Neonatal Intensive Care Nurse Exam Neonatal Neurological Assessment and Care 1 — Questions and Answers
Question 1: Hypoxic-ischemic encephalopathy (HIE) is graded using the Sarnat classification. Grade II (moderate) HIE is characterized by:
- Lethargy, hypotonia, absent Moro reflex, and possible seizures (Correct answer)
- Hyperalertness and normal tone
- Coma, flaccidity, and absent primitive reflexes
- Mild irritability with normal feeding
Correct answer: Lethargy, hypotonia, absent Moro reflex, and possible seizures
Sarnat Grade II HIE presents with lethargy, hypotonia, suppressed primitive reflexes, and seizures occurring within 24 hours of birth.
Question 2: The anterior fontanelle normally closes at approximately:
- 12–18 months of age (Correct answer)
- 2–3 months of age
- At birth
- 24–36 months of age
Correct answer: 12–18 months of age
The anterior fontanelle closes between 12–18 months as the frontal and parietal bones complete ossification.
Question 3: A bulging anterior fontanelle in a febrile neonate is a sign of:
- Increased intracranial pressure (e.g., meningitis) (Correct answer)
- Normal hydration status
- Dehydration
- Normal variant of head shape
Correct answer: Increased intracranial pressure (e.g., meningitis)
A tense, bulging fontanelle indicates elevated intracranial pressure, which in a febrile neonate is a warning sign of meningitis.
Question 4: Intraventricular hemorrhage (IVH) in preterm infants is most commonly associated with:
- Gestational age under 32 weeks and respiratory distress (Correct answer)
- Term birth complicated by prolonged labor
- Hyperoxia during delivery
- Hyperthermia in the first hour
Correct answer: Gestational age under 32 weeks and respiratory distress
IVH risk is highest in the most immature neonates; fragile germinal matrix capillaries rupture under hemodynamic and hypoxic stress.
Question 5: Neonatal seizures most commonly manifest as:
- Subtle seizures (eye deviation, lip smacking, cycling limb movements) (Correct answer)
- Grand mal tonic-clonic convulsions
- Absence episodes
- Myoclonic jerks only
Correct answer: Subtle seizures (eye deviation, lip smacking, cycling limb movements)
Due to immature cortical organization, neonatal seizures most often present as subtle signs rather than classic tonic-clonic activity.
Question 6: Grade III IVH is distinguished from Grade II by the presence of:
- Blood filling and distending the ventricles (intraventricular clot with ventricular dilation) (Correct answer)
- Blood only in the germinal matrix
- Blood in the subdural space
- Blood limited to the choroid plexus
Correct answer: Blood filling and distending the ventricles (intraventricular clot with ventricular dilation)
Grade III IVH involves blood filling and distending the ventricles, increasing risk of post-hemorrhagic hydrocephalus.
Neonatal Intensive Care Nurse Exam Neonatal Neurological Assessment and Care 1
Hypoxic-ischemic encephalopathy (HIE) is graded using the Sarnat classification.
Grade II (moderate) HIE is characterized by: