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NCC NNP-BC practice questions

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Question 1Antepartum and Intrapartum Assessment and Care

A primigravida at 39 weeks has a reactive nonstress test but reports decreased fetal movement over the past day. According to ACOG guidance, which additional antepartum test is most appropriate to complete the assessment of fetal status?

  1. Biophysical profile Correct answer.
  2. Contraction stress test
  3. Maternal serum alpha-fetoprotein
  4. Amniotic fluid index alone

Explanation

A biophysical profile combines the nonstress test with ultrasound assessment of fetal breathing, movement, tone, and amniotic fluid volume, giving a more complete picture of fetal well-being. ACOG supports BPP as a follow-up when decreased fetal movement raises concern despite a reactive NST.

Question 2Antepartum and Intrapartum Assessment and Care

During auscultation of fetal heart tones in early labor, the nurse notes a rate of 90 beats per minute sustained for 3 minutes. Which term best describes this finding?

  1. Fetal tachycardia
  2. Acceleration
  3. Fetal bradycardia Correct answer.
  4. Baseline variability

Explanation

Fetal bradycardia is defined as a baseline fetal heart rate below 110 beats per minute. A sustained rate of 90 bpm for several minutes meets this definition and warrants evaluation for causes such as maternal hypotension or cord compression.

Question 3Antepartum and Intrapartum Assessment and Care

A laboring patient at 6 cm dilation has repetitive variable decelerations. Which physiologic mechanism most directly explains variable decelerations?

  1. Maternal hyperglycemia
  2. Fetal head compression
  3. Umbilical cord compression Correct answer.
  4. Uteroplacental insufficiency

Explanation

Variable decelerations are abrupt decreases in fetal heart rate that reflect umbilical cord compression and resultant baroreceptor-mediated responses. Interventions such as maternal repositioning and amnioinfusion target relief of cord compression.

Question 4Antepartum and Intrapartum Assessment and Care

Which finding on a fetal heart rate tracing is classified as Category III under the three-tier NICHD system?

  1. Moderate variability with no decelerations
  2. Early decelerations with moderate variability
  3. Absent baseline variability with recurrent late decelerations Correct answer.
  4. Tachycardia with moderate variability and no decelerations

Explanation

Category III tracings are abnormal and include absent baseline variability accompanied by recurrent late or variable decelerations, or a sinusoidal pattern. These tracings require prompt evaluation and intervention because they predict abnormal fetal acid-base status.

Question 5Antepartum and Intrapartum Assessment and Care

A patient in active labor has a Category II tracing with recurrent late decelerations and maternal hypotension after epidural placement. Which initial nursing action is most appropriate?

  1. Increase oxytocin to shorten labor
  2. Reposition the patient and administer an intravenous fluid bolus Correct answer.
  3. Perform a sterile vaginal exam to assess dilation
  4. Document the tracing and reassess in 30 minutes

Explanation

Late decelerations with maternal hypotension suggest uteroplacental insufficiency, and the priority is to restore maternal blood pressure and uterine perfusion. Repositioning and an intravenous fluid bolus are standard first-line intrauterine resuscitation measures.

Question 6Antepartum and Intrapartum Assessment and Care

A patient at 34 weeks presents with a fundal height of 30 cm and a history of two prior preterm births. Which risk factor most strongly predicts spontaneous preterm birth in this patient?

  1. Advanced maternal age
  2. Gestational diabetes
  3. Prior spontaneous preterm birth Correct answer.
  4. Multiparity without prior preterm delivery

Explanation

A history of spontaneous preterm birth is the strongest single clinical risk factor for recurrent preterm birth. Current guidelines support surveillance and consideration of progesterone therapy in such patients.

Question 7Antepartum and Intrapartum Assessment and Care

A patient at 32 weeks with contractions is being evaluated for preterm labor. Which cervical finding on transvaginal ultrasound is most consistent with increased risk of preterm delivery?

  1. Closed cervix with length of 35 mm
  2. Cervical length of 40 mm
  3. Cervical funneling absent with length of 30 mm
  4. Cervical length of 20 mm Correct answer.

