values
Family-centered palliative care meetings are the ethical standard to ensure informed, values-based decision-making when redirecting care for critically ill neonates.
NNP Neonatal Nurse Practitioner for Professional 3
A 30-week infant on mechanical ventilation develops sudden deterioration with decreased breath sounds on the left and shift of the cardiac impulse to the right.
The priority intervention is: