A term infant is born to a mother with Sjögren syndrome who takes no medications. Apgar scores are 8 and 9. On admission the infant is pink and well perfused, with a regular heart rate of 58 bpm that does not change with crying or stimulation. Which mechanism MOST likely explains the bradycardia?

Maternal anti-Ro/SSA antibodies damaging the fetal conduction system

Increased vagal tone from raised intracranial pressure after delivery

Sinus node depression from intrapartum hypoxia and acidosis

A 2.8-kg term infant has a heart rate of 50/min after 60 seconds of coordinated compressions and ventilation with 100% oxygen. An emergency UVC is in place, and epinephrine 0.1 mg/mL is available. Which order reflects the recommended initial dose and route?

0.056 mg (0.56 mL) via the UVC, then a 3 mL normal saline flush

0.28 mg (2.8 mL) via the UVC, then a 3 mL normal saline flush

0.28 mg (2.8 mL) via the endotracheal tube, then continued PPV

A preterm infant's peripheral IV infusing PN is found with blanching, swelling, and coolness extending above the elbow. The infusion is stopped. Which additional management is MOST appropriate?

Aspirate residual fluid, remove the catheter, elevate the limb, and give hyaluronidase per protocol

Leave the catheter in place, apply cold compresses, and restart the infusion at a lower rate

Remove the catheter, apply warm compresses, and infiltrate phentolamine subcutaneously around the injured area

A ventilated 39-week infant with meconium aspiration suddenly develops bradycardia, hypotension, and an SpO₂ of 62%. Breath sounds are diminished on the left, the point of maximal impulse is shifted to the right, and the left chest transilluminates brightly. What is the PRIORITY intervention?

Needle decompression of the left chest at the 2nd intercostal space, midclavicular line

Needle decompression of the right chest at the 2nd intercostal space, midclavicular line

A stat chest radiograph to confirm the diagnosis before intervening

A 38-week infant is being evaluated for hyperbilirubinemia. Which finding is a hyperbilirubinemia neurotoxicity risk factor that lowers the phototherapy threshold under the current AAP guideline?

A sibling who required phototherapy

Exclusive breastfeeding with an 8% weight loss

A mother with chronic immune thrombocytopenia (platelet count 62,000/µL) delivers a vigorous term infant vaginally. Which neonatal plan is MOST appropriate?

Check platelet counts at birth and serially for several days

Transfuse platelets prophylactically before obtaining any count

Omit testing, because maternal platelet antibodies cannot cross the placenta

A 39-week infant with micrognathia and glossoptosis has suprasternal retractions and desaturations while supine. Which intervention is MOST appropriate to relieve the obstruction?

Place prone and insert a small ETT through the nose into the posterior pharynx

Keep supine in the sniffing position and provide free-flow oxygen by mask

Keep supine with a shoulder roll under the neck and provide face-mask CPAP at 5 cm H₂O

A 25-week infant on day 3 of life requires PICC placement. Which skin antisepsis practice is MOST appropriate?

Apply a minimal amount of chlorhexidine, avoid pooling, and remove the excess after drying

Apply 70% isopropyl alcohol generously and leave it under the occlusive dressing

Apply povidone-iodine generously and leave it on the skin to provide prolonged antisepsis

A 24-week infant on conventional ventilation has rising oxygen and pressure requirements on day 4. The radiograph shows multiple small cystic and linear lucencies throughout the left lung, while the right lung is less affected. Which plan is MOST appropriate?

Lower pressures, consider high-frequency ventilation, and position left side down

Insert a left chest tube to evacuate the interstitial air

Increase the PIP and PEEP to recruit the lucent areas, and position left side up

A nurse is caring for a 37-week infant receiving intensive phototherapy. Which action requires intervention?

Using transcutaneous bilirubin to assess the phototherapy response

Leaving the diaper off or folded down to maximize skin exposure

Removing the eye shields during feeds while the lights are off

Neonatal Intensive Care Nurse

Free Neonatal Intensive Care Nurse Practice Questions

10 sample questions for the Neonatal Intensive Care Nurse, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: General Assessment, General Management, Professional Issues, Hematopoietic, Genetic, Metabolic, and Endocrine, Infection and Immunology.

Question 1 · General Assessment
A term infant is born to a mother with Sjögren syndrome who takes no medications. Apgar scores are 8 and 9. On admission the infant is pink and well perfused, with a regular heart rate of 58 bpm that does not change with crying or stimulation. Which mechanism MOST likely explains the bradycardia?
- A.Maternal anti-Ro/SSA antibodies damaging the fetal conduction system
- B.Increased vagal tone from raised intracranial pressure after delivery
- C.Sinus node depression from intrapartum hypoxia and acidosis
Show answer and explanation
Answer: A. Maternal anti-Ro/SSA antibodies damaging the fetal conduction system
Anti-Ro/SSA (and anti-La/SSB) antibodies cross the placenta and damage the fetal conduction system, producing congenital complete heart block: a fixed, slow rate that does not rise with stimulation in an otherwise well infant, and the block is permanent. Raised intracranial pressure would be accompanied by neurologic signs and is not suggested by an uncomplicated course. Hypoxic sinus bradycardia comes with low Apgar scores, poor perfusion, and acidosis, and it improves with ventilation.
Question 2 · General Management
A 2.8-kg term infant has a heart rate of 50/min after 60 seconds of coordinated compressions and ventilation with 100% oxygen. An emergency UVC is in place, and epinephrine 0.1 mg/mL is available. Which order reflects the recommended initial dose and route?
- A.0.28 mg (2.8 mL) via the UVC, then a 3 mL normal saline flush
- B.0.28 mg (2.8 mL) via the endotracheal tube, then continued PPV
- C.0.056 mg (0.56 mL) via the UVC, then a 3 mL normal saline flush
Show answer and explanation
Answer: C. 0.056 mg (0.56 mL) via the UVC, then a 3 mL normal saline flush
The preferred IV dose is 0.02 mg/kg: 2.8 kg × 0.02 mg/kg = 0.056 mg, and 0.056 mg ÷ 0.1 mg/mL = 0.56 mL, followed by a 3 mL saline flush. A dose of 0.28 mg (0.1 mg/kg) is the endotracheal dose, which is five times too high if given IV, and the endotracheal route is used only while vascular access is being obtained.
Question 3 · General Management
A preterm infant's peripheral IV infusing PN is found with blanching, swelling, and coolness extending above the elbow. The infusion is stopped. Which additional management is MOST appropriate?
- A.Leave the catheter in place, apply cold compresses, and restart the infusion at a lower rate
- B.Remove the catheter, apply warm compresses, and infiltrate phentolamine subcutaneously around the injured area
- C.Aspirate residual fluid, remove the catheter, elevate the limb, and give hyaluronidase per protocol
Show answer and explanation
Answer: C. Aspirate residual fluid, remove the catheter, elevate the limb, and give hyaluronidase per protocol
PN is a vesicant; after stopping the infusion, residual fluid is aspirated, the catheter is removed, the limb is elevated, the provider is notified, and hyaluronidase is injected subcutaneously around the site per protocol to promote dispersion and absorption. Phentolamine is the antidote for vasopressor extravasation, not PN. Restarting the infusion through an extravasated site extends the tissue injury.
Question 4 · General Assessment
A ventilated 39-week infant with meconium aspiration suddenly develops bradycardia, hypotension, and an SpO₂ of 62%. Breath sounds are diminished on the left, the point of maximal impulse is shifted to the right, and the left chest transilluminates brightly. What is the PRIORITY intervention?
- A.Needle decompression of the right chest at the 2nd intercostal space, midclavicular line
- B.A stat chest radiograph to confirm the diagnosis before intervening
- C.Needle decompression of the left chest at the 2nd intercostal space, midclavicular line
Show answer and explanation
Answer: C. Needle decompression of the left chest at the 2nd intercostal space, midclavicular line
Diminished left breath sounds, mediastinal shift away from the left, bright left transillumination, and cardiovascular collapse indicate a left tension pneumothorax, which requires immediate needle aspiration at the 2nd intercostal space, midclavicular line (or 4th–5th intercostal space, anterior axillary line), followed by chest tube placement. Waiting for a radiograph in an unstable infant delays lifesaving decompression. The right side is the side the heart has shifted toward, not the side of the air.
Question 5 · Hematopoietic
A 38-week infant is being evaluated for hyperbilirubinemia. Which finding is a hyperbilirubinemia neurotoxicity risk factor that lowers the phototherapy threshold under the current AAP guideline?
- A.Serum albumin of 2.7 g/dL
- B.A sibling who required phototherapy
- C.Exclusive breastfeeding with an 8% weight loss
Show answer and explanation
Answer: A. Serum albumin of 2.7 g/dL
