Advanced Newborn Resuscitation: Compressions, Heart Rate Thresholds, Epinephrine, Volume, and Airway Devices Practice Questions

25 multiple-choice questions on Advanced newborn resuscitation: compressions, heart rate thresholds, epinephrine, volume, and airway devices for paramedic and EMT students, from Chapter 43 (Neonatal Care). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Chest compressions are indicated in a newborn when the heart rate remains below:

   1. A. 100 beats/min after the initial steps have been completed
   2. B. 80 beats/min with or without effective ventilation
   3. C. 60 beats/min after 30 seconds of effective ventilation
   4. D. 60 beats/min before any ventilation is given
   Show answer

   Answer: C. 60 beats/min after 30 seconds of effective ventilation

   Compressions start only after at least 30 seconds of ventilation that inflates the lungs, ideally through an alternative airway, fails to bring the rate above 60. Starting compressions before ventilating skips the step that fixes most newborn bradycardia.

2. The compression-to-ventilation ratio for newborn resuscitation is:

   1. A. 15:2
   2. B. 3:1
   3. C. 30:2
   4. D. 5:1
   Show answer

   Answer: B. 3:1

   Newborns receive 3 compressions to 1 breath because their arrest is almost always respiratory. The 15:2 ratio is used for two-rescuer CPR in infants and children outside the newborn period.

3. In newborn CPR, the 3:1 cycle should deliver about how many total events per minute?

   1. A. 100 events: 100 compressions and 10 breaths
   2. B. 150 events: 120 compressions and 30 breaths
   3. C. 60 events: 45 compressions and 15 breaths
   4. D. 120 events: 90 compressions and 30 breaths
   Show answer

   Answer: D. 120 events: 90 compressions and 30 breaths

   Each 2-second cycle of 'one-and-two-and-three-and-breathe' gives 90 compressions and 30 breaths per minute. A rate of 100 to 120 compressions is the target for older infants and adults, not for the coordinated newborn cycle.

4. The preferred technique for newborn chest compressions is:

   1. A. Two fingers on the sternum with the other hand on the back
   2. B. The heel of one hand on the lower half of the sternum
   3. C. Two thumbs on the sternum with hands encircling the chest
   4. D. Two thumbs over the xiphoid with the fingers on the back
   Show answer

   Answer: C. Two thumbs on the sternum with hands encircling the chest

   The two-thumb encircling technique generates better blood pressure and is less tiring, and it lets a second rescuer reach the umbilicus. Thumbs over the xiphoid risk injuring the liver; the correct landmark is the lower third of the sternum just above it.

5. Newborn chest compressions should depress the sternum about:

   1. A. One third of the chest depth
   2. B. One half of the full chest depth
   3. C. One quarter inch (6 mm)
   4. D. Two inches (5 cm)
   Show answer

   Answer: A. One third of the chest depth

   Compressing about one third of the anterior-posterior diameter produces effective flow without excessive trauma. Two inches is an adult or larger-child depth and would be far too deep for a newborn.

6. When chest compressions begin in a newborn, the oxygen concentration should be:

   1. A. Increased to 100%
   2. B. Kept at 21% room air
   3. C. Lowered to 30%
   4. D. Titrated to 80%
   Show answer

   Answer: A. Increased to 100%

   Once compressions are needed, oxygen is increased to 100% until the heart rate recovers and a reliable saturation reading guides weaning. Room air is the correct starting point for ventilation alone, not for an infant needing compressions.

7. Before starting chest compressions in a newborn, the guidelines strongly recommend that you:

   1. A. Insert an IO needle and give a dose of epinephrine first
   2. B. Check a blood glucose level and give dextrose if low
   3. C. Wait 2 full minutes to see if the heart rate improves
   4. D. Secure an ET tube or laryngeal mask airway
   Show answer

   Answer: D. Secure an ET tube or laryngeal mask airway

   An advanced airway makes ventilation more reliable during coordinated compressions, which compete with breaths for time. Epinephrine comes later, after 60 seconds of compressions with effective ventilation.

8. How often should the heart rate be reassessed once chest compressions have begun in a newborn?

   1. A. Every 15 seconds
   2. B. Every 60 seconds
   3. C. Every 5 minutes
   4. D. Every 2 minutes
   Show answer

   Answer: B. Every 60 seconds

   Compressions continue for 60 seconds before the heart rate is rechecked, ideally by ECG, to limit interruptions. Checking every 15 seconds would interrupt perfusion too often to be useful.

9. During newborn CPR, compressions should be stopped when the heart rate rises to:

   1. A. 100 beats/min or more
   2. B. 80 beats/min or more
   3. C. 60 beats/min or more
   4. D. 120 beats/min or more
   Show answer

   Answer: C. 60 beats/min or more

   Once the rate is 60 or higher, compressions stop and ventilation continues until the rate exceeds 100 and breathing is adequate. Waiting for 100 continues compressions on a heart that is already beating at a perfusing rate.

