NPS Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Continue ventilation alone at 40–60 breaths/min and recheck the heart rate in 60 seconds: Incorrect. NRP calls for compressions once the heart rate stays below 60/min despite 30 seconds of ventilation that inflates the lungs.

Start chest compressions coordinated 3:1 with ventilation and increase oxygen to 100%: Correct. With effective ventilation established and HR <60/min, begin compressions (90 compressions + 30 breaths per minute) and raise FIO2 to 1.0.

Give intravenous epinephrine before compressions because the airway is already secured: Incorrect. Epinephrine is indicated if HR stays below 60/min after at least 60 seconds of compressions with 100% oxygen.

Extubate and return to mask ventilation because the tube may be in the esophagus: Incorrect. Visible chest rise indicates effective ventilation; removing a working airway delays resuscitation.

NRP: HR <60/min after 30 s of effective PPV (preferably through an airway) leads to compressions at 3:1 with 100% O2; epinephrine comes after 60 s of compressions.

Answer: C

The tracheostomy tube is too small, allowing excessive airflow around it: Incorrect. Airflow around the tube is what lets a speaking valve work; a small tube makes exhalation easier, not harder.

The valve needs supplemental oxygen to open during inhalation: Incorrect. The one-way valve opens on inspiratory effort with or without added oxygen.

The cuff is still inflated, blocking exhaled air from going around the tube: Correct. A speaking valve closes on exhalation, so air must flow around the tube to the upper airway. An inflated cuff blocks that route and traps air.

Secretions are thinner than usual and leaking past the valve membrane: Incorrect. Thin secretions do not stop exhalation; a blocked exhaled-air route around the tube does.

Always fully deflate the cuff before placing a one-way speaking valve; an inflated cuff with a valve makes exhalation impossible.

Answer: D

Malposition of the foot probe, because neonatal readings should match at every site: Incorrect. A sustained gap this large is a known physiologic finding and should not be assumed to be artifact without checking for shunting.

Left-to-right shunting across a patent foramen ovale that raises preductal saturation: Incorrect. Left-to-right shunting sends oxygenated blood back to the lungs; it does not cause low postductal saturation.

Methemoglobinemia, which lowers saturation more in the lower extremities: Incorrect. Methemoglobinemia lowers saturation evenly at all sites; it does not create a pre/postductal gap.

Right-to-left shunting across the ductus arteriosus from pulmonary hypertension: Correct. The right hand is preductal; the foot is postductal. High pulmonary pressure pushes deoxygenated blood through the PDA into the descending aorta, typical of PPHN with meconium aspiration.

Preductal (right hand) SpO2 higher than postductal (foot) SpO2 by more than a few percent points to ductal right-to-left shunting, the hallmark of PPHN.

Answer: A

Keep the child calm with the parent and arrange airway control in the OR with anesthesia and ENT: Correct. The 'thumb sign' with toxic appearance and drooling indicates epiglottitis; agitation or instrumentation can cause complete obstruction, so the airway is secured in a controlled setting with surgical backup.

Have the child lie supine and inspect the pharynx with a tongue blade to confirm the swelling: Incorrect. Forcing a supine position or depressing the tongue can provoke laryngospasm and total obstruction in epiglottitis.

Give nebulized racemic epinephrine and oral dexamethasone, then reassess in two hours: Incorrect. That is croup management (subglottic swelling, steeple sign); it does not secure an airway threatened by supraglottic infection.

Draw an arterial blood gas sample to document the severity of hypercapnia before deciding: Incorrect. A painful puncture can agitate the child and precipitate obstruction; blood gases are not needed to act on this clinical picture.

Epiglottitis = thumb sign on lateral neck film: keep the child calm and upright, avoid exams that upset the child, and secure the airway in the OR.

Answer: B

Raise PIP and PEEP to re-expand the left lung: Incorrect. More pressure enlarges a tension pneumothorax and worsens cardiovascular compromise.

Needle-aspirate the left hemithorax, then place a chest tube: Correct. Mediastinal shift with a hyperlucent glow on transillumination indicates a left tension pneumothorax; emergency needle aspiration relieves it, followed by a chest tube.

Needle-aspirate the right hemithorax, where the heart has moved: Incorrect. The heart shifts away from the tension pneumothorax, so the air is on the left.

Get a chest radiograph before taking any other action: Incorrect. In a deteriorating infant with clear signs, decompression should not wait for an x-ray.

Tension pneumothorax: shift away from the affected side plus bright transillumination; decompress that side immediately.

Answer: C

4.0; mild oxygenation failure that should improve with weaning: Incorrect. This divides PaO2 by MAP and omits FIO2 × 100; the formula puts PaO2 in the denominator.

25; moderate failure where iNO is usually started: Incorrect. This underestimates the result; 18 × 100 / 45 = 40, not 25.

40; severe failure meeting common ECMO referral levels: Correct. OI = (MAP × FIO2 × 100) / PaO2 = (18 × 1.0 × 100) / 45 = 40. An OI of 40 or more is a common ECMO criterion.

81; severe failure that rules out further ventilator support: Incorrect. This arithmetic is wrong, and no OI value by itself rules out continued support.

OI = MAP × FIO2 × 100 / PaO2. Roughly: ≥25 consider iNO, ≥40 consider ECMO.