Facts read from nccwebsite.org · last checked Nov 7, 2026
NCC writes the NNP-BC for neonatal nurse practitioners, and for NP-level decisions about high-risk neonates and infants up to 2 years old: diagnosing, ordering, dosing, reading a gas or a film. Below are the numbers that decide how you prepare, the five-part outline and a short sample set.
Practice questions
60 questions written to the NNP-BC outline; each choice is explained once you pick.
Multiple choice with 3 options: one answer and two distractorsOptions appear in alphabetical order; labs show conventional units first, SI in parentheses. The testing screen has an on-screen calculator and a comment box for each question; scratch paper is not allowed.
Criterion-referenced ability score with no set percentage to passForms are statistically equated, and a wrong answer costs nothing extra. Score reports use words (very weak to very strong), not numbers.
In 2025, 84% of the 289 candidates tested passed89% in 2024 (416 tested) and 81% in 2023 (444 tested). NCC reports all candidates tested, not only first-time ones.
From January 1, 2029 candidates must test within 5 years of graduating; graduates after December 31, 2029 need 750 direct patient care clinical hoursSimulation does not count toward the 750 hours. NCC’s policy table lets graduates before 2029 register under the 600-hour standard until December 31, 2033 within 8 years, but its summary and the NNP exam page require everyone to test within 5 years of graduating from January 1, 2029. After 2033 everyone needs 750 hours and the 5-year window.
NCC builds the test around the newborn who needs intensive or intermediate care and the infant who carries that history into infancy: extreme prematurity, a failing transition at delivery, an infant on a ventilator, a duct-dependent heart. The questions ask what an NP decides there. You interpret the blood gas, choose the next study, set the fluid and glucose plan, pick the drug and its interval.
Two neighboring credentials get mixed up with it:
Primary care of healthy babies after discharge (well visits, the vaccine schedule from 2 months, office follow-up of jaundice) belongs to the pediatric primary care board, covered on CPNP-PC.
The bedside NICU nursing credential from the same certifying body tests RN actions. Some of its reading list overlaps with the NNP list; the role does not.
The pediatric acute care exam (CPNP-AC) also covers acutely ill infants. It has no page on this site yet.
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Five content areas, one split into twelve systems
source [1]
The guide gives five percentages. NCC's 2023 job analysis gives the item count inside each, so the systems area (14 items on the lungs, 11 on infection, 10 on the heart, and so on) can be planned question by question (job analysis report, Table 5).
Table 2. NNP-BC outline: scored questions by content area[1]
Embryology, Physiology, Pathophysiology and Systems Management (Neonatal respiratory care, Neonatal infectious diseases, Neonatal cardiac care, Neonatal neurology, Neonatal gastrointestinal care, Neonatal hematology and bilirubin, Metabolic, endocrine and genetic disorders, Renal and genitourinary, Musculoskeletal, Integumentary, Ears, Eyes, Nose, and Throat)
Maternal history affecting the newborn; neonatal examination; family integration; discharge preparation and follow-up care.
II. General Management
Thermoregulation; resuscitation and stabilization; growth and nutrition; fluids and electrolytes.
III. Neonatal pharmacology
Pharmacokinetics and pharmacodynamics; common drug therapies.
IV. Embryology, Physiology, Pathophysiology and Systems Management
Embryology to management of twelve body systems in newborns and infants to age 2; item counts per system from the 2023 job analysis, Table 5.
V. Professional Issues
Legal, ethical, neonatal safety and quality improvement.
Three options on every question often wrong
Each scored question on the current form offers three choices, listed alphabetically, with lab values in conventional units first (candidate guide, p. 6). Prep sets built with four choices per question reflect another format; the content may still help, but the elimination rhythm will not match test day.
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5 neonatal NP questions to start
0 / 5 answered5 questions
Tap an option: why each one is right or wrong appears under it.
General Assessment · 15%
A term newborn's parietal bones near the sagittal suture indent with pressure and spring back like a ping-pong ball. The exam is otherwise normal. The best interpretation is
A depressed fracture stays depressed after a traumatic delivery; the ping-pong recoil of a soft area near the suture is a normal finding and does not justify radiation.
Soft parietal bone next to the sagittal suture in an otherwise normal term newborn is physiologic craniotabes, which firms up as the skull mineralizes over the first months.
Rickets can soften the skull, but it develops after months of deficiency with other bone signs; treating a normal newborn for it confuses a variant with disease.
Paired umbilical cord gases are labeled: artery pH 7.30, PCO2 40 mmHg; vein pH 7.20, PCO2 55 mmHg. The best interpretation is
The umbilical artery returns fetal blood and must have the lower pH and higher PCO2; here the 'artery' looks better than the 'vein', which can only mean the two samples were reversed.
Each number looks plausible on its own, which tempts acceptance, but the pair is physiologically reversed, so neither value can be trusted as labeled.
Cord occlusion widens the gap in the normal direction, with an acidotic artery and a near-normal vein; it cannot make the vein more acidotic than the artery.
A 5-week-old has completed 21 days of IV acyclovir for HSV encephalitis, and the end-of-therapy CSF HSV PCR is negative. The NEXT management is
IV therapy is extended only when the end-of-therapy CSF PCR is still positive; with a negative result, more IV days add line risk without benefit.
After IV treatment of CNS or skin-eye-mouth HSV disease, 6 months of oral acyclovir suppression improves neurodevelopment after encephalitis and cuts skin recurrences; neutrophils are monitored.
A negative end-of-therapy PCR ends the IV course but not treatment; stopping here forfeits the neurodevelopmental benefit of oral suppression after CNS disease.
An infant with established BPD is still on nasal cannula oxygen at 36 weeks' postmenstrual age. The recommended screening for a serious complication is
Reflux is often blamed for desaturations in BPD, but routine pH testing is not recommended and does not look for the complication that drives mortality.
Four-limb pressures screen for coarctation in a newborn with weak femoral pulses; coarctation is not a complication of chronic lung disease.
Pulmonary hypertension complicates a sizable share of moderate-to-severe BPD and raises mortality, so an echocardiogram is recommended once BPD is established around 36 weeks PMA.
A cyanotic neonate has massive cardiomegaly on chest radiograph. The mother took lithium during the first trimester. The MOST likely cardiac lesion is
Tetralogy causes cyanosis with a normal-sized, boot-shaped heart, not massive cardiomegaly, and it has no particular link to lithium.
Tricuspid atresia is the near-miss because it is also a cyanotic tricuspid lesion, but the heart is usually normal in size with reduced pulmonary markings.
Lithium in the first trimester is the classic link to Ebstein anomaly, where the displaced tricuspid valve and huge right atrium give a wall-to-wall heart and right-to-left atrial shunting.
NNP-BC eligibilityWho can apply now, and NCC rules by graduation date to 2033
NNP-BC study guidePlan by NCC item counts, reading list, answers that changed
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Before you apply for the NNP-BC
Does the NNP-BC cover infants after they leave the NICU?
Yes. The outline covers high-risk neonates and infants up to 2 years old, so a baby with chronic lung disease, a repaired heart or a neurologic injury is in scope. Routine well-child care of healthy infants is a primary care topic.
Is the NNP-BC offered by ANCC or the AANP certification board?
Neither. The neonatal NP board is NCC's; the other boards and their exams are compared on NP specialties.
How long is the NNP-BC exam, and can I take a break?
You get 3 hours, with no breaks. The clock does not stop, so plan water and the restroom before you start.
Can I sit the neonatal NP board from home?
Yes. Live remote proctoring runs around the clock, and PSI test centers are the other choice.