10. The first medication indicated during newborn resuscitation when the heart rate stays below 60 despite ventilation and compressions is:

    1. A. Atropine
    2. B. Naloxone
    3. C. Epinephrine
    4. D. Sodium bicarbonate
    Show answer

    Answer: C. Epinephrine

    Epinephrine is given when the heart rate stays below 60 after 60 seconds of compressions with effective ventilation, preferably 100% oxygen through an advanced airway. Atropine is not used because newborn bradycardia is caused by hypoxia, not vagal tone.

11. The recommended IV or IO dose of epinephrine for a newborn is:

    1. A. 0.1 mg/kg (range 0.05 to 0.1 mg/kg)
    2. B. 0.02 mg/kg (range 0.01 to 0.03 mg/kg)
    3. C. 1 mg regardless of the infant's weight
    4. D. 0.2 mg/kg (range 0.1 to 0.3 mg/kg)
    Show answer

    Answer: B. 0.02 mg/kg (range 0.01 to 0.03 mg/kg)

    The IV or IO dose is 0.01 to 0.03 mg/kg, which is 0.1 to 0.3 mL/kg of the 0.1 mg/mL concentration. The 0.05 to 0.1 mg/kg range is the higher endotracheal dose, used only while vascular access is being obtained.

12. The endotracheal dose of epinephrine for a newborn is:

    1. A. 0.05 to 0.1 mg/kg
    2. B. 0.01 to 0.03 mg/kg
    3. C. 0.5 to 1 mg/kg
    4. D. 1 mg total
    Show answer

    Answer: A. 0.05 to 0.1 mg/kg

    Endotracheal absorption is unreliable, so the dose is higher, 0.05 to 0.1 mg/kg (0.5 to 1 mL/kg of 0.1 mg/mL). Using the IV dose down the tube is a common error that delivers too little drug.

13. For newborn resuscitation, epinephrine should be drawn up in which concentration?

    1. A. 1 mg/mL
    2. B. 0.01 mg/mL
    3. C. 10 mg/mL
    4. D. 0.1 mg/mL
    Show answer

    Answer: D. 0.1 mg/mL

    The 0.1 mg/mL (1 mg in 10 mL) concentration allows small, accurate doses for an infant weighing a few kilograms. The 1 mg/mL concentration is used intramuscularly for anaphylaxis and invites a tenfold dosing error in a newborn.

14. You are resuscitating a newborn estimated at 3 kg. The IV dose of epinephrine at 0.02 mg/kg is:

    1. A. 0.6 mg (6 mL of 0.1 mg/mL)
    2. B. 0.06 mg (0.6 mL of 0.1 mg/mL)
    3. C. 0.006 mg (0.06 mL of 0.1 mg/mL)
    4. D. 0.3 mg (0.3 mL of 1 mg/mL)
    Show answer

    Answer: B. 0.06 mg (0.6 mL of 0.1 mg/mL)

    Three kilograms times 0.02 mg/kg equals 0.06 mg, which is 0.6 mL of the 0.1 mg/mL solution. The 0.3 mg option is the adult anaphylaxis dose and would be a fivefold overdose here.

15. If the heart rate remains below 60 after the first dose of epinephrine, the dose may be repeated every:

    1. A. 3 to 5 minutes
    2. B. 30 to 60 seconds
    3. C. 10 minutes
    4. D. 1 minute
    Show answer

    Answer: A. 3 to 5 minutes

    Epinephrine may be repeated every 3 to 5 minutes while ventilation and compressions continue, and an IV dose is preferred if the first was given by ET tube. Repeating every 30 seconds risks hypertension and myocardial injury without benefit.

16. The preferred route of epinephrine during newborn resuscitation is:

    1. A. Endotracheal, through the breathing tube
    2. B. Intramuscular, into the lateral thigh muscle
    3. C. Intravenous, through an umbilical vein or IO
    4. D. Subcutaneous, into the upper arm
    Show answer

    Answer: C. Intravenous, through an umbilical vein or IO

    Intravascular epinephrine, by umbilical venous catheter or intraosseous needle, is preferred because it reliably reaches the heart. The endotracheal route may be used while access is being obtained, but absorption is unpredictable.

17. A newborn's mother had a large placental abruption. Despite effective ventilation and compressions, the infant is pale with weak pulses. You should consider:

    1. A. Normal saline 20 mL/kg pushed as fast as possible
    2. B. Dextrose 10% at 10 mL/kg over 1 minute
    3. C. Sodium bicarbonate 1 mEq/kg IV push
    4. D. Normal saline 10 mL/kg over 5 to 10 minutes
    Show answer

    Answer: D. Normal saline 10 mL/kg over 5 to 10 minutes

    Volume expansion with 10 mL/kg of isotonic crystalloid (or O-negative blood) over 5 to 10 minutes is indicated for suspected blood loss with signs of shock. Rapid large boluses are avoided in newborns, particularly preterm infants, because of the risk of intraventricular hemorrhage.

