Facts read from nccwebsite.org · last checked Nov 7, 2026
General Assessment is 15% of the score, 23 questions. It starts before birth, with what the mother's history predicts, and ends at discharge, with what the family needs to take over. In between is the newborn exam, done at NP level: which finding is a variant, which needs a study, which study.
Practice questions
60 questions written to the NNP-BC outline; each choice is explained once you pick.
Family integration: communication, grief and palliative care, parental depression, periviability, culturally supportive care.
Discharge and follow-up: anticipatory guidance, follow-up screening, developmental risk.
2
Maternal conditions that reach the newborn
Questions here give you the mother's condition and ask what to expect, check or order in the baby. Three pairings that are easy to miss because the mother can look well:
Anti-Ro/SSA antibodies (lupus, Sjögren syndrome, or no diagnosis at all) can cause congenital heart block and a neonatal lupus rash; a slow fetal heart rate is often the first sign.
Graves disease treated before pregnancy with surgery or radioiodine: the mother's TSH-receptor antibodies can persist and cross the placenta, so the newborn can be thyrotoxic while the mother takes replacement. The American Thyroid Association's 2017 pregnancy guideline asks for the antibody level for that reason.
An SSRI late in pregnancy is linked to transient adaptation signs (jitteriness, fast breathing, feeding trouble) that usually settle within the first two weeks. They are not opioid withdrawal.
The mother's own prenatal care, GBS screening included, is a women's health topic, on WHNP-BC prenatal care.
3
15 questions on the newborn assessment
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
General Assessment · 15%
A term infant's mother has phenylketonuria and did not follow a phenylalanine-restricted diet during pregnancy. The infant is at greatest risk for
The infant is usually only a carrier, so the newborn screen is normal; the damage came from the mother's blood levels in utero.
High maternal phenylalanine is teratogenic, so maternal PKU syndrome brings microcephaly, congenital heart disease, growth restriction and later intellectual disability.
A musty odor with seizures describes untreated PKU in the child over months, not the effect of maternal PKU at birth.
A 6-hour-old cyanotic term infant has a right radial PaO2 of 42 mmHg after 10 minutes in FiO2 1.0. Pre- and post-ductal SpO2 are equal. The most likely diagnosis is
Lung disease such as TTN improves with 100% oxygen, usually lifting the PaO2 well above 150 mmHg.
A PaO2 that stays low in 100% oxygen means fixed right-to-left mixing, and d-TGA typically shows no pre- to post-ductal saturation gap.
PPHN can also fail the hyperoxia test, but ductal shunting usually produces a pre- to post-ductal saturation difference.
A 10-day-old former 30-week infant in the NICU has white plaques on the tongue and buccal mucosa that do not wipe off and bleed slightly when scraped. The most likely diagnosis is
Adherent white plaques on the tongue and buccal mucosa that leave a raw, bleeding base when scraped are thrush.
Milk residue looks similar but wipes away easily without bleeding, which is the bedside test that separates it from thrush.
Bohn nodules are small, firm cysts on the gum ridges, not plaques spread over the tongue and cheeks.
A 3-week-old has persistent nasal discharge, a desquamating rash on the palms and soles, and will not move the left arm. The most likely diagnosis is
Snuffles, a desquamating palm-and-sole rash and refusal to move a limb from painful osteochondritis (pseudoparalysis) are classic early congenital syphilis.
Erb palsy also causes a still arm, but it is present from birth after a stretch injury and comes without rhinitis or rash.
Scalded skin causes widespread tender exfoliation with fever, not nasal discharge with bone pain.
Before discharge from the newborn nursery on day 3, a well girl has a small amount of blood-tinged mucoid vaginal discharge and mildly swollen breast buds. The BEST action is
Imaging for a tumor is for persistent bleeding or a mass; a transient discharge with a normal exam does not suggest one.
A mucoid, blood-tinged discharge in the first days is hormonal; testing for a sexually transmitted infection misreads a normal finding.
Withdrawal of maternal estrogen causes pseudomenses and breast bud swelling in the first week; both resolve without treatment, and the breasts should not be squeezed.
A mother with a mechanical heart valve took warfarin in the first trimester. The newborn has nasal hypoplasia. The characteristic radiographic finding is
Warfarin exposure in weeks 6 to 12 causes nasal hypoplasia with stippled epiphyses (chondrodysplasia punctata).
Periosteal reaction on long bones points to infection or trauma, not to warfarin embryopathy.
Butterfly vertebrae are a clue to Alagille syndrome, a different cause of a characteristic face.
When a term infant cries, the left corner of the mouth does not move downward. Forehead wrinkling, eye closure and nasolabial folds are symmetric. The most likely cause is
A central palsy spares the forehead but still flattens the nasolabial fold and weakens the lower face broadly, not just the corner of the mouth.
Asymmetric crying facies affects only the lower lip because the depressor anguli oris is absent or small; it can accompany cardiac defects and 22q11 deletion.
