NNP-BC Practice Questions (2026) — Free Sample Questions with Answers

Answer: C

Symmetric growth restriction from an early congenital viral infection: Early insults such as congenital infection or chromosomal disorders reduce weight, length and head size in proportion (symmetric), which is not the case here.

Large for gestational age from maternal hyperglycemia and fetal hyperinsulinemia: A weight below the 10th percentile is small, not large, for gestational age.

Asymmetric growth restriction from late uteroplacental insufficiency: Correct. Late placental insufficiency (as with preeclampsia) mainly limits weight, while length and head growth are relatively spared (head-sparing).

Appropriate growth for gestational age with a normal constitutional variant: A birth weight below the 10th percentile with a clear maternal cause is growth restriction, not AGA.

Asymmetric IUGR (weight low, head spared) points to a late placental cause; symmetric IUGR points to an early intrinsic cause such as infection or aneuploidy.

Answer: C

Give intravenous epinephrine before starting chest compressions: Epinephrine is indicated if the heart rate stays below 60 despite 60 seconds of compressions coordinated with effective ventilation and 100% oxygen.

Give a 10 mL/kg normal saline bolus for presumed hypovolemia: Volume expansion is for suspected blood loss or shock that does not respond to resuscitation; it is not the next step here.

Start coordinated chest compressions and raise oxygen to 100%: Correct. A heart rate below 60/min after at least 30 seconds of ventilation that inflates the lungs calls for compressions at a 3:1 ratio with ventilation and 100% oxygen.

Continue ventilation alone for 60 more seconds and then reassess: Ventilation is already effective; a heart rate below 60 requires compressions now, not more ventilation alone.

NRP sequence: effective PPV first; HR below 60 after 30 s of effective ventilation → compressions (3:1) with 100% O2; HR still below 60 → epinephrine.

Answer: A

Apnea: Correct. Apnea is the most important dose-related adverse effect of PGE1, especially in smaller infants and early in the infusion; be ready to support ventilation.

Hypertension: PGE1 is a vasodilator; it can cause hypotension, not hypertension.

Hypothermia: PGE1 is associated with fever, not hypothermia.

Polycythemia: Polycythemia is not a recognized adverse effect of PGE1.

PGE1 keeps the ductus open; main adverse effects are apnea, fever, flushing and hypotension. Have airway support ready.

Answer: C

Left-to-right shunting across the ductus from low pulmonary resistance: Left-to-right shunting sends oxygenated blood into the lungs; it does not lower postductal saturation.

Complete mixing of systemic and pulmonary venous return in the atria: Complete intracardiac mixing gives similar pre- and postductal saturations, not a large difference.

Right-to-left shunting across the ductus from high pulmonary resistance: Correct. In PPHN, high pulmonary vascular resistance diverts deoxygenated blood across the ductus into the descending aorta, so postductal SpO2 is lower.

Falsely low readings from placing the probe on the lower extremity: A difference of 13 points with lability on handling is a true physiologic finding, not a probe artifact.

Preductal minus postductal SpO2 over about 5–10% suggests right-to-left ductal shunting from PPHN; treat with optimal ventilation, oxygen and iNO as indicated.

Answer: D

Respiratory distress syndrome from surfactant deficiency: RDS causes marked respiratory distress and hypoxemia that improves with oxygen; the heart shape would be normal.

Persistent pulmonary hypertension of the newborn: PPHN often causes labile saturations with a pre- to postductal difference, and the heart silhouette is usually normal.

Tetralogy of Fallot with right ventricular outflow obstruction: Tetralogy usually has a loud murmur from outflow obstruction and a boot-shaped heart, not an egg-shaped heart with a narrow mediastinum.

Transposition of the great arteries: Correct. TGA causes early, severe cyanosis with little distress or murmur, no response to oxygen and an 'egg on a string' radiograph.

Severe cyanosis + calm breathing + failed hyperoxia test + egg on a string = TGA; give PGE1 and arrange balloon atrial septostomy if mixing is poor.

Answer: B

Beneficence: Beneficence is the duty to act for the patient's good; the consent process itself centers on the right to make an informed choice.

Autonomy: Correct. Informed consent respects the right of the parents, as surrogate decision-makers, to make an informed, voluntary decision about their infant's care.

Non-maleficence: Non-maleficence is the duty to avoid harm; discussing risks supports it, but the purpose of informed consent is self-determination.

Justice: Justice concerns fair distribution of resources and equal treatment, not an individual consent discussion.

Informed consent = autonomy (self-determination by the patient or surrogate); beneficence = do good; non-maleficence = avoid harm; justice = fairness.