2024candidate guide neonatal nurse practitioner nnp-bc

2024 Candidate Guide:

Neonatal Nurse Practitioner

2024 CANDIDATE GUIDE

NEONATAL NURSE PRACTITIONER

NNP-BC

Congratulations on taking the next step in your career – earning your NNP-BC certification!

INFORMATION INCLUDED:

Fees & General Policies 2-5

About the Exam 6

Exam Content 7-9

Study Guides 10-17

Study Resources 18

Sample Questions 19

Scoring & Test Report 20-21

Terms of Certification and

Certification Maintenance 2-23

THIS EXAM’S PURPOSE

The purpose of the Neonatal

Nurse Practitioner Core Board

Certification is to provide an

entry-level, competency-based

examination that tests specialty

knowledge and the application of

that knowledge for licensed

registered nurses in the US and

Canada who have completed a US

accredited nurse practitioner

program in the role of a Neonatal

Nurse Practitioner to provide

neonatal critical care to acutely

and critically ill neonatal patients

and their families within

intensive/critical care units,

hospitals or outpatient settings.

IT IS IMPORTANT TO READ THE

INFORMATION IN THIS GUIDE. IT

EXPLAINS ALL POLICIES TO WHICH

CANDIDATES WILL BE SUBJECT.

ABOUT THIS GUIDE

This guide lists fees and provides information that will help candidates

prepare for the examination. It includes the exam content in outline form,

competency statements and study guide. It also provides sample exam

questions to familiarize the test taker with question format, study

resources and lists some of NCC administrative policies & procedures. It is

recommended that candidates familiarize themselves with the

information in this guide.

NCC examinations are offered in several different test administrations

options. The NCC publication Guide to Testing Methods will explain the

different rules and policies based on how the candidate is taking the

examination. Please download this publication from the NCC website and

review the exam administration options. It will answer any questions

about the NCC examination process.

If there are other questions, please feel free to contact NCC through the

“Contact Us” page at NCCwebsite.org.

NCC’S PHILOSOPHY OF TESTING

Certification is an evaluative process that provides the opportunity for

advanced practice nurses in the obstetric, gynecologic and/or neonatal

specialty to demonstrate publicly what they know and to be recognized

for the special knowledge they possess. The NCC certification carries no

licensing authority. The ability to practice as an advanced practice nurse is

regulated by the state boards of nursing, and while certification may be

required in some states for advanced practice roles, NCC has no

regulatory power to require states to recognize NCC certification for this

purpose. Practice and educational standards are reflected in the

certification process, but the responsibility for development of such

standards rests with the professional nursing specialty organizations and

the nursing educational community. NCC encourages individual advanced

practice nurses to seek out information about how certification relates to

state licensure requirements, program accreditation of the educational

institutions attended, the educational and practice standards of national

nursing specialty organizations, and employment expectations.

NCC core and subspecialty programs are accredited by the National Commission for Certifying Agencies

FEES & GENERAL POLICIES

2024 Candidate Guide:

Neonatal Nurse Practitioner

EXAMINATION AND RELATED FEES

EXAMINATION FEES*

Test Center and Live Remote Proctoring (LRP) Computer Exam Fees are

$325 which includes the non-refundable $50 application fee.

*Examination fees are subject to change.

CANCELLATION: 6 HOUR WINDOW

Candidates have six hours from the time the submit an exam application to

cancel the exam. The order can be canceled by logging into the account and

clicking on "Cancel Application" found under the new certification. Only the

candidate can cancel the application and they must meet the 6-hour

window. After the six hours they must withdraw or pay for a change.

CHANGE REQUEST

Candidates who cannot take their

currently scheduled examination, have

missed their testing date or need to take a

different exam - can request a change for

a fee of $125. Details are on the NCC

website.

WITHDRAWAL FEE

A Testing Center or LRP testing candidate

who withdraws from testing is subject to a

$165 withdrawal fee. The candidate will

receive $160 of their $325 payment,

minus any outstanding charges. Bulk

Purchase Voucher candidates cannot

withdraw.

RETEST FEE

Retest candidates must pay full application and examination fees. There are

no discounts and they must complete a 90-day wait period* before

resubmitting an application for testing. (*see Retest Policy page 4).

Certification exams of the same specialty can only be taken TWICE in a

calendar year for the same candidate. Candidates must submit a new

application and again demonstrate eligibility and licensure.

SUBSTITUTION FEE

Candidate substitutions are not allowed for any reason.

THIRD PARTY PAYMENTS

Applicant fees paid by third parties will be refunded to the third party in

accordance with stated refund policies, in the event the applicant is

determined ineligible or withdraws within the specified time. Vouchers are

nonrefundable.

NO REFUNDS WILL BE

CONSIDERED FOR ANY

CANDIDATE

• who has taken an

examination

• who is not successful in

achieving certification

• who failed to take the exam

at a Test Center or via Live

Remote Proctoring (LRP)

within the 90-day testing

window and did not submit

a change request within

stated time frames

• who failed to schedule an

appointment to test within

the first 30 days of their 90-

day eligibility window and is

unable to schedule their

exam within their eligibility

window.

• who failed to have proper ID

or meet any required rules

• who failed to login to the

test portal or appear at the

test center (no-show) or

who signed in late to the

test portal or arrived late to

the test center

• who failed to take a

scheduled exam for any

reason (illness, quarantine,

accident, death, etc.)

Test Date Change

Test Center and Live Remote

Proctoring (LRP) exam

candidates can change their

scheduled testing date to

another date within their

window once for free.

Candidates must handle this

directly with PSI/AMP.

Refer to the NCC testing

guide for details.

