100+ Free NCC NNP-BC Practice Questions

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Question 1

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A term infant is born to a mother with a positive GBS culture who received only one dose of penicillin 2 hours before delivery. The infant is asymptomatic at 4 hours of life. According to current AAP/CDC guidance and the Kaiser Permanente Neonatal Sepsis Calculator framework, which approach is MOST appropriate?

Start empiric ampicillin and gentamicin immediately based on inadequate intrapartum prophylaxis alone

Use risk-based assessment (sepsis calculator inputs and serial physical exams) and treat only if clinical signs develop or risk score warrants

Discharge home at 24 hours without further observation

Obtain a lumbar puncture before any further evaluation

to track

2026 Statistics

Key Facts: NCC NNP-BC Exam

175

Total Questions

NCC NNP-BC test plan

150 + 25

Scored + Pretest

NCC NNP-BC test plan

Exam Time

NCC NNP-BC handbook

$375

Total Exam Fee

NCC ($75 application + $300 testing)

15%

Respiratory Domain

NCC NNP-BC test plan (largest content area)

12%

Cardiovascular & Assessment

NCC NNP-BC test plan

3 yr

Cert Validity

NCC CCM recertification cycle

NCC NNP-BC validates advanced practice scope for neonatal nurse practitioners. The computer-based exam delivers 175 questions (150 scored + 25 pretest) over 3 hours via PSI testing centers, with a total cost of $375 ($75 application + $300 testing). Eligibility requires a graduate-level NNP program, current RN/APRN license, and supervised NICU clinical hours. Recertification through NCC's CCM (Continued Competency Assessment) every 3 years.

Sample NCC NNP-BC Practice Questions

Try these sample questions to test your NCC NNP-BC exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A term infant is born to a mother with a positive GBS culture who received only one dose of penicillin 2 hours before delivery. The infant is asymptomatic at 4 hours of life. According to current AAP/CDC guidance and the Kaiser Permanente Neonatal Sepsis Calculator framework, which approach is MOST appropriate?

A.Start empiric ampicillin and gentamicin immediately based on inadequate intrapartum prophylaxis alone

B.Use risk-based assessment (sepsis calculator inputs and serial physical exams) and treat only if clinical signs develop or risk score warrants

C.Discharge home at 24 hours without further observation

D.Obtain a lumbar puncture before any further evaluation

Explanation: Current AAP guidance for infants 35 weeks or greater favors a risk-stratified approach using either the Kaiser Permanente Neonatal Sepsis Calculator or serial clinical observation. Inadequate intrapartum antibiotic prophylaxis alone, in an asymptomatic well-appearing infant, no longer mandates empiric antibiotics.

2An infant is delivered at 38 weeks via emergency C-section for non-reassuring fetal heart tracing. At 1 minute, the infant has a heart rate of 90 bpm, weak cry, some flexion, grimace with stimulation, and acrocyanosis. What is the correct 1-minute APGAR score?

A.4

B.5

C.6

D.7

Explanation: APGAR scoring: HR 90 = 1 point (less than 100), weak cry/respiratory effort = 1, some flexion = 1, grimace only = 1, acrocyanosis = 1. Total = 5.

3A 39-week infant born to a mother with poorly controlled type 1 diabetes is large for gestational age (4.6 kg). At 1 hour of life, point-of-care glucose is 28 mg/dL. The infant is asymptomatic. According to AAP 2011 guidance for transient neonatal hypoglycemia in IDM, what is the BEST initial management?

A.Continue routine feeding only and recheck in 4 hours

B.Provide a feeding (breast or 5 mL/kg formula) and recheck glucose within 30-60 minutes; treat with IV D10W if persistently low or symptomatic

C.Administer IV D10W bolus at 5 mL/kg immediately as first-line

D.Begin glucagon 0.3 mg/kg IM immediately

Explanation: AAP guidance for asymptomatic IDM with glucose less than 40 mg/dL in the first 4 hours is to feed first and recheck. IV dextrose (D10W 2 mL/kg over 1 minute followed by infusion at 5-8 mg/kg/min) is reserved for symptomatic infants or persistent hypoglycemia after feeding.

