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NRP(NEONATAL RESUSCITATION PROGRAM)
FINAL EXAM STUDY GUIDE|2025-2026||QUESTIONS
WITH CORRECT VERIFIED ANSWERS||A+ GRADE
1. A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires positive-pressure ventilation because she is not breathing. You are unable to achieve a seal with bag and mask. Which intervention is indicated? Insert a laryngeal mask
2. You are at the resuscitation of a newborn that is gasping and
has a heart rate of 60 beats per minute. What is the most important action you can take? Provide positive pressure ventilation
3. What size (internal diameter) endotracheal tube should be
used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 800 g)? 2.5mm
4. Your team attends an emergency cesarean delivery of a term
baby because of chorioamnionitis, meconium-stained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Start positive pressure ventilation and check HR response after 15 sec.
5. During the resuscitation of a newborn, you auscultate the
apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? 100 bpm
6. You are part of a team preparing for the birth of a baby who
has meconium-stained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be Present at birth
7. You are at a delivery of a baby born through meconium-
stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? The baby should be brought to the radiant warmer for initial steps ofnewborn care
8. What is the most effective maneuver to establish
spontaneous breathing in a baby that is apneic after initial steps? Administration of positive pressure ventilation that inflates the lungs
9. A newborn of 34 weeks' gestation is not breathing (apneic) at
birth, does not respond to initial steps and requires positive- pressure ventilation. What concentration of oxygen should be used as you begin positive-pressure ventilation? 21-30%
10. You have started positive-pressure ventilation for a
newborn because her heart rate is low (bradycardia). What is the most important indicator of successful positive-pressure ventilation? A rising HR
11. A baby requires positive-pressure ventilation because
she is not breathing (apneic), but she soon establishes spontaneous respirations and a heart rate over 100 beats per
Is the baby breathing or crying?
17. What is the recommended way to determine if a baby
requires supplemental oxygen in the delivery room? Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation.
18. You have determined a baby needs resuscitation at
birth. What are the initial steps of newborn care? Provide warmth, position head and neck to open the airway, clearsecretions from the airway if needed, dry, stimulate
19. The steps of intubation should ideally be completed
within which duration? 30 seconds
20. Effective team functioning is critical in ensuring the
best performance. Which of these characteristics is critical in team leaders? They should be able to maintain situational awareness
21. You have been called to attend a birth and are the only
healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help? Before birth, when you have identified thepresence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation.
22. After the initial steps of newborn care, a baby is apneic.
What is the most important and effective action to take in the resuscitation of this baby?
Provide positive pressure ventilation
23. Which statement describes recommended practice when
using a pulse oximeter in the delivery room? Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation.
24. Which of the following is an indication for endotracheal
intubation? The need for positive pressure ventilation lasting more than a few minutes
25. Your hospital is planning Neonatal Resuscitation
Program® training and trying to decide who should be included. For every delivery, what is the minimum requirement for care of the newborn at birth? Someone capable of initiating neonatal resuscitation should bepresent at every delivery whose only responsibility is management of the newborn.
26. A premature newborn is born apneic and requires
ongoing respiratory support and chest compressions. You and 3 colleagues provide care immediately following birth. What behavioral skills are critical to ensure successful and optimal care during resuscitation? Teamwork, leadership, communication
27. A full-term newborn has a heart rate less than 60 beats
per minute despite 30 seconds of positive-pressure ventilation that moves the chest. Your team plans to intubate. Which of the following is a true statement regarding the procedure? The baby should be positioned on a flat surface with the
30. A laboring woman received a narcotic medication for
pain relief 1 hour before delivery. The baby does not have spontaneous respirations and does not improve with stimulation. Your first priority is to Start positive pressure ventilation
31. During resuscitation, a baby is responding to positive-
pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen. She has decreased breath sounds on the left side and trans- illumination, also reveals a bright glow on the left side. What is the most likely cause of this distress? Left side pneumothorax
32. Which of the following is true about the preparation
and resources needed for a very preterm birth? Prepare thepreheated radiant warmer with a thermal mattress, plasticwrap or bag, and a hat.
