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Neonatal Resuscitation Program (NRP) study materials
Neonatal Resuscitation Program (NRP) study resources

Neonatal Resuscitation Program (NRP) practice questions

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Question 1Antenatal care and team preparation

Which set of questions is asked before every birth during the pre-birth huddle?

  1. Maternal blood type, fetal heart rate, birth weight, and Apgar score
  2. Labor length, analgesia, delivery mode, and nursery availability
  3. Maternal age, parity, prenatal vitamins, and diabetes status
  4. Gestational age, amniotic fluid, number of babies, and risk factors Correct answer.

Explanation

The pre-birth huddle uses four standard questions to anticipate needs: expected gestational age, amniotic fluid appearance, number of babies, and additional risk factors. These answers determine how many providers and what equipment are needed. Other details may be relevant clinically but are not part of this standard set.

Question 2Antenatal care and team preparation

At every birth, which provider must be present for the newborn?

  1. A pediatrician or neonatologist
  2. Two nurses trained in chest compressions
  3. One person assigned solely to the baby who can start resuscitation Correct answer.
  4. An anesthesiologist or respiratory therapist

Explanation

Every birth requires at least one person whose only responsibility is the newborn and who is capable of beginning resuscitation and calling for help. This person must be immediately available, not on call. Additional specialists are added when risk factors are present.

Question 3Antenatal care and team preparation

When should the resuscitation equipment be checked and turned on?

  1. After birth if the baby needs help
  2. Only for births before 35 weeks
  3. Before every birth Correct answer.
  4. Once at the start of each shift

Explanation

Equipment should be checked, turned on, and confirmed functional before every birth because deterioration can occur without warning. A shift check does not ensure readiness for each delivery. The check includes suction, oxygen, ventilation devices, and warming equipment.

Question 4Antenatal care and team preparation

Which delivery room temperature range is recommended for a birth before 32 weeks?

  1. 22 to 23 degrees C
  2. 20 to 22 degrees C
  3. 23 to 25 degrees C Correct answer.
  4. 18 to 20 degrees C

Explanation

For very preterm births, a warmer delivery room helps limit heat loss. The recommended range is approximately 23 to 25 degrees C. Additional measures such as plastic wrap, hats, thermal mattresses, and warmed humidified gases are also used.

Question 5Antenatal care and team preparation

Which antenatal condition increases the newborn's risk of needing resuscitation?

  1. Maternal fever Correct answer.
  2. Spontaneous labor at 39 weeks
  3. Maternal age of 24 years
  4. Clear amniotic fluid

Explanation

Maternal fever is an antenatal risk factor associated with infection and a greater chance of newborn depression. Risk factors prompt additional personnel and equipment preparation. Uncomplicated term labor and clear fluid are not risk factors.

Question 6Antenatal care and team preparation

For a vigorous term newborn, what is the recommended umbilical cord management?

  1. Clamp the cord within 5 seconds
  2. Wait until the placenta is delivered
  3. Milk the cord five times before clamping
  4. Delay clamping for at least 30 seconds Correct answer.

Explanation

For a vigorous term newborn, delayed cord clamping for at least 30 seconds is recommended and may be extended if the infant is stable. This allows placental transfusion and improves iron stores. Immediate clamping is not required for a vigorous infant.

Question 7Antenatal care and team preparation

What is the main purpose of a pre-birth team briefing?

  1. To decide whether to induce labor
  2. To obtain written consent for resuscitation
  3. To predict the infant's Apgar score
  4. To assign roles and review the plan and equipment Correct answer.

Explanation

A pre-birth briefing allows the team to clarify roles, review anticipated problems, confirm equipment, and plan communication. It does not predict the Apgar score or replace consent discussions. Effective briefings improve teamwork during resuscitation.

Question 8Antenatal care and team preparation

What initial oxygen concentration should the blender be set to for a term newborn?

  1. 30%
  2. 21% Correct answer.
  3. 40%
  4. 100%

Explanation

Term newborns should initially receive 21% oxygen, which is room air. Oxygen is titrated based on pulse oximetry and clinical response. Starting with higher concentrations is not recommended for term infants.

Question 9Antenatal care and team preparation

Two infants are expected. How should the resuscitation team prepare?

  1. A separate team and set of equipment for each infant Correct answer.
  2. Only the first-born infant needs a team
  3. One team can manage both infants if delivery is rapid
  4. Equipment can be shared after cleaning between births

Explanation

Multiple gestation requires a separate team and a complete set of equipment for each infant because both may need simultaneous resuscitation. Sharing a team or equipment creates delays and unsafe care. Each team should have clearly assigned roles.

Question 10Antenatal care and team preparation

When meconium-stained fluid is present, which team preparation is recommended?

  1. A provider trained only in bag-mask ventilation
  2. A provider who can perform chest compressions
  3. A provider skilled in intubation and suctioning Correct answer.
  4. A provider who can place a pulse oximeter

Explanation

Meconium-stained fluid calls for a provider skilled in intubation and tracheal suctioning because the airway may need clearing. This is in addition to standard resuscitation personnel. Routine intubation of every meconium-stained infant is not recommended.

Question 11Antenatal care and team preparation

Which preparation best reduces heat loss for a preterm infant below 32 weeks?

  1. Delay drying the infant for 5 minutes
  2. Use plastic wrap, a hat, warmed gases, and a thermal mattress Correct answer.
  3. Place the infant on an unheated scale
  4. Set the room temperature to 20 to 22 degrees C and use a single blanket

Explanation

Very preterm infants lose heat rapidly, so the team should combine a warm room, plastic wrap, a hat, a thermal mattress, and warmed humidified gases. These measures are started immediately after birth. A single blanket or a cool room is insufficient.

Question 12Antenatal care and team preparation

When a high-risk birth is anticipated, which team composition is most appropriate?

  1. A provider who can only suction the airway
  2. One provider who can start bag-mask ventilation and call for help
  3. No additional providers if a pediatrician is on call
  4. Two providers skilled in intubation and chest compressions Correct answer.

Explanation

High-risk births require at least two providers with advanced skills, including intubation and chest compressions, plus a plan for additional help. A single provider is sufficient only for lower-risk births. Roles should be assigned before delivery.

Question 13Antenatal care and team preparation

Which maternal condition is an antenatal risk factor for neonatal resuscitation?

  1. Chronic hypertension Correct answer.
  2. Clear amniotic fluid
  3. Spontaneous labor at term
  4. Normal prepregnancy weight

Explanation

Chronic hypertension is an antenatal risk factor that can affect placental function and fetal well-being, increasing the chance of newborn depression. Risk factors should prompt a pre-birth huddle and team preparation. Normal weight, term labor, and clear fluid are not risk factors.

Question 14Antenatal care and team preparation

What suction pressure range is recommended for a newborn?

  1. 20 to 40 mm Hg
  2. 150 to 200 mm Hg
  3. 300 mm Hg
  4. 80 to 100 mm Hg Correct answer.

Explanation

Newborn suction should be set to approximately 80 to 100 mm Hg to clear secretions without causing airway injury. Higher pressures can damage tissue. The device should be checked before every birth.

Question 15Antenatal care and team preparation

The team leader says, "Give 30 seconds of PPV and tell me the heart rate." The provider repeats the order and reports back. This is an example of what?

  1. Passive listening
  2. Debriefing
  3. Closed-loop communication Correct answer.
  4. Handoff reporting

Explanation

Closed-loop communication occurs when the receiver repeats the order and later reports the result back to the leader. This confirms that the message was heard and the task was completed. It is a core teamwork behavior in resuscitation.

Question 16Antenatal care and team preparation

At 42 weeks' gestation, which antenatal finding most increases the risk of newborn problems?

  1. Clear amniotic fluid
  2. Appropriate fetal growth
  3. Meconium-stained amniotic fluid Correct answer.
  4. Spontaneous vertex presentation

Explanation

Postterm pregnancy is associated with meconium-stained fluid, which can increase the risk of airway obstruction and newborn depression. The team should prepare for possible suctioning and resuscitation. Clear fluid and appropriate growth are reassuring findings.

Question 17Antenatal care and team preparation

For a preterm newborn below 35 weeks, what initial oxygen concentration is recommended?

  1. 21% to 30% Correct answer.
  2. 0%
  3. 100%
  4. 40% to 60%

Explanation

Preterm newborns below 35 weeks should begin resuscitation with blended oxygen in the range of 21% to 30%, titrated using pulse oximetry. Starting with room air alone may be insufficient, while higher concentrations increase oxidative risk. Oxygen should be adjusted to target saturations.