4A neonate is born to a mother who took oxycodone throughout pregnancy. At 36 hours, the infant has tremors when undisturbed, hyperactive Moro, mild tachypnea, and excessive crying. Per current AAP NAS/NOWS guidance and the Eat-Sleep-Console (ESC) approach, which is the FIRST-LINE intervention?

A.Initiate oral morphine 0.04 mg/kg every 3 hours immediately

B.Begin non-pharmacologic care (rooming-in, swaddling, low stimulation, breastfeeding when appropriate) and assess function-based ESC criteria before pharmacotherapy

C.Give phenobarbital 20 mg/kg loading dose

D.Start clonidine 1 mcg/kg every 4 hours

Explanation: Modern NOWS care prioritizes non-pharmacologic measures and ESC functional assessment (can the infant Eat, Sleep, and be Consoled?). Pharmacotherapy is added only when these functional benchmarks cannot be met despite optimized non-pharmacologic care.

5Maternal preeclampsia with severe features is associated with which constellation of neonatal findings?

A.Macrosomia and polycythemia exclusively

B.IUGR/SGA, thrombocytopenia, neutropenia, and increased risk of magnesium toxicity if mother received MgSO4

C.Congenital heart block and isolated thrombocytosis

D.Hyperinsulinemia with persistent hypoglycemia for weeks

Explanation: Placental insufficiency in preeclampsia produces IUGR/SGA. Maternal disease and/or magnesium therapy can cause neonatal thrombocytopenia, neutropenia, and respiratory depression/hypotonia from magnesium effect.

6Per NRP 8th edition, after 30 seconds of effective positive pressure ventilation that achieves chest rise, the infant's heart rate remains at 50 bpm. What is the NEXT step?

A.Begin chest compressions immediately at 3:1 ratio

B.Intubate (or place laryngeal mask) and provide PPV with 100% oxygen; if HR remains less than 60 after another 30 seconds of effective PPV, then begin chest compressions at 3:1 with 100% O2

C.Administer epinephrine 0.02 mg/kg via ETT immediately

D.Stop resuscitation efforts

Explanation: NRP 8th edition emphasizes that ventilation is the most important step. If HR is less than 60 after 30 seconds of PPV that moves the chest, the team should secure the airway (intubation or LMA), increase to 100% O2, and only then begin compressions if HR remains less than 60 after another 30 seconds of effective ventilation.

7Per NRP 8th edition, the recommended ratio of chest compressions to ventilations during neonatal CPR is:

A.15:2

B.30:2

C.3:1

D.5:1

Explanation: NRP uses a 3:1 compression-to-ventilation ratio (90 compressions and 30 breaths per minute, totaling 120 events per minute). This reflects the predominantly respiratory etiology of neonatal arrest.

8Per NRP 8th edition, what is the recommended dose of epinephrine when given via the endotracheal tube during neonatal resuscitation?

A.0.01 mg/kg of 1:10,000

B.0.02 mg/kg of 1:10,000 (range 0.05-0.1 mg/kg has been replaced)

C.0.1 mg/kg of 1:1,000

D.0.001 mg/kg of 1:10,000

Explanation: NRP 8th edition recommends ETT epinephrine dosing of 0.05-0.1 mg/kg (0.5-1 mL/kg of 1:10,000), reflecting that the older 0.01-0.03 mg/kg ETT dose is inadequate. The IV/UVC dose is 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000); higher concentration is used because absorption from ETT is poor. Note: examiners often write 0.02 mg/kg as shorthand for the IV dose; verify dose by route.

9A 28-week infant with respiratory distress is delivered. NRP recommends targeting which initial FiO2 for resuscitation?

