CCRN-NEONATAL Sample Questions & Answers
Free CCRN (Neonatal) - Direct Care Eligibility Pathway practice questions with worked answers and explanations. See how the ExamJungle simulator prepares you — then jump into the full test.
Launch the full CCRN-NEONATAL simulator →Showing 6 of 12 free samples.
- Question 1Intermediate
CLINICAL JUDGMENT · Congenital anomalies (e.g., CDH, TEF-EA, choanal atresia, tracheal malacia/stenosis/atresia, CPAM, chylothorax)
A neonate is delivered at 38 weeks' gestation with prenatal ultrasound findings concerning for a left-sided congenital diaphragmatic hernia (CDH). Immediately following delivery, the infant is apneic with a scaphoid abdomen and heart sounds displaced toward the right hemithorax. What is the immediate priority nursing intervention in the delivery room?
flowchart TD Delivery([Delivery of CDH Infant]) --> CheckResp{Respiratory Distress?} CheckResp -->|Yes| Intubate[Immediate Endotracheal Intubation] CheckResp -->|Avoid| BagMask[Bag-Mask Ventilation CONTRAINDICATED] Intubate --> Decompress[Insert Replogle/OG Tube to Low Continuous Suction]Show answer & explanation
Correct answer: B
Bag-mask ventilation is strictly contraindicated in CDH because air enters the herniated stomach/intestines, worsening mediastinal shift. Immediate endotracheal intubation and gastric suction prevent pulmonary compromise.
- Question 2Beginner
CLINICAL JUDGMENT · Congenital anomalies (e.g., CDH, TEF-EA, choanal atresia, tracheal malacia/stenosis/atresia, CPAM, chylothorax)
A term newborn shortly after birth exhibits excessive, frothy oral secretions that bubble from the mouth and nose. When the nurse attempts to pass an 8-French orogastric tube to decompress the stomach prior to the initial feeding, the catheter meets firm resistance and curls back in the upper esophagus at approximately 10 cm. Which congenital anomaly should the critical care nurse immediately suspect?
Show answer & explanation
Correct answer: D
Excessive frothy oral secretions, choking episodes, and inability to advance an orogastric tube past 10–12 cm into the stomach are hallmark clinical indicators of esophageal atresia.
- Question 3Intermediate
CLINICAL JUDGMENT · Respiratory distress syndrome (RDS) / Non-invasive positive pressure ventilation
A multidisciplinary NICU quality improvement committee is reviewing evidence-based respiratory management protocols for spontaneously breathing preterm infants born between 26 and 29 weeks' gestation. Based on randomized clinical trials and neonatal resuscitation guidelines, what is the primary clinical benefit of initiating respiratory stabilization with continuous positive airway pressure (CPAP) compared to routine prophylactic endotracheal intubation?
Show answer & explanation
Correct answer: D
Evidence demonstrates that starting spontaneously breathing very preterm neonates on CPAP reduces the composite outcome of death and BPD (number needed to treat is 25) without increasing adverse outcomes like IVH or NEC.
- Question 4Beginner
CLINICAL JUDGMENT · Acute respiratory distress and/or failure / Therapeutic gases
The resuscitation team attends the precipitous vaginal birth of an infant born at 31 weeks' gestation. The newborn is apneic and limp with a heart rate of 80 bpm. In accordance with neonatal resuscitation guidelines, what initial fraction of inspired oxygen (FiO2) should the nurse ensure is dialed on the gas blender when positive-pressure ventilation (PPV) is initiated?
Show answer & explanation
Correct answer: B
Resuscitation guidelines recommend initiating positive-pressure ventilation in preterm infants (<35 weeks' gestation) with 21% to 30% oxygen and titrating based on pre-ductal pulse oximetry to avert hyperoxic tissue damage.
- Question 5Beginner
CLINICAL JUDGMENT · Non-invasive positive pressure ventilation / Necrotizing enterocolitis
True or False: Large multicenter clinical trials demonstrate that initiating non-invasive continuous positive airway pressure (CPAP) instead of routine endotracheal intubation in extremely preterm neonates significantly increases their risk of developing necrotizing enterocolitis (NEC).
Show answer & explanation
Correct answer: B
Systematic reviews and clinical trials show early CPAP in very preterm neonates does not increase the incidence of necrotizing enterocolitis, pneumothorax, severe intraventricular hemorrhage, or retinopathy of prematurity.
- Question 6Intermediate
CLINICAL JUDGMENT · Glucose homeostasis (hypo- and hyperglycemia)
A 39-week neonate who required advanced resuscitation including chest compressions and epinephrine in the delivery room is admitted to the neonatal intensive care unit. Why is serial blood glucose monitoring and tight glycemic regulation a critical post-resuscitation nursing action in this patient?
Show answer & explanation
Correct answer: A
Hypoglycemia deprives ischemic cerebral tissue of essential substrate, while hyperglycemia promotes lactic acidosis and oxidative stress. Both dysglycemic states aggravate secondary brain injury.
Ready for the real thing?
The full CCRN-NEONATAL simulator has every exam-style question, timed mode, and instant scoring.