Explanation

A short cervix, generally defined as less than 25 mm on transvaginal ultrasound, is associated with an increased risk of preterm birth. A length of 20 mm falls below that threshold and supports intervention.

Question 8Antepartum and Intrapartum Assessment and Care

Which medication is recommended for fetal neuroprotection when preterm birth is anticipated between 24 and 34 weeks?

  1. Nifedipine
  2. Betamethasone
  3. Terbutaline
  4. Magnesium sulfate Correct answer.

Explanation

Antenatal magnesium sulfate given when preterm birth is anticipated reduces the risk of cerebral palsy in offspring. It is recommended for pregnancies at risk of delivery before approximately 32 weeks, with many protocols extending to 34 weeks.

Question 9Antepartum and Intrapartum Assessment and Care

A patient at 41 weeks with an unfavorable cervix is being counseled about induction. Which Bishop score finding indicates an unfavorable cervix?

  1. Score of 9
  2. Score of 4 Correct answer.
  3. Score of 7
  4. Score of 11

Explanation

A Bishop score of 6 or less generally indicates an unfavorable cervix, meaning induction is more likely to require cervical ripening. A score of 4 falls into the unfavorable range.

Question 10Antepartum and Intrapartum Assessment and Care

A patient receiving oxytocin for induction has contractions every 2 minutes lasting 70 seconds, with a reassuring fetal heart rate. Which action is most appropriate?

  1. Reduce or stop the oxytocin infusion Correct answer.
  2. Increase the oxytocin rate to augment progress
  3. Encourage the patient to push
  4. Administer a second dose of misoprostol

Explanation

Contractions occurring more frequently than every 2 minutes or lasting longer than 60 seconds suggest uterine tachysystole. Reducing or discontinuing oxytocin is the appropriate first step to prevent fetal compromise.

Question 11Antepartum and Intrapartum Assessment and Care

A patient at 38 weeks reports a gush of fluid and is admitted. Which test is most useful to confirm rupture of membranes when the diagnosis is uncertain?

  1. Maternal urinalysis
  2. Contraction stress test
  3. Nonstress test
  4. Pooling of fluid in the vaginal vault on sterile speculum exam Correct answer.

Explanation

Direct visualization of amniotic fluid pooling in the posterior vaginal vault during a sterile speculum exam is a standard method to confirm rupture of membranes. Additional tests such as nitrazine or ferning may support the finding.

Question 12Antepartum and Intrapartum Assessment and Care

A patient at 36 weeks with ruptured membranes has a temperature of 38.4°C, maternal tachycardia, and fetal tachycardia. Which condition should the nurse suspect first?

  1. Placental abruption
  2. Intraamniotic infection Correct answer.
  3. Gestational hypertension
  4. Hyperthyroidism

Explanation

Maternal fever with tachycardia and fetal tachycardia after membrane rupture is highly suggestive of intraamniotic infection. Prompt evaluation and antibiotic therapy are indicated to reduce maternal and neonatal morbidity.

Question 13Antepartum and Intrapartum Assessment and Care

A patient at 30 weeks presents with painless bright red vaginal bleeding. Which condition is most consistent with this presentation?

  1. Uterine rupture
  2. Placental abruption
  3. Cervical laceration
  4. Placenta previa Correct answer.

Explanation

Painless bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa. Digital vaginal examination should be avoided until the placental location is confirmed by ultrasound.

Question 14Antepartum and Intrapartum Assessment and Care

A patient at 33 weeks with painless vaginal bleeding is admitted. Which action should the nurse avoid until placental location is confirmed?

  1. Digital vaginal examination Correct answer.
  2. Continuous fetal monitoring
  3. Intravenous access placement
  4. Maternal vital sign assessment

Explanation

Digital vaginal examination is contraindicated in suspected placenta previa because it can provoke catastrophic hemorrhage. Ultrasound should establish placental location before any vaginal examination.

Question 15Antepartum and Intrapartum Assessment and Care

A patient at 35 weeks presents with painful vaginal bleeding, uterine tenderness, and a firm abdomen. Which diagnosis is most likely?

