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Quizzes > Health & Medicine

NRP practice test: assess your neonatal resuscitation skills

Quick NRP quiz to test your knowledge. Instant results.

Editorial: Review CompletedCreated By: Amy CapeloUpdated Aug 26, 2025
Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art style quiz banner shows NRP certification test invitation with bold text on a golden yellow background

This NRP practice test helps you review neonatal resuscitation steps and spot weak areas before the certification exam. Answer concise questions on airway, ventilation, compressions, meds, and teamwork, with instant scoring to guide your next study session. For more practice, try our cpr practice quiz, pediatric nursing practice quiz, and fundamentals of nursing quiz.

What is the first step in the initial assessment of a newborn at birth?
Provide positive-pressure ventilation
Suction the mouth and nose
Check the heart rate
Dry and warm the baby
The initial steps in neonatal resuscitation focus on maintaining body temperature and stimulating breathing by drying and warming the infant. Suctioning is performed only if there is visible obstruction in the airway. Heart rate assessment and ventilation follow once initial warmth and stimulation are provided.
Which position helps to open the airway of a newborn during resuscitation?
Flexed neck with chin tucked
Prone position
Hyperextended neck
Neutral 'sniffing' position
The neutral or 'sniffing' position aligns the oral, pharyngeal, and laryngeal axes to optimize airway patency. Hyperextension can obstruct the airway and flexion can close the glottis. Prone positioning is not recommended during initial resuscitation efforts.
At what heart rate threshold should chest compressions be initiated in a newborn during resuscitation if effective ventilation has been established?
Heart rate below 100 bpm
Heart rate below 40 bpm
Heart rate below 80 bpm
Heart rate below 60 bpm
If the newborn's heart rate remains below 60 beats per minute despite adequate ventilation for 30 seconds, chest compressions should begin. A heart rate above 100 is reassuring and does not require compressions. A threshold below 40 bpm is too low and compressions should already be in progress.
What fraction of inspired oxygen (FiO2) is recommended to start for a term infant requiring positive-pressure ventilation?
100%
60%
21%
30%
Term infants typically begin resuscitation with room air (21% oxygen) to avoid hyperoxia. Oxygen concentration can be titrated based on pre-ductal saturation targets. Starting at higher concentrations is reserved for preterm or markedly distressed infants.
What is the recommended compression-to-ventilation ratio for neonatal resuscitation with two providers?
2:1
3:1
15:2
4:1
The recommended compression-to-ventilation ratio in neonatal resuscitation is 3 compressions to 1 ventilation. This achieves approximately 90 compressions and 30 ventilations per minute when timed correctly. Ratios used in older children and adults differ from the neonatal ratio.
Where should a pre-ductal pulse oximeter probe be placed during resuscitation of a newborn?
Right hand or wrist
Left hand or wrist
Left foot
Right foot
Pre-ductal oxygen saturation is measured on the right hand or wrist before the ductus arteriosus, reflecting cerebral oxygenation. Post-ductal readings on the feet can differ due to shunting through the ductus arteriosus. Accurate placement ensures correct assessment of oxygen delivery to vital organs.
Which tactile stimulation method can be used to encourage breathing in a newborn?
Shaking the trunk vigorously
Flicking the soles of the feet
Pinching the nose
Placing under a radiant warmer without stimulation
Gentle flicking of the soles of the feet is an accepted tactile stimulation that can prompt spontaneous breathing. Pinching or shaking vigorously can cause trauma or stress. Radiant warming provides thermal support but does not stimulate respiration directly.
How long should the initial steps of drying, warming, and clearing the airway take before reassessment?
30 seconds
90 seconds
10 seconds
60 seconds
The initial 'golden minute' of neonatal resuscitation includes drying, warming, and clearing the airway, with reassessment by 30 seconds. If spontaneous respiration and heart rate above 100 bpm are not achieved, further intervention is warranted. Delaying interventions beyond this timeframe can worsen the outcome.
What is the recommended rate of positive-pressure ventilation for neonatal resuscitation?
20 - 30 breaths per minute
40 - 60 breaths per minute
15 - 20 breaths per minute
100 - 120 breaths per minute
Ventilation should be delivered at a rate of 40 - 60 breaths per minute to achieve adequate lung inflation without causing barotrauma. Slower rates may not generate sufficient oxygenation, and faster rates risk air trapping. This rate applies until spontaneous breathing is established.
If the heart rate remains below 60 bpm after 30 seconds of effective ventilation, what is the next step?
Prepare epinephrine
Increase the oxygen concentration to 100%
Give a fluid bolus
Start chest compressions
Persistent bradycardia (HR <60 bpm) despite effective ventilation indicates the need for chest compressions. Oxygen concentration adjustments and medications follow if compressions and ventilation do not improve heart rate. Immediate fluid bolus is not indicated unless hypovolemia is suspected.
Which device delivers the most consistent peak inspiratory pressure during positive-pressure ventilation in neonates?
Flow-inflating bag
Nasal cannula
T-piece resuscitator
Self-inflating bag
A T-piece resuscitator allows preset peak inspiratory pressure and positive end-expiratory pressure, providing consistent and controlled ventilation. Self-inflating and flow-inflating bags depend on operator technique, and nasal cannulae are not used for initial resuscitation.
What is the correct depth of chest compressions during neonatal resuscitation?
One-fifth of chest depth
Half of the anterior-posterior chest diameter
Approximately one-quarter of chest depth
