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NEONATAL RESUSCITATION PROGRAM (NRP) 8TH
EDITION
COMPREHENSIVE CERTIFICATION EXAM - 100 QUESTIONS
SECTION 1: PRINCIPLES OF RESUSCITATION AND INITIAL STEPS
- What percentage of newborns require some assistance to begin breathing at birth? A) 1-3% B) 5-10% C) 10-15% D) 20-25% ANSWER: B EXPLANATION: Approximately 5-10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitation measures such as chest compressions or medications.
- What is the single most important and effective action in neonatal resuscitation? A) Chest compressions B) Administration of epinephrine C) Ventilation of the lungs D) Umbilical vein catheterization
ANSWER: C
EXPLANATION: Ventilation of the lungs is the single most important and effective action in neonatal resuscitation. Most newborns who require resuscitation respond to appropriate ventilation support.
- Which of the following are risk factors that increase the likelihood of needing resuscitation? (Select all that apply) A) Maternal diabetes B) Multiple gestation C) Meconium-stained amniotic fluid D) Elective cesarean delivery with regional anesthesia E) All of the above ANSWER: E EXPLANATION: All listed factors increase the likelihood of needing resuscitation. Additional risk factors include maternal hypertension, fetal anemia, fetal hydrops, prolonged rupture of membranes, maternal infection, and fetal malformations.
- The initial steps of newborn care should be completed within what time frame? A) 15 seconds B) 30 seconds C) 60 seconds D) 90 seconds ANSWER: C EXPLANATION: The initial steps of newborn care (provide warmth, position head, clear secretions if needed, dry, stimulate) should be completed within approximately 60 seconds—often called "The Golden Minute."
D) Only if the heart rate is less than 60 bpm ANSWER: B EXPLANATION: For non-vigorous newborns (depressed respirations, decreased muscle tone, heart rate <100 bpm) born through meconium-stained amniotic fluid, direct tracheal suctioning should be performed immediately after birth before other resuscitation steps.
- What is the correct sequence for initial newborn care? A) Dry, stimulate, clear airway B) Clear airway, dry, stimulate C) Stimulate, clear airway, dry D) Dry, clear airway if needed, stimulate ANSWER: D EXPLANATION: The correct sequence is: provide warmth, position head, dry the newborn, clear airway if needed (bulb syringe or suction catheter), and then stimulate to breathe if needed. ========================================================== ====================== SECTION 2: ASSESSMENT AND DECISION-MAKING ========================================================== ======================
- What are the three vital signs assessed during neonatal resuscitation? A) Temperature, blood pressure, oxygen saturation B) Respirations, heart rate, color C) Heart rate, respirations, muscle tone
D) Heart rate, oxygen saturation, blood pressure ANSWER: B EXPLANATION: The three vital signs assessed during neonatal resuscitation are respirations, heart rate, and color (or oxygen saturation). These are assessed approximately every 30 seconds.
- What heart rate determines the need for positive-pressure ventilation (PPV)? A) Less than 60 bpm B) Less than 80 bpm C) Less than 100 bpm D) Less than 120 bpm ANSWER: C EXPLANATION: If the heart rate is less than 100 beats per minute (bpm) after initial steps, positive-pressure ventilation (PPV) should be initiated. Heart rate is the primary determinant for moving to next steps in resuscitation.
- How should heart rate be assessed during resuscitation? A) Palpating the umbilical pulse B) Auscultation with a stethoscope C) Pulse oximetry D) All of the above ANSWER: D EXPLANATION: Heart rate can be assessed by palpating the umbilical pulse (base of cord), auscultation with stethoscope, or pulse oximetry. A pulse oximeter provides continuous heart rate monitoring and is recommended when available.
D) To decide when to stop resuscitation efforts ANSWER: B EXPLANATION: The Apgar score is a tool for documenting the newborn's status at specific time points (1, 5, and 10 minutes) and response to resuscitation. It should not be used to determine resuscitation actions, which are based on assessment of respirations, heart rate, and oxygen saturation.
- When should the initial assessment be performed after birth? A) Immediately upon delivery B) After drying and stimulation C) After 30 seconds of life D) After 60 seconds of life ANSWER: A EXPLANATION: Initial assessment should begin immediately upon delivery. Ask: "Is the newborn term? Is there good muscle tone? Is the newborn breathing or crying?" Based on answers, proceed with appropriate initial steps.
