Neonatal/Pediatric Specialty (NPS) Examination — Questions and Answers

Question 1: Which of the following should the neonatal/pediatric specialist recommend for an 8 year-old child with cerebral atrophy and poor cognitive skills in order to promote bronchial hygiene while delivering a bronchodilator?

intermittent positive pressure breathing
external chest wall percussive device
intrapulmonary percussive ventilation (Correct answer)
in-insufflator

Correct answer: intrapulmonary percussive ventilation

Intrapulmonary percussive ventilation (IPV) delivers small, rapid bursts of air into the lungs, creating oscillations that help mobilize secretions and improve bronchial hygiene. For a child with cerebral atrophy and poor cognitive skills, IPV can be more effective and less dependent on patient cooperation than other methods, while also facilitating bronchodilator delivery directly into the airways.

Question 2: What is the normal fetal hemoglobin (HbF) percentage in a term newborn at birth?

10–20%
30–40%
60–80% (Correct answer)
90–100%

Correct answer: 60–80%

At birth, fetal hemoglobin (HbF) comprises approximately 60–80% of total hemoglobin in term newborns, gradually replaced by adult HbA over the first year.

Question 3: A neonate in the NICU suddenly develops cyanosis, bradycardia, and absent breath sounds on the left. Chest transillumination is positive. What is the immediate intervention?

Increase PEEP on the ventilator
Needle decompression of the left chest at the 2nd intercostal space, midclavicular line (Correct answer)
Chest X-ray to confirm diagnosis
Administer epinephrine IV

Correct answer: Needle decompression of the left chest at the 2nd intercostal space, midclavicular line

A tension pneumothorax in a neonate requires immediate needle decompression at the 2nd ICS, MCL on the affected side — waiting for X-ray confirmation is inappropriate.

Question 4: A breastfeeding mother of a NICU infant is struggling with milk supply. Which intervention has the strongest evidence for increasing supply?

Formula supplementation to reduce demand on the mother
Restricting fluid intake to concentrate milk
Frequent pumping (8+ times per day) combined with skin-to-skin contact (Correct answer)
Domperidone as first-line pharmacologic therapy

Correct answer: Frequent pumping (8+ times per day) combined with skin-to-skin contact

Frequent pumping mimicking an infant's feeding pattern (8 or more times per day), combined with kangaroo care, is the most effective evidence-based strategy for establishing and maintaining milk supply.

Question 5: To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the nurse do?

Maintain the infant's temperature above 97.7°F. (Correct answer)
Assess blood glucose levels every 3 hours for the first twelve hours.
Feed the infant glucose water every 3 hours until breastfeeding well.
Encourage the mother to breastfeed every 4 hours.

Correct answer: Maintain the infant's temperature above 97.7°F.

Hypothermia in newborns significantly increases their metabolic rate and oxygen consumption, which rapidly depletes their limited glucose stores. Maintaining a stable core body temperature above 97.7°F (36.5°C) minimizes this metabolic stress and helps conserve glucose, thereby directly reducing the risk of hypoglycemia. Thermal regulation is crucial for glucose homeostasis.

Question 6: What is the correct IV dose of adenosine for a pediatric patient with supraventricular tachycardia (SVT)?

0.3 mg/kg rapid IV push
0.1 mg/kg rapid IV push (Correct answer)
1 mg/kg rapid IV push
0.05 mg/kg rapid IV push

Correct answer: 0.1 mg/kg rapid IV push

Adenosine 0.1 mg/kg (max 6 mg first dose) is given as a rapid IV push for pediatric SVT, followed by a saline flush to ensure rapid delivery to the heart.

Question 7: A term neonate has a capillary blood gas drawn from the heel. The results are as follows: pH 7.28, PCO2 52 mm Hg, HCO3 24 mEq/L. How should these results be interpreted?

Normal
Respiratory acidosis (Correct answer)
Mixed acidosis
Metabolic acidosis

Correct answer: Respiratory acidosis

The blood gas results show a pH of 7.28 (acidic) and an elevated PCO2 of 52 mm Hg, while the HCO3 is within the normal range. An elevated PCO2 indicates that the lungs are not effectively eliminating carbon dioxide, leading to a buildup of carbonic acid in the blood. Therefore, the primary problem is respiratory acidosis.