FEES & GENERAL POLICIES

2024 Candidate Guide

: Neonatal Nurse

Practitioner

PAYMENT INFORMATION

• All applications are subject to a

nonrefundable application fee.

• All fees are nonrefundable

except where otherwise noted.

• Payments can be made by

credit card (Visa, American

Express and MasterCard only).

NCC does not accept debit cards

or split payments (part check and

part credit card).

• Payments can be made by e-

check: bank routing number and

account number required.

• For payments made by third

parties, any refund will be issued

to the third party and not to the

applicant. Vouchers are

nonrefundable.

• All payments must be in US

funds.

• Exam fees can only be

submitted online at the NCC

website. Applications will not be

accepted by mail, phone or fax.

• NCC will accept group

payments for certification exams

from institutions. Details are on

the NCC website under Bulk

Purchases.

OTHER NON-REFUNDABLE PAYMENT RELATED FEES

INCOMPLETE APPLICATION FEE

All incomplete applications are subject to a non-refundable $30

reprocessing fee upon the submission of proper documentation.

Incomplete applications are those submitted with missing information, (e.g.

required licensure information and corroborating uploaded documentation;

containing incomplete or incorrect information; or do not include full fee

payment).

RETURNED CHECKS AND CREDIT CARD CHARGEBACK FEE

A $30 fee will be assessed for any check or e-check returned or a credit card

payment disputed for any reason. Remittance thereafter of all fees and

applications must be in the form requested by NCC.

LICENSE VERIFICATION

If licensure information is requested requiring an additional submission, the

candidate will have two weeks to provide the license with all the correct

information and pay the non-refundable $30 reprocessing fee. If this is not

provided within the two weeks, the application will be marked ineligible.

Ineligible applicants will receive a refund minus the $50.00 non-refundable

application fee. There are no refunds or withdrawals for applications using

a bulk code.

VERIFICATION OF CERTIFICATION

Third party notification of status will NOT be released without authorization

from the NP. A $30 fee is required for any third-party notification or

issuance of duplicates of test results reports. Verification requests can only

be submitted after official results with score report have been uploaded to

the candidate’s NCC account.

Verification requests can only be made via the online verification system on

the NCC website. NCC does not issue verifications via the mail or fax.

Certification will be revoked or withheld if a returned check or a

chargeback request on a credit card payment results in loss of

income to NCC and the monies are not recovered in an alternate

payment. Fees received at any time will first be applied to any

unpaid prior certification/special fees.

FEES & GENERAL POLICIES

2024 Candidate Guide:

Neonatal Nurse Practitioner

UNSUCCESSFUL CANDIDATES

A candidate who sits for the

examination and does not receive a

passing score is not eligible for any

refund nor for any credit on any

later NCC exam.

NONDISCRIMINATION

It is the policy of NCC that no

individual will be excluded from

the examinations as a result of

age, sex, race, religion, national

origin, ethnicity, disability,

marital status, sexual

orientation, military status or

gender identity.

AMERICANS WITH DISABILITIES

ACT

Special testing accommodations

will be provided pursuant to the

Americans with Disabilities Act.

Any requests for special testing

accommodations must be made

in writing and submitted with the

application. The accommodation

request form can be downloaded

from the NCC website. Upon

receipt of a request for special

accommodations, NCC will

contact the applicant. Such

requests must be signed by a

clinician, physician, or other

qualified specialist with training

and experience appropriate to

diagnose and treat the specified

disability.

GENERAL POLICIES

EXAM CATEGORY CHANGES

Candidates can only request an exam category change by completing a

Change Request Form on the NCC website and submitting with non-

refundable payment of $125. Candidates are only allowed one change

request (e.g. After a change request is submitted no other change request

can be submitted). All change requests must be approved by NCC. There

will be no refund of original or Change Request fees. Eligibility must be re-

established for the new exam category, and additional documentation and

fees may be required. The time to consider eligibility for the new category

will count toward the original assigned 90-day testing window.

Examination category cannot be changed from a subspecialty or RN Core

application to a NNP or WHNP certification. Examinees must take the

exam for which they have been determined eligible. No changes will be

permitted on examination day. If a candidate knowingly or unknowingly

takes an examination other than the one they were found eligible to take,

the examination will not be scored. No refunds will be allowed, and all fee

policies will apply if the candidate reapplies for an examination. See

website for complete details.

RETEST POLICY

Candidates may retake the examination if they do not pass. They must

reapply 90 days after the test was taken, submit all applicable fees and

documentation, and re-establish eligibility according to the appropriate

deadlines. There is no limit to the number of times a candidate may retake

the examination. However, the maximum number of times a candidate

can take the same NCC test in a calendar year is two.

All retest candidates must wait 90 days from the date their exam was

taken before they can submit a new application to retest.

• this date is provided in the candidate's results notification

• this 90-day wait period affects all modes of testing

Any loss of power or internet during an exam in which there was more than

15 minutes of testing with exposure to more than 10% of the exam requires

a retest at a Test Center. Candidates will have to wait 90-days before they

can reschedule and they must follow NCC’s retest policy. A decision on the

timing of a second attempt will be made after NCC reviews the test

exposure. There is no need to complete a new application, but candidates

MUST notify NCC of the internet disconnection issue as soon as computer

access is available.

If a retest application is submitted prior to the 90-day wait period, the

application will be returned as ineligible. The applicant will be subject to

the $50 non-refundable application fee.

FEES & GENERAL POLICIES

2024 Candidate Guide

: Neonatal Nurse

Practitioner

REVIEW COURSES AND

MATERIALS

NCC does not offer or sponsor

review courses or review

materials for its certification

examinations. Examination

candidates should view any

course of study as being

independent of NCC. Candidates

should carefully examine the

merits of any individual exam

preparation offering before

participating.

