NNP-BC Neonatal nurse practitioner
certification recognizing advanced knowledge
managing high-risk newborn populations
and conditions.
Question 1
A 34-week gestation infant is admitted to the NICU with respiratory distress. The
mother has a history of chorioamnionitis and prolonged rupture of membranes
(PROM). Which antepartum risk factor is MOST significant in this infant's
presentation?
A. Premature rupture of membranes (PROM)
B. Maternal hypertension
C. Maternal diabetes
D. Maternal age over 35
Answer: A. Premature rupture of membranes (PROM)
Rationale: Prolonged rupture of membranes (PROM) is a significant antepartum
risk factor associated with neonatal sepsis and respiratory distress.
Chorioamnionitis, an infection of the amniotic fluid and membranes, is a
complication of PROM that increases the risk of early-onset neonatal sepsis.
Infants born to mothers with chorioamnionitis require evaluation for sepsis and
may present with respiratory distress, temperature instability, and lethargy.
Maternal hypertension, diabetes, and advanced maternal age are also risk factors
but are less directly associated with the acute presentation of respiratory distress in
this context.
Question 2
A 28-week gestation infant is being assessed for gestational age. Which physical
finding is MOST consistent with a preterm infant of this gestational age?
A. Well-developed ear cartilage
B. Prominent plantar creases
,C. Abundant lanugo hair
D. Palpable breast bud tissue
Answer: C. Abundant lanugo hair
Rationale: Abundant lanugo hair is a characteristic finding in preterm infants,
particularly those less than 30 weeks gestation. As gestational age increases,
lanugo diminishes. Well-developed ear cartilage, prominent plantar creases, and
palpable breast bud tissue are findings associated with more mature infants (greater
than 34-36 weeks gestation). The Ballard Score assesses physical and
neuromuscular maturity to estimate gestational age.
Question 3
A newborn requires resuscitation in the delivery room. According to the Neonatal
Resuscitation Program (NRP), which of the following is the INITIAL step in
resuscitation?
A. Endotracheal intubation
B. Positive pressure ventilation
C. Warm, dry, stimulate, and position airway
D. Chest compressions
Answer: C. Warm, dry, stimulate, and position airway
Rationale: The initial steps of neonatal resuscitation are to warm the infant, dry
the infant, stimulate breathing, and position the airway (head in a neutral or slightly
extended position to open the airway). These steps are performed before assessing
the need for positive pressure ventilation. Endotracheal intubation and chest
compressions are advanced interventions performed after positive pressure
ventilation if the heart rate remains below 60 beats/min.
Question 4
A 32-week gestation infant is receiving parenteral nutrition. The NNP calculates
the infant's fluid requirements. What is the approximate daily fluid requirement for
a preterm infant on day 2 of life?
A. 40-60 mL/kg/day
B. 60-80 mL/kg/day
,C. 80-100 mL/kg/day
D. 100-120 mL/kg/day
Answer: C. 80-100 mL/kg/day
Rationale: Preterm infants have higher fluid requirements due to increased
insensible water losses from immature skin and higher metabolic demands. On day
1 of life, fluid requirements are typically 60-80 mL/kg/day, increasing to 80-100
mL/kg/day by day 2-3. By day 7, requirements may reach 120-150 mL/kg/day.
Fluid management must be individualized based on weight, urine output, serum
electrolytes, and clinical status.
Question 5
A 27-week gestation infant is being monitored for glucose homeostasis. Which of
the following is the PRIMARY risk factor for hypoglycemia in this infant?
A. Polycythemia
B. Hyperinsulinism due to maternal diabetes
C. Inadequate glycogen stores
D. Hyperthyroidism
Answer: C. Inadequate glycogen stores
Rationale: Preterm infants have limited glycogen stores because glycogen
deposition in the liver and other tissues occurs primarily in the third trimester.
Inadequate glycogen stores predispose preterm infants to hypoglycemia, especially
in the first 24-48 hours of life. Hyperinsulinism is more common in infants of
diabetic mothers. Polycythemia can cause hypoglycemia but is not the primary risk
factor in preterm infants.
Question 6
A 34-week gestation infant is being started on enteral feedings. The NNP
understands that the PRIMARY indication for trophic feeding in a premature infant
is:
A. To provide complete nutrition
B. To stimulate gastrointestinal tract maturation
, C. To prevent necrotizing enterocolitis
D. To promote weight gain
Answer: B. To stimulate gastrointestinal tract maturation
Rationale: Trophic feeding (minimal enteral nutrition) is provided in small
volumes (typically 10-20 mL/kg/day) to stimulate gastrointestinal tract maturation,
including the development of digestive enzymes and hormones. Trophic feeding
does not provide complete nutrition; parenteral nutrition is used to meet the infant's
caloric and protein needs. The goal is to prime the gut for full enteral feedings and
reduce the time to full feeds.
Question 7
A 29-week gestation infant is on mechanical ventilation. The NNP notes that the
infant's arterial blood gas shows pH 7.28, PaCO₂ 55 mmHg, and HCO₃ 22 mEq/L.
This indicates:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
Rationale: Respiratory acidosis is characterized by a low pH (<7.35) and elevated
PaCO₂ (>45 mmHg) with a normal bicarbonate level (22-26 mEq/L). This pattern
indicates inadequate ventilation, which may be due to the infant's underlying
respiratory condition or ventilator settings. The HCO₃ of 22 mEq/L is within
normal range, indicating that the acidosis is primarily respiratory in origin.
Question 8
A 30-week gestation infant is in a servo-controlled radiant warmer. The NNP notes
that the infant's axillary temperature is 36.8°C (98.2°F). This temperature is:
A. Hypothermic
B. Normothermic
C. Hyperthermic
D. Fever
certification recognizing advanced knowledge
managing high-risk newborn populations
and conditions.
