10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The NNP exam has 175 questions and runs 3 hours.
These 10 free NNP questions are organized by exam domain, so you can see how each part of the Neonatal Nurse Practitioner (NNP) blueprint is tested. Reveal the answer and explanation under each question.
Discharge screening of an otherwise well 26-hour-old newborn shows oxygen saturations of 97% in the right hand and 92% in a foot. Both measurements are obtained in room air with reliable waveforms. One hour later, the readings are 97% and 93%, respectively. Under the updated AAP critical congenital heart disease screening algorithm, how should this result be handled?
Correct answer: A - Classify the screen as failed and evaluate hypoxemia before discharge
Following a vacuum-assisted delivery, a term newborn has diffuse, fluctuant scalp swelling that extends across sutures toward the neck. Over 90 minutes, head circumference increases by 1.8 cm, heart rate rises to 192 beats/min, and capillary refill lengthens to 4 seconds. Hemoglobin falls from 16.1 to 11.8 g/dL. In which anatomic space is the clinically important blood loss most likely occurring?
Correct answer: D - Between the galea aponeurotica and the cranial periosteum
At 2 minutes after birth, a 39-week newborn has received 30 seconds of ventilation through an endotracheal tube. Chest movement and bilateral air entry are present. The ECG heart rate has risen from 48 to 84 beats/min, but the infant remains apneic. Which action fits the resuscitation sequence at this point?
Correct answer: B - Continue effective positive-pressure ventilation without chest compressions
Following treatment of recurrent hypoglycemia, the infusion plan for a 1.5-kg infant is being revised. The infant receives no enteral feeds. A central line delivers 10% dextrose at 6 mL/hour, and a separate medication carrier delivers 5% dextrose at 1.2 mL/hour. The prescribed total glucose infusion rate is now 9 mg/kg/min, without increasing total hourly fluid volume. The medication carrier must remain unchanged. Which replacement for the central-line dextrose meets both requirements?
Correct answer: A - 12.5% dextrose at 6 mL/hour
At nutrition rounds, a stable infant born at 29 weeks is receiving unfortified expressed human milk at 160 mL/kg/day by gastric tube. At 4 weeks of age, weight gain has averaged 9 g/kg/day over the past week, below the team’s 15-20 g/kg/day goal, and head growth has slowed. Feeds are tolerated, sodium is normal, and there is no edema or intercurrent illness. The mother asks whether her milk should be abandoned. Which modification best addresses the nutritional problem?
Correct answer: A - Add multinutrient fortifier to improve the milk’s protein and mineral content
The pharmacist reviews gentamicin concentrations for a preterm infant who still requires culture-directed treatment. The appropriately timed peak is 9.4 mg/L and the trough is 2.6 mg/L; the treatment targets are a peak of 8-12 mg/L and a trough below 1 mg/L. Creatinine has increased, and the next dose has been held. Once the concentration permits redosing, which adjustment best preserves antibacterial activity while addressing accumulation?
Correct answer: C - Retain the peak-producing dose and lengthen the interval using repeat levels
On day 4, a term infant who had been feeding well develops tachypnea, oliguria, and cool legs. Right-arm blood pressure is 78/48 mm Hg; calf blood pressure is 43/26 mm Hg. Brachial pulses are readily palpable, femoral pulses are barely detectable, and lactate is 6.2 mmol/L. Blood cultures have been collected and empiric antibiotics started. Echocardiography is not immediately available. Which additional intervention should begin while the cardiac anatomy is being clarified?
Correct answer: D - Start alprostadil with personnel and equipment immediately available to manage apnea
A 28-week infant receiving enteral feeds develops abdominal distension, tenderness, and bloody stools on day 14. The platelet count is 84 × 10^9/L, arterial pH is 7.28, and bicarbonate is 18 mmol/L. Radiographs show pneumatosis intestinalis and portal venous gas without free intraperitoneal air. Blood pressure and respiratory support requirements remain stable. Using modified Bell staging, the findings are most consistent with:
Correct answer: B - Stage IIB: definite NEC, moderately ill
Intensive phototherapy is underway for a 40-week newborn with DAT-positive isoimmune hemolysis. At 48 hours, total serum bilirubin is 19.0 mg/dL and direct bilirubin is 1.4 mg/dL. The infant has no signs of acute bilirubin encephalopathy. The applicable AAP exchange-transfusion threshold is 20.1 mg/dL. What is the appropriate level of care now?
Correct answer: D - Escalate to exchange-capable care with intravenous hydration, intensive phototherapy, and bilirubin checks every 2 hours
Despite lung recruitment and mechanical ventilation, a 39-week newborn with meconium aspiration has a right-hand oxygen saturation of 95% and a foot saturation of 82%. Echocardiography excludes structural heart disease and estimates right-ventricular systolic pressure above systemic pressure. Which mechanism accounts for the lower foot saturation?
Correct answer: C - Desaturated pulmonary arterial blood enters the descending aorta through the ductus
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