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NEONATAL NURSE PRACTITIONER (NNP)
CERTIFICATION ACTUAL EXAM 2026/2027
COMPLETE ACCURATE EXAM REAL
QUESTIONS WITH WELL ELABORATED
ANSWERS AND RATIONALES. (100%
CORRECT VERIFIED SOLUTIONS)
Question 1
A 34-week gestation fetus has absent end-diastolic flow in the
umbilical artery on Doppler study. Which acid-base status is
most likely at birth?
A) Metabolic alkalosis
B) Respiratory acidosis
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C) Metabolic acidosis with normal lactate
D) Metabolic acidosis with elevated lactate
Answer: D
Rationale: Absent end-diastolic flow indicates high placental
resistance and chronic hypoxia. This leads to anaerobic
metabolism, elevated lactate, and metabolic acidosis.
Question 2
A mother with chorioamnionitis delivers at 38 weeks. The
newborn is vigorous at birth. What is the MOST appropriate
immediate management?
A) Admit to NICU for 48 hours of empirical antibiotics
B) Obtain blood culture and initiate ampicillin and gentamicin
C) Observe in well-baby nursery with vital signs q4h
D) Perform a complete septic workup including lumbar
puncture
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Answer: B
Rationale: Maternal chorioamnionitis is a risk factor for early-
onset sepsis. Current guidelines (AAP 2025) recommend blood
culture and empirical antibiotics (ampicillin + gentamicin) even
in asymptomatic vigorous newborns.
Question 3
A 25-year-old G2P1 with diet-controlled gestational diabetes
delivers at 39 weeks. The infant weighs 4.5 kg. What is the
priority screening test?
A) Bilirubin at 6 hours of life
B) Point-of-care glucose within 30 minutes of birth
C) Hemoglobin and hematocrit at 2 hours
D) Serum calcium at 12 hours
Answer: B
Rationale: Large for gestational age (LGA) infants of diabetic
mothers are at high risk for hypoglycemia due to
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hyperinsulinism. Glucose should be checked within 30 minutes
of birth.
Question 4
A mother with untreated Group B Streptococcus (GBS) presents
in precipitous labor and delivers before antibiotics can be
given. The newborn is term and asymptomatic. What is the
recommended management?
A) Discharge at 24 hours if well
B) Observe for 48 hours with vital signs q4h
C) Limited evaluation (CBC, blood culture) and observe for 48
hours
D) Full septic workup and antibiotics for 48 hours pending
cultures
Answer: C
Rationale: 2021 CDC guidelines: For inadequate GBS
prophylaxis (precipitous labor), perform limited evaluation
NEONATAL NURSE PRACTITIONER (NNP)
CERTIFICATION ACTUAL EXAM 2026/2027
COMPLETE ACCURATE EXAM REAL
QUESTIONS WITH WELL ELABORATED
ANSWERS AND RATIONALES. (100%
CORRECT VERIFIED SOLUTIONS)
Question 1
A 34-week gestation fetus has absent end-diastolic flow in the
umbilical artery on Doppler study. Which acid-base status is
most likely at birth?
A) Metabolic alkalosis
B) Respiratory acidosis
,Page 2 of 233
C) Metabolic acidosis with normal lactate
D) Metabolic acidosis with elevated lactate
Answer: D
Rationale: Absent end-diastolic flow indicates high placental
resistance and chronic hypoxia. This leads to anaerobic
metabolism, elevated lactate, and metabolic acidosis.
Question 2
A mother with chorioamnionitis delivers at 38 weeks. The
newborn is vigorous at birth. What is the MOST appropriate
immediate management?
A) Admit to NICU for 48 hours of empirical antibiotics
B) Obtain blood culture and initiate ampicillin and gentamicin
C) Observe in well-baby nursery with vital signs q4h
D) Perform a complete septic workup including lumbar
puncture
,Page 3 of 233
Answer: B
Rationale: Maternal chorioamnionitis is a risk factor for early-
onset sepsis. Current guidelines (AAP 2025) recommend blood
culture and empirical antibiotics (ampicillin + gentamicin) even
in asymptomatic vigorous newborns.
Question 3
A 25-year-old G2P1 with diet-controlled gestational diabetes
delivers at 39 weeks. The infant weighs 4.5 kg. What is the
priority screening test?
A) Bilirubin at 6 hours of life
B) Point-of-care glucose within 30 minutes of birth
C) Hemoglobin and hematocrit at 2 hours
D) Serum calcium at 12 hours
Answer: B
Rationale: Large for gestational age (LGA) infants of diabetic
mothers are at high risk for hypoglycemia due to
, Page 4 of 233
hyperinsulinism. Glucose should be checked within 30 minutes
of birth.
Question 4
A mother with untreated Group B Streptococcus (GBS) presents
in precipitous labor and delivers before antibiotics can be
given. The newborn is term and asymptomatic. What is the
recommended management?
A) Discharge at 24 hours if well
B) Observe for 48 hours with vital signs q4h
C) Limited evaluation (CBC, blood culture) and observe for 48
hours
D) Full septic workup and antibiotics for 48 hours pending
cultures
Answer: C
Rationale: 2021 CDC guidelines: For inadequate GBS
prophylaxis (precipitous labor), perform limited evaluation