A.21% (room air)

B.21-30%, titrated to pre-ductal SpO2 targets

C.100% from the start

D.60-65% as the standard initial setting

Explanation: For preterm infants less than 35 weeks, NRP 8th edition recommends starting with 21-30% FiO2 and titrating to pre-ductal SpO2 targets (60-65% at 1 minute, climbing to 80-85% by 5 minutes and 85-95% by 10 minutes).

10A late-preterm infant (35 weeks) is born to a mother with chorioamnionitis. The infant is asymptomatic. Per current AAP and CDC guidance, the BEST initial approach is:

A.Discharge after 24 hours regardless of clinical status

B.Obtain a CBC and blood culture and apply a risk-stratified approach (sepsis calculator or enhanced observation), starting empiric ampicillin/gentamicin if risk warrants

C.Empirically start vancomycin and cefotaxime for 14 days

D.Treat with oral amoxicillin for 7 days as outpatient

Explanation: Maternal intrapartum fever or chorioamnionitis raises sepsis risk. Current practice uses the Kaiser sepsis calculator or enhanced clinical observation with selective antibiotics, rather than blanket empiric treatment of all such infants.

About the NCC NNP-BC Exam

NCC NNP-BC is the national certification for advanced practice neonatal nurse practitioners who manage acutely ill, premature, and high-risk newborns in NICU settings. The exam validates knowledge of general assessment, fetal-maternal history and transition (12%); cardiovascular (12%); respiratory (15%); neurologic (10%); GI/nutrition (10%); renal/GU (5%); hematology/bilirubin (10%); infection (10%); genetics/anomalies (5%); endocrine/metabolic (3%); and professional role/ethics/health policy (8%).

Questions

175 scored questions

Time Limit

3 hours

Passing Score

Scaled score per NCC standard-setting (approx 70% of 150 scored items)

Exam Fee

$375 total ($75 application + $300 testing) (National Certification Corporation (NCC) / PSI)

NCC NNP-BC Exam Content Outline

12%

General Assessment, Fetal-Maternal History & Transition

Perinatal risk factors, APGAR scoring, maternal conditions affecting newborn (preeclampsia, GDM/T1DM, chorioamnionitis, GBS prophylaxis, magnesium, opioid/SSRI exposure), Ballard score, NRP transition algorithms

12%

Cardiovascular

Congenital heart defects (TOF, TGA, HLHS, VSD, ASD, PDA, coarctation), differential cyanosis, ductal-dependent lesions, prostaglandin E1, PPHN, inhaled nitric oxide

15%

Respiratory

RDS and surfactant therapy (Curosurf, Survanta, Infasurf), BPD/CLD, MAS, TTN, pneumothorax, neonatal ventilation (HFOV, HFJV, NIV, CPAP), oxygen targeting (90-95% per BOOST II/SUPPORT)

10%

Neurology

IVH grading (Papile), HIE/therapeutic hypothermia (Sarnat staging, NICHD/CoolCap criteria), neonatal seizures, NAS/NOWS scoring, CNS malformations

10%

GI / Nutrition

Feeding advancement, NEC (Bell staging), bowel atresias, gastroschisis vs omphalocele, TPN/PN, breast milk fortification, parenteral nutrition complications

Renal / GU

UTI in neonates, posterior urethral valves, hydronephrosis, electrolyte disturbances, neonatal AKI

10%

Hematology / Bilirubin

Hyperbilirubinemia (Bhutani nomogram, AAP 2022 guidelines, exchange transfusion criteria), anemia of prematurity, ABO/Rh incompatibility, polycythemia, NAIT

10%

Infection

Early-onset vs late-onset sepsis (Kaiser Permanente Neonatal Sepsis Calculator), GBS, CMV, HSV, candida, coagulase-negative staph CLABSI

Genetics & Congenital Anomalies

Trisomy 21, 18, 13; Turner; DiGeorge; chromosomal evaluation; dysmorphology

Endocrine / Metabolic

IDM hypoglycemia, IEM newborn screening, congenital adrenal hyperplasia, congenital hypothyroidism

