Neonatal Nurse Practitioner Exam Neonatal Neurology and Developmental Care 1 — Questions and Answers
Question 1: Hypoxic-ischemic encephalopathy (HIE) in a term neonate is most accurately assessed using which scoring system?
- Apgar score alone
- Sarnat or Thompson staging of HIE severity (Correct answer)
- Ballard gestational age score
- CRIB score
Correct answer: Sarnat or Thompson staging of HIE severity
Sarnat and Thompson staging systems assess the severity of HIE based on neurological signs, guiding decisions about therapeutic hypothermia.
Question 2: Therapeutic hypothermia (whole-body cooling) for HIE is initiated within what time window to be effective?
- Within 24 hours of birth
- Within 6 hours of birth (Correct answer)
- Within 12 hours of birth
- Anytime in the first 72 hours
Correct answer: Within 6 hours of birth
Therapeutic hypothermia must be initiated within 6 hours of birth to interrupt the secondary energy failure phase and reduce neuronal death.
Question 3: Which neonatal seizure type is most commonly missed because it lacks classic convulsive movements?
- Clonic seizures
- Subtle seizures (lip smacking, eye deviation, bicycling movements) (Correct answer)
- Tonic seizures
- Myoclonic seizures
Correct answer: Subtle seizures (lip smacking, eye deviation, bicycling movements)
Subtle seizures manifest as lip smacking, eye deviation, bicycling of the legs, or apnea and are easily missed without continuous EEG monitoring.
Question 4: Intraventricular hemorrhage (IVH) is most commonly graded using which system in neonates?
- Glasgow Coma Scale
- Papile grading system (Grades I-IV) (Correct answer)
- Neonatal Neurological Risk Score
- FLACC scale
Correct answer: Papile grading system (Grades I-IV)
The Papile grading system classifies IVH from Grade I (subependymal only) to Grade IV (parenchymal involvement), guiding prognosis and management.
Question 5: Which factor is the strongest predictor of IVH in premature neonates?
- Gestational age above 34 weeks
- Lower gestational age and birth weight (Correct answer)
- Female sex
- Cesarean delivery
Correct answer: Lower gestational age and birth weight
IVH risk is inversely related to gestational age and birth weight; extremely premature infants have the most fragile germinal matrix vasculature.
Question 6: Which intervention has been shown to reduce the incidence and severity of IVH in premature neonates?
- Routine lumbar puncture
- Antenatal corticosteroids administered to the mother (Correct answer)
- Immediate delivery room intubation
- High-dose vitamin E
Correct answer: Antenatal corticosteroids administered to the mother
Antenatal corticosteroids accelerate fetal brain maturation and vascular stability, significantly reducing the incidence and severity of IVH in premature infants.
Neonatal Nurse Practitioner Exam Neonatal Neurology and Developmental Care 1
Hypoxic-ischemic encephalopathy (HIE) in a term neonate is most accurately assessed using which scoring system?