TEST DISCLOSURE

NCC does not make test

questions available for review.

Because test questions may be

used for more than one

examination administration,

distributing this information

would compromise the security

of the test questions and would

increase the cost of certification

if the questions had to be

replaced each year.

REVOCATION

Your certification may be

revoked for falsifying any

information submitted to

determine eligibility to take the

certification examination or for

maintaining certification, for

losing your license to practice

nursing, or for failing to pay

designated certification or

maintenance fees.

POLICIES ARE SUBJECT

TO CHANGE

WITHOUT NOTICE.

GENERAL POLICIES (CONTINUED)

INTERNET DISCONNECTIONS

If the candidate has started the exam and is disconnected, please use the

PSI tech lines if testing with LRP or if at a Test Center discuss immediately

with the proctor to attempt to get reconnected and continue testing.

If the candidate is unable to get reconnected after starting the exam, the

timing for a second attempt to take the exam will be based on how much

time and how many questions they were exposed to. If a candidate is

disconnected and cannot be reconnected and has tested for under 15

minutes and were exposed to less than 10% of the exam they may be able

to reschedule within their current eligibility window. Candidates must work

directly with PSI that day to reschedule and if they run into any issues

they must notify NCC within 3 days of testing. If a candidate tests for

longer than 15 minutes and/or saw more than 10% of the questions on the

exam they will have to wait 90 days before they can reschedule, and they

must follow NCC’s retest policy. A decision on the timing of a second

attempt will be made after NCC reviews the test exposure. Please note,

candidates will need to retest at a Test Center. Please notify NCC of the

internet disconnection issue as soon as computer access is available.

APPEALS PROCEDURE

Any request to waive any policy of the NCC Board of Directors relative to

eligibility, administration, examination content issues, or certification

maintenance must be received in writing within 60 days of the dispute. All

requests should be sent to the attention of the NCC President at

nccpresident@nccnet.org. The correspondence should contain a detailed

account as to why the NCC policy should be waived or the candidate’s

status should be changed. Such requests are referred to the NCC Policy

Review Committee of the Board of Directors. All decisions will be provided

in writing. Cases not resolved by the Policy Review Committee will be

referred to the full Board of Directors.

DESIGNATION AUTHORIZATION

Certification is a non-transferable, revocable, limited, non-exclusive license

to use the certification designation “NNP-BC®”, subject to compliance with

the policies and procedures, as may be revised from time to time.

Any use or display of NCC certification marks and/or logos without the prior

written permission of the NCC is prohibited. Any candidate or certificant

who manufacturers, modifies, reproduces, distributes or uses a fraudulent

or otherwise unauthorized NCC certificate, NCC designation or other

credential may be subject to disciplinary action, including denial or

revocation of eligibility or certification. Any individual who engages in such

behavior also may be subject to legal action.

ABOUT THE EXAM

2024 Candidate Guide

: Neonatal Nurse

Practitioner

ABOUT THE EXAM

TIMED EXAMINATION

Three (3) hours are allotted to

complete the examination.

EXAM FORMAT

The Neonatal Nurse Practitioner

examination consists of 175 test

questions. 150 are scored and the

remainder are embedded in the

exam as pretest items. The pretest

items do not count toward the

examinee’s final results.

- There is one question format

used for all NCC examinations.

- Each question has a premise

(stem) and three possible

answers, two distractors and

only one correct answer.

- The answer options are

alphabetized by the first word in

each answer option to

randomize the answers.

- Tests are delivered in a different

random order for each

candidate.

- Questions will test both basic

knowledge and application of

knowledge.

- Questions that contain

laboratory data will show results

in conventional units of measure

with international units in

parentheses.

- Drugs are listed in both generic

and trade names where

appropriate.

EXAMINATION CONTENT DEVELOPMENT

The development of NCC certification involves many individuals and

involves a meticulous process of review. There are three major groups

that contribute to the test development process:

ITEM WRITERS:

NPs and others identified with special expertise have the responsibility of

drafting test items per designated assignment for review by the content

team and expert reviewers. Item writers are solicited from the NCC

certified population, by recommendations or through the volunteer

portal.

REVIEWERS:

Reviewers are NPs or other designated experts who assist the content

teams in review of test items developed by the item writers. Reviewers

are responsible for reviewing items for content relevance and confirming

that references cited for the questions support the items as written.

CONTENT TEAMS:

Content team members are experienced practitioners and are appointed

on an annual basis by the NCC President. Content teams are solicited from

the NCC certified population, by recommendations or through the

volunteer portal. To see the current membership composition of the

Content Team responsible for the Neonatal Nurse Practitioner

examination, please visit the NCC website under the section on NCC

Leadership.

Content team members are NPs or other identified experts who:

- develop and update the test outline and competency statements

- review test items developed by item writers

- review item statistics from exam administrations and pretest

examinations

- approve the exam forms to be administered

- review item banks

In addition, NCC uses volunteers for standard setting and content

validation studies/job analysis studies.

EXAMINATION CONTENT

2024 Candidate Guide

: Neonatal Nurse

Practitioner

Neonatal Nurse Practitioner exam

The above chart shows the percentage distribution of questions on the Neonatal Nurse Practitioner exam across the

major content categories covered on the examination. The major focus of the examination is on Embryology,

Physiology, Pathophysiology and Systems Management. Less emphasis is on General Management, General

Assessment and Pharmacology while the Professional Issues category has the lowest percentage of content covered

on the exam.