Möbius syndrome causes bilateral facial weakness with abducens palsy and a mask-like face, far more than one corner of the mouth.
A mother received indomethacin tocolysis for 5 days at 29 weeks and delivered soon after. Which neonatal problem is most associated with this exposure?
Neonatal hypoglycemia follows beta-agonist tocolysis such as terbutaline, not a prostaglandin inhibitor.
Hypotonia and respiratory depression are effects of magnesium sulfate exposure, a different tocolytic.
Indomethacin lowers fetal renal blood flow, so infants exposed late in pregnancy can have oliguria and a raised creatinine that usually recover; it can also narrow the ductus.
A 3-hour-old infant has a suspected subgaleal hemorrhage after vacuum delivery. Which monitoring best detects ongoing bleeding?
Ultrasound looks inside the skull, but a subgaleal bleed lies outside it, and a daily scan is far too slow for a bleed that can cause shock in hours.
Jaundice rises later as the collected blood breaks down; bilirubin does not track ongoing blood loss.
Subgaleal bleeding shows as a growing head circumference, a falling hematocrit and tachycardia, so these are checked often with volume and blood ready.
After a prolonged second stage, a term infant has noisy nasal breathing, asymmetric nostrils and a columella deviated to one side. When the nasal tip is pressed, the septum does not straighten. The BEST management is
When the septum does not straighten with pressure on the tip, the septal cartilage is truly dislocated and should be reduced by ENT in the first days while it is pliable.
CPAP prongs do not realign a dislocated septum and may worsen the deformity while adding pressure injury.
Choanal atresia is tested by passing a catheter, and it does not cause a deviated columella or asymmetric nostrils.
On the NICU discharge exam at 6 weeks, a former 30-week infant has seven smooth-bordered café-au-lait macules, each 6–8 mm, and no other findings. The most appropriate next step is
One to three small macules are common in healthy infants, but seven crosses the threshold that needs evaluation.
Six or more café-au-lait macules over 5 mm before puberty meet a diagnostic criterion for neurofibromatosis type 1, so genetics and eye follow-up are indicated.
McCune-Albright gives a few large macules with jagged, coast-of-Maine borders, not many smooth-edged ones.
A CBC shows WBC 15,000/mm³ with 40% segmented neutrophils, 15% bands and 5% metamyelocytes. The immature-to-total neutrophil (I:T) ratio is
Immature forms are bands plus metamyelocytes (20%) and total neutrophils add the segmented cells (60%), so I:T = 20 ÷ 60 = 0.33; even a high ratio predicts sepsis only modestly.
Dividing immature forms by the whole white count (20 ÷ 100) uses the wrong denominator; lymphocytes and monocytes are not neutrophils.
Dividing immature by mature neutrophils (20 ÷ 40) gives the I:M ratio, a different index that always runs higher than I:T.
A 7-day-old has fever, diffuse tender erythema, flaccid bullae with a positive Nikolsky sign and perioral crusting; mucous membranes are spared. The most likely diagnosis is
Toxic epidermal necrolysis also shows a Nikolsky sign, but it involves mucous membranes with full-thickness necrosis and is usually drug-induced.
In staphylococcal scalded skin, an exfoliative toxin splits the superficial epidermis diffusely and spares the mucosa, giving tender erythema, Nikolsky-positive blisters and perioral crusting.
Bullous impetigo is caused by the same toxin acting locally, so the blisters stay localized without diffuse tender erythema.
A running total sits here; it fills in after your last pick.
4
Assessment traps NNP candidates fall into
Working up a variant. Erythema toxicum and transient neonatal pustular melanosis need no culture. Congenital dermal melanocytosis needs only its size and site written down at the first exam, so a later examiner does not mistake it for bruising (Tappero and Honeyfield, 7th ed.).
Gestational age from one measure. Size for dates comes from birth weight against gestational age on a growth chart, and the gestational age itself from dates, early ultrasound and the maturity exam together.
A normal maternal platelet count. With a severely thrombocytopenic newborn and a well mother whose count is normal, think of alloimmune thrombocytopenia rather than maternal ITP; details are on hematology.
Safe sleep left for discharge day. AAP's 2022 safe sleep policy asks NICUs to place preterm infants supine as soon as they are stable and well before discharge, so parents see at the bedside what they should do at home.
5
Where assessment meets other pages
After discharge: routine well-baby visits, the outpatient vaccine schedule and office follow-up belong to pediatric primary care, on CPNP-PC health maintenance.
Retinopathy of prematurity screening: a brief note in the study guide.
The guide lists gestational age assessment under the newborn exam, so expect to interpret a maturity score, not only name it.
How much family and grief content does the neonatal exam include?
Family integration is one of four parts of General Assessment, alongside maternal history, the exam and discharge planning. Palliative care, parental depression and periviability are named in it.