- What is the definition of "term gestation" in NRP? A) 35-40 weeks B) 37-42 weeks C) 38-41 weeks D) 39-40 weeks ANSWER: B
EXPLANATION: Term gestation is defined as 37 0/7 to 41 6/7 weeks. Preterm is less than 37 weeks, and post-term is 42 weeks or more. Gestational age assessment helps guide resuscitation approach, especially for preterm infants. ========================================================== ====================== SECTION 3: POSITIVE-PRESSURE VENTILATION ========================================================== ======================
- What are the indications for positive-pressure ventilation (PPV)? (Select all that apply) A) Apnea or gasping B) Heart rate less than 100 bpm C) Persistent cyanosis despite 100% oxygen D) All of the above ANSWER: D EXPLANATION: Indications for PPV include apnea or gasping, heart rate less than 100 bpm despite initial steps, and persistent cyanosis or low oxygen saturation despite supplemental oxygen.
- What is the initial peak inspiratory pressure (PIP) recommended for term newborns? A) 10-15 cm H2O B) 15-20 cm H2O C) 20-25 cm H2O D) 25-30 cm H2O ANSWER: C
B) Perform the MR SOPA mnemonic steps C) Immediately intubate D) Begin chest compressions ANSWER: B EXPLANATION: If there is no chest movement during PPV, perform the MR SOPA mnemonic steps: M-Mask adjustment, R-Reposition head, S-Suction mouth and nose, O- Open mouth, P-Pressure increase, A-Airway alternative.
- How long should PPV be continued before reassessment? A) 15 seconds B) 30 seconds C) 60 seconds D) 90 seconds ANSWER: B EXPLANATION: After 30 seconds of effective PPV, pause briefly to assess heart rate. If heart rate is increasing, continue PPV until heart rate is >100 bpm and the newborn is breathing spontaneously.
- What device is preferred for providing PPV in the delivery room? A) Self-inflating bag B) Flow-inflating bag C) T-piece resuscitator D) Any of the above are acceptable ANSWER: C
EXPLANATION: The T-piece resuscitator is preferred because it allows precise control of peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP). However, self- inflating and flow-inflating bags are acceptable alternatives.
- What is the recommended initial FiO2 for resuscitating a term newborn? A) 21% (room air) B) 30-40% C) 60-80% D) 100% ANSWER: A EXPLANATION: For term newborns, begin resuscitation with 21% oxygen (room air). Use pulse oximetry to guide oxygen titration to meet target saturation ranges. For preterm newborns (<35 weeks), begin with 21-30% oxygen. ========================================================== ====================== SECTION 4: ENDOTRACHEAL INTUBATION ========================================================== ======================
- What are the indications for endotracheal intubation? (Select all that apply) A) Need for prolonged PPV B) Ineffective ventilation with bag-mask C) Need for chest compressions D) Special circumstances (congenital diaphragmatic hernia) E) All of the above
B) Listening for equal breath sounds C) Absence of air over stomach D) All of the above E) None of the above - use exhaled CO2 detector ANSWER: D EXPLANATION: All methods should be used to confirm placement: watch for chest rise, listen for equal breath sounds (especially in axillae), listen over stomach for absence of air sounds, and use an exhaled CO2 detector.
- What is the maximum time allowed for intubation attempts? A) 15 seconds B) 30 seconds C) 45 seconds D) 60 seconds ANSWER: B EXPLANATION: Intubation attempts should be limited to 30 seconds. If not successful within 30 seconds, withdraw the laryngoscope, provide bag-mask ventilation with 100% oxygen, then reattempt if needed.
- What is the preferred method for securing an endotracheal tube? A) Tape B) Commercial tube holder C) Sutures D) Any of the above are acceptable
ANSWER: B
EXPLANATION: A commercial endotracheal tube holder is preferred for securing the tube. If not available, tape may be used. The tube should be secured at the correct depth to prevent dislodgement or migration.
- When should a meconium aspirator be attached to the endotracheal tube? A) Before inserting the tube B) Immediately after confirming placement C) Only if the newborn develops respiratory distress D) It should not be used with endotracheal tubes ANSWER: B EXPLANATION: For non-vigorous newborns with meconium-stained fluid, attach a meconium aspirator to the endotracheal tube immediately after confirming placement, then apply suction as the tube is withdrawn.
