APRN ACCNS(N) - Final Test Review(Qns & Ans) - 2025, Exams of Nursing

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APRN ACCNS-N

Final Test Review

(Questions & Solutions)

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

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

ANS : B

Rationale: Congenital heart disease with cyanosis increases risk of embolic and thrombotic cerebral infarction.

10. Therapeutic hypothermia in HIE neonates is contraindicated in which situation? A) Postnatal age >6 hours B) Corrected gestational age <35 weeks C) Presence of severe coagulopathy D) Normal initial EEG ANS : C Rationale: Severe coagulopathy increases bleeding risk and is a contraindication to hypothermia.
11. In acute care of neonates with congenital CNS malformations, which intervention is most critical immediately post-birth? A) Administration of prophylactic anticonvulsants B) Early neurosurgical closure of myelomeningocele sac C) Maintaining normothermia and airway patency D) Correction of electrolyte abnormalities ANS : C Rationale: Airway protection and maintaining homeostasis like normothermia are immediately critical.
12. Which biochemical test is most specific to diagnose bacterial meningitis in neonates? A) Elevated CSF protein B) Positive CSF Gram stain and culture C) Decreased CSF glucose D) Elevated CSF lactate ANS : B Rationale: Positive Gram stain and culture is definitive for bacterial

16. Which electrolyte imbalance is most likely to precipitate neonatal seizures? A) Hypercalcemia B) Hyponatremia C) Hypermagnesemia D) Hypokalemia ANS : B Rationale: Hyponatremia by causing cerebral edema frequently precipitates seizures.
17. Which anesthetic agent used in neonatal surgery has the lowest neurotoxicity profile according to current evidence? A) Nitrous oxide B) Isoflurane C) Dexmedetomidine D) Ketamine ANS : C Rationale: Dexmedetomidine is considered to have less neurotoxic effects in neonatal brain compared to volatile agents.
18. Which clinical monitoring modality best assesses the risk of cerebral hypoxia in ventilated neonates? A) Continuous pulse oximetry B) Near-infrared spectroscopy (NIRS) C) Central venous pressure monitoring D) Capnography ANS : B Rationale: NIRS non-invasively monitors regional cerebral oxygen saturation, reflecting brain oxygenation status.
19. In neonatal seizures, which EEG pattern is pathognomonic for benign familial neonatal seizures?

A) Burst suppression B) Hypsarrhythmia C) Focal sharp waves with periodicity D) Normal background activity with ictal spikes ANS : D Rationale: Benign familial neonatal seizures show normal background with ictal discharges.

20. Which antenatal factor increases risk for neonatal white matter injury? A) Maternal hypertension B) Maternal infection-chorioamnionitis C) Maternal diabetes mellitus D) Maternal hypothyroidism ANS : B Rationale: Intrauterine infection causes inflammatory damage predisposing white matter injury in neonates.
21. The optimal timing of MRI to assess neonatal brain injury post- asphyxia is: A) Within first 6 hours of birth B) Between 3 to 7 days post-injury C) After 2 months of age D) At term corrected age only ANS : B Rationale: Brain injury becomes apparent on MRI after several days; early MRI less sensitive.
22. In neonates with suspected CNS bleeding, what laboratory value is critical to evaluate before lumbar puncture? A) Platelet count B) Serum glucose

ANS : C

Rationale: Hib vaccine prevents meningitis caused by H. influenzae type b.

26. Neonatal hypothermia therapy is associated with increased risk of which complication? A) Thrombocytopenia B) Hyperglycemia C) Pulmonary hemorrhage D) Disseminated intravascular coagulation (DIC) ANS : D Rationale: Hypothermia can worsen coagulopathy leading to DIC.
27. Which neonatal CNS pathology presents with non-communicating hydrocephalus due to aqueductal stenosis? A) Dandy-Walker malformation B) Chiari II malformation C) Arnold-Chiari malformation D) Congenital aqueductal stenosis ANS : D Rationale: Aqueductal stenosis causes obstructive hydrocephalus by blocking CSF flow.
28. The primary cause for cerebral palsy in neonates is: A) Genetic abnormalities B) Perinatal brain injury due to hypoxia-ischemia C) Infections during childhood D) Postnatal trauma ANS : B Rationale: Perinatal hypoxic-ischemic injury is the leading cause of

cerebral palsy.

29. In evaluating neonatal encephalopathy, which cerebrospinal fluid (CSF) finding is most suggestive of viral infection? A) High neutrophils B) High lymphocytes C) Low glucose D) High protein with red blood cells ANS : B Rationale: Lymphocytic predominance is typical in viral meningitis/encephalitis.
30. The pharmacokinetics of anticonvulsants in neonates is impacted primarily by: A) Increased hepatic enzyme activity B) Decreased renal clearance C) Immature hepatic metabolism and renal function D) High plasma protein binding ANS : C Rationale: Immature liver and kidney function alter drug metabolism/excretion in neonates.
31. The most sensitive clinical indicator of neonatal CNS infection is: A) Fever B) Lethargy and poor feeding C) Seizures D) Rash ANS : B Rationale: Lethargy and poor feeding are early, nonspecific but sensitive signs of CNS infection in neonates.
32. A term neonate presents with cephalohematoma after vacuum

neonatal brain injury? A) To treat underlying infection B) To reduce secondary neuronal injury from seizures C) To promote neurogenesis D) To lower intracranial pressure ANS : B Rationale: Seizures exacerbate brain injury; anticonvulsants prevent secondary damage.

