APRN ACCNS-N
Final Test Review
(Questions & Solutions)
2025
1
,1. A preterm neonate (28 weeks) develops sudden apnea and
bradycardia on day 4 of life. Head ultrasound reveals periventricular-
intraventricular hemorrhage (IVH). Which pathophysiological factor
primarily contributes to IVH in this population?
A) Immature cerebral vasculature and fluctuating cerebral blood flow
B) Hypoglycemia and metabolic acidosis
C) Excessive oxygen administration leading to oxidative stress
D) Hypernatremia and volume depletion
ANS: A
Rationale: The germinal matrix in premature neonates contains fragile
blood vessels prone to rupture due to immature autoregulation of
cerebral blood flow, leading to IVH.
2. A neonate with hypoxic-ischemic encephalopathy (HIE) is undergoing
therapeutic hypothermia. Which biomarker is most predictive of long-
term neurodevelopmental outcomes?
A) Elevated serum lactate dehydrogenase (LDH)
B) Amplitude-integrated EEG (aEEG) abnormalities within 6 hours
C) Serum bilirubin levels
D) Cranial MRI on day 15 showing white matter injury
ANS: B
Rationale: Early aEEG abnormalities correlate strongly with neurological
outcomes following HIE treated with hypothermia.
3. In a term neonate presenting with seizures and encephalopathy, which
metabolic disorder should be ruled out first?
A) Urea cycle defects
B) Hypocalcemia
C) Neonatal hypoglycemia
2
,D) Medium-chain acyl-CoA dehydrogenase deficiency
ANS: C
Rationale: Hypoglycemia is a common and readily reversible cause of
neonatal seizures and must be promptly excluded.
4. A 32-week gestational age neonate develops a posthemorrhagic
hydrocephalus. What is the initial management approach to prevent
progression?
A) Immediate ventriculoperitoneal shunt placement
B) Serial lumbar punctures and temporizing ventricular taps
C) IV mannitol administration
D) High-dose corticosteroids
ANS: B
Rationale: Temporizing measures like serial lumbar punctures or
ventricular reservoir taps are preferred initially to temporize
hydrocephalus in unstable neonates.
5. Which advanced neuroimaging modality best assesses brain
connectivity in neonates with suspected periventricular leukomalacia?
A) Cranial ultrasound
B) Diffusion tensor imaging (DTI) MRI
C) CT head without contrast
D) PET scan
ANS: B
Rationale: DTI MRI provides detailed assessment of white matter tracts
and is highly sensitive to white matter injury like periventricular
leukomalacia.
6. When managing neonatal seizures refractory to phenobarbital, which
anticonvulsant is considered the second-line agent?
A) Phenytoin
B) Levetiracetam
3
, C) Diazepam
D) Carbamazepine
ANS: B
Rationale: Levetiracetam is increasingly used and preferred due to better
side effect profile and ease of dosing.
7. What physiological parameter should be tightly controlled in neonates
undergoing ECMO to prevent CNS injury?
A) Hemoglobin concentration
B) Mean arterial pressure (MAP)
C) Serum calcium levels
D) Oxygen saturation maintained >95%
ANS: B
Rationale: Maintaining stable cerebral perfusion pressure by controlling
MAP is critical to avoid ischemic or hemorrhagic CNS injury during ECMO.
8. MRI findings in neonatal hypoglycemic brain injury typically involve
which area?
A) Basal ganglia and thalamus
B) Frontal white matter
C) Cerebellar vermis
D) Hippocampus
ANS: A
Rationale: Hypoglycemia commonly affects deep grey matter structures
including basal ganglia and thalami.
9. Which neonate is at highest risk for neonatal arterial ischemic stroke?
A) Infant of a diabetic mother with macrosomia
B) Neonate with suspected congenital heart disease and cyanosis
C) Full-term infant with uneventful delivery
D) Neonate with transient tachypnea
4
Final Test Review
(Questions & Solutions)
2025
1
,1. A preterm neonate (28 weeks) develops sudden apnea and
bradycardia on day 4 of life. Head ultrasound reveals periventricular-
intraventricular hemorrhage (IVH). Which pathophysiological factor
primarily contributes to IVH in this population?
A) Immature cerebral vasculature and fluctuating cerebral blood flow
B) Hypoglycemia and metabolic acidosis
C) Excessive oxygen administration leading to oxidative stress
D) Hypernatremia and volume depletion
ANS: A
Rationale: The germinal matrix in premature neonates contains fragile
blood vessels prone to rupture due to immature autoregulation of
cerebral blood flow, leading to IVH.
2. A neonate with hypoxic-ischemic encephalopathy (HIE) is undergoing
therapeutic hypothermia. Which biomarker is most predictive of long-
term neurodevelopmental outcomes?
A) Elevated serum lactate dehydrogenase (LDH)
B) Amplitude-integrated EEG (aEEG) abnormalities within 6 hours
C) Serum bilirubin levels
D) Cranial MRI on day 15 showing white matter injury
ANS: B
Rationale: Early aEEG abnormalities correlate strongly with neurological
outcomes following HIE treated with hypothermia.
3. In a term neonate presenting with seizures and encephalopathy, which
metabolic disorder should be ruled out first?
A) Urea cycle defects
B) Hypocalcemia
C) Neonatal hypoglycemia
2
,D) Medium-chain acyl-CoA dehydrogenase deficiency
ANS: C
Rationale: Hypoglycemia is a common and readily reversible cause of
neonatal seizures and must be promptly excluded.
4. A 32-week gestational age neonate develops a posthemorrhagic
hydrocephalus. What is the initial management approach to prevent
progression?
A) Immediate ventriculoperitoneal shunt placement
B) Serial lumbar punctures and temporizing ventricular taps
C) IV mannitol administration
D) High-dose corticosteroids
ANS: B
Rationale: Temporizing measures like serial lumbar punctures or
ventricular reservoir taps are preferred initially to temporize
hydrocephalus in unstable neonates.
5. Which advanced neuroimaging modality best assesses brain
connectivity in neonates with suspected periventricular leukomalacia?
A) Cranial ultrasound
B) Diffusion tensor imaging (DTI) MRI
C) CT head without contrast
D) PET scan
ANS: B
Rationale: DTI MRI provides detailed assessment of white matter tracts
and is highly sensitive to white matter injury like periventricular
leukomalacia.
6. When managing neonatal seizures refractory to phenobarbital, which
anticonvulsant is considered the second-line agent?
A) Phenytoin
B) Levetiracetam
3
, C) Diazepam
D) Carbamazepine
ANS: B
Rationale: Levetiracetam is increasingly used and preferred due to better
side effect profile and ease of dosing.
7. What physiological parameter should be tightly controlled in neonates
undergoing ECMO to prevent CNS injury?
A) Hemoglobin concentration
B) Mean arterial pressure (MAP)
C) Serum calcium levels
D) Oxygen saturation maintained >95%
ANS: B
Rationale: Maintaining stable cerebral perfusion pressure by controlling
MAP is critical to avoid ischemic or hemorrhagic CNS injury during ECMO.
8. MRI findings in neonatal hypoglycemic brain injury typically involve
which area?
A) Basal ganglia and thalamus
B) Frontal white matter
C) Cerebellar vermis
D) Hippocampus
ANS: A
Rationale: Hypoglycemia commonly affects deep grey matter structures
including basal ganglia and thalami.
9. Which neonate is at highest risk for neonatal arterial ischemic stroke?
A) Infant of a diabetic mother with macrosomia
B) Neonate with suspected congenital heart disease and cyanosis
C) Full-term infant with uneventful delivery
D) Neonate with transient tachypnea
4
