Neonatal Intensive Care Nurse Exam Neonatal Neurological Assessment and Care 2 — Questions and Answers
Question 1: The NICU nurse caring for an infant with HIE on therapeutic hypothermia should position the infant:
- Supine with head midline and slightly elevated to 15–30 degrees (Correct answer)
- Prone only
- Head-down Trendelenburg position
- Left lateral decubitus position
Correct answer: Supine with head midline and slightly elevated to 15–30 degrees
Head midline positioning with slight elevation reduces ICP and promotes venous drainage in infants with suspected brain injury.
Question 2: Amplitude-integrated EEG (aEEG) in the NICU is used primarily to:
- Continuously monitor background cerebral activity and detect seizures (Correct answer)
- Measure intracranial pressure
- Assess brain stem reflexes
- Monitor peripheral nerve function
Correct answer: Continuously monitor background cerebral activity and detect seizures
aEEG provides continuous bedside monitoring of cerebral electrical activity to detect seizures and assess brain function in at-risk neonates.
Question 3: Post-hemorrhagic hydrocephalus after IVH is identified by:
- Progressive head circumference increase, bulging fontanelle, and cranial ultrasound findings (Correct answer)
- Fever and irritability alone
- Declining blood pressure
- Hyperglycemia
Correct answer: Progressive head circumference increase, bulging fontanelle, and cranial ultrasound findings
Hydrocephalus after IVH causes CSF accumulation, progressive ventricular dilation seen on cranial ultrasound, and increasing head circumference.
Question 4: Cranial ultrasound screening for IVH should be performed in all infants born at:
- Less than 30 weeks gestation (Correct answer)
- All term neonates after birth
- Only symptomatic neonates
- Infants over 35 weeks gestation
Correct answer: Less than 30 weeks gestation
AAP guidelines recommend routine cranial ultrasound screening for all infants born before 30 weeks due to high IVH risk.
Question 5: Which primitive reflex is normally absent at birth and indicates neurological damage if present?
- No primitive reflexes are normally absent at birth; all should be present
- Babinski reflex
- Asymmetric tonic neck reflex beyond 6 months (Correct answer)
- Moro reflex
Correct answer: Asymmetric tonic neck reflex beyond 6 months
The asymmetric tonic neck reflex (ATNR) is normal in newborns but persistent beyond 6 months suggests upper motor neuron pathology.
Question 6: A neonate born at 34 weeks has decreased tone, minimal response to stimulation, and poor suck. These findings are MOST consistent with:
- Hypotonia from prematurity, birth asphyxia, or CNS depression (Correct answer)
- Normal development for 34 weeks gestation
- Hyperthyroidism
- Hyperkalemia
Correct answer: Hypotonia from prematurity, birth asphyxia, or CNS depression
Hypotonia, poor responsiveness, and weak suck in a preterm infant suggest CNS depression from asphyxia, metabolic causes, or prematurity.
Neonatal Intensive Care Nurse Exam Neonatal Neurological Assessment and Care 2
The NICU nurse caring for an infant with HIE on therapeutic hypothermia should position the infant: