Safety Training Seminars

NRP Written Test

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The Neonatal Resuscitation Program (NRP) written test challenges healthcare professionals with critical scenarios they’ll face in delivery rooms. Passing this exam requires solid knowledge of newborn assessment, resuscitation algorithms, and emergency interventions.

Healthcare providers who work with newborns—including nurses, respiratory therapists, and physicians—must demonstrate competency through both written and practical assessments. The NRP written test evaluates your understanding of the science behind neonatal resuscitation and your ability to make quick, life-saving decisions.

This comprehensive guide covers the most common NRP test questions, organized by key topics. You’ll find detailed explanations that go beyond simple memorization, helping you understand the reasoning behind each correct answer. Whether you’re preparing for initial certification or renewal, these practice questions will strengthen your knowledge and boost your confidence.

Initial Assessment and Golden Minute

The first 60 seconds after birth—known as the “Golden Minute”—are crucial for newborn survival. Most NRP test questions focus on this critical timeframe.

Question: What are the three rapid assessment questions for every newborn?

Answer: The three rapid assessment questions are:

  • Is the baby term gestation?
  • Is the baby breathing or crying?
  • Does the baby have good muscle tone?

If you answer “yes” to all three questions, routine care is appropriate. A “no” to any question means the baby needs immediate evaluation and possible resuscitation.

Question: What is the most important and effective action in neonatal resuscitation?

Answer: Establishing effective ventilation is the most important action. Most newborns who need resuscitation have respiratory problems, not cardiac issues. Once you establish good ventilation, the heart rate typically improves quick

Question: When should you begin positive pressure ventilation?

Answer: Begin positive pressure ventilation if the baby is:

  • Apneic (not breathing)
  • Gasping
  • Has a heart rate below 100 bpm despite stimulation

Don’t wait beyond 60 seconds to start ventilation if these conditions exist.

Heart Rate Assessment and Response

Heart rate determines your next steps in neonatal resuscitation. NRP emphasizes heart rate as the primary indicator of resuscitation effectiveness.

Question: What heart rate ranges require different interventions?

Answer: Heart rate ranges and interventions:

  • Above 100 bpm: Continue current care if breathing well
  • 60-100 bpm: Provide positive pressure ventilation
  • Below 60 bpm: Begin chest compressions with continued ventilation

Electronic cardiac monitoring provides continuous assessment but isn’t always immediately available.

Question: If heart rate remains below 60 bpm despite effective ventilation and chest compressions, what's the next step?

Answer: Administer epinephrine. The dose is 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000 solution) given intravenously through an umbilical venous catheter.

Positive Pressure Ventilation

Effective ventilation skills are essential for neonatal resuscitation success. Many test questions focus on proper technique and troubleshooting.

Question: What are the initial ventilation parameters for a newborn?

Answer: Initial ventilation settings:

  • Pressure: 20-25 cm H2O for term babies
  • Rate: 40-60 breaths per minute
  • Oxygen: Room air (21%) initially, then adjust based on pulse oximetry

Question: How do you know if positive pressure ventilation is effective?

Answer: Signs of effective ventilation include:

  • Rising heart rate (most important indicator)
  • Visible chest movement with each breath
  • Improved color and muscle tone
  • Audible breath sounds bilaterally

Question: What should you do if chest isn't rising during positive pressure ventilation?

Answer: Use the MR. SOPA acronym:

  • Mask adjustment (check seal)
  • Reposition airway (extend neck slightly)
  • Suction mouth and nose
  • Open mouth (jaw thrust)
  • Pressure increase (up to 30-40 cm H2O)
  • Alternative airway (consider intubation)

Chest Compressions

Chest compressions are rarely needed but represent a critical skill when heart rate remains below 60 bpm.

Question: When do you start chest compressions?

Answer: Begin chest compressions when:

  • Heart rate remains below 60 bpm
  • After at least 30 seconds of effective positive pressure ventilation
  • You’ve confirmed the ventilation is working (chest rising, heart rate initially improved but then declined)

Question: What's the correct technique for chest compressions?

Answer: Proper technique includes:

  • Thumb technique: Preferred method with hands encircling the chest
  • Depth: One-third of the anterior-posterior diameter of the chest
  • Rate: 90 compressions per minute
  • Ratio: 3 compressions to 1 ventilation (3:1)
  • Location: Lower third of the sternum, just below the nipple line

Question: How do you coordinate compressions and ventilation?

Answer: Use the “One-and-Two-and-Three-and-Breathe” rhythm. The person doing compressions counts out loud while the person ventilating provides a breath on “Breathe.”

Medications and Vascular Access

While medications are rarely needed, understanding their use is crucial for severe cases.

Question: What's the first-line medication in neonatal resuscitation?

Answer: Epinephrine is the first-line medication. It’s indicated when heart rate remains below 60 bpm despite adequate ventilation and chest compressions.

Question: What's the preferred route for epinephrine administration?

Answer: Intravenous (IV) route through umbilical venous catheter is preferred. The endotracheal route may be used while establishing IV access, but requires a higher dose (0.05-0.1 mg/kg).

Question: When might you consider volume expansion?

Answer: Volume expansion is considered when:

  • Blood loss is suspected
  • Baby appears pale despite adequate ventilation
  • Heart rate remains low despite other interventions
  • Normal saline is the preferred solution (10 mL/kg over 5-10 minutes)

Special Situations

Real-world scenarios often involve complications that require modified approaches.

Question: How do you manage meconium-stained amniotic fluid?

Answer: Current guidelines state:

  • Vigorous baby: Provide routine care regardless of meconium
  • Non-vigorous baby: Begin resuscitation immediately; don’t delay for suctioning
  • Avoid routine intubation and suctioning for meconium removal

Question: What's different about preterm resuscitation?

Answer: Preterm considerations include:

  • Temperature: Use plastic wrap or thermal mattress
  • Pressure: Start with lower ventilation pressures (20 cm H2O)
  • Oxygen: Consider higher oxygen concentrations earlier
  • CPAP: May be appropriate for spontaneously breathing preterm infants

Question: How do you manage a baby born with a known heart defect?

Answer: Follow standard NRP algorithms initially, but:

  • Pulse oximetry readings may not reflect true oxygenation
  • Consider prostaglandin infusion for ductal-dependent lesions
  • Transport to specialized cardiac center quickly

Team Dynamics and Communication

Effective resuscitation requires coordinated teamwork and clear communication.

Question: Who should lead the resuscitation team?

Answer: The most qualified person present should lead, typically:

  • Neonatologist or pediatrician
  • Experienced nurse practitioner
  • Anesthesiologist familiar with neonates
  • The leader delegates tasks and makes clinical decisions

Question: What's the importance of debriefing after a resuscitation?

Answer: Debriefing helps the team:

  • Review what went well and identify improvements
  • Process emotional responses to the event
  • Strengthen team dynamics for future cases
  • Ensure documentation is complete and accurate

Ethical Considerations

NRP includes guidelines for when resuscitation may not be appropriate.

Question: When is it appropriate to discontinue resuscitation efforts?

Answer: Consider discontinuing when:

  • No heart rate after 10 minutes of adequate resuscitation
  • Gestation less than 23 weeks or birth weight less than 400g (depending on institutional guidelines)
  • Confirmed lethal anomalies incompatible with life

Question: How should you approach parents during resuscitation?

Answer: When possible:

  • Explain what’s happening in simple terms
  • Allow parents to see their baby if they wish
  • Provide honest updates about the baby’s condition
  • Respect cultural and religious preferences

Quality Improvement and Documentation

Proper documentation and quality improvement are integral parts of neonatal resuscitation programs.

Question: What key elements should be documented during resuscitation?

Answer: Essential documentation includes:

  • Time of birth and initial assessment
  • Interventions performed and timing
  • Heart rate and oxygen saturation values
  • Medications given (dose, route, time)
  • Response to interventions
  • Final outcome and disposition

Question: How often should NRP skills be practiced?

Answer: NRP recommends:

  • Initial certification every 2 years
  • Regular skills practice and simulation training
  • Institutional mock codes and drills
  • Ongoing education about guideline updates

Prepare for Success with Professional Training

Understanding these common NRP test questions provides a strong foundation, but hands-on training remains essential for true competency. The written exam tests your knowledge, while practical skills sessions ensure you can apply that knowledge under pressure.

We offer comprehensive NRP certification courses that combine American Academy of Pediatrics online coursework with intensive skills training. Our experienced instructors guide you through realistic scenarios, helping you master the techniques and decision-making skills needed for successful neonatal resuscitation.

Our NRP classes feature small group settings that allow for personalized attention and plenty of practice time. We provide same-day certification cards, convenient scheduling options, and the lowest prices in California. Whether you’re a new healthcare provider or renewing your certification, we’re committed to helping you gain the confidence and competence needed to save newborn lives.

Contact Safety Training Seminars today to schedule your NRP certification class. Join thousands of healthcare professionals who have trusted us for their life-saving training needs since 1989.