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Neonatal Resuscitation Program (NRP) Final Exam Study Guide: Questions and Answers, Exams of Pediatrics

This comprehensive study guide provides a series of questions and verified answers for the neonatal resuscitation program (nrp) final exam. it covers key aspects of neonatal resuscitation, including initial steps, positive-pressure ventilation, intubation techniques, and the management of various complications. The guide is designed to help students prepare for the exam and improve their understanding of neonatal care.

Typology: Exams

2024/2025

Available from 05/12/2025

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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
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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