The AAP neurotoxicity risk factors are gestational age <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or other hemolysis, sepsis, and significant clinical instability in the prior 24 hours; low albumin leaves more unbound bilirubin able to enter the brain. Suboptimal breastfeeding intake and a sibling who needed phototherapy increase the risk of developing significant hyperbilirubinemia but are not neurotoxicity risk factors and do not change the threshold curve used.
Question 6 · General Assessment
A mother with chronic immune thrombocytopenia (platelet count 62,000/µL) delivers a vigorous term infant vaginally. Which neonatal plan is MOST appropriate?
- A.Check platelet counts at birth and serially for several days
- B.Transfuse platelets prophylactically before obtaining any count
- C.Omit testing, because maternal platelet antibodies cannot cross the placenta
Show answer and explanation
Answer: A. Check platelet counts at birth and serially for several days
Maternal ITP antibodies are IgG and cross the placenta, so the infant can develop thrombocytopenia; the neonatal count often reaches its lowest point between days 2 and 5, which is why serial counts are obtained. Treatment, including platelets or IVIG, is guided by the count and any bleeding, not given empirically before testing.
Question 7 · General Management
A 39-week infant with micrognathia and glossoptosis has suprasternal retractions and desaturations while supine. Which intervention is MOST appropriate to relieve the obstruction?
- A.Keep supine in the sniffing position and provide free-flow oxygen by mask
- B.Place prone and insert a small ETT through the nose into the posterior pharynx
- C.Keep supine with a shoulder roll under the neck and provide face-mask CPAP at 5 cm H₂O
Show answer and explanation
Answer: B. Place prone and insert a small ETT through the nose into the posterior pharynx
In Pierre Robin sequence, the tongue falls back against the posterior pharynx; prone positioning lets the tongue fall forward, and a small ETT (for example, 2.5 mm) passed through the nose to the posterior pharynx bypasses the obstruction, with a laryngeal mask if needed. The supine position worsens glossoptosis, and neither mask CPAP nor free-flow oxygen relieves a mechanical obstruction at the tongue base.
Question 8 · General Management
A 25-week infant on day 3 of life requires PICC placement. Which skin antisepsis practice is MOST appropriate?
- A.Apply 70% isopropyl alcohol generously and leave it under the occlusive dressing
- B.Apply povidone-iodine generously and leave it on the skin to provide prolonged antisepsis
- C.Apply a minimal amount of chlorhexidine, avoid pooling, and remove the excess after drying
Show answer and explanation
Answer: C. Apply a minimal amount of chlorhexidine, avoid pooling, and remove the excess after drying
Chlorhexidine is effective but carries a caution in infants <2 months because chemical burns occur in ELBW skin; the minimum amount is used, pooling is avoided, and excess is removed with sterile water or saline after drying per protocol. Isopropyl alcohol left under an occlusive dressing causes chemical burns, and povidone-iodine left on immature skin is absorbed and can cause transient hypothyroidism.
Question 9 · General Assessment
A 24-week infant on conventional ventilation has rising oxygen and pressure requirements on day 4. The radiograph shows multiple small cystic and linear lucencies throughout the left lung, while the right lung is less affected. Which plan is MOST appropriate?
- A.Lower pressures, consider high-frequency ventilation, and position left side down
- B.Insert a left chest tube to evacuate the interstitial air
- C.Increase the PIP and PEEP to recruit the lucent areas, and position left side up
Show answer and explanation
Answer: A. Lower pressures, consider high-frequency ventilation, and position left side down
Cystic and linear lucencies in a ventilated extremely preterm infant indicate pulmonary interstitial emphysema; management lowers pressures and tidal volumes, often with high-frequency (especially jet) ventilation, and positions the affected side down to reduce its ventilation. Raising pressures enlarges the interstitial air. Air trapped in the interstitium is not in the pleural space, so a chest tube does not drain it.
Question 10 · Hematopoietic
A nurse is caring for a 37-week infant receiving intensive phototherapy. Which action requires intervention?
- A.Leaving the diaper off or folded down to maximize skin exposure
- B.Removing the eye shields during feeds while the lights are off
- C.Using transcutaneous bilirubin to assess the phototherapy response
Show answer and explanation
Answer: C. Using transcutaneous bilirubin to assess the phototherapy response
Transcutaneous bilirubin is unreliable during and shortly after phototherapy because exposed skin bleaches, so TSB must be used to monitor response. Removing eye shields when the lights are off during feeds supports eye contact and assessment of the eyes. Maximizing exposed skin surface increases the effectiveness of phototherapy.

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