One-third of the anterior-posterior chest diameter
Compressions should depress the chest by about one-third of its anterior-posterior diameter to effectively circulate blood. Too shallow compressions are ineffective, and excessive depth risks injury. This guideline ensures adequate perfusion while minimizing trauma.
When should umbilical venous catheterization be considered during neonatal resuscitation?
Immediately after birth
After 60 seconds of effective ventilation and compressions
After intubation failure
Only in preterm infants
If resuscitation requiring chest compressions and effective ventilation extends beyond 60 seconds, secure IV access with an umbilical venous catheter to administer medications. Immediate catheterization is not necessary in brief, successful resuscitations. It is indicated regardless of gestational age when prolonged intervention is needed.
What is the recommended initial intravenous dose of epinephrine during neonatal resuscitation?
0.01 - 0.03 mg/kg
0.001 - 0.005 mg/kg
0.1 - 0.3 mg/kg
1 - 3 mg/kg
The initial IV dose of epinephrine in neonates is 0.01 - 0.03 mg/kg to stimulate heart rate and improve perfusion during arrest. Higher doses can increase the risk of arrhythmias. ET doses differ and are generally higher if IV access is not available.
Which fluid bolus is recommended for suspected hypovolemia during neonatal resuscitation?
Calcium gluconate 100 mg/kg
Sodium bicarbonate 2 mEq/kg
Epinephrine 0.01 mg/kg
Normal saline or type O negative blood 10 mL/kg
For suspected hypovolemia (e.g., blood loss), a fluid bolus of normal saline or type O negative blood at 10 mL/kg is recommended to restore circulating volume. Medications such as epinephrine and bicarbonate are used for cardiac support or metabolic acidosis, not initial volume replacement.
What is the typical insertion depth for an umbilical venous catheter in a term newborn?
5 - 7 cm
3 cm
10 cm
2 cm
In a term newborn, the umbilical venous catheter is typically advanced 5 - 7 cm from the umbilicus to reach the ductus venosus. Shorter distances may not permit medication delivery into the central circulation. Longer insertion risks hepatic or cardiac perforation.
Which laryngoscope blade is usually preferred for endotracheal intubation in a term neonate?
Macintosh size 1
Miller size 0
Macintosh size 2
Miller size 1
A straight Miller blade size 1 is generally preferred for term neonates because it directly lifts the epiglottis and provides a clear view of the vocal cords. A size 0 blade is more suitable for very low birth weight infants. Macintosh blades are curved and less commonly used in newborns.
In preterm infants less than 32 weeks' gestation requiring ventilation, what initial FiO2 is recommended?
100%
21%
60%
30%
Preterm infants (<32 weeks) often benefit from an initial FiO2 of about 30% to reduce the risk of oxidative injury. Oxygen concentrations should be titrated based on target oxygen saturation ranges. Term infants typically start at 21%.
What pre-ductal oxygen saturation range should be reached by 5 minutes of life during neonatal resuscitation?
60 - 65%
75 - 80%
80 - 85%
95 - 100%
By 5 minutes of life, the target pre-ductal saturation should be approximately 80 - 85% as the newborn transitions from fetal to neonatal circulation. Saturations below this range may indicate inadequate oxygenation, while higher values risk hyperoxia.
When is sodium bicarbonate administration considered in advanced neonatal resuscitation?
For bradycardia at the start
For persistent metabolic acidosis after prolonged resuscitation
Immediately after birth
With the first dose of epinephrine
Sodium bicarbonate may be considered for persistent metabolic acidosis after prolonged resuscitation efforts when ventilation, compressions, and medications have failed to correct acidosis. It is not used immediately or for initial bradycardia. Routine use with the first epinephrine dose is not recommended.
What total event rate (compressions plus ventilations) should be targeted during neonatal chest compressions?
60 events per minute
180 events per minute
90 events per minute
120 events per minute
Neonatal resuscitation with a 3:1 compression-to-ventilation ratio at 90 compressions and 30 breaths per minute yields about 120 total events per minute. This coordinated approach optimizes both circulation and oxygenation.
During chest compressions in neonatal resuscitation, what oxygen concentration is recommended?
Same as during ventilation
30%
21%
100%
When chest compressions are initiated, 100% oxygen is recommended to maximize oxygen delivery during low perfusion states. After return of spontaneous circulation, oxygen should be titrated to pre-ductal saturation targets.
What is the primary indicator of effective bag-mask ventilation during neonatal resuscitation?
Audible breath sounds
Stable body temperature
Visible chest rise with each breath
Moist skin
Visible chest rise is the most immediate indicator of effective positive-pressure ventilation. It confirms that air is entering the lungs. Moist skin and body temperature do not reflect ventilation adequacy, and breath sounds may lag behind visible rise.
When using a self-inflating bag without a PEEP valve for neonatal ventilation, what is a common limitation?
High compression volume
Excessive PEEP
Inadequate PEEP
Uncontrolled oxygen concentration
Self-inflating bags without a PEEP valve cannot provide positive end-expiratory pressure, which may lead to alveolar collapse and inadequate oxygenation. This limitation can reduce functional residual capacity in the newborn lung.
What is the recommended dose of epinephrine when administered via endotracheal tube during neonatal resuscitation?
0.1 - 0.3 mg/kg
0.05 - 0.1 mg/kg
0.2 - 0.4 mg/kg
0.01 - 0.03 mg/kg
When IV access is not available, endotracheal epinephrine at a dose of 0.05 - 0.1 mg/kg is recommended, diluted in 0.5 - 1 mL of sterile water or normal saline. Lower doses may be ineffective and higher doses increase arrhythmia risk. Following ET administration, IV access should be secured for more reliable delivery.
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Study Outcomes

  1. Analyze NRP Test Structure -

    Engage with realistic nrp practice test questions to understand the format, timing, and distribution of topics on the actual exam.

  2. Apply Neonatal Resuscitation Protocols -

    Use case-based scenarios to apply the latest guidelines and interventions covered in the nrp certification online test.

  3. Identify Knowledge Gaps -

    Review your scored results to pinpoint strengths and areas for improvement, ensuring targeted study before taking the nrp test.

  4. Practice Time Management -

    Develop strategies for pacing yourself through timed questions on the nrp certification test to maximize accuracy under exam conditions.

  5. Recall Key NRP Concepts -

    Study flashcards and explanations to reinforce critical neonatal resuscitation principles and common nrp questions.

  6. Build Exam Confidence -

    Track your progress over multiple attempts to boost preparedness and reduce test-day anxiety for the nrp certification online test.

Cheat Sheet

  1. Initial Assessment: The Golden Minute -

    Within the first 60 seconds, evaluate breathing, heart rate, and muscle tone to decide on intervention steps. Use the DRS ABC mnemonic - Danger, Response, Send for help, Airway, Breathing, Circulation - endorsed by the American Academy of Pediatrics to cover all critical checks. Practicing this sequence with an nrp practice test makes recall automatic under pressure.

  2. Airway Management & Mask Ventilation -

    Optimal mask seal and correct head position (sniffing position) are critical when providing positive-pressure ventilation at 40 - 60 breaths per minute. A T-piece resuscitator with 5 - 8 cm H₂O PEEP helps establish functional residual capacity as recommended by the NRP guidelines. Incorporating these steps into your nrp certification online test routine builds muscle memory and boosts ventilation confidence.

  3. Chest Compression Technique & Ratio -

    When heart rate remains below 60 bpm despite effective ventilation, begin compressions at a 3 : 1 ratio (90 compressions and 30 breaths per minute) using the two-thumb encircling hands technique. Aim for a depth equal to one-third of the chest's anteroposterior diameter to optimize perfusion. Mastering this metric on your nrp practice test ensures precision under exam conditions.

  4. Epinephrine Dosing & Calculation -

    Epinephrine is indicated if heart rate stays under 60 bpm after at least 30 seconds of effective compressions and ventilation; IV dose is 0.01 - 0.03 mg/kg, while the endotracheal dose is 0.05 - 0.1 mg/kg. Use the formula dose (mg) = weight (kg) × dose per kg and confirm concentration (1:10 000 = 0.1 mg/mL) to draw the correct volume. Regular practice with these calculations in your nrp practice test sessions builds confidence and prevents critical delays.

  5. Thermal Management & Oxygen Titration -

    Maintaining a neutral thermal environment (36.5 - 37.5 °C) and starting resuscitation with 21 percent oxygen reduces risks of hypothermia and hyperoxia. Titrate FiO₂ to hit target preductal SpO₂ levels (e.g., 60 - 65 percent at 1 minute, 85 - 95 percent by 5 minutes), using pulse oximetry on the right hand. Familiarity with these targets in your nrp certification online test helps you adjust oxygen delivery precisely under exam conditions.

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