  1. Vasa previa
  2. Cervical insufficiency
  3. Placental abruption Correct answer.
  4. Placenta previa

Explanation

Painful vaginal bleeding with a tender, hypertonic uterus is characteristic of placental abruption. Fetal heart rate abnormalities and maternal hemodynamic instability may accompany significant abruption.

Question 16Antepartum and Intrapartum Assessment and Care

A patient at 28 weeks is diagnosed with gestational hypertension. Which blood pressure threshold defines gestational hypertension?

  1. 130/85 mm Hg on two occasions
  2. 160/110 mm Hg on one occasion
  3. 120/80 mm Hg or higher on one occasion
  4. 140/90 mm Hg or higher on two occasions Correct answer.

Explanation

Gestational hypertension is defined as blood pressure of 140/90 mm Hg or higher on two occasions at least 4 hours apart after 20 weeks of gestation without proteinuria. This threshold distinguishes it from chronic hypertension.

Question 17Antepartum and Intrapartum Assessment and Care

A patient at 37 weeks with severe preeclampsia reports a severe headache and visual changes. Which medication is recommended for seizure prophylaxis?

  1. Betamethasone
  2. Labetalol
  3. Magnesium sulfate Correct answer.
  4. Hydralazine

Explanation

Magnesium sulfate is the standard agent for prevention and treatment of eclamptic seizures in severe preeclampsia. Serum magnesium levels and clinical signs of toxicity should be monitored during infusion.

Question 18Antepartum and Intrapartum Assessment and Care

A patient receiving magnesium sulfate for preeclampsia develops absent deep tendon reflexes and a respiratory rate of 10 breaths per minute. Which action is the priority?

  1. Stop the magnesium infusion and notify the provider Correct answer.
  2. Encourage the patient to ambulate
  3. Administer hydralazine
  4. Increase the infusion rate to maintain therapeutic levels

Explanation

Loss of deep tendon reflexes and respiratory depression are signs of magnesium toxicity. The infusion should be stopped immediately, and the provider notified; calcium gluconate is the antidote.

Question 19Antepartum and Intrapartum Assessment and Care

A patient at 39 weeks in active labor has a sudden prolonged fetal bradycardia to 60 beats per minute. Which action should the nurse take first?

  1. Administer oxytocin
  2. Apply fundal pressure
  3. Perform a sterile vaginal exam to check for cord prolapse
  4. Reposition the patient and start an intravenous fluid bolus Correct answer.

Explanation

A sudden prolonged bradycardia requires immediate intrauterine resuscitation, beginning with maternal repositioning and an intravenous fluid bolus to improve placental perfusion. A vaginal exam is also appropriate but follows initial resuscitative measures.

Question 20Antepartum and Intrapartum Assessment and Care

During a sterile vaginal exam in active labor, the nurse palpates a pulsating cord in the vagina. Which action is the priority?

  1. Attempt to replace the cord into the uterus
  2. Administer oxytocin to expedite delivery
  3. Encourage the patient to push
  4. Relieve pressure on the cord and prepare for emergency cesarean delivery Correct answer.

Explanation

Umbilical cord prolapse is an obstetric emergency requiring relief of cord compression and immediate delivery, usually by cesarean. The examiner should keep the presenting part elevated off the cord while preparing for surgery.

Question 21Antepartum and Intrapartum Assessment and Care

A patient at 38 weeks in active labor has a fetal heart rate baseline of 175 beats per minute with moderate variability. Which factor is most likely to contribute to this finding?

  1. Fetal head compression
  2. Maternal hypotension
  3. Maternal fever Correct answer.
  4. Umbilical cord compression

Explanation

Fetal tachycardia can result from maternal fever, infection, or maternal hyperthyroidism. Identifying and treating the underlying cause, such as infection, is essential to fetal assessment.

Question 22Antepartum and Intrapartum Assessment and Care

A patient at 24 weeks with a history of second-trimester pregnancy loss is being evaluated for cervical insufficiency. Which finding supports this diagnosis?