Question 18Antenatal care and team preparation

Why is antenatal counseling recommended before an anticipated preterm birth?

  1. To calculate the Apgar score
  2. To discuss the resuscitation plan and the family's preferences Correct answer.
  3. To decide whether to use maternal antibiotics
  4. To determine the mode of delivery

Explanation

Antenatal counseling allows the obstetric and neonatal teams to discuss expected outcomes, the anticipated resuscitation plan, and the family's values and preferences. It supports shared decision-making when outcomes are uncertain. It does not determine obstetric mode or calculate Apgar scores.

Question 19Antenatal care and team preparation

Which antenatal history most increases the likelihood that a newborn will require resuscitation?

  1. Rupture of membranes for 24 hours Correct answer.
  2. Maternal age of 30 years
  3. First prenatal visit at 8 weeks
  4. Gestational age of 39 weeks

Explanation

Prolonged rupture of membranes, especially beyond 18 hours, is associated with maternal and fetal infection and an increased need for newborn resuscitation. The team should prepare accordingly. Term gestation and routine prenatal care are not risk factors.

Question 20Antenatal care and team preparation

What should the team do when a high-risk birth is recognized shortly before delivery?

  1. Begin chest compressions on the mother
  2. Call for help and complete a pre-birth briefing Correct answer.
  3. Wait for the infant to be born to assess
  4. Send the resuscitation team to another delivery

Explanation

When risk is recognized, the team should immediately call for additional personnel and conduct a brief pre-birth huddle to assign roles and confirm equipment. Waiting until birth delays needed preparation. Maternal chest compressions are unrelated to newborn preparation.

Question 21Antenatal care and team preparation

Which antenatal diagnosis specifically warrants preparing for possible airway obstruction and need for immediate intubation?

  1. Gestational diabetes
  2. Congenital diaphragmatic hernia Correct answer.
  3. Polyhydramnios without other findings
  4. Maternal anemia

Explanation

Congenital diaphragmatic hernia can cause pulmonary hypoplasia and respiratory distress, and bag-mask ventilation may distend the stomach and worsen compromise. The team should prepare for immediate intubation and avoid prolonged mask ventilation. This is a specific airway and ventilation concern.

Question 22Antenatal care and team preparation

An emergency cesarean birth under general anesthesia is planned for fetal bradycardia. Which preparation is most important?

  1. Assign one provider to the mother and no one to the baby
  2. Prepare only a suction catheter and blankets
  3. Assign a team leader and prepare for PPV and chest compressions Correct answer.
  4. Wait for the pediatrician to arrive after birth

Explanation

Emergency cesarean birth with fetal bradycardia places the newborn at high risk for depression and requires a full team prepared to provide positive-pressure ventilation and chest compressions immediately. A team leader should coordinate roles and communication. Minimal preparation or waiting until after birth is unsafe.

Question 23Antenatal care and team preparation

Which is the best example of effective pre-birth preparation for a preterm twin birth?

  1. Waiting until the first infant is born to assign roles
  2. Reviewing roles, equipment, and the plan for both infants Correct answer.
  3. Assuming one team can care for both infants
  4. Checking equipment only after delivery

Explanation

A preterm twin birth requires two teams, two sets of equipment, and a clear plan for each infant before delivery. Reviewing roles and equipment in advance improves coordination. Assigning roles after birth or sharing one team creates dangerous delays.

Question 24Antenatal care and team preparation

A 42-week gestation with thick meconium and a nonreassuring fetal heart tracing is about to deliver. Which preparation is most appropriate?

  1. Prepare only a bulb syringe and warm blankets
  2. Set the oxygen blender to 100% for all newborns
  3. Ensure a provider skilled in intubation and suctioning is present Correct answer.
  4. Plan to start chest compressions immediately after birth

Explanation

Thick meconium with a nonreassuring tracing combines two risk factors for airway obstruction and newborn depression. A provider skilled in intubation and suctioning should be present, along with standard resuscitation equipment. Chest compressions are not started routinely without assessing the heart rate.

Question 25Antenatal care and team preparation

Which approach best reflects appropriate antenatal counseling for a birth at 23 weeks?