18. Naloxone in the delivery setting for a newborn with respiratory depression whose mother received opioids:

    1. A. Is the first step, given before ventilation
    2. B. Is not recommended; support ventilation
    3. C. Is given IM at 1 mg per kilogram
    4. D. Is given by the ET tube route first
    Show answer

    Answer: B. Is not recommended; support ventilation

    Current guidelines do not recommend naloxone as part of initial newborn resuscitation; the priority is effective ventilation, which treats the cause of the depressed breathing. Naloxone can also cause seizures in an infant of an opioid-dependent mother.

19. During newborn resuscitation, sodium bicarbonate is:

    1. A. Given first to correct acidosis
    2. B. Given with every dose of epinephrine
    3. C. Given by ET tube if no IV is placed
    4. D. Not recommended for routine use
    Show answer

    Answer: D. Not recommended for routine use

    Sodium bicarbonate is not part of routine newborn resuscitation, because acidosis is corrected by ventilation and restored perfusion. Its hyperosmolarity can harm the preterm brain, and it must never go down an ET tube.

20. For most term newborns, the correct endotracheal tube size is:

    1. A. 3.5 mm
    2. B. 2.5 mm
    3. C. 4.5 mm
    4. D. 5.0 mm
    Show answer

    Answer: A. 3.5 mm

    A 3.5-mm uncuffed tube fits most term infants over about 34 weeks or 2 kg, a 3.0-mm tube fits 28 to 34 weeks, and a 2.5-mm tube fits infants under 28 weeks. A 4.5-mm tube would suit an older child, not a newborn.

21. For a very preterm infant of about 26 weeks' gestation, the appropriate ET tube size is:

    1. A. 3.0 mm
    2. B. 3.5 mm
    3. C. 2.5 mm
    4. D. 4.0 mm
    Show answer

    Answer: C. 2.5 mm

    Infants under 28 weeks or under 1 kg need a 2.5-mm tube. A 3.0-mm tube is sized for 28 to 34 weeks and would likely be too large and traumatic for this infant.

22. You must place an emergency umbilical venous catheter in a newborn for epinephrine. The catheter should be advanced:

    1. A. About 2 to 4 cm, until blood flows back
    2. B. About 15 cm, so the tip lies in the heart
    3. C. Into one of the two umbilical arteries
    4. D. Until you feel resistance at the liver
    Show answer

    Answer: A. About 2 to 4 cm, until blood flows back

    For emergency use, the catheter goes into the single, thin-walled umbilical vein only 2 to 4 cm, just until blood returns freely. Advancing farther can place the tip in the liver, where drugs can cause injury. The two smaller, thick-walled vessels are arteries and are not used for this.

23. A newborn weighing about 3 kg has been intubated. Using the common estimate of weight in kilograms plus 6 cm, the tube mark at the lip should be about:

    1. A. 6 cm
    2. B. 12 cm
    3. C. 15 cm
    4. D. 9 cm
    Show answer

    Answer: D. 9 cm

    Weight in kilograms plus 6 cm gives 9 cm at the lip for a 3-kg infant. The NRP 9th edition now measures depth at the upper gum using a gestational-age table or the nasal-tragus length plus 1 cm, so follow the reference your protocol uses; whatever the rule, confirm placement with a rising heart rate, CO2 detection, and equal breath sounds. Six centimeters leaves out the weight and would leave the tip high, near the cords. Twelve or 15 centimeters would likely place the tube in the right mainstem bronchus. (NRP 9th ed.; CPS 9th edition summary.)

24. When an ET tube is placed in a newborn with a heart rate above 60, correct tracheal placement is best confirmed by:

    1. A. Fogging inside the tube and an absence of gastric sounds
    2. B. An immediate rise in blood glucose and tone
    3. C. A rising heart rate and a CO2 detector color change
    4. D. A chest radiograph obtained at the bedside
    Show answer

    Answer: C. A rising heart rate and a CO2 detector color change

    A prompt increase in heart rate plus exhaled CO2 detection is the primary confirmation in the field. Tube fogging is unreliable, because condensation can appear even when the tube is in the esophagus.

25. A laryngeal mask may be used as an alternative airway for newborn ventilation when the infant is at least about:

    1. A. 24 weeks' gestation or 600 g
    2. B. 34 weeks' gestation or 2 kg
    3. C. 28 weeks' gestation or 1 kg
    4. D. 40 weeks' gestation or 4 kg
    Show answer

    Answer: B. 34 weeks' gestation or 2 kg

    Laryngeal masks are accepted for infants of about 34 weeks or more, and most devices are sized for about 2 kg and up. The 2025 AHA/AAP guidelines and NRP 9th edition allow one as a primary interface or when face-mask ventilation or intubation is unsuccessful or unavailable. There is not enough evidence to set a safe lower limit, and the smallest sizes may not seal in very small preterm infants, so 24 weeks or 28 weeks is below the accepted range. Forty weeks or 4 kg is far too restrictive and would deny the device to most term infants. (AHA/AAP 2025; NRP 9th ed.)