15%

General Assessment

19%

General Management

Pharmacology

54%

Embryology,

Physiology,

Pathophysiology and

Systems Management

Professional Issues

Percentage of Questions in Content Categories

EXAMINATION CONTENT

2024 Candidate Guide:

Neonatal Nurse Practitioner

EXAM OUTLINE

Areas of knowledge to be tested

on the Neonatal Nurse

Practitioner examination are

listed in the following outline.

This list is not intended as an all-

inclusive review of the role and

scope of knowledge of the

neonatal nurse practitioner. It is

provided only to help

certification candidates evaluate

their own nursing practice.

Percentages identified for the

topic areas represent the number

of test questions assigned to

each content area. These areas

do not necessarily reflect the

content of future examinations.

11.00 General Assessment (15%)

Maternal History affecting the Newborn

Neonatal

Family Integration

Discharge Preparation and Follow-up Care

12.00 General Management (19%)

Thermoregulation

Resuscitation and Stabilization

Growth and Nutrition

Fluids and Electrolytes

15.00 Pharmacology (9%)

Pharmacokinetics and Pharmacodynamics

Common Drug Therapies

13.00 Embryology, Physiology, Pathophysiology and Systems Management

(54%)

Cardiac

Respiratory

Gastrointestinal

Renal/Genitourinary

Metabolic/Endocrine

Hematopoietic

Infectious Diseases

Musculoskeletal

Integumentary

Genetics

Neurological

Ears, Eyes, Nose & Mouth/Throat

14.00 Professional Issues (3%)

Including: (e.g. Legal, Ethical, Neonatal Safety and QI)

EXAMINATION CONTENT

2024 Candidate Guide:

Neonatal Nurse Practitioner

ASSOCIATED COMPETENCIES

• Demonstrate the knowledge inherent in the role and scope of NNP practice

• Apply knowledge of basic sciences to the provision of neonatal health care

• Obtain and interpret a comprehensive perinatal history and a systematic assessment of all body systems

• Obtain clinical laboratory information and interpret the resultant data

• Institute diagnostic procedures and techniques and interpret the resultant data

• Apply critical thinking to diagnose reasoning and clinical decision make with the care giver and family

• Evaluate the benefits and risks of diagnostic and therapeutic intervention

• Use adult learning principles when teaching about the care, growth and development of the high-risk infant up

to 2 years of age

• Formulate a diagnosis and a plan of care in collaboration with physicians, other health care professionals and

family.

• Initiate appropriate therapeutic and educational interventions including consultations and referral

• Evaluate and document responses to interventions and modify the plan of care as indicated

• Maintain current knowledge regarding advances in neonatal health care

• Apply knowledge of basic research principles to practice

• Integrate legal and ethical principles into neonatal health care

STUDY GUIDE

2024 Candidate Guide:

Neonatal Nurse Practitioner

GENERAL ASSESSMENT

I. Maternal History affecting the Newborn

Antepartum

• Neonatal complications: maternal risk factors &

complications

-gestational hypertension

-cardiac/pulmonary disease

-diabetes

-common infectious diseases

-common hematologic diseases

-placental insufficiency

-substance abuse

-medication effects

common prescription or non-prescription drugs

• Fetal assessment

-fetal fibronectin

-nonstress test

-biophysical profile

-ultrasound/doppler flow

-amniocentesis

-antenatal screening/quad screen

• Fetal procedures

Intrapartum

• Fetal Heart Rate (FHR) Patterns

• Effects on the Fetus/Neonate

-tocolysis/induction

-analgesia

-anesthesia

-neuroprotective agents

• Intrapartum Complications

-amniotic fluid volume

-oligohydramnios

-polyhydramnios

• Rupture of Membranes

-premature

-prolonged

Intrauterine Drug Exposure

• Nicotine

• Alcohol

• Prescription/nonprescription

• Illicit Drug

II. Neonatal

Physical Examination & Gestational Age/Behavioral

Assessment Identify Normal, Normal Variants and

Abnormal Findings

• General appearance

• Head, eyes, nose, ears and mouth

• Neck and throat

• Chest

• Abdomen

• Spine/back

• Extremities

• Genitalia

• Musculoskeletal

• Skin

• Vital signs

• Gestational age assessment physical

Characteristics of

-preterm

-term

-post-term

-AGA

-SGA

-LGA

• Associated risks/Complications of variations in

gestational age

• Abnormalities of intrauterine parameters

• Behavioral assessment

-state

• Muscle movement/tone/reflexes

• Autonomic control/responses

• Neurosensory capabilities

• Neurological assessment

STUDY GUIDE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

Clinical Laboratory Tests

• Microbiological

• Biochemical

• Hematological

• Endocrine

• Immunologic

• Genetic

Diagnostic Studies, Techniques and Equipment

Diagnostic studies

• Ultrasound/Doppler

• CT scan

• MRI

• X-ray/fluoroscopy

• EKG

• EEG

• Echocardiogram

• Voiding Cystourethrogram

Techniques & Equipment

• Procedures

-bag and mask ventilation and T-piece

-LMA’s

-endotracheal intubation

-umbilical vessel and peripheral catheterization

-chest tube insertion/removal

-needle aspiration

-spinal/lumbar tap

-intraosseous access

-intravenous line placement (central/peripheral)

