NNP Neonatal Nurse Practitioner for Professional 5 — Questions and Answers
Question 1: A term neonate with meconium aspiration syndrome (MAS) fails to improve on conventional ventilation. The ventilator strategy most likely to improve oxygenation while minimizing volutrauma is:
- High-frequency oscillatory ventilation (HFOV) with lung recruitment strategy (Correct answer)
- Increasing conventional rate to 80 breaths/min with low PEEP
- Transitioning to nasal CPAP at 8 cm H2O
- Reducing FiO2 to 40% to avoid oxygen toxicity
Correct answer: High-frequency oscillatory ventilation (HFOV) with lung recruitment strategy
HFOV provides consistent mean airway pressure for lung recruitment while delivering very small tidal volumes, reducing volutrauma in MAS.
Question 2: Which retinopathy of prematurity (ROP) finding requires treatment within 72 hours to prevent retinal detachment?
- Type 1 ROP: Zone I any stage with plus disease, or Zone II Stage 3 with plus disease (Correct answer)
- Zone III Stage 1 without plus disease
- Zone II Stage 2 without plus disease
- Regressing ROP at any zone
Correct answer: Type 1 ROP: Zone I any stage with plus disease, or Zone II Stage 3 with plus disease
Type 1 ROP is the threshold for urgent treatment with laser photocoagulation or anti-VEGF therapy to prevent progression to detachment.
Question 3: A neonate has neonatal abstinence syndrome (NAS) with a Finnegan score consistently above 8. After maximizing non-pharmacologic interventions, which first-line pharmacologic treatment is recommended?
- Oral morphine or methadone titrated to symptom control (Correct answer)
- Phenobarbital as the sole agent
- IV lorazepam for acute agitation episodes
- Clonidine as monotherapy
Correct answer: Oral morphine or methadone titrated to symptom control
Opioid replacement with oral morphine or methadone is first-line pharmacotherapy for NAS due to opioid exposure, targeting the underlying receptor withdrawal.
Question 4: A 36-week infant has a serum calcium of 6.2 mg/dL with jitteriness and prolonged QTc on EKG. The immediate treatment is:
- IV 10% calcium gluconate infused slowly over 10–15 minutes with cardiac monitoring (Correct answer)
- Oral calcium carbonate supplementation
- Magnesium sulfate IV push
- Furosemide to correct the electrolyte imbalance
Correct answer: IV 10% calcium gluconate infused slowly over 10–15 minutes with cardiac monitoring
Symptomatic hypocalcemia with EKG changes requires slow IV calcium gluconate with continuous cardiac monitoring to avoid bradycardia.
Question 5: Which chromosomal abnormality is most commonly associated with duodenal atresia in the newborn?
- Trisomy 21 (Down syndrome) (Correct answer)
- Trisomy 18 (Edwards syndrome)
- Trisomy 13 (Patau syndrome)
- Turner syndrome (45,X)
Correct answer: Trisomy 21 (Down syndrome)
Approximately 30% of duodenal atresia cases are associated with Trisomy 21, making it the most common chromosomal association.
Question 6: When counseling parents about the expected developmental trajectory of their 25-week infant at hospital discharge, which statement reflects evidence-based prognostic guidance?
- Outcomes vary widely; most infants benefit from early intervention therapies with individualized follow-up (Correct answer)
- Most 25-week infants will have no significant neurodevelopmental impairment by school age
- Severe cognitive impairment affects all infants born at 25 weeks gestation
- Developmental outcomes are fully predictable from the neonatal brain MRI at term equivalent age
Correct answer: Outcomes vary widely; most infants benefit from early intervention therapies with individualized follow-up
Outcomes at 25 weeks are highly variable; early intervention services improve outcomes, and individualized, honest counseling respects family autonomy.
Question 7: A 3-week-old infant presents with fever, bulging fontanelle, and CSF findings of glucose 25 mg/dL, protein 320 mg/dL, and 480 WBC with 90% PMNs. The most likely causative organism is:
- Group B Streptococcus (GBS) (Correct answer)
- Escherichia coli
- Listeria monocytogenes
- Staphylococcus epidermidis
Correct answer: Group B Streptococcus (GBS)
Group B Streptococcus is the most common cause of late-onset neonatal meningitis (7–90 days), followed by E. coli.
NNP Neonatal Nurse Practitioner for Professional 5
A term neonate with meconium aspiration syndrome (MAS) fails to improve on conventional ventilation.
The ventilator strategy most likely to improve oxygenation while minimizing volutrauma is: