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

Question 1: Late-onset sepsis in premature neonates is most commonly caused by which organism?

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

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 2: A neonate presents with hypoglycemia, macrosomia, and polycythemia. What is the most likely maternal history?

Systemic lupus erythematosus
Poorly controlled gestational diabetes (Correct answer)
Group B Streptococcus colonization
Gestational hypertension

Correct answer: Poorly controlled gestational diabetes

Infant of a diabetic mother (IDM) classically presents with macrosomia (from fetal hyperinsulinism), hypoglycemia after birth, and polycythemia from elevated fetal EPO.

Question 3: 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)
Metabolic acidosis
Mixed 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 4: Which glucose infusion rate (GIR) is typically required to maintain euglycemia in a term neonate?

6–8 mg/kg/min (Correct answer)
8–10 mg/kg/min
2–4 mg/kg/min
4–6 mg/kg/min

Correct answer: 6–8 mg/kg/min

Term neonates typically require a glucose infusion rate of 6–8 mg/kg/min to maintain blood glucose between 50–100 mg/dL.

Question 5: During neonatal resuscitation, chest compressions are indicated when the heart rate remains below what threshold after 30 seconds of effective positive pressure ventilation?

80 bpm
40 bpm
60 bpm (Correct answer)
100 bpm

Correct answer: 60 bpm

NRP guidelines specify initiating chest compressions when HR remains <60 bpm after 30 seconds of effective PPV with 100% oxygen.

Question 6: A 28-week gestational age neonate presents with grunting, nasal flaring, and intercostal retractions. What is the most likely diagnosis?

Meconium aspiration syndrome
Congenital diaphragmatic hernia
Transient tachypnea of the newborn
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 7: A neonatal/pediatric specialist is called to the ED to administer a bronchodilator to a 7-year-old child with asthma. The child is on oxygen via nasal cannula at 2L/min. Pulse oximetry reveals a saturation of 84%. The specialist finds the end of the oxygen tubing under the chair of the mother at the bedside. The specialist reattaches the tubing and notes that the SpO2 is now 93%. The specialist should?

Contact the ED physician
Increase the oxygen flow
Maintain the current oxygen flow (Correct answer)
Change the device to a non-rebreather mask

Correct answer: Maintain the current oxygen flow

The patient's SpO2 improved from 84% to 93% after reattaching the oxygen tubing, which is within an acceptable and safe range for oxygen saturation. Since the immediate problem (dislodged tubing) has been resolved and the patient's oxygenation is now adequate, maintaining the current oxygen flow is the appropriate action. There is no indication to increase flow or change devices unless the SpO2 drops again.

Question 8: A neonate born at 26 weeks gestation has a brain ultrasound showing blood in the lateral ventricles without dilation. This is classified as which grade of IVH?

Grade II (Correct answer)
Grade IV
Grade III
Grade I

Correct answer: Grade II

Grade II IVH (Papile classification) involves blood within the ventricles without ventricular dilation, indicating bleeding into the ventricular system from the germinal matrix.

Question 9: A neonate on HFOV has a rising PaCO2. Which ventilator parameter should be increased?

Frequency (Hz)
Inspired oxygen (FiO2)
Amplitude (ΔP) (Correct answer)
Mean airway pressure (MAP)

Correct answer: Amplitude (ΔP)

Amplitude (ΔP) determines tidal volume delivery in HFOV; increasing amplitude improves CO2 elimination and lowers PaCO2.

Question 10: A preterm neonate on total parenteral nutrition develops cholestatic jaundice. Which TPN component is most likely responsible?

Amino acids
Dextrose
Lipid emulsion (IVFE) (Correct answer)
Electrolytes

Correct answer: Lipid emulsion (IVFE)

Intravenous fat emulsions (IVFE), particularly phytosterol-containing soybean-based lipids, are strongly associated with parenteral nutrition-associated liver disease in neonates.

Question 11: During neonatal transport, maintaining normothermia is critical. What is the target core temperature range for a sick neonate?

34–35°C
36–37.5°C (Correct answer)
37.5–38.5°C
38.5–39°C

Correct answer: 36–37.5°C

Neonatal normothermia target is 36–37.5°C axillary; hypothermia increases oxygen consumption, metabolic acidosis, surfactant dysfunction, and mortality.

Question 12: A 4-year-old child presents in status epilepticus lasting 10 minutes. What is the first-line pharmacologic intervention?

IV levetiracetam 60 mg/kg
IV fosphenytoin 20 mg PE/kg
IV/IM/intranasal benzodiazepine (e.g., lorazepam, midazolam) (Correct answer)
IV phenobarbital 20 mg/kg

Correct answer: IV/IM/intranasal benzodiazepine (e.g., lorazepam, midazolam)

Benzodiazepines (lorazepam IV, midazolam IM/IN/buccal) are first-line for pediatric status epilepticus due to rapid onset and efficacy in terminating seizure activity.

Question 13: Which of the following devices is most commonly used for administering surfactant therapy to neonates?

CPAP machine
Nasal cannula
Mechanical ventilator
Endotracheal tube (Correct answer)

Correct answer: Endotracheal tube

Surfactant therapy is administered directly into the lungs to replace deficient natural surfactant, primarily in premature neonates with Respiratory Distress Syndrome (RDS). This is typically achieved by instilling the surfactant solution through an endotracheal tube, which allows for direct and effective delivery to the lower airways and alveoli where it is needed.

Question 14: The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the following is the scientific rationale for this action?

Amniotic fluid may contain harmful viruses. (Correct answer)
Meconium is filled with enteric bacteria.
The high alkalinity of fetal urine is caustic to the skin.
The baby is high risk for infection and must be protected.

Correct answer: Amniotic fluid may contain harmful viruses.

Wearing gloves when admitting neonates is a standard infection control practice to protect healthcare workers from potential exposure to pathogens. Amniotic fluid, blood, and other bodily fluids from the mother or newborn can potentially contain harmful viruses, such as HIV or Hepatitis B. Gloves act as a crucial barrier to prevent transmission.

Question 15: A neonate with congenital diaphragmatic hernia (CDH) is intubated at birth. Why is bag-mask ventilation avoided in CDH?

It inflates herniated bowel, worsening lung compression (Correct answer)
It causes bradycardia
It increases pulmonary vascular resistance
It delivers too much oxygen

Correct answer: It inflates herniated bowel, worsening lung compression

Bag-mask ventilation forces air into the stomach and herniated intestinal loops, further compressing the hypoplastic lung and worsening respiratory failure.

Question 16: Which approach is central to family-centered care in the NICU?

Delegating family communication to social workers only
Limiting parental visits to preserve quiet healing time
Treating parents as partners in care and decision-making (Correct answer)
Restricting information to reduce parental anxiety

Correct answer: Treating parents as partners in care and decision-making

Family-centered care positions parents as essential partners in their infant's care team, promoting parental presence, education, and shared decision-making.

Question 17: What is the significance of a pulmonary interstitial emphysema (PIE) finding on chest X-ray in a ventilated preterm neonate?

It confirms surfactant therapy success
It represents air dissecting into lung interstitium, a risk factor for tension pneumothorax (Correct answer)
It indicates adequate lung recruitment
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 18: Which of the following is a sign of increased work of breathing in a pediatric patient?

Regular respiratory rate
Subcostal retractions (Correct answer)
Eupnea
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 19: What is the normal fetal hemoglobin (HbF) percentage in a term newborn at birth?

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

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 20: Which ethical obligation requires healthcare providers to disclose all relevant information to parents so they can make informed decisions for their neonate?

Confidentiality
Beneficence
Informed consent (Correct answer)
Justice

Correct answer: Informed consent

Informed consent requires that providers disclose diagnosis, prognosis, treatment options, risks, and benefits in understandable language so parents can make voluntary, autonomous decisions.