-blood sampling

-circumcisions - complications/contraindications

• Equipment

-cardiopulmonary monitors

-oxygenation equipment/end tidal CO

monitoring

-invasive/non-invasive blood gas monitoring

-indwelling catheters

-incubators/radiant warmers

-ventilators

-phototherapy

III. Family Integration

Communication

• Family centered care

• Barriers to parent/infant interaction

Grieving Process

• Stages of grieving and common behaviors

• Factors influencing enhancement or impediment of

grief process

• Palliative care/End of life

• Parental depression

IV. Discharge Planning and Follow Up

• Anticipatory guidance

• Follow up screening

• Hearing

• Vision - ROP

• Developmental

• Health risks

• Discharge preparation

• Follow-up care

STUDY GUIDE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

GENERAL MANAGEMENT

I. Thermoregulation

• Mechanisms and management of heat transfer

-evaporation

-conduction

-convection

-radiation

• Rewarming techniques

• Mechanisms of heat production

• Temperature assessment

• Neutral thermal environment

II. Resuscitation and Stabilization

• Transition to extrauterine life

• Delivery room assessment

• Techniques of resuscitation

• Indications for interventions

• Cord blood gas interpretation

• Neonatal transport

III. Growth and Nutrition

• Physiology of Digestion and Absorption

• Nutritional Requirements

• Enteral Feeding

• Parenteral Nutrition

• Composition of Breast Milk/Formulas/Donor milk

• Dietary Supplementation

IV. Fluids and Electrolytes

• Common problems and conditions

• Fluid & Electrolyte requirements

• Insensible water loss/gain

• Central & peripheral infusion

• Acid base balance

• Fish oil emulsion (Omegaven) SMOF

STUDY GUIDE

2024 Candidate Guide:

Neonatal Nurse Practitioner

PHARMACOLOGY

I. Pharmacokinetics & Pharmacodynamics

• Pharmacokinetics

-distribution

-excretion

-absorption

-metabolism

-withdrawal

• Principles of administration

-dosage/interval

-route

-tolerance/weaning

• II. Common Drug Therapies

• Analgesia/narcotics

• Anticoagulants

• Anticonvulsants

• Antihypertensive drugs

• Antimicrobials

-biologics/immunities

-vaccinations

• Cardiovascular drugs

-vasodilators/vasopressors

-antidysrhythmia drugs

• Diuretics

• GI drugs

-antacids

-prokinetic

-proton pump inhibitors

• Inhalants

-iNO

• Neurologic agents

-anesthetics agents

-sedatives

-hypnotics

• Respiratory drugs

-bronchodilators

-respiratory stimulants

-surfactant therapy

• Steroids

• Drugs and breastfeeding

- Drug transfer

- Drug safety

STUDY GUIDE

2024 Candidate Guide:

Neonatal Nurse Practitioner

EMBRYOLOGY, PHYSIOLOGY, PATHOPHYSIOLOGY & SYSTEMS MANAGEMENT

I. Cardiac

• Congenital Cardiac Defects

-cyanotic

Ebstein’s Anomaly

Tetralogy of Fallot

truncus arteriosus

transposition of great vessels

total anomalous pulmonary venous return

tricuspid atresia

-acyanotic

ventricular septal defect

coarctation of aorta (interrupted arch)

atrial septal defect septal defect

hypoplastic left heart syndrome

endocardial cushion defect (AV canal)

aortic stenosis

• Patent ductus arteriosus

• Congestive heart failure

• Hypertension/Hypotension

• Shock

• Dysrhythmias

• PGE’s

II. Respiratory

• Respiratory distress syndrome

• Transient tachypnea

• Pneumothorax and air leaks/chylothorax

• Congenital pulmonary airway malformation (CPAM)

• Cystic pulmonary

• Apnea of prematurity

• Meconium aspiration

• Diaphragmatic eventrations

• Persistent pulmonary hypertension

• Pneumonia

• Pulmonary hemorrhage

• Pulmonary hypoplasia

• Diaphragmatic hernia

• Chronic lung disease

• Laryngeal, tracheomalacia/stenosis

• Respiratory support

-principles and methods of oxygen

-administration/ventilation

-risk factors affecting oxygenation/ventilation

-oxyhemoglobin dissociation curve

-high frequency ventilation (HFV)

-extracorporeal membrane oxygenation (ECMO)

-nitric oxide

-neurally adjusted ventilatory assist (NAVA)

-nasal intermittent positive pressure ventilation

(NIPPV)

-noninvasive ventilation (NIV)

III. Gastrointestinal

• Development of the GI tract

• Digestive and absorptive disorders

-diarrhea/short gut

• Disorders of suck/swallow/motility

-GERD

-cleft lip palate

-Duodenal atresia

-tracheoesophageal fistula

-esophageal atresia

-small left colon syndrome

-Hirschsprung disease

-volvulus

-imperforate anus

-pyloric stenosis

• Malabsorption/maldigestion

• Diarrhea/short gut

• Anomalies/obstruction of upper and lower GI tract

-small left colon syndrome

-Hirschsprung’s disease

• Abdominal wall defects

-gastroschisis

-omphalocele

• Obstructions

• Perforations

• Meconium ileus

• Tracheoesophageal fistula

• Necrotizing enterocolitis

• Inguinal hernia

STUDY GUIDE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

IV. Renal/Genitourinary

• Renal vein/artery thrombosis

• Acute renal failure/insufficiency

• Polycystic/multicystic dysplastic kidneys

• Urinary outflow tract obstruction

• Testicular torsion

• Exstrophy of the bladder

• Hypospadias/epispadias

• Hydronephrosis grading system/hydroureter

V. Endocrine/Metabolic

• Adrenal disorders

• Ambiguous genitalia

• Calcium disorders

• Glucose disorders

• Magnesium disorders

• Phosphorus disorders

• Pituitary disorders

• Thyroid disorders

• Infants of diabetic mothers

• Osteopenia of prematurity

VI. Hematopoietic

• Hematological disorders

-anemia

-polycythemia

-platelet disorders

-coagulopathies

vitamin K deficiency

disseminated intravascular coagulation

-factor deficiencies

-neutropenia/neutrophilia

-Rh disease and ABO incompatibility

• Blood component therapy

• Jaundice and liver disease

• Hyperbilirubinemia (direct and indirect)