  1. Painless cervical dilation in the second trimester Correct answer.
  2. A cervical length of 40 mm
  3. Positive fetal fibronectin at 22 weeks
  4. Painful uterine contractions with bleeding

Explanation

Cervical insufficiency is characterized by painless cervical dilation and effacement in the second trimester, often leading to pregnancy loss if untreated. Cerclage may be considered in selected patients.

Question 23Antepartum and Intrapartum Assessment and Care

A patient at 40 weeks is in the second stage of labor. Which fetal heart rate pattern is considered a normal response to pushing?

  1. Absent variability
  2. Prolonged decelerations
  3. Early decelerations Correct answer.
  4. Late decelerations

Explanation

Early decelerations are a benign response to fetal head compression during contractions and pushing. They mirror the contraction and return to baseline promptly.

Question 24Antepartum and Intrapartum Assessment and Care

A patient at 26 weeks reports regular uterine contractions and is diagnosed with preterm labor. Which tocolytic agent is commonly used for short-term prolongation of pregnancy?

  1. Oxytocin
  2. Methylergonovine
  3. Dinoprostone
  4. Nifedipine Correct answer.

Explanation

Nifedipine, a calcium channel blocker, is commonly used for short-term tocolysis to delay preterm delivery. It is used to allow time for antenatal corticosteroids to take effect.

Question 25Transition to Extrauterine Life and Resuscitation

A term newborn is delivered after an uncomplicated pregnancy and is breathing spontaneously. According to NRP, which action should be performed first?

  1. Start chest compressions coordinated with ventilations
  2. Begin positive pressure ventilation at 40 breaths per minute
  3. Provide warm, dry, stimulate, and position the airway Correct answer.
  4. Obtain a preductal oxygen saturation and apply a pulse oximeter

Explanation

Every newborn's initial steps are to be warmed, dried, stimulated, and positioned with the airway opened while breathing and tone are assessed. Ventilation, oximetry, or compressions are added only when the assessment shows they are needed.

Question 26Transition to Extrauterine Life and Resuscitation

At 30 seconds after birth, a newborn is apneic with a heart rate of 70 beats per minute. What is the most appropriate next intervention?

  1. Initiate positive pressure ventilation Correct answer.
  2. Suction the mouth and nose with a bulb syringe
  3. Begin chest compressions immediately
  4. Apply free-flow oxygen by mask

Explanation

Apnea with a heart rate below 100 after initial steps is the trigger for positive pressure ventilation, which is the most effective and important step in newborn resuscitation. Compressions are not started until ventilation has been provided and the rate remains below 60.

Question 27Transition to Extrauterine Life and Resuscitation

Which device is preferred for providing positive pressure ventilation to a newborn at birth?

  1. A self-inflating bag with a mask
  2. A T-piece resuscitator with a mask Correct answer.
  3. Mouth-to-mouth-and-nose breathing
  4. A flow-inflating bag without a manometer

Explanation

A T-piece resuscitator with a mask is preferred because it delivers a consistent, set peak inspiratory pressure and positive end-expiratory pressure. Self-inflating and flow-inflating bags can be used when a T-piece device is unavailable, but they depend more on operator technique.

Question 28Transition to Extrauterine Life and Resuscitation

During positive pressure ventilation of a term newborn, which initial inflation pressure and rate are recommended by NRP?

  1. 40 cm H2O at 30 breaths per minute
  2. 30 cm H2O at 60 breaths per minute
  3. 25 cm H2O at 40 to 60 breaths per minute Correct answer.
  4. 20 cm H2O at 20 breaths per minute

Explanation

For a term newborn, NRP recommends an initial peak inspiratory pressure of about 25 cm H2O at a rate of 40 to 60 breaths per minute. Pressures are then adjusted to chest movement and response.

Question 29Transition to Extrauterine Life and Resuscitation

A newborn receiving positive pressure ventilation has a heart rate of 50 beats per minute after 30 seconds of effective ventilation with chest rise. What should be done next?

  1. Continue ventilation alone and reassess in 60 seconds
  2. Place the newborn in the prone position
  3. Increase the peak inspiratory pressure to 40 cm H2O
  4. Begin chest compressions with coordinated ventilations Correct answer.

