CCRN (Neonatal) Certification demonstrating advanced neonatal intensive care knowledge, critical thinking, patient monitoring, and evidence-based nursing practice.

CCRN (Neonatal) Certification demonstrating
advanced neonatal intensive care knowledge, critical
thinking, patient monitoring, and evidence-based
nursing practice.

Question 1
A neonate at 2 hours of life presents with cyanosis that does not improve with
100% oxygen. Echocardiogram shows ductal-dependent pulmonary blood flow
with an intact ventricular septum. Which medication is indicated emergently?
A) Indomethacin
B) Prostaglandin E1 (alprostadil)
C) Furosemide
D) Epinephrine
Rationale: Prostaglandin E1 maintains ductal patency to allow mixing. In lesions
with decreased pulmonary blood flow (pulmonary atresia, critical pulmonary
stenosis), PGE1 is life-saving until surgical intervention.


Question 2
A 3-day-old neonate has a blood pressure of 45/25 mm Hg, weak femoral pulses,
and a 20 mm Hg gradient between preductal (right arm) and postductal (lower
extremity) oxygen saturation. The most likely diagnosis is:
A) Atrial septal defect
B) Coarctation of the aorta
C) Truncus arteriosus
D) Total anomalous pulmonary venous return
Rationale: Coarctation presents with upper extremity hypertension, decreased
lower extremity pulses, and a pre/post-ductal saturation difference. It may be
ductal-dependent.


Question 3

,A neonate with hypoplastic left heart syndrome (HLHS) is on PGE1 infusion.
Which laboratory finding requires immediate intervention?
A) Serum glucose 65 mg/dL
B) Apnea and bradycardia
C) Platelet count 150,000
D) Sodium 135 mEq/L
Rationale: PGE1 commonly causes apnea, especially in low-birth-weight infants.
Apnea requires respiratory support and possible dose reduction. Bradycardia may
precede apnea.


Question 4
A premature infant (28 weeks) has a hemodynamically significant patent ductus
arteriosus (PDA). Which finding is most consistent with this diagnosis?
A) Systolic murmur at the right sternal border
B) Bounding pulses, widened pulse pressure, and a continuous murmur
C) Hepatomegaly and ascites
D) Fixed split S2
Rationale: PDA causes left-to-right shunting, leading to bounding pulses
(increased stroke volume), widened pulse pressure, and a continuous “machinery”
murmur (best heard at left infraclavicular area).


Question 5
A neonate has a central line and develops sudden respiratory distress, cyanosis, and
hypotension. The most likely cause is:
A) Pneumothorax
B) Catheter-related air embolism
C) Necrotizing enterocolitis
D) Pulmonary hemorrhage
Rationale: Air embolism is a rare but catastrophic complication of central lines.
Presentation is sudden cardiovascular collapse. Position the patient in left lateral
decubitus (to trap air in right ventricle) and call for help.

,Question 6
A term neonate has a single S2, cyanosis, and a chest X-ray showing a “egg-on-a-
string” cardiac silhouette with a narrow base. The likely diagnosis is:
A) Tetralogy of Fallot
B) Transposition of the great arteries (TGA)
C) Truncus arteriosus
D) Ebstein anomaly
Rationale: TGA classic CXR: narrow mediastinal shadow with an egg-shaped
heart. TGA is ductal-dependent for mixing; PGE1 is critical.


Question 7
A neonate with a history of asphyxia has a 2D echo showing depressed myocardial
function. Which drug is first-line for hypotension in this setting?
A) Dopamine
B) Dobutamine
C) Milrinone
D) Norepinephrine
Rationale: Dopamine is first-line for neonatal hypotension (especially after
asphyxia) due to its alpha and beta effects. Dobutamine is used for low cardiac
output with normal BP. Milrinone for pulmonary hypertension.


Question 8
A 34-week neonate on high-frequency oscillatory ventilation (HFOV) develops
sudden hypotension, muffled heart sounds, and pulsus paradoxus. The immediate
action is:
A) Administer volume bolus
B) Perform bedside echocardiogram or pericardiocentesis preparation for
cardiac tamponade
C) Increase mean airway pressure
D) Administer epinephrine

, Rationale: Cardiac tamponade can occur from central line perforation. Beck’s
triad: hypotension, muffled heart sounds, JVD (in neonates, hepatomegaly).
Emergent pericardiocentesis is lifesaving.


Question 9
A neonate with supraventricular tachycardia (SVT) at 280 bpm is
hemodynamically stable. The first-line vagal maneuver is:
A) Carotid sinus massage
B) Application of ice to the face
C) Ocular pressure
D) Adenosine IV push
Rationale: For stable SVT, vagal maneuvers first: ice to face (diving reflex).
Adenosine is next (rapid IV push followed by saline flush). Unstable SVT requires
synchronized cardioversion.


Question 10
Which finding suggests a neonate is adequately perfused after cardiac surgery?
A) Capillary refill >5 seconds
B) Serum lactate <2 mmol/L, normal base deficit, urine output >1 mL/kg/hr
C) Mean arterial pressure less than gestational age
D) mottled skin with cool extremities
Rationale: Adequate perfusion: lactate <2, normal pH/base deficit, urine output >1
mL/kg/hr, warm extremities, capillary refill <3 seconds.


Question 11
A neonate with a single ventricle (Norwood palliation) has a superior vena cava
(SVC) pressure of 18 mm Hg after the Glenn procedure. This indicates:
A) Normal finding
B) Elevated SVC pressure, which may indicate obstruction or low cardiac
output
C) Hypovolemia
D) Aortic stenosis