  1. Discuss uncertainty and the family's values with the team Correct answer.
  2. Promise the family a normal outcome
  3. Avoid discussing resuscitation until after birth
  4. Recommend the same plan used for term infants

Explanation

At the limit of viability, outcomes are uncertain, so counseling should acknowledge that uncertainty and incorporate the family's values and preferences. The obstetric and neonatal teams should share a consistent plan. Promising a normal outcome or delaying discussion is inappropriate.

Question 26Initial assessment and airway/breathing

Which three questions are used for the rapid assessment of a newborn immediately after birth?

  1. Term gestation, clear amniotic fluid, and oxygen saturation over 90%
  2. Good tone, heart rate over 100/min, and breathing or crying
  3. Term gestation, good tone, and breathing or crying Correct answer.
  4. Birth weight over 2500 g, good tone, and heart rate over 100/min

Explanation

The three rapid assessment questions are whether the newborn is at term gestation, has good tone, and is breathing or crying. If all three answers are yes, the infant can remain with the mother for routine care; if any answer is no, the initial steps are provided under a radiant warmer.

Question 27Initial assessment and airway/breathing

What are the recommended initial steps for a newborn who is not breathing after birth?

  1. Provide warmth, dry the skin, and stimulate Correct answer.
  2. Start positive-pressure ventilation at 40 to 60 breaths/min
  3. Suction the mouth and nose and begin chest compressions
  4. Apply free-flow oxygen and reassess after one minute

Explanation

The initial steps for a nonbreathing newborn are to provide warmth, dry the skin, stimulate, and position the head to open the airway. These steps are provided for about 30 seconds; if apnea or a heart rate below 100/min persists, positive-pressure ventilation is started.

Question 28Initial assessment and airway/breathing

When suctioning a newborn's mouth and nose is needed, which sequence is recommended?

  1. Mouth first, then nose Correct answer.
  2. Nose only, to prevent aspiration
  3. Either order, if suction is brief
  4. Nose first, then mouth

Explanation

Suctioning the mouth before the nose prevents aspiration of secretions if the infant gasps when the nose is suctioned. Suction should be brief and performed only when secretions obstruct the airway.

Question 29Initial assessment and airway/breathing

Which method is recommended for the most accurate assessment of heart rate during neonatal resuscitation?

  1. Palpate the brachial pulse for six seconds
  2. Apply a 3-lead ECG Correct answer.
  3. Assess the color of the lips and tongue
  4. Count the respiratory rate for one minute

Explanation

A 3-lead ECG provides the most accurate and continuous heart rate during resuscitation and is recommended when positive-pressure ventilation or compressions are needed. Auscultation with a stethoscope can be used but is less reliable.

Question 30Initial assessment and airway/breathing

What is the recommended rate for positive-pressure ventilation in a newborn?

  1. 40 to 60 breaths per minute Correct answer.
  2. 20 to 30 breaths per minute
  3. 60 to 80 breaths per minute
  4. 80 to 100 breaths per minute

Explanation

Positive-pressure ventilation is delivered at 40 to 60 breaths per minute, which approximates normal newborn breathing and supports gas exchange. Rates outside this range can impair ventilation and cardiac output.

Question 31Initial assessment and airway/breathing

What oxygen concentration should be used initially for positive-pressure ventilation in a term newborn?

  1. 21% oxygen Correct answer.
  2. 100% oxygen
  3. 30% to 40% oxygen
  4. 50% to 60% oxygen

Explanation

Term newborns should begin positive-pressure ventilation with 21% oxygen, with the concentration increased as needed based on the preductal oxygen saturation target. High initial oxygen is avoided unless the infant remains cyanotic despite effective ventilation.

Question 32Initial assessment and airway/breathing

For which newborn is free-flow oxygen most appropriate?

  1. An apneic infant with a heart rate of 80/min
  2. A gasping infant with a heart rate of 60/min
  3. A breathing infant with low saturation Correct answer.
  4. An infant receiving chest compressions

Explanation

Free-flow oxygen is used for infants who are breathing but have low oxygen saturation or central cyanosis after the initial steps. It is not an effective treatment for apnea or gasping, which require positive-pressure ventilation.

Question 33Initial assessment and airway/breathing

After the initial steps, how long should you wait before reassessing the newborn?

  1. 15 seconds
  2. 25 seconds
  3. 30 seconds Correct answer.
  4. 20 seconds

Explanation

After the initial steps, the newborn is reassessed at about 30 seconds. If breathing is absent or the heart rate is below 100/min, positive-pressure ventilation should begin promptly.