33. Which of the following may be associated with delayed
cord clamping in vigorous preterm newborns? Decreased need for blood transfusions
34. For a newborn weighing 1 kg, what dose of 1:10,
(0.1 mg/mL) concentration of intravenous epinephrine is indicated? 0.1ml
35. A baby required ventilation and chest compressions.
After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute.
What is your next action? Stop chest compression-continuepositive pressure ventilation
36. How soon after administration of intravenous
epinephrine should you pause compressions and reassess the baby's heart rate? 1 minute
37. What is the preferred method for assessing heart rate
during chest compressions? ECG monitoring
38. A baby's heart rate does not increase after intubation
and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? ET tube is in too deep
39. If a preterm birth is anticipated, at what temperature
should the room be set? 23ºC to 25ºC (74° F - 77 ° F)
40. After chest compressions with coordinated ventilations
are started, the heart rate should be assessed: after 60 seconds
41. In most cases, who is (are) the usual and appropriate
surrogate decision maker(s) for a newborn? The newbornsparents
42. You are in the delivery room caring for a preterm
newborn at 27 weeks' gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 beats per minute and the oxygen saturation is 90% in room
be checked soon after resuscitation and then at regularintervals until stable and normal.
48. What is the appropriate dose of 1:10,000 (0.1 mg/mL)
concentration of epinephrine for endotracheal administration to a baby weighing 3 kg? 1.5 ml
49. When coordinating positive-pressure ventilation with
chest compressions, how many events are performed each minute? 30 breaths, 90 compressions
50. A newborn requires complex resuscitation. You have
intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures? Respiration, heart rate, oxygen saturation
51. Which of the following statements is true about
resuscitating and stabilizing extremely premature newborns? They have more difficulty achieving effective spontaneous ventilation than term newborns
52. Which of the following is the best indication for
volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak.
53. A mother had an emergency cesarean birth at 39 weeks'
gestational because of sudden fetal bradycardia and a
suspected placental abruption. After birth, the baby required extensive resuscitation including positive pressure ventilation, intubation, chest compressions and intravenous epinephrine. Afterward, the baby has poor tone, lethargy, and apnea. Which of the following statements is true? Promptly evaluate her for possible therapeutic hypothermia (cooling)treatment and contact the nearest cooling center.
54. When a newborn has a high risk of mortality and there
is a significant burden of morbidity among survivors, what should be included in your discussion with the parents concerning options for resuscitation? The option of providing comfort care can be considered.
55. Premature newborns are vulnerable to hyperoxia.
Which action is appropriate with a pulse oximeter and blender during and immediately following resuscitation of preterm babies? Adjusting the oxygen concentration to maintain oxygen saturations in the 85% to 95% range at 10 minutes after birth.
56. A newborn requires complex resuscitation. You have
intubated and are administering positive-pressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures? Respirations, heart rate, oxygen saturation
57. What is the target axillary temperature range for the
preterm newborn? 36.5ºC to 37.5ºC (97.7-99.5)
RAPID EVALUATION FOR ALL NEWBORNS IS
REQUIRED—ASK IF THE BABY IS:
1. Term?
2. Tone? (Healthy babies should be active and flex
extremities)
3. Breathing/Crying? (Gasping is a sign of severely
impaired gas exchange)
**If the answer is NO to any of these, the newborn
should be brought to the radiant warmer for the initial
steps of newborn care
Fetal lungs do not participate in gas exchange but are
expanded—alveoli is filled with fluid, NOT air but are
still expanded—pulmonary vessels are tightly
constricted
Oxygenated fetal blood leaves placenta through
umbilical vein—there is 1 vein, 2 arteries in the
umbilicus
Opening in atrium is a Patent Foramen Ovale-most
blood bypasses lungs through the foramen OR flows
from pulmonary artery into aorta through ductus
arteriosis
Right to left shunting is when blood follows
acirculation path and bypasses the lungs
Oligohydramnios- deficiency of amniotic fluid
Polyhydramnios- excessive amniotic fluid
Fetal hydrops- serious condition defined as abnormal
accumulation of fluid in 2 or more compartments
including ascites, pleural effusion, pericardial effusion,
and skin edema
Can gently stimulate baby by rubbing back, trunk or
extremities—Don't’ over stimulate—Can cause injury
If newborn remains apneic, begin PPV (positive
pressure ventilation)- 21% Oxygen
**NRP recommends that resuscitation of the baby
32 weeks and greater is initiated with 21% oxygen.