Explanation

When the heart rate remains below 60 after effective ventilation has been given, chest compressions are started. Compressions are coordinated with ventilation, typically at a 3:1 ratio for a total of about 90 compressions and 30 breaths per minute.

Question 30Transition to Extrauterine Life and Resuscitation

What compression-to-ventilation ratio is used during newborn CPR, and what is the resulting per-minute rate?

  1. 5 compressions to 1 breath, about 60 compressions per minute
  2. 15 compressions to 2 breaths, about 100 compressions per minute
  3. 30 compressions to 2 breaths, about 100 compressions per minute
  4. 3 compressions to 1 breath, about 90 compressions and 30 breaths per minute Correct answer.

Explanation

Newborn resuscitation uses a 3:1 compression-to-ventilation ratio, giving about 90 compressions and 30 breaths per minute. This ratio reflects the primary role of ventilation in newborn compromise.

Question 31Transition to Extrauterine Life and Resuscitation

Which technique is recommended for chest compressions in a newborn?

  1. One-handed heel of the hand over the xiphoid
  2. Two-finger technique over the lower sternum
  3. Single thumb over the upper sternum
  4. Two-thumb technique with hands encircling the chest Correct answer.

Explanation

The two-thumb encircling technique is preferred because it generates more consistent pressure and depth and allows access for umbilical line placement. The two-finger technique is a reasonable alternative when access is limited, such as by a large umbilical cord.

Question 32Transition to Extrauterine Life and Resuscitation

A newborn is receiving chest compressions and coordinated ventilation. When should the team reassess the heart rate?

  1. Every 15 seconds during compressions
  2. After about 60 seconds of compressions and ventilation Correct answer.
  3. Only after epinephrine has been given
  4. After 5 minutes of uninterrupted compressions

Explanation

The heart rate is reassessed after about 60 seconds of coordinated compressions and ventilation to determine whether the rate has risen above 60. If it has not, epinephrine and consideration of hypovolemia are indicated.

Question 33Transition to Extrauterine Life and Resuscitation

A newborn's heart rate remains below 60 after 60 seconds of effective ventilation and coordinated compressions. Which medication and route are recommended first?

  1. Sodium bicarbonate 1 mEq/kg intravenously
  2. Epinephrine 0.01 to 0.03 mg/kg intravenously or intraosseously Correct answer.
  3. Atropine 0.02 mg/kg intravenously
  4. Naloxone 0.1 mg/kg intramuscularly

Explanation

Epinephrine at 0.01 to 0.03 mg/kg is given intravenously or intraosseously when the heart rate stays below 60 despite effective ventilation and compressions. It increases coronary perfusion pressure and cardiac output.

Question 34Transition to Extrauterine Life and Resuscitation

A newborn born after suspected fetal anemia is pale, has a heart rate of 40, and does not improve with ventilation and compressions. Which additional intervention should be considered?

  1. Immediate extubation
  2. Volume expansion with normal saline or blood Correct answer.
  3. Routine sodium bicarbonate
  4. A second dose of naloxone

Explanation

Persistent bradycardia with pallor or a history suggesting blood loss should prompt consideration of hypovolemia. Volume expansion with normal saline or packed red blood cells is given while resuscitation continues.

Question 35Transition to Extrauterine Life and Resuscitation

Which oxygen concentration should be used to begin positive pressure ventilation in a term newborn?

  1. 60% oxygen
  2. 40% oxygen
  3. 21% oxygen (room air) Correct answer.
  4. 100% oxygen

Explanation

For a term newborn, positive pressure ventilation is begun with room air (21% oxygen). Oxygen is titrated upward based on preductal oxygen saturation targets and the newborn's response.

Question 36Transition to Extrauterine Life and Resuscitation

Which preductal oxygen saturation target applies to a newborn at 5 minutes after birth?

  1. 85% to 95% Correct answer.
  2. 50% to 60%
  3. 95% to 100%
  4. 70% to 80%

Explanation

At 5 minutes, the target preductal oxygen saturation is approximately 85% to 95%. Targets rise progressively from about 60% to 65% at 1 minute to 85% to 95% by 5 minutes.