-Breastmilk jaundice

• Kernicterus

• Phototherapy

• Exchange transfusion

• Biliary atresia

VII. Infectious Diseases

• Normal immunologic function

• Common neonatal infections

-group B streptococcal

-e-coli

-staphylococcal

-klebsiella

-enterococcus

-candidiasis

-pseudomonas

-enterovirus

-respiratory syncytial virus (RSV)

-CMV

-hepatitis B

-toxoplasmosis

-herpes

-HIV/AIDS

-chlamydia

-gonorrhea

-syphilis

-varicella

• Neonatal sepsis

• SIRS

• Meningitis

• Septic shock

• Infection control and universal precautions

• MRSA/VRSE

• Osteomyelitis

VIII. Musculoskeletal

• Abnormalities of the skeleton

-metatarsus adductus

-achondroplasia

• Clubfoot

• Developmental dysplasia of the hip

• Spinal abnormalities

• Musculoskeletal birth injuries

-fractures

-nerve damage

-torticollis

• Aperts, crouzon, etc.

STUDY GUIDE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

IX. Integumentary

• General skin development and care

• Disorders

-ecchymosis

-epidermolysis bullosa

-hemangiomas

-ichthyosis

-subcutaneous fat necrosis

• Milia/miliara

• Hyperpigmented macule

• Erythema toxicum

• Neonatal pustular melanosis

• Auricular tags

• Petechiae

• Port wine stain

• Hyper/hypopigmentation

X. Genetics

• Genetic processes

-multifactorial inheritance

-nondisjunction

-translocation

-deletion/duplication

-sex linked inheritance

• Inborn errors of metabolism

• Hyperammonemia

• Newborn Screening

-galactosemia

-cystic fibrosis

• Chromosomal abnormalities/syndromes

-Trisomy 21

-Trisomy 13

-Trisomy 18

-Turner syndrome

-Beckwith-Wiedemann syndrome

-DiGeorge syndrome

• Osteogenesis imperfecta

• Potter sequence

• VATER/VACTERL

• CHARGE

XI. Neurological

• Perinatal – depression/asphyxia

• Hypoxic ischemic encephalopathy

-therapeutic hypothermia

• Cranial hemorrhages

• Hydrocephalus

• Neural tube defects

• Seizures

• Jitteriness

• Periventricular leukomalacia

• Auto regulation

• Cerebral palsy

• aEEG

• Near-infrared spectroscopy (NIRS)

• Congenital neuromuscular disorders

• Craniosynostosis

XII. Ears, Eyes, Nose and Throat

• Eyes

-eye prophylaxis

-cataracts

-coloboma

-glaucoma

-retinopathy of prematurity

-strabismus

-conjunctivitis

• Nose

-nasolacrimal duct obstruction

-choanal atresia

-deviated septum

• Ears

-malformations

• Mouth/throat

-cleft lip and palate

-micrognathia/retrognathia

-macroglossia

• airway obstruction

STUDY GUIDE

2024 Candidate Guide:

Neonatal Nurse Practitioner

PROFESSIONAL PRACTICE ISSUES

Ethical Principles

• Autonomy

• Beneficence

• Non-maleficence

• Justice

Professional/Legal Issues

• Professional

-Regulation

-Practice

-HIPPA

• Staffing issues

• Legal liability

-Consent

-Documentation/medical records

-Negligence/malpractice

Evidence based practice

• Terminology

-Reliability

-Validity

-Significance

-Levels of Evidence

Quality Improvement

• Research utilization

Neonatal Safety

• Communication

• Interprofessional practice

STUDY RESOURCES

2024 Candidate Guide:

Neonatal Nurse Practitioner

• American Academy of Pediatrics, American Heart Association, Textbook of Neonatal Resuscitation, 8

ed, AAP,

2021.

• Blackburn, Maternal, Fetal, & Neonatal Physiology, 5

ed, Elsevier, 2018.

• Fanaroff, et al., Klaus & Fanaroff's Care of the High-Risk Neonate, Elsevier-Saunders, 2019.

• Gardner, et al., Handbook of Neonatal Intensive Care: An Interprofessional Approach, Elsevier, 2021.

• Gleason, et al., Avery's Diseases of the Newborn, 11

ed, Elsevier, 2023.

• Goldsmith, et al., Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory

Care, Elsevier, 2022.

• Gomella, Neonatology, 8th ed., Lange, 2020.

• Janke, et al. Core Curriculum for MAternl-Newborn Nursing, 6

ed, Elsevier, 2023.

• Jnah, et al. Fetal and Neonatal Physiology for the Advanced Practice Nurse, Springer, 2018.

• Katzung, et al., Basic and Clinical Pharmacology, McGraw Hill, 2021.

• Kenner, et al. Comprehensive Neonatal Nursing Care, Springer, 2019.

• Koehn, A. R., Neonatal nurse practitioner certification intensive review: Fast facts and practice questions, 2

ed. Springer Publishing Company, 2023.

• MacDonald, et al., Atlas of Procedures in Neonatology, 6

ed, LWW, 2020.

• Martin, et al., Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant, 11

ed,

Elsevier, 2020.

• Polit, et al., Essentials of Nursing Research: Appraising Evidence for Nursing Practice, LWW, 2021.

• Resnik, et al., Creasy & Resnik’s Maternal Fetal Medicine Principles and Practice, 9

ed, Elsevier, 2022.