Professional Role / Ethics / Health Policy

APRN scope, NRP, family-centered care, advance directives in NICU, palliative care, golden hour, antibiotic stewardship

How to Pass the NCC NNP-BC Exam

What You Need to Know

Passing score: Scaled score per NCC standard-setting (approx 70% of 150 scored items)
Exam length: 175 questions
Time limit: 3 hours
Exam fee: $375 total ($75 application + $300 testing)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NCC NNP-BC Study Tips from Top Performers

1Master NRP 8th edition algorithms — PPV, chest compressions 3:1, intubation criteria, epinephrine dosing (0.02 mg/kg ETT, 0.01-0.03 mg/kg IV)

2Memorize surfactant products and dosing — Curosurf 2.5 mL/kg (200 mg/kg), Survanta 4 mL/kg, Infasurf 3 mL/kg

3Know the AAP 2022 hyperbilirubinemia guidelines and Bhutani nomogram phototherapy/exchange thresholds

4Practice neonatal ventilator setup — typical PIP, PEEP, rate, Ti, FiO2 targets for RDS, MAS, BPD, and PPHN

5Review Bell staging for NEC, Papile grading for IVH, Sarnat staging for HIE, and Finnegan/ESC for NAS

6Study the Kaiser Permanente Neonatal Sepsis Calculator inputs and how it changes empiric antibiotic decisions

7Understand APRN scope, prescriptive authority, and procedural privileges (intubation, UAC/UVC, LP, chest tube, paracentesis)

Frequently Asked Questions

What is the NCC NNP-BC exam?

The NNP-BC (Neonatal Nurse Practitioner Board Certified) is the National Certification Corporation's advanced practice credential for nurse practitioners who manage acutely ill, premature, and high-risk newborns in NICU settings. It is distinct from the RN-level CCRN-Neonatal and RNC-NIC because it validates an APRN scope including diagnosis, prescribing, and procedures (intubation, UAC/UVC placement, lumbar puncture, chest tube).

How many questions are on the NNP-BC exam?

The NCC NNP-BC exam contains 175 multiple-choice questions: 150 scored items and 25 unscored pretest items. You have 3 hours to complete the computer-based exam at a PSI testing center.

How much does the NNP-BC exam cost?

The NCC NNP-BC core exam is $375 total — a $75 application fee plus a $300 testing fee. Subspecialty add-on assessments and recertification CCM (Continued Competency Assessment) modules carry separate fees.

What are the eligibility requirements for NNP-BC?

Candidates must (1) hold a current, unrestricted RN license; (2) have completed a graduate-level NNP program (master's, post-master's certificate, or DNP) accredited by CCNE or ACEN; and (3) meet NCC's clinical hour requirements in neonatal advanced practice. New graduates may apply within 8 years of program completion.

How is NNP-BC different from CCRN-Neonatal?

CCRN-Neonatal is an RN-level critical care certification from AACN focused on bedside nursing of critically ill neonates. NNP-BC is an advanced practice (APRN) certification from NCC for graduate-prepared neonatal nurse practitioners who diagnose, prescribe medications, perform procedures, and serve as neonatologist-extenders within the NICU team.

How does NNP-BC recertification work?

NCC uses a Continued Competency Assessment (CCM) every 3 years. Candidates take a personalized assessment that identifies knowledge gaps, then complete required continuing education modules in those areas. There is no fixed CE-hour requirement — the CCM tailors learning to each candidate's results.

What NRP topics appear on NNP-BC?

NRP 8th edition concepts are heavily tested: PPV initiation criteria, chest compressions at a 3:1 ratio, intubation indications, epinephrine dosing (0.02 mg/kg ETT or 0.01-0.03 mg/kg IV/UVC), thermoregulation goals, golden hour management, and team communication. Surfactant administration, oxygen targeting (90-95% SpO2), and ventilator escalation pathways are also high-yield.