Question 37Transition to Extrauterine Life and Resuscitation

A newborn is breathing but has a heart rate of 80 beats per minute and central cyanosis despite free-flow oxygen. What is the most appropriate action?

  1. Provide positive pressure ventilation Correct answer.
  2. Give epinephrine intravenously
  3. Begin chest compressions
  4. Continue observation and reassess in 5 minutes

Explanation

A heart rate below 100 with persistent cyanosis despite free-flow oxygen indicates inadequate breathing and the need for positive pressure ventilation. Compressions are not yet indicated because the rate is above 60.

Question 38Transition to Extrauterine Life and Resuscitation

Which finding best indicates that positive pressure ventilation is effectively inflating the newborn's lungs?

  1. A rising oxygen saturation alone
  2. Audible air leak around the mask
  3. Visible chest rise with each breath Correct answer.
  4. A falling heart rate

Explanation

Visible chest rise with each breath is the primary clinical sign of effective lung inflation during positive pressure ventilation. Oxygen saturation changes lag behind and a falling heart rate suggests worsening, not improvement.

Question 39Transition to Extrauterine Life and Resuscitation

Positive pressure ventilation is being given but there is no chest rise. Which action should the team take first?

  1. Increase the peak inspiratory pressure immediately to 40 cm H2O
  2. Administer epinephrine
  3. Reposition the head and check mask seal and airway patency Correct answer.
  4. Begin chest compressions

Explanation

When there is no chest rise, the team should first correct the most common causes: poor mask seal, incorrect head position, and airway obstruction from secretions. The mnemonic MR SOPA guides this corrective sequence before increasing pressure.

Question 40Transition to Extrauterine Life and Resuscitation

Which initial settings are appropriate when using a T-piece resuscitator for a preterm newborn at 28 weeks' gestation?

  1. Peak inspiratory pressure 40 cm H2O and no PEEP
  2. Peak inspiratory pressure 30 cm H2O and PEEP 0 cm H2O
  3. Peak inspiratory pressure 15 cm H2O and PEEP 10 cm H2O
  4. Peak inspiratory pressure 25 cm H2O and PEEP 5 cm H2O Correct answer.

Explanation

For a preterm newborn, an initial peak inspiratory pressure of about 20 to 25 cm H2O with PEEP of 5 cm H2O is recommended. PEEP helps maintain functional residual capacity and prevents atelectasis.

Question 41Transition to Extrauterine Life and Resuscitation

A newborn born through thick meconium is not vigorous, with a heart rate of 60 and poor respiratory effort. What is the recommended approach?

  1. Begin positive pressure ventilation without routine tracheal suctioning Correct answer.
  2. Perform chest compressions first
  3. Suction the mouth and nose vigorously with a bulb syringe
  4. Intubate and suction the trachea before any ventilation

Explanation

Current NRP guidance does not recommend routine tracheal suctioning for meconium, even when thick; ventilation should begin promptly. Tracheal suction may be considered only if the airway is obstructed.

Question 42Transition to Extrauterine Life and Resuscitation

Which statement about therapeutic hypothermia for a newborn with hypoxic-ischemic encephalopathy is correct?

  1. It is contraindicated in all newborns with a history of fetal distress
  2. It replaces the need for ongoing resuscitation and monitoring
  3. It is considered for eligible infants and should be initiated within 6 hours of birth Correct answer.
  4. It should be started in the delivery room for every depressed newborn

Explanation

Therapeutic hypothermia is considered for newborns who meet criteria for moderate to severe hypoxic-ischemic encephalopathy and is most effective when started within 6 hours of birth. It is not applied routinely to every depressed newborn.

Question 43Transition to Extrauterine Life and Resuscitation

A newborn is apneic and floppy after maternal opioid administration. After initial steps and effective ventilation, the heart rate rises above 100 but respirations remain inadequate. Which medication may be considered?

  1. Epinephrine
  2. Atropine
  3. Sodium bicarbonate
  4. Naloxone Correct answer.

Explanation

Naloxone may be considered for a newborn with persistent respiratory depression after effective ventilation when there is a history of maternal opioid exposure. Ventilation must always be established first because naloxone does not correct hypoxemia.