Question 8: Which bundle component is most evidence-based for preventing ventilator-associated events (VAE) in mechanically ventilated neonates?

Prophylactic antibiotics throughout the duration of mechanical ventilation
Closed suctioning systems combined with appropriate head-of-bed elevation when feasible (Correct answer)
Routine chest physiotherapy every 4 hours
Routine instillation of normal saline before endotracheal suctioning

Correct answer: Closed suctioning systems combined with appropriate head-of-bed elevation when feasible

Closed suctioning systems reduce contamination risk during suctioning, and head-of-bed elevation reduces aspiration risk; both are evidence-based VAP prevention bundle components.

Question 9: A pediatric patient with traumatic brain injury has a GCS of 7. What is the initial target PaCO2?

50–60 mmHg
35–40 mmHg (normocapnia) (Correct answer)
45–50 mmHg (permissive hypercapnia)
25–30 mmHg (aggressive hyperventilation)

Correct answer: 35–40 mmHg (normocapnia)

Normocapnia (PaCO2 35–40 mmHg) is targeted in pediatric TBI to avoid cerebral vasoconstriction from hypocapnia; prophylactic hyperventilation is no longer recommended.

Question 10: A 28-week gestational age neonate presents with grunting, nasal flaring, and intercostal retractions. What is the most likely diagnosis?

Transient tachypnea of the newborn
Meconium aspiration syndrome
Congenital diaphragmatic hernia
Respiratory distress syndrome (RDS) (Correct answer)

Correct answer: Respiratory distress syndrome (RDS)

Respiratory distress syndrome (RDS) is highly common in premature neonates, especially those born at 28 weeks gestation, due to insufficient surfactant production in their immature lungs. The presented symptoms of grunting, nasal flaring, and intercostal retractions are classic signs of increased work of breathing characteristic of RDS. Other options are less likely given the specific gestational age and clinical presentation.

Question 11: During neonatal transport, a 27-week premature neonate becomes increasingly tachycardic and pale. Blood glucose is 22 mg/dL. What is the first intervention?

IV epinephrine 0.01 mg/kg
Administer sodium bicarbonate 2 mEq/kg
IV dextrose 10% at 2 mL/kg bolus (Correct answer)
Increase ventilator rate by 5 breaths/min

Correct answer: IV dextrose 10% at 2 mL/kg bolus

Symptomatic hypoglycemia in a neonate is treated with a D10W minibolus of 2 mL/kg IV, providing approximately 200 mg/kg glucose to rapidly restore euglycemia.

Question 12: Why are preterm neonates at increased risk for hypoglycemia compared to term infants?

Increased glucose uptake by brown fat
Limited glycogen stores and immature gluconeogenesis (Correct answer)
Maternal diabetes causing beta-cell hyperplasia
Higher insulin secretion

Correct answer: Limited glycogen stores and immature gluconeogenesis

Preterm neonates have limited hepatic glycogen stores, immature gluconeogenic enzymes, and high glucose utilization by the rapidly growing brain.

Question 13: A 6-week-old infant presents with apnea, bradycardia, and poor perfusion. Heart rate is 40 bpm. After initiating CPR, which vascular access is the fastest to establish?

Peripheral IV in antecubital vein
Intraosseous access (IO) (Correct answer)
Central venous catheter
Umbilical venous catheter

Correct answer: Intraosseous access (IO)

Intraosseous access is the fastest vascular access in pediatric emergencies when peripheral IV fails, allowing immediate delivery of resuscitative medications.

Question 14: A preterm neonate requires indomethacin for PDA closure. Which lab value must be monitored most closely?

Hemoglobin
Serum sodium
Serum creatinine (Correct answer)
Serum calcium

Correct answer: Serum creatinine

Indomethacin reduces renal prostaglandin synthesis, causing decreased GFR and elevated serum creatinine; renal function must be monitored closely.

Question 15: A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first?

Insert eye prophylaxis.
Remove wet blankets. (Correct answer)
Assess Apgar score.
Elicit the Moro reflex

Correct answer: Remove wet blankets.

The most immediate and critical nursing intervention for a newborn is to prevent heat loss, as neonates are highly susceptible to hypothermia. Removing wet blankets and replacing them with warm, dry ones helps maintain the infant's core body temperature. Maintaining thermal stability is paramount for metabolic function and overall well-being, preceding other assessments or interventions.

Question 16: Which piece of equipment is essential for delivering inhaled nitric oxide (iNO) therapy in neonates with persistent pulmonary hypertension?

Oxygen blender
Venturi mask
Nitric oxide delivery system (Correct answer)
Inhalation nebulizer

Correct answer: Nitric oxide delivery system

Inhaled nitric oxide (iNO) therapy requires a specialized Nitric Oxide Delivery System to precisely administer the gas to neonates. This system ensures accurate dosing, mixing with oxygen, and continuous monitoring of iNO levels, which is crucial for treating conditions like persistent pulmonary hypertension. Other equipment like oxygen blenders or nebulizers are not designed for the specific and precise delivery of nitric oxide.

Question 17: A 34-week neonate is ready for discharge. Which parenting education topic is MOST critical before discharge home?

Immunization schedule for 9-month visit
Starting vitamin D supplementation at 2 years
Safe sleep practices (supine positioning, firm flat surface, no co-sleeping) (Correct answer)
Introduction to solid foods at 6 months

Correct answer: Safe sleep practices (supine positioning, firm flat surface, no co-sleeping)

Safe sleep education (back to sleep, firm surface, room-sharing without bed-sharing) is critical before NICU discharge to reduce the risk of sudden infant death syndrome (SIDS).

Question 18: What is the primary function of a pulse oximeter in neonatal and pediatric care?

To monitor heart rate
To measure blood pressure
To assess oxygen saturation levels (Correct answer)
To measure respiratory rate

Correct answer: To assess oxygen saturation levels

A pulse oximeter is a non-invasive device that measures the oxygen saturation of hemoglobin in arterial blood (SpO2). It is a critical tool in neonatal and pediatric care for continuously monitoring a patient's oxygenation status. This allows clinicians to detect hypoxemia early and guide appropriate oxygen therapy or respiratory support.

Question 19: What is the significance of a pulmonary interstitial emphysema (PIE) finding on chest X-ray in a ventilated preterm neonate?

It indicates adequate lung recruitment
It represents air dissecting into lung interstitium, a risk factor for tension pneumothorax (Correct answer)
It confirms surfactant therapy success
It is a benign finding requiring no intervention

Correct answer: It represents air dissecting into lung interstitium, a risk factor for tension pneumothorax

PIE represents air trapped in the pulmonary interstitium and perivascular sheaths, and can progress to pneumothorax, pneumomediastinum, or pneumopericardium.

Question 20: In the context of neonatal palliative care, what does the term 'comfort care' primarily involve?

Focusing care on relief of pain and discomfort while withdrawing life-sustaining interventions (Correct answer)
Transferring the neonate to hospice outside the hospital
Discontinuation of all monitoring and parental visitation
Mandatory discontinuation of nutrition and hydration

Correct answer: Focusing care on relief of pain and discomfort while withdrawing life-sustaining interventions

Neonatal comfort care redirects the goals of treatment toward symptom relief and dignity, withdrawing or withholding life-sustaining interventions while maintaining pain management and family presence.

Question 21: Which antibiotic combination is considered first-line empiric therapy for early-onset neonatal sepsis in the US?

Cefotaxime and clindamycin
Ampicillin and gentamicin (Correct answer)
Vancomycin and gentamicin
Meropenem and fluconazole

Correct answer: Ampicillin and gentamicin

Ampicillin and gentamicin is the standard first-line empiric regimen for early-onset neonatal sepsis, covering GBS and gram-negative organisms.

Question 22: A neonatologist believes continued intensive care for a 24-week neonate is futile. The parents disagree. What is the most appropriate next step?

Continue all interventions without further discussion
Transfer the patient to another institution immediately
Withdraw care based on the physician's medical judgment alone
Convene an ethics committee consultation to facilitate discussion (Correct answer)

Correct answer: Convene an ethics committee consultation to facilitate discussion

Ethics committee consultation provides a structured, multidisciplinary forum to facilitate communication, explore values, and find consensus when clinicians and families disagree about care goals.

