Neonatal Nurse Practitioner Exam Neonatal Neurology and Developmental Care 2 — Questions and Answers
Question 1: A premature infant in the NICU benefits most from which developmental care principle to reduce stress?
- Frequent bathing and stimulation
- Clustering care activities and providing containment/nesting (Correct answer)
- Bright overhead lighting 24 hours a day
- Continuous auditory stimulation
Correct answer: Clustering care activities and providing containment/nesting
Clustering care reduces the frequency of disturbing the infant, while containment/nesting provides proprioceptive boundaries that mimic the womb and reduce stress.
Question 2: Kangaroo care (skin-to-skin holding) in the NICU has been shown to provide which benefit?
- Increase infection risk
- Stabilize temperature, heart rate, and improve breastfeeding outcomes (Correct answer)
- Delay weight gain
- Increase oxygen requirements
Correct answer: Stabilize temperature, heart rate, and improve breastfeeding outcomes
Kangaroo care stabilizes neonatal temperature, heart rate, and respiratory rate, promotes breastfeeding, and improves neurodevelopmental and bonding outcomes.
Question 3: Which finding on neonatal MRI is most predictive of adverse neurodevelopmental outcomes after HIE?
- Mild cortical edema only
- Basal ganglia and thalamic injury on diffusion-weighted imaging (Correct answer)
- Isolated periventricular white matter signal change
- Small germinal matrix cysts
Correct answer: Basal ganglia and thalamic injury on diffusion-weighted imaging
Basal ganglia and thalamic injury on MRI in HIE is strongly predictive of motor and cognitive impairment, particularly cerebral palsy.
Question 4: A neonate presents with jitteriness and irritability at 24 hours of age. Mother has a history of opioid use disorder. What condition is most likely?
- Hypoglycemia
- Neonatal opioid withdrawal syndrome (NOWS) (Correct answer)
- Neonatal meningitis
- Hypocalcemia
Correct answer: Neonatal opioid withdrawal syndrome (NOWS)
NOWS (formerly NAS) presents with jitteriness, irritability, high-pitched cry, and feeding difficulties in infants exposed to opioids in utero.
Question 5: Which scoring tool is most commonly used to assess neonatal opioid withdrawal syndrome (NOWS) severity?
- Modified Sarnat score
- Finnegan Neonatal Abstinence Scoring Tool (Correct answer)
- Ballard Maturity Score
- Thompson Score
Correct answer: Finnegan Neonatal Abstinence Scoring Tool
The Finnegan score assesses 21 signs of neonatal abstinence across CNS, autonomic, and GI categories to guide pharmacologic treatment decisions.
Question 6: Periventricular leukomalacia (PVL) is associated with which long-term outcome?
- Congenital deafness
- Spastic diplegia and cerebral palsy (Correct answer)
- Congenital heart disease
- Retinopathy of prematurity
Correct answer: Spastic diplegia and cerebral palsy
PVL involves white matter injury adjacent to the lateral ventricles, disrupting descending motor tracts and predisposing to spastic diplegia and cerebral palsy.
Neonatal Nurse Practitioner Exam Neonatal Neurology and Developmental Care 2
A premature infant in the NICU benefits most from which developmental care principle to reduce stress?