• Simpson, et al., AWHONN’s Perinatal Nursing, 5

ed, Wolters Kluwer, 2021.

• Snell, et al., Care of the Well Newborn, Jones & Bartlett, 2017.

• Taketomo, Pediatric and Neonatal Dosage Handbook, 28

ed, Lexi-comp, 2021.

• Tappero, et. al., Physical Assessment of the Newborn, Springer, 2019.

• Verklan, et al. Core Curriculum for Neonatal Intensive Care Nursing, Elsevier, 2021.

• Volpe, et. al., Neurology of the Newborn, Elsevier, 2018.

• Walsh, et al., Neonatal and Pediatric Respiratory Care, Elsevier, 2019.

SAMPLE QUESTIONS

2024 Candidate Guide:

Neonatal Nurse Practitioner

NEONATAL NURSE PRACTITIONER SAMPLE QUESTIONS

Listed below are five sample questions to acquaint the candidate with the test question format. These questions do

not reflect the scope or the difficulty level of the questions on the actual examination. The reference from which

each question is derived is also cited. However, other references might substantiate a different answer, and the

answer shown here might be substantiated by other references.

The rigorous review to which actual test questions are subject is not applied to these sample questions. The focus

that should be attended to in reviewing these items is format, not content.

1. The goal of treatment of gastroesophageal reflux in the

premature neonate is to

A. achieve normal gastric emptying

B. decrease lower esophageal sphincter pressure

C. increase gastric pH

Answer: A

Martin, et al., Fanaroff and Martin’s Neonatal Perinatal

Medicine Diseases of the Fetus and Infant, Elsevier Mosby,

St. Louis, 2020, 1517

2. When auscultating the lungs of a neonate, the nurse

practitioner hears stridor. This most likely indicates

A. bronchospasm

B. inflammation of the pleura

C. subglottic stenosis

Answer: C

Tappero, et al., Physical Assessment of the Newborn,

Springer, 2019, p. 88

3. Upper and lower extremity blood pressures should be

taken for the neonate with decreased femoral pulses

to evaluate for

A. coarctation of the aorta

B. patent ductus arteriosus

C. transposition of the great arteries

Answer: A

Verklan, et a l., Core Curriculum for Neonatal Intensive

Care, Elsevier, 2021, p 480

4. The recommended hepatitis B immunization schedule

for a neonate born to a hepatitis B surface antigen (HBsAg)

positive mother is

Initial Second Third

A. At birth 1 month 6 months

B. Before discharge 2 months 6 months

C. 0-7 days 1 month 12 months

Answer: A

Verklan, et a l., Core Curriculum for Neonatal Intensive

Care, Elsevier, 2021, p. 60

5. A neonate with bronchopulmonary dysplasia has the

following blood gas values:

pH 38

PCO

50 mmHg

HCO

29 mEq/L (mmol)

Base excess +3 mEq/L

The best interpretation of the blood gas is

A. compensated metabolic acidosis

B. compensated respiratory acidosis

C. normal value

Answer: B

Gardner, et al., Handbook of Neonatal Intensive Care,

Elsevier, Mosby, St. Louis, 2021, p. 187

SCORING & TEST REPORT

2024 Candidate Guide:

Neonatal Nurse Practitioner

HOW EXAMS ARE SCORED

NCC examinations are criterion-referenced. This means the passing score is

based on a predetermined criterion. This criterion is a statistical ability level

established by the Content Team based on evaluation of criticality of

content and the test questions’ past statistical performance. Questions

used to determine pass/fail have proven statistical history that

demonstrates the question is appropriate for use to measure an

individual’s ability level.

There is no set percentage passing level. An ability level for each candidate

is calculated based on the number of questions they answer correctly

(there is no penalty for wrong answers). Pass/fail is determined based on

this ability level as compared to pass/fail standard which is a

predetermined ability criterion. When different forms of the examination

are used, a process called equating is initiated. This procedure converts all

results to a common scale. So someone who takes a slightly more difficult

form of the exam will need to answer fewer questions correctly than

someone who takes a slightly easier form of the exam.

NCC utilizes the item response theory of psychometrics for the analysis of

its examinations. Item response theory (Rasch analysis) is the study of test

and item scores based on assumptions concerning the mathematical

relationship between abilities and item responses. This is a commonly used

system, and such examinations as the NCLEX and other health related

certification examinations utilize this type of psychometric analysis.

Test reports identify pass/fail status, and they give feedback on the various

content areas of the examination in the form of word descriptors: very

weak, weak, average, strong and very strong. No percentages or standard

scores are given. These descriptors are based on the items within a given

subtest. The overall pass/fail decisions are based on the full test, and the

verbal descriptors are intended to provide suggested feedback on strengths

and weaknesses in various content areas. Since this feedback is based on

relatively few items, general verbal descriptions are given instead of

subtest scores. These word descriptors are for information only, and they

should be interpreted cautiously due to the small number of items included

in each content area.

HAND SCORING YOUR

EXAMINATION

If you believe there might be a

discrepancy in your test

results, you may request a

hand score for a fee of $55.

You must make this request

via the NCC website within 60

days of receiving the pass/fail

report by selecting that option

from your NCC profile at

NCCwebsite.org or go to the

certification tab

https://www.nccwebsite.org/

certification-exams, scroll

down to “Other helpful

information” and click “Exam

hand score request” to submit

your request.

SCORING & TEST REPORT

2024 Candidate Guide

: Neonatal Nurse

Practitioner

SAMPLE TEST REPORT

Candidates will receive an official test results report from NCC. It will be located in your NCC account. Shown below is

a sample test result report for a candidate who has passed the examination.