Question 44Transition to Extrauterine Life and Resuscitation

Which statement about the role of the Apgar score in the delivery room is correct?

  1. It replaces the need for heart rate assessment
  2. It guides the timing of chest compressions
  3. It should not be used to determine the need for resuscitation Correct answer.
  4. It determines the oxygen concentration to use

Explanation

The Apgar score describes the newborn's condition and response to resuscitation but should not be used to determine whether resuscitation is needed or how it is performed. Resuscitation decisions are based on heart rate, breathing, and tone.

Question 45Transition to Extrauterine Life and Resuscitation

A newborn has a heart rate of 90 that does not improve with mask ventilation. Which intervention should be considered to improve ventilation?

  1. Apply a tighter mask and increase the rate to 60
  2. Insert a laryngeal mask airway or endotracheal tube Correct answer.
  3. Give a fluid bolus
  4. Begin chest compressions

Explanation

When mask ventilation is ineffective, the team should consider an alternative airway such as a laryngeal mask airway or endotracheal tube. This is part of the corrective steps after positioning, suctioning, and seal have been addressed.

Question 46Transition to Extrauterine Life and Resuscitation

Which action best prevents heat loss in a preterm newborn immediately after birth?

  1. Placing the newborn under a radiant warmer and using a plastic wrap or cap Correct answer.
  2. Delaying drying to preserve the vernix
  3. Keeping the delivery room at standard adult temperature
  4. Bathing the newborn to remove vernix

Explanation

Preterm newborns lose heat rapidly, so they should be placed under a radiant warmer and covered with plastic wrap or a cap to reduce evaporative and conductive losses. Drying and warming are central to the initial steps.

Question 47Transition to Extrauterine Life and Resuscitation

Which statement about the use of a pulse oximeter during newborn resuscitation is correct?

  1. Oximetry replaces the need to assess heart rate
  2. The sensor should be placed on the right hand or wrist for preductal readings Correct answer.
  3. Oximetry is only useful after 10 minutes of life
  4. The sensor should be placed on the umbilical cord

Explanation

A preductal sensor is placed on the right hand or wrist to reflect oxygenation before the ductus arteriosus. Pulse oximetry supplements, but does not replace, clinical heart rate assessment.

Question 48Transition to Extrauterine Life and Resuscitation

During resuscitation, the team must decide whether to continue or stop efforts. Which factor is most relevant to that decision?

  1. The gestational age and the presence of a heartbeat after appropriate resuscitation Correct answer.
  2. The Apgar score at 1 minute
  3. The color of the newborn's skin
  4. The mother's preference alone

Explanation

Decisions about continuing or discontinuing resuscitation consider gestational age, the presence of a heartbeat after adequate resuscitation, and the clinical context. The 1-minute Apgar score and skin color are not reliable determinants.

Question 49Respiratory System

A term newborn at 3 minutes of life has a spontaneous respiratory rate of 20 breaths/min with a weak, gasping cry. According to the NRP algorithm, which action is indicated first?

  1. Provide positive pressure ventilation Correct answer.
  2. Begin chest compressions coordinated with ventilation
  3. Apply supplemental oxygen by free-flow
  4. Stimulate and reassess after 30 seconds

Explanation

A respiratory rate below normal with gasping or apnea indicates ineffective breathing, and NRP directs the team to positive pressure ventilation rather than continued stimulation. Chest compressions require a heart rate below 60 despite effective ventilation, and free-flow oxygen addresses oxygenation only after breathing is established.

Question 50Respiratory System

Which finding in a newborn most strongly indicates that positive pressure ventilation should be initiated rather than continued tactile stimulation alone?

  1. Heart rate of 130 beats/min
  2. Central cyanosis at 1 minute
  3. Apnea persisting after initial steps Correct answer.
  4. Nasal flaring with grunting

Explanation

Persistent apnea after the initial steps of warmth, positioning, drying, and stimulation is the trigger for positive pressure ventilation in the NRP algorithm. A normal heart rate, transient cyanosis, and work-of-breathing signs may warrant oxygen or monitoring but do not by themselves mandate immediate ventilation.