Question 34Initial assessment and airway/breathing

A newborn born through thick meconium is limp and not breathing. What is the recommended initial approach?

  1. Intubate and suction the trachea before drying the infant
  2. Give free-flow oxygen by mask and reassess in one minute
  3. Begin initial steps and provide PPV if apnea persists Correct answer.
  4. Suction the mouth and nose with a bulb syringe, then observe

Explanation

For a nonvigorous infant born through meconium, routine tracheal intubation and suction are not recommended. The infant should receive the initial steps, and positive-pressure ventilation should begin if apnea persists; tracheal suction is reserved for suspected airway obstruction.

Question 35Initial assessment and airway/breathing

What initial peak inspiratory pressure is typically used for positive-pressure ventilation in a newborn?

  1. 30 to 35 cm H2O
  2. 10 to 15 cm H2O
  3. 40 to 45 cm H2O
  4. 20 to 25 cm H2O Correct answer.

Explanation

Initial positive-pressure ventilation typically uses a peak inspiratory pressure of 20 to 25 cm H2O. The pressure is then adjusted based on chest rise and the clinical response.

Question 36Initial assessment and airway/breathing

Which sign best indicates that positive-pressure ventilation by mask is effective?

  1. A loud cry with each inflation
  2. Visible chest movement with each breath Correct answer.
  3. A rise in oxygen saturation within 10 seconds
  4. Pinking of the lips and nail beds

Explanation

Visible chest movement with each inflation is the most reliable bedside sign that positive-pressure ventilation is reaching the lungs. A rising saturation or color change occurs too slowly to guide the first minutes of ventilation.

Question 37Initial assessment and airway/breathing

During positive-pressure ventilation with a mask, the chest does not rise. According to the ventilation corrective steps, which adjustment is performed first?

  1. Increase the inflation pressure
  2. Suction the mouth and nose
  3. Open the mouth and lift the jaw
  4. Adjust the mask seal Correct answer.

Explanation

The ventilation corrective steps are remembered as MR SOPA: mask adjustment, reposition the head, suction, open the mouth, pressure increase, and alternative airway. Mask adjustment is performed first because a poor seal is a common cause of ineffective ventilation.

Question 38Initial assessment and airway/breathing

What oxygen concentration should be used initially for positive-pressure ventilation in a newborn at 30 weeks' gestation?

  1. 100%
  2. 40% to 50%
  3. 30% to 40%
  4. 21% to 30% Correct answer.

Explanation

For preterm infants below 35 weeks' gestation, positive-pressure ventilation is started with 21% to 30% oxygen. The concentration is then titrated to the preductal oxygen saturation target.

Question 39Initial assessment and airway/breathing

Where should the pulse oximeter sensor be placed to obtain a preductal oxygen saturation?

  1. Right hand Correct answer.
  2. Forehead
  3. Left foot
  4. Left hand

Explanation

A preductal oxygen saturation is obtained from a sensor on the right hand or wrist, because this site reflects blood perfusing the brain before the ductus arteriosus. Postductal sites can be affected by right-to-left shunting.

Question 40Initial assessment and airway/breathing

What is the target preductal oxygen saturation at 5 minutes after birth?

  1. 80% to 85% Correct answer.
  2. 75% to 80%
  3. 70% to 75%
  4. 90% to 95%

Explanation

The target preductal oxygen saturation at 5 minutes is 80% to 85%. Saturations rise gradually after birth, and oxygen is titrated to these targets rather than to 100%.

Question 41Initial assessment and airway/breathing

A newborn is apneic with a heart rate of 90/min after the initial steps. What is the most appropriate next action?

  1. Continue stimulation for another 30 seconds
  2. Start positive-pressure ventilation Correct answer.
  3. Give free-flow oxygen and monitor
  4. Begin chest compressions

Explanation

Apnea with a heart rate below 100/min after the initial steps is an indication to start positive-pressure ventilation. Continuing stimulation or giving free-flow oxygen would delay effective ventilation.

Question 42Initial assessment and airway/breathing

For which newborn is CPAP most appropriate?