NEONATAL NURSE PRACTITIONER EXAMINATION

Test Results

NAME DATE:

ADDRESS

Pass/Fail: PASS Maintenance Due Date:

Your credential is designated as: NNP-BC® (Neonatal Nurse Practitioner - Board Certified)

EXAM CONTENT REPORT

Overall pass/fail decisions are based on your overall exam performance. A candidate must obtain a score equal to or

higher than the “passing score” to pass the exam. A candidate’s performance on the examination is not compared to

the performance of others taking the examination.

In addition, the test report provides you with feedback on the various content areas of the examination in the form

of word descriptors: Very Weak, Weak, Average, Strong and Very Strong. No percentages or standard scores are

given. These descriptors are based on items within a given subtest and are intended to provide suggested feedback

on strengths and weaknesses in various content areas. Since this feedback is based on relatively few items, general

verbal descriptions are given instead of subtest scores. Word descriptors for scoring are set using these ability levels

and utilize equal intervals of scale above and below the pass point to provide additional feedback. See the Important

Facts and Information on Test Results and Scores page for more detail. These word descriptors are for information

only, and they should be interpreted cautiously due to the small number of items included in each content area.

Content Area (Percentage of Questions on Exam) Your Results:

General Assessment (17%) WEAK

General Management (19%) AVERAGE

Embryology, Physiology, Pathophysiology

and Systems Management (52%) VERY STRONG

Pharmacology; Professional Issues (12%) AVERAGE

TERMS OF CERTIFICATION AND CERTIFICATION MAINTENANCE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

AFTER PASSING THE EXAM

CREDENTIAL

Successfully completing the

Neonatal Nurse Practitioner exam

entitles the newly certified

candidate to use the credential

NNP-BC® (Neonatal Nurse

Practitioner-Board Certified)

TERMS OF CERTIFICATION

NCC certification is awarded for a

period of three years.

The effective date for certification

is the date on the official NCC score

report letter that shows a passed

examination.

MAINTENANCE AUDITS

Certificants must maintain the

conference/CE description and/or

objectives, along with the CE

certificate which are required to be

uploaded if chosen for random

audit. Pre-approval of CE does not

exempt a certificant from random

audit.

NO CONTINUING EDUCATION

IS ISSUED FOR TAKING THE

NEONATAL NURSE

PRACTITIONER EXAM.

MAINTAINING CERTIFICATION

- NCC certification must be maintained every three years.

- Certification that is not maintained will expire

- The NCC certification maintenance program allows certified nurses to

continue their certification status by obtaining specific hours of

continuing education credit as defined in their Education Plan, which is

generated by their Continuing Competency Assessment (CCA).

- For continuing education credit to be used for certification

maintenance it must be earned AFTER the certified nurse has taken

the CAA and in the areas defined by the new Education Plan before

their maintenance is due.

- The maintenance process includes submitting a maintenance

application prior to the maintenance due date with appropriate fees

and requested documentation. Using NCC CE modules does NOT

automatically maintain your certification. Individuals must submit a

maintenance application and pay a maintenance fee in addition to any

CE fees.

- Maintenance applications are subject to random audit. If an individual

is chosen for audit, they will be required to upload CE certificates and

course descriptions. These records should be maintained during each

maintenance cycle, until the maintenance application has been

approved. Individuals can upload these documents in their

maintenance application throughout their maintenance cycle.

Documents from NCC modules are already on file with NCC and

therefore are not requested or audited.

- The maintenance due date is the last day the certification is active. NCC

Certified professionals do not need to wait until their maintenance

deadline to apply. As long as they have obtained the required contact

hours of continuing education credit - maintenance applications can be

submitted up to 12 months before this date to avoid a lapsed

certification while the maintenance application is in review.

Maintenance will be due in the quarter in which they were notified of

their certification (not the date on which they took the examination).

Maintenance due dates can be found by signing into the certified

professional’s NCC account. Sign into the account using the associated

email and password.

The NCC website has more detailed information

For more information about the certification maintenance program and

the Continuing Competency Assessment (CCA), click the purple "Maintain

your Certification" box.

TERMS OF CERTIFICATION AND CERTIFICATION MAINTENANCE

2024 Candidate Guide

: Neonatal Nurse

Practitioner

VISIT THE NCC WEBSITE

AND DOWNLOAD THE

CONTINUING

COMPETENCY

ASSESSMENT BROCHURE

FOR COMPLETE DETAILS!

CONTINUING COMPETENCY ASSESSMENT (CCA)

NCC views certification as a process that functions throughout an

individual nurse or nurse practitioner's career. It reflects life-long

learning, ongoing professional development and is supported by

maintaining specialty knowledge competencies.

The standard process for the NCC Certification Maintenance Program

makes use of an assessment tool and resulting personal education plan:

• Complete the continuing competency assessment (CCA) that reflects

the current knowledge competencies aligned with the certified nurse’s

certification specialty at the beginning of each new certification

maintenance cycle.

• Individuals earn CE as specified by the education plan developed from

their assessment. Their education plan outlines the CE needed to

maintain their NCC certification. Only CE earned after they have taken

their assessment can be used to maintain their certification. It must

address the CE needs as outlined by their educational plan.

This program provides continuing validation that NCC certified nurses and

nurse practitioners are maintaining their specialty knowledge

competencies based on current practice and examination content.

Download Continuing Competency Assessment brochures for details by

clicking the links below.

Four Steps to Continuing Competency

https://www.nccwebsite.org/content/documents/cms/cca-steps.pdf

Continuing Competency Assessment - Education Plan Examples

https://www.nccwebsite.org/content/documents/cms/cca-education-

plans.pdf