If baby doesn’t have spontaneous respirations and a
heart rate of 100bpm or higher within 1 minute of birth,
begin PPV
HR should be at least 100bpm—auscultation along the
left side of the chest is the most accurate to determine
HR
- Palpation at the umbilical cord base may be felt
but is less accurate and may underestimate the
true HR
- Using a stethoscope, estimate the HR by counting
the number of beats in 6 seconds and multiply by
10 ie. 6 seconds x 12 beats= 120bpm
If HR cannot be determined, connect ECG and/or Pulse
Ox—pulse ox may not function is HR is too low or baby
has low perfusion so ECG would be preferred method
After The Initial Steps Listed Above, What To Do If
The Baby Is Not Breathing Or HR Is Low:
- Start PPV if baby is not breathing (apnea) OR if the
baby has gasping respirations
- Start PPV if the baby appears to be breathing, but
the HR is below 100bpm
- Call for help if alone at the warmers - If the baby has not responded to the initial steps
within the first minute of life, it is NOT appropriate
to continue to provide only tactile stimulation
What Do You Do If The Baby Is Breathing And The
Heart Rate Is At Least 100bpm, But The Baby
Appears Persistently Cyanotic?
Apply a pulse oximeter
Indications to apply a pulse oximeter:
- When resuscitation is anticipated
- To confirm your perception of persistent central
cyanosis
- When supplemental oxygen is administered
- When positive-pressure ventilation is required
Acrocyanosis is normal-blue hands and feet
**A healthy newborn breathing room air may take
more than 10 minutes to achieve oxygen saturation
greater than 90%
Supplemental O2 is indicated when the oximeter
remains below the target range for baby’s age
FREE FLOWING oxygen is when the oxygen is held close
to the baby’s mouth and nose-CANNOT GIVE IF BABY IS
NOT BREATHING!!
* For free flowing oxygen delivery, adjust the flow
meter to 10L/min
* Start free flow oxygen supplementation with the
blender to set to 30% oxygen. Using the blender, adjust
the oxygen concentration as needed to achieve oxygen
saturation target.
**Goal is to prevent hypoxia without using excess
oxygen to cause hyperoxia
To prevent heat loss, oxygen given to newborns for a
prolonged period should be heated and humidified
If the baby has labored breathing or persistently low
oxygen saturation, apply CPAP
**This should only be considered in the delivery room is
the baby is breathing and the HR is at least 100bpm
**Cannot be given using a self inflating bag
Meconium-stained fluid and a NON-VIGOROUS newborn
- If baby is born through meconium stained amniotic
fluid, bring baby to the radiant warmer
- Perform initial steps of newborn care
- Use a bulb syringe to clear secretions- M to N
- If baby is not breathing or HR is less than 100bpm
after initial steps are completed, proceed with PPV
**Do not intubate for tracheal suction-there is
insufficient evidence to continue recommending this
practice
PIP- peak inspiratory pressure- highest
pressureadministered with each breath
PEEP- positive end-expiratory pressure- the gas
pressuremaintained in the lungs between breaths when
the babyis receiving assisted breaths
CPAP- continuous positive airway pressure- gas
pressuremaintained in the lungs between breathes
when the baby is breathing spontaneously
RATE- number of assisted breaths administered per
minute
IT- inspiratory time- time duration (seconds) of
theinspiratory phase of each positive pressure
breath