  1. A breathing infant with retractions Correct answer.
  2. A gasping infant with poor tone
  3. An infant receiving chest compressions
  4. An apneic infant with a heart rate of 70/min

Explanation

CPAP is used for a spontaneously breathing infant with signs of respiratory distress such as grunting or retractions. It is not a treatment for apnea or gasping, which require positive-pressure ventilation.

Question 43Initial assessment and airway/breathing

A self-inflating bag without a reservoir is connected to 100% oxygen. What oxygen concentration does it deliver?

  1. About 21%
  2. About 100%
  3. About 40% Correct answer.
  4. About 60%

Explanation

A self-inflating bag without a reservoir entrains room air and delivers about 40% oxygen when supplied with 100% oxygen. Adding a reservoir raises the delivered concentration to about 90% to 100%.

Question 44Initial assessment and airway/breathing

During positive-pressure ventilation, the heart rate remains 70/min and the chest rise is poor. What is the most appropriate action?

  1. Check chest rise and correct ventilation Correct answer.
  2. Continue PPV without changes for one minute
  3. Administer epinephrine intravenously
  4. Begin chest compressions immediately

Explanation

If the heart rate remains below 100/min during positive-pressure ventilation, the first priority is to assess and correct ventilation, often using the MR SOPA steps. Chest compressions are indicated only when the heart rate is below 60/min despite effective ventilation.

Question 45Initial assessment and airway/breathing

Which finding after the initial steps indicates that positive-pressure ventilation should begin?

  1. Heart rate of 110/min with central cyanosis
  2. Heart rate of 120/min with mild retractions
  3. Heart rate of 90/min with apnea Correct answer.
  4. Heart rate of 105/min with grunting

Explanation

Positive-pressure ventilation is indicated for apnea or gasping, or when the heart rate is below 100/min after the initial steps. A heart rate of 90/min with apnea meets that threshold.

Question 46Initial assessment and airway/breathing

Which endotracheal tube size is appropriate for a newborn weighing 1.5 kg?

  1. 3.5 mm
  2. 3.0 mm Correct answer.
  3. 4.0 mm
  4. 2.5 mm

Explanation

An infant weighing about 1.5 kg generally requires a 3.0-mm endotracheal tube. Tube size is estimated by weight: 2.5 mm for under 1 kg, 3.0 mm for 1 to 2 kg, and 3.5 mm for 2 to 3 kg.

Question 47Initial assessment and airway/breathing

After intubation, a colorimetric CO2 detector fails to change color. What is the most likely explanation?

  1. Adequate ventilation of the lungs
  2. Low cardiac output
  3. Esophageal placement of the tube Correct answer.
  4. Excessive oxygen flow

Explanation

A colorimetric CO2 detector that fails to change color after intubation suggests the tube is in the esophagus. The tube should be removed and ventilation reestablished with a mask while preparing to reintubate.

Question 48Initial assessment and airway/breathing

For which infant is a laryngeal mask airway most appropriate?

  1. An infant with thick meconium and limp tone
  2. An infant with a heart rate of 50/min
  3. A 2.5-kg infant with failed mask PPV Correct answer.
  4. An infant who requires chest compressions

Explanation

A laryngeal mask is an alternative airway for infants at least 34 weeks' gestation and about 2000 g when mask ventilation is unsuccessful. It is not used for meconium suction or as a first step for bradycardia.

Question 49Initial assessment and airway/breathing

When is tracheal suction indicated for a newborn born through meconium?

  1. Whenever the infant has poor tone
  2. When airway obstruction persists despite PPV Correct answer.
  3. Whenever meconium is present at delivery
  4. Before the initial steps are performed

Explanation

Tracheal suction for meconium is not routine; it is reserved for infants with suspected airway obstruction in whom positive-pressure ventilation is ineffective. The initial steps and ventilation should not be delayed for suctioning.

Question 50Initial assessment and airway/breathing

A 35-week newborn receiving PPV with 21% oxygen has a preductal SpO2 of 55% at 3 minutes and a heart rate of 95/min. What is the most appropriate next step?

  1. Decrease the peak inspiratory pressure
  2. Stop PPV and provide free-flow oxygen
  3. Begin chest compressions
  4. Increase oxygen and continue PPV Correct answer.

Explanation

At 3 minutes, the target preductal SpO2 is about 70% to 75%, so a saturation of 55% is below target. The oxygen concentration should be increased while positive-pressure ventilation continues; compressions are not indicated because the heart rate is above 60/min.