Question 1
A 34-week gestation infant is admitted to the NICU with respiratory distress. The
mother has a history of chorioamnionitis and prolonged rupture of membranes
(PROM). Which antepartum risk factor is MOST significant in this infant's
presentation?
A. Premature rupture of membranes (PROM)
B. Maternal hypertension
C. Maternal diabetes
D. Maternal age over 35
Answer: A. Premature rupture of membranes (PROM)
Rationale: Prolonged rupture of membranes (PROM) is a significant antepartum
risk factor associated with neonatal sepsis and respiratory distress.
Chorioamnionitis, an infection of the amniotic fluid and membranes, is a
complication of PROM that increases the risk of early-onset neonatal sepsis.
Infants born to mothers with chorioamnionitis require evaluation for sepsis and
may present with respiratory distress, temperature instability, and lethargy.
Maternal hypertension, diabetes, and advanced maternal age are also risk factors
but are less directly associated with the acute presentation of respiratory distress in
this context.
Question 2
A 28-week gestation infant is being assessed for gestational age. Which physical
finding is MOST consistent with a preterm infant of this gestational age?
A. Well-developed ear cartilage
B. Prominent plantar creases
,C. Abundant lanugo hair
D. Palpable breast bud tissue
Answer: C. Abundant lanugo hair
Rationale: Abundant lanugo hair is a characteristic finding in preterm infants,
particularly those less than 30 weeks gestation. As gestational age increases,
lanugo diminishes. Well-developed ear cartilage, prominent plantar creases, and
palpable breast bud tissue are findings associated with more mature infants (greater
than 34-36 weeks gestation). The Ballard Score assesses physical and
neuromuscular maturity to estimate gestational age.
Question 3
A newborn requires resuscitation in the delivery room. According to the Neonatal
Resuscitation Program (NRP), which of the following is the INITIAL step in
resuscitation?
A. Endotracheal intubation
B. Positive pressure ventilation
C. Warm, dry, stimulate, and position airway
D. Chest compressions
Answer: C. Warm, dry, stimulate, and position airway
Rationale: The initial steps of neonatal resuscitation are to warm the infant, dry
the infant, stimulate breathing, and position the airway (head in a neutral or slightly
extended position to open the airway). These steps are performed before assessing
the need for positive pressure ventilation. Endotracheal intubation and chest
compressions are advanced interventions performed after positive pressure
ventilation if the heart rate remains below 60 beats/min.
Question 4
A 32-week gestation infant is receiving parenteral nutrition. The NNP calculates
the infant's fluid requirements. What is the approximate daily fluid requirement for
a preterm infant on day 2 of life?
A. 40-60 mL/kg/day
B. 60-80 mL/kg/day
,C. 80-100 mL/kg/day
D. 100-120 mL/kg/day
Answer: C. 80-100 mL/kg/day
Rationale: Preterm infants have higher fluid requirements due to increased
insensible water losses from immature skin and higher metabolic demands. On day
1 of life, fluid requirements are typically 60-80 mL/kg/day, increasing to 80-100
mL/kg/day by day 2-3. By day 7, requirements may reach 120-150 mL/kg/day.
Fluid management must be individualized based on weight, urine output, serum
electrolytes, and clinical status.
Question 5
A 27-week gestation infant is being monitored for glucose homeostasis. Which of
the following is the PRIMARY risk factor for hypoglycemia in this infant?
A. Polycythemia
B. Hyperinsulinism due to maternal diabetes
C. Inadequate glycogen stores
D. Hyperthyroidism
Answer: C. Inadequate glycogen stores
Rationale: Preterm infants have limited glycogen stores because glycogen
deposition in the liver and other tissues occurs primarily in the third trimester.
Inadequate glycogen stores predispose preterm infants to hypoglycemia, especially
in the first 24-48 hours of life. Hyperinsulinism is more common in infants of
diabetic mothers. Polycythemia can cause hypoglycemia but is not the primary risk
factor in preterm infants.
Question 6
A 34-week gestation infant is being started on enteral feedings. The NNP
understands that the PRIMARY indication for trophic feeding in a premature infant
is:
A. To provide complete nutrition
B. To stimulate gastrointestinal tract maturation
, C. To prevent necrotizing enterocolitis
D. To promote weight gain
Answer: B. To stimulate gastrointestinal tract maturation
Rationale: Trophic feeding (minimal enteral nutrition) is provided in small
volumes (typically 10-20 mL/kg/day) to stimulate gastrointestinal tract maturation,
including the development of digestive enzymes and hormones. Trophic feeding
does not provide complete nutrition; parenteral nutrition is used to meet the infant's
caloric and protein needs. The goal is to prime the gut for full enteral feedings and
reduce the time to full feeds.
Question 7
A 29-week gestation infant is on mechanical ventilation. The NNP notes that the
infant's arterial blood gas shows pH 7.28, PaCO₂ 55 mmHg, and HCO₃ 22 mEq/L.
This indicates:
A. Metabolic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Answer: B. Respiratory acidosis
Rationale: Respiratory acidosis is characterized by a low pH (<7.35) and elevated
PaCO₂ (>45 mmHg) with a normal bicarbonate level (22-26 mEq/L). This pattern
indicates inadequate ventilation, which may be due to the infant's underlying
respiratory condition or ventilator settings. The HCO₃ of 22 mEq/L is within
normal range, indicating that the acidosis is primarily respiratory in origin.
Question 8
A 30-week gestation infant is in a servo-controlled radiant warmer. The NNP notes
that the infant's axillary temperature is 36.8°C (98.2°F). This temperature is:
A. Hypothermic
B. Normothermic
C. Hyperthermic
D. Fever
