NPS EXAM 2026 – NEONATAL & PEDIATRIC
RESPIRATORY CARE PRACTICE QUESTIONS
& VERIFIED ANSWERS
Question 1
A newborn has noisy breathing with mild retractions but normal oxygen
saturation. What is the most appropriate immediate action?
A. Provide immediate intubation for airway protection
B. Give bag-mask ventilation to normalize oxygenation
C. Provide careful observation and supportive care as needed
D. Administer epinephrine immediately
E. Start high-dose systemic steroids immediately
Correct Answer: C
EXPERT RATIONALE (Correct option: C): Mild retractions with normal oxygenation
and stable status typically warrants supportive care and close monitoring.
Escalation to intubation or bag-mask ventilation is reserved for respiratory failure
(e.g., worsening work of breathing, rising oxygen requirement, apnea, or impending
fatigue).
Question 2
Which finding best indicates the need for suctioning in a non-breathing infant
after birth?
A. Mild nasal congestion only
B. Visible oropharyngeal secretions preventing ventilation
C. Normal spontaneous crying with no secretions
D. Pink color with occasional sneezing
E. Transient tachypnea without distress
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Suctioning is indicated when secretions
are obstructing airflow/ventilation. If the airway is already clear and the infant is
ventilating effectively, routine suctioning is not beneficial and can cause harm.
,Question 3
In neonatal positive pressure ventilation, what is the primary goal during
initial breaths?
A. Reduce respiratory rate
B. Establish effective ventilation with adequate chest rise
C. Normalize arterial CO₂ immediately
D. Prevent any lung inflation
E. Deliver only minimal tidal volume
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Effective ventilation—reflected by
adequate chest rise and improvement in heart rate/spontaneous breathing—is the
primary objective. CO₂ and oxygenation targets are secondary and adjusted after
ventilation is effective.
Question 4
A term newborn is cyanotic and requires supplemental oxygen. The most
appropriate next step is to:
A. Increase FiO₂ without reassessing ventilation
B. Ensure effective ventilation and assess for airway problems
C. Start antibiotics immediately without evaluation
D. Give diuretics for fluid overload
E. Withhold oxygen entirely until color improves
Correct Answer: B
EXPERT RATIONALE (Correct option: B): In a cyanotic newborn, ventilation issues
(airway obstruction, mask seal, inadequate pressure) must be assessed first.
Oxygen alone cannot correct ineffective ventilation.
Question 5
Which parameter is most useful for deciding whether a neonatal patient is
responding to oxygen therapy?
, A. Skin temperature only
B. Oxygen saturation trend and clinical work of breathing
C. Urine output only
D. Random capillary glucose
E. Reflex responsiveness
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Response to oxygen is judged by oxygen
saturation trend and whether respiratory effort is improving. Skin temperature,
glucose, or reflexes do not directly guide oxygen titration.
Question 6
A pediatric patient with suspected asthma has wheezing and prolonged
expiration. What is the best initial bronchodilator therapy?
A. Oral antibiotics
B. Inhaled short-acting beta-agonist (SABA)
C. IM magnesium sulfate first line in mild disease
D. Systemic opioids to reduce breathing effort
E. Nebulized hypertonic saline only
Correct Answer: B
EXPERT RATIONALE (Correct option: B): SABA inhalation is first-line for
bronchospasm. Antibiotics, opioids, or saline are not initial treatments for acute
bronchoconstriction.
Question 7
For a child in respiratory distress, which sign most strongly suggests
impending respiratory failure?
A. Mild intermittent cough
B. Increasing fatigue with decreasing air entry
C. Nasal flaring with stable saturation
RESPIRATORY CARE PRACTICE QUESTIONS
& VERIFIED ANSWERS
Question 1
A newborn has noisy breathing with mild retractions but normal oxygen
saturation. What is the most appropriate immediate action?
A. Provide immediate intubation for airway protection
B. Give bag-mask ventilation to normalize oxygenation
C. Provide careful observation and supportive care as needed
D. Administer epinephrine immediately
E. Start high-dose systemic steroids immediately
Correct Answer: C
EXPERT RATIONALE (Correct option: C): Mild retractions with normal oxygenation
and stable status typically warrants supportive care and close monitoring.
Escalation to intubation or bag-mask ventilation is reserved for respiratory failure
(e.g., worsening work of breathing, rising oxygen requirement, apnea, or impending
fatigue).
Question 2
Which finding best indicates the need for suctioning in a non-breathing infant
after birth?
A. Mild nasal congestion only
B. Visible oropharyngeal secretions preventing ventilation
C. Normal spontaneous crying with no secretions
D. Pink color with occasional sneezing
E. Transient tachypnea without distress
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Suctioning is indicated when secretions
are obstructing airflow/ventilation. If the airway is already clear and the infant is
ventilating effectively, routine suctioning is not beneficial and can cause harm.
,Question 3
In neonatal positive pressure ventilation, what is the primary goal during
initial breaths?
A. Reduce respiratory rate
B. Establish effective ventilation with adequate chest rise
C. Normalize arterial CO₂ immediately
D. Prevent any lung inflation
E. Deliver only minimal tidal volume
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Effective ventilation—reflected by
adequate chest rise and improvement in heart rate/spontaneous breathing—is the
primary objective. CO₂ and oxygenation targets are secondary and adjusted after
ventilation is effective.
Question 4
A term newborn is cyanotic and requires supplemental oxygen. The most
appropriate next step is to:
A. Increase FiO₂ without reassessing ventilation
B. Ensure effective ventilation and assess for airway problems
C. Start antibiotics immediately without evaluation
D. Give diuretics for fluid overload
E. Withhold oxygen entirely until color improves
Correct Answer: B
EXPERT RATIONALE (Correct option: B): In a cyanotic newborn, ventilation issues
(airway obstruction, mask seal, inadequate pressure) must be assessed first.
Oxygen alone cannot correct ineffective ventilation.
Question 5
Which parameter is most useful for deciding whether a neonatal patient is
responding to oxygen therapy?
, A. Skin temperature only
B. Oxygen saturation trend and clinical work of breathing
C. Urine output only
D. Random capillary glucose
E. Reflex responsiveness
Correct Answer: B
EXPERT RATIONALE (Correct option: B): Response to oxygen is judged by oxygen
saturation trend and whether respiratory effort is improving. Skin temperature,
glucose, or reflexes do not directly guide oxygen titration.
Question 6
A pediatric patient with suspected asthma has wheezing and prolonged
expiration. What is the best initial bronchodilator therapy?
A. Oral antibiotics
B. Inhaled short-acting beta-agonist (SABA)
C. IM magnesium sulfate first line in mild disease
D. Systemic opioids to reduce breathing effort
E. Nebulized hypertonic saline only
Correct Answer: B
EXPERT RATIONALE (Correct option: B): SABA inhalation is first-line for
bronchospasm. Antibiotics, opioids, or saline are not initial treatments for acute
bronchoconstriction.
Question 7
For a child in respiratory distress, which sign most strongly suggests
impending respiratory failure?
A. Mild intermittent cough
B. Increasing fatigue with decreasing air entry
C. Nasal flaring with stable saturation