Question 23: Kangaroo care (skin-to-skin contact) in the NICU has been shown to have which evidence-based benefit?

Improved temperature regulation, breastfeeding rates, and neurodevelopmental outcomes (Correct answer)
Increased oxygen requirements due to handling stress
Increased risk of infection from parental skin flora
Delayed parental bonding due to equipment access difficulties

Correct answer: Improved temperature regulation, breastfeeding rates, and neurodevelopmental outcomes

Kangaroo care improves thermoregulation, promotes breastfeeding, reduces apnea episodes, enhances parent-infant bonding, and improves long-term neurodevelopmental outcomes.

Question 24: What is the primary purpose of performing a Silverman-Anderson score on a neonate?

To assess gestational age
To determine the need for surfactant therapy
To monitor oxygen saturation levels
To evaluate the severity of respiratory distress (Correct answer)

Correct answer: To evaluate the severity of respiratory distress

The Silverman-Anderson score is a clinical assessment tool specifically designed to quantify the severity of respiratory distress in neonates. It evaluates five parameters related to respiratory effort, such as nasal flaring and retractions. A higher score indicates more severe respiratory distress, which helps guide appropriate medical interventions and monitoring.

Question 25: Which of the following is a sign of increased work of breathing in a pediatric patient?

Eupnea
Subcostal retractions (Correct answer)
Regular respiratory rate
Clear breath sounds

Correct answer: Subcostal retractions

Subcostal retractions are a clear sign of increased work of breathing in a pediatric patient. This occurs when the child uses accessory muscles, pulling the skin inward below the rib cage, to overcome airway resistance or decreased lung compliance. It indicates that the respiratory system is working harder than normal to achieve adequate ventilation.

Question 26: Which of the following is a common clinical finding in a neonate with patent ductus arteriosus (PDA)?

Decreased breath sounds
Bradycardia
Bounding peripheral pulses (Correct answer)
Cyanosis

Correct answer: Bounding peripheral pulses

Patent ductus arteriosus (PDA) involves the failure of a fetal blood vessel to close after birth, leading to shunting of blood from the aorta to the pulmonary artery. This results in increased systemic blood flow during diastole, causing a wide pulse pressure and characteristically bounding peripheral pulses. This clinical finding is a key indicator of PDA.

Question 27: Which finding on chest X-ray is classic for neonatal respiratory distress syndrome (RDS)?

Hyperinflation with flattened diaphragms
Diffuse ground-glass opacity with air bronchograms (Correct answer)
Lobar consolidation
Pleural effusions

Correct answer: Diffuse ground-glass opacity with air bronchograms

Neonatal RDS classically shows diffuse ground-glass opacification with air bronchograms due to surfactant deficiency causing widespread alveolar atelectasis.

Question 28: Late-onset sepsis in premature neonates is most commonly caused by which organism?

Haemophilus influenzae
Listeria monocytogenes
Coagulase-negative Staphylococcus (CoNS) (Correct answer)
Streptococcus agalactiae (Group B Strep)

Correct answer: Coagulase-negative Staphylococcus (CoNS)

Coagulase-negative Staphylococcus, particularly S. epidermidis, is the leading cause of late-onset sepsis in premature neonates, largely due to its ability to form biofilms on central venous catheters.

Question 29: Which electrolyte abnormality is most common in preterm neonates in the first 24–48 hours of life?

Hypocalcemia
Hypernatremia (Correct answer)
Hypokalemia
Hypermagnesemia

Correct answer: Hypernatremia

Hypernatremia (or hyperchloremia) occurs in the first days of life due to high insensible water losses from immature skin and inadequate free water intake.

Neonatal/Pediatric Specialty (NPS) Examination

The NPS Examination, administered by the National Board for Respiratory Care (NBRC), certifies respiratory therapists in specialized neonatal and pediatric respiratory care. It assesses competencies in patient assessment, equipment management, pharmacology, therapeutic procedures, and critical care of neonatal and pediatric patients.

170

Questions

240 min

Time Limit

70%

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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

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

nbrc.org — Test delivery, passing score, test dates, renewal, score validity, eligibility, fees, exam format, registration deadline, retake fee · verified Oct 2026
test-takers.psiexams.com — Retake policy · verified Oct 2026