- What alternative airway device may be used if intubation is unsuccessful? A) Nasal trumpet B) Laryngeal mask airway (LMA) C) Oral airway D) Tracheostomy tube ANSWER: B EXPLANATION: The laryngeal mask airway (LMA) may be used for term or near-term newborns (>34 weeks, >2000g) if bag-mask ventilation is ineffective and intubation is unsuccessful or not feasible.
- Where should pressure be applied during chest compressions? A) Over the heart B) Lower third of sternum C) Upper third of sternum D) Just below nipple line ANSWER: B EXPLANATION: Pressure should be applied to the lower third of the sternum. This is approximately one finger's breadth below an imaginary line drawn between the nipples.
- What is the correct depth of chest compressions? A) One-fourth the anteroposterior chest diameter B) One-half the anteroposterior chest diameter C) One-third the anteroposterior chest diameter D) 2-3 cm regardless of size ANSWER: C EXPLANATION: Chest compressions should depress the sternum approximately one-third the anteroposterior diameter of the chest. This is typically about 1.5 inches (4 cm) in a term newborn.
- What is the compression to ventilation ratio during neonatal resuscitation? A) 5: B) 15: C) 30: D) 3:
ANSWER: D
EXPLANATION: The compression to ventilation ratio is 3:1 (3 compressions followed by 1 ventilation). There should be approximately 120 events per minute (90 compressions + 30 ventilations).
- How should compressions and ventilations be coordinated? A) Asynchronous - both simultaneously B) Synchronous - compression during ventilation C) Pause compressions for ventilations D) Either B or C ANSWER: C EXPLANATION: Compressions and ventilations should be coordinated so that compressions pause briefly to allow a ventilation breath. The mnemonic is "one-and-two- and-three-and-breathe-and..."
- When should chest compressions be stopped for reassessment? A) After 30 seconds B) After 60 seconds C) After 2 minutes D) When team leader orders ANSWER: B EXPLANATION: After 60 seconds of coordinated chest compressions and ventilation, stop briefly to assess heart rate. If heart rate is >60 bpm, stop compressions and continue ventilation at 40-60 breaths/minute.
- What is the recommended intravenous (IV) dose of epinephrine? A) 0.01 mg/kg (0.1 mL/kg of 1:10,000) B) 0.1 mg/kg (0.1 mL/kg of 1:1,000) C) 0.01 mg/kg (0.1 mL/kg of 1:1,000) D) 0.1 mg/kg (1 mL/kg of 1:10,000) ANSWER: A EXPLANATION: The IV dose is 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution). The lower dose (0.01 mg/kg) is recommended initially. Higher doses (up to 0.03 mg/kg) may be considered if there is no response.
- What is the recommended endotracheal (ET) dose of epinephrine? A) Same as IV dose B) 0.01 mg/kg C) 0.1 mg/kg (0.1 mL/kg of 1:1,000) D) 0.05 mg/kg ANSWER: C EXPLANATION: The ET dose is 0.05-0.1 mg/kg (0.5-1 mL/kg of 1:10,000 solution or 0.05- 0.1 mL/kg of 1:1,000 solution). This is 5-10 times higher than the IV dose because absorption from lungs is less efficient.
- How should epinephrine be administered via ET tube? A) Rapid push followed by positive-pressure ventilation B) Slow push over 30 seconds C) Diluted in 3-5 mL normal saline followed by positive-pressure ventilation
D) Undiluted rapid push ANSWER: A EXPLANATION: Epinephrine should be given rapidly via ET tube followed immediately by several positive-pressure ventilation breaths to distribute the medication throughout the lungs.
- How often can epinephrine be repeated? A) Every 1 minute B) Every 3-5 minutes C) Every 10 minutes D) Only once ANSWER: B EXPLANATION: Epinephrine may be repeated every 3-5 minutes if heart rate remains < bpm. Continue chest compressions and ventilation between doses.
- What volume expander is recommended for neonatal resuscitation? A) 5% albumin B) Normal saline (0.9% NaCl) C) Lactated Ringer's D) Packed red blood cells ANSWER: B EXPLANATION: Normal saline (0.9% sodium chloride) is the recommended volume expander. Lactated Ringer's is an acceptable alternative. For acute blood loss, O-negative blood cross-matched with the mother is preferred.
