Page 1 of 54
NEONATAL NP FINAL EXAM
|500+QS&AS|:-UNIVERSITY OF SOUTH
ALABAMA
Q1. A 38-week gestation infant is 8 hours old. The nurse
practitioner notes respiratory rate of 72, mild grunting, and
nasal flaring. Oxygen saturation is 92% in room air. What is the
most appropriate initial action?
a) Start CPAP at 6 cm H₂O
b) Obtain a chest x-ray
c) Place the infant in a prone position
d) Administer surfactant via endotracheal tube
Correct Answer: b) Obtain a chest x-ray
Rationale: This infant has signs of respiratory distress (tachypnea,
grunting, flaring). While transient tachypnea of the newborn (TTN)
is likely, a chest x-ray helps differentiate TTN from other causes
,Page 2 of 54
(e.g., pneumonia, pneumothorax). CPAP or surfactant would be
premature without an x-ray.
Q2. A term infant has a pre-ductal SpO₂ of 88% and
post-ductal SpO₂ of 78% on the first day of life. The most likely
diagnosis is:
a) Meconium aspiration syndrome
b) Persistent pulmonary hypertension of the newborn (PPHN)
c) Transposition of the great arteries
d) Coarctation of the aorta
Correct Answer: b) Persistent pulmonary hypertension of the
newborn (PPHN)
Rationale: A significant pre-ductal – post-ductal oxygen saturation
difference (>5-10%) suggests right-to-left shunting through the
ductus arteriosus, classic for PPHN. Coarctation might cause lower
extremity pressures but not such a saturation gradient.
,Page 3 of 54
Q3. A 35-week preterm infant is placed in a radiant warmer.
The axillary temperature is 36.2°C (97.2°F) at 1 hour of age.
The most effective way to maintain temperature is:
a) Increase room temperature to 28°C
b) Place a stocking cap on the infant’s head and wrap with a
plastic blanket
c) Double the radiant warmer power output
d) Bathe the infant to remove vernix
Correct Answer: b) Place a stocking cap on the infant’s head
and wrap with a plastic blanket
Rationale: Preterm infants lose heat primarily through evaporation,
conduction, and radiation. A plastic wrap (occlusive) reduces
evaporative loss; a cap reduces heat loss from the large surface
area of the head.
Q4. Which of the following is a normal finding on a neonatal
cranial ultrasound at 3 days of life in a 28-week infant?
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a) Grade IV intraventricular hemorrhage
b) Periventricular leukomalacia (PVL)
c) Germinal matrix without hemorrhage
d) Subependymal pseudocyst
Correct Answer: c) Germinal matrix without hemorrhage
Rationale: The germinal matrix is a normal structure in preterm
infants; it is the origin of neuroblasts and regresses by term.
Presence of hemorrhage would be abnormal. PVL is an ischemic
injury, not a normal finding.
Q5. A newborn has a heart rate of 80 bpm at 5 minutes of life,
is apneic, and limp. The initial resuscitation step after drying and
stimulating is:
a) Intubate and administer epinephrine
b) Begin chest compressions
c) Provide positive-pressure ventilation (PPV)
d) Administer 100% oxygen via mask
NEONATAL NP FINAL EXAM
|500+QS&AS|:-UNIVERSITY OF SOUTH
ALABAMA
Q1. A 38-week gestation infant is 8 hours old. The nurse
practitioner notes respiratory rate of 72, mild grunting, and
nasal flaring. Oxygen saturation is 92% in room air. What is the
most appropriate initial action?
a) Start CPAP at 6 cm H₂O
b) Obtain a chest x-ray
c) Place the infant in a prone position
d) Administer surfactant via endotracheal tube
Correct Answer: b) Obtain a chest x-ray
Rationale: This infant has signs of respiratory distress (tachypnea,
grunting, flaring). While transient tachypnea of the newborn (TTN)
is likely, a chest x-ray helps differentiate TTN from other causes
,Page 2 of 54
(e.g., pneumonia, pneumothorax). CPAP or surfactant would be
premature without an x-ray.
Q2. A term infant has a pre-ductal SpO₂ of 88% and
post-ductal SpO₂ of 78% on the first day of life. The most likely
diagnosis is:
a) Meconium aspiration syndrome
b) Persistent pulmonary hypertension of the newborn (PPHN)
c) Transposition of the great arteries
d) Coarctation of the aorta
Correct Answer: b) Persistent pulmonary hypertension of the
newborn (PPHN)
Rationale: A significant pre-ductal – post-ductal oxygen saturation
difference (>5-10%) suggests right-to-left shunting through the
ductus arteriosus, classic for PPHN. Coarctation might cause lower
extremity pressures but not such a saturation gradient.
,Page 3 of 54
Q3. A 35-week preterm infant is placed in a radiant warmer.
The axillary temperature is 36.2°C (97.2°F) at 1 hour of age.
The most effective way to maintain temperature is:
a) Increase room temperature to 28°C
b) Place a stocking cap on the infant’s head and wrap with a
plastic blanket
c) Double the radiant warmer power output
d) Bathe the infant to remove vernix
Correct Answer: b) Place a stocking cap on the infant’s head
and wrap with a plastic blanket
Rationale: Preterm infants lose heat primarily through evaporation,
conduction, and radiation. A plastic wrap (occlusive) reduces
evaporative loss; a cap reduces heat loss from the large surface
area of the head.
Q4. Which of the following is a normal finding on a neonatal
cranial ultrasound at 3 days of life in a 28-week infant?
, Page 4 of 54
a) Grade IV intraventricular hemorrhage
b) Periventricular leukomalacia (PVL)
c) Germinal matrix without hemorrhage
d) Subependymal pseudocyst
Correct Answer: c) Germinal matrix without hemorrhage
Rationale: The germinal matrix is a normal structure in preterm
infants; it is the origin of neuroblasts and regresses by term.
Presence of hemorrhage would be abnormal. PVL is an ischemic
injury, not a normal finding.
Q5. A newborn has a heart rate of 80 bpm at 5 minutes of life,
is apneic, and limp. The initial resuscitation step after drying and
stimulating is:
a) Intubate and administer epinephrine
b) Begin chest compressions
c) Provide positive-pressure ventilation (PPV)
d) Administer 100% oxygen via mask