Question 21: What is the primary purpose of performing a Silverman-Anderson score on a neonate?

To assess gestational age
To monitor oxygen saturation levels
To determine the need for surfactant therapy
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 22: What is the primary goal of the 'Neonatal Integrative Developmental Care' model in the NICU?

Reducing nursing workload through standardized care protocols
Eliminating all sensory stimulation during the acute phase
Supporting the infant's neurodevelopment and family well-being through integrating developmental principles into clinical care (Correct answer)
Maximizing medical interventions to ensure survival

Correct answer: Supporting the infant's neurodevelopment and family well-being through integrating developmental principles into clinical care

The Neonatal Integrative Developmental Care model aims to optimize neurodevelopmental outcomes by aligning medical care with each infant's developmental needs and integrating family as caregivers.

Question 23: A newborn with trisomy 21 (Down syndrome) is found to have a large atrioventricular septal defect (AVSD). What is the most likely reason this lesion is particularly associated with trisomy 21?

Pulmonary hypertension prevents normal cardiac development
Thyroid dysfunction from trisomy 21 impairs heart formation
Gene on chromosome 21 directly causes cardiac malformation
Defects in endocardial cushion formation are common in trisomy 21 (Correct answer)

Correct answer: Defects in endocardial cushion formation are common in trisomy 21

Trisomy 21 is associated with defective endocardial cushion development, leading to AVSD (affecting the AV valves and septal tissue) in up to 40% of affected individuals.

Question 24: Which surfactant is administered intratracheally as a natural bovine-derived preparation for neonatal RDS?

Beractant (Survanta)
All of the above (Correct answer)
Calfactant (Infasurf)
Poractant alfa (Curosurf)

Correct answer: All of the above

Beractant, calfactant, and poractant alfa are all natural animal-derived surfactants approved for intratracheal administration in neonatal RDS.

Question 25: The correct compression-to-ventilation ratio during neonatal CPR is:

30:2
5:1
15:2
3:1 (Correct answer)

Correct answer: 3:1

NRP recommends a 3:1 compression-to-ventilation ratio (90 compressions + 30 breaths per minute) for neonatal CPR to prioritize ventilation in asphyxia-driven cardiac arrest.

Question 26: What is the primary advantage of nasal CPAP (nCPAP) over mechanical ventilation for preterm neonates with mild-moderate RDS?

Easier nursing care
Avoidance of intubation and reduced BPD risk (Correct answer)
More precise tidal volume control
Higher oxygen delivery

Correct answer: Avoidance of intubation and reduced BPD risk

nCPAP avoids the trauma of intubation and reduces the incidence of bronchopulmonary dysplasia by recruiting alveoli non-invasively.

Question 27: Which of the following is a common clinical finding in a neonate with patent ductus arteriosus (PDA)?

Bounding peripheral pulses (Correct answer)
Decreased breath sounds
Bradycardia
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 28: Which piece of equipment is essential for delivering inhaled nitric oxide (iNO) therapy in neonates with persistent pulmonary hypertension?

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

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 29: The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that the teaching was successful when the mother states that the test screens for the presence in the newborn of which of the following diseases? (Select all that apply)

Sickle cell disease. (Correct answer)
Galactosemia. (Correct answer)
Hypothyroidism. (Correct answer)
Cerebral palsy.
Cystic fibrosis. (Correct answer)

Correct answer: Sickle cell disease.

Neonatal blood screening tests, often called heel prick tests, are designed to identify several serious genetic, metabolic, and endocrine disorders early in life. Common conditions screened for include hypothyroidism, sickle cell disease, galactosemia, and cystic fibrosis, allowing for timely intervention to prevent severe complications. Cerebral palsy is a neurological condition not typically detected by these blood tests.

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.

Questions

35 min

Time Limit

70%

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