36. Which form of neonatal intracranial hemorrhage is most associated with fetal distress and difficult delivery? A) Subdural hemorrhage B) Subarachnoid hemorrhage C) Epidural hemorrhage D) Intraparenchymal hemorrhage ANS : B Rationale: Subarachnoid hemorrhage is often linked to delivery trauma and fetal distress.
37. In neonatal neurocritical care, seizure monitoring via continuous video EEG is recommended because: A) Clinical seizures are easily detectable without EEG B) Neonatal seizures are often electrographic-only, without clinical signs C) EEG is useful only for long-term prognosis D) It helps reduce medication side effects ANS : B Rationale: Many neonatal seizures are subclinical requiring EEG for detection and management.
38. Which of the following is the most reliable prognostic tool for neonatal stroke outcomes? A) Cranial ultrasound findings alone

B) MRI combined with neurological exam findings C) Apgar scores at 5 minutes D) Head circumference measurements ANS : B Rationale: MRI with clinical assessment provides the best prognostic information.

39. What physiological mechanism explains why premature infants have increased CNS vulnerability to injury compared to term infants? A) Enhanced blood-brain barrier function B) Reduced cerebral blood flow C) Immature autoregulation of cerebral blood flow D) Increased myelination ANS : C Rationale: Immature autoregulatory mechanisms lead to fluctuations in cerebral perfusion, increasing injury risk.
40. Which CNS pathology is most common in neonatal sepsis survivors leading to long-term outcomes? A) Hydrocephalus B) Periventricular leukomalacia C) Intracranial hemorrhage D) Brain abscess ANS : B Rationale: Periventricular leukomalacia is common among neonates surviving sepsis and associates with cerebral palsy. Which of the following is the primary risk factor for intraventricular hemorrhage (IVH) in preterm infants? A) Maternal diabetes B) Low birth weight

Which of the following assessments is most critical in evaluating a neonate for potential hypothermia? A) Heart rate B) Skin temperature C) Capillary refill time D) Respiratory rate Correct ANS : B) Skin temperature Rationale: Skin temperature is a direct indicator of a neonate’s thermal status and is essential in assessing for hypothermia. What is the primary indication for performing a lumbar puncture in a neonate? A) To assess for jaundice B) To evaluate for sepsis C) To measure intracranial pressure D) To administer medications Correct ANS : B) To evaluate for sepsis Rationale: Lumbar puncture is commonly performed to analyze cerebrospinal fluid for signs of infection in suspected cases of sepsis. Which of the following is a characteristic feature of neonatal abstinence syndrome (NAS)? A) Hypotonia B) Hyperactivity C) Decreased reflexes D) Decreased feeding Correct ANS : B) Hyperactivity Rationale: Hyperactivity is a common symptom of NAS, reflecting the central nervous system irritability due to withdrawal from substances. In the management of congenital diaphragmatic hernia (CDH), which therapeutic intervention is typically prioritized? A) Immediate surgery B) Endotracheal intubation

C) Chest tube placement D) High-frequency ventilation Correct ANS : B) Endotracheal intubation Rationale: Endotracheal intubation is prioritized to secure the airway and facilitate ventilation in infants with CDH. Which of the following findings is most indicative of retinopathy of prematurity (ROP)? A) Corneal opacity B) Retinal detachment C) Abnormal blood vessel growth in the retina D) Optic nerve atrophy Correct ANS : C) Abnormal blood vessel growth in the retina Rationale: ROP is characterized by abnormal vascular development in the retina of premature infants, leading to potential vision loss. What is the recommended initial treatment for a neonate presenting with hypoglycemia? A) Oral glucose B) Intravenous dextrose C) Glucagon injection D) Increased feeding Correct ANS : B) Intravenous dextrose Rationale: Intravenous dextrose provides rapid correction of hypoglycemia in neonates, particularly when they are unable to tolerate oral intake. Which laboratory test is most useful in diagnosing neonatal sepsis? A) Complete blood count B) Blood culture C) C-reactive protein D) Urinalysis Correct ANS : B) Blood culture Rationale: Blood cultures are the gold standard for diagnosing sepsis, allowing for the identification of the causative organism.

A) Murmur B) Cyanosis C) Tachycardia D) Bounding pulses Correct ANS : B) Cyanosis Rationale: Cyanosis indicates inadequate oxygenation and is a critical sign of potential congenital heart disease requiring immediate evaluation. Which dietary modification is considered most beneficial for infants diagnosed with cow's milk protein allergy? A) Introduction of solid foods B) Hydrolyzed formula C) Soy formula D) Cow's milk formula Correct ANS : B) Hydrolyzed formula Rationale: Hydrolyzed formula is recommended for infants with cow's milk protein allergy, as it reduces allergenic potential. What is the primary goal of developmental care in the neonatal intensive care unit (NICU)? A) Increase weight gain B) Minimize stress and promote neurodevelopment C) Enhance feeding tolerance D) Reduce length of stay Correct ANS : B) Minimize stress and promote neurodevelopment Rationale: Developmental care focuses on minimizing stressors and fostering an environment conducive to optimal neurodevelopment. Which of the following interventions is critical in the management of a newborn experiencing apnea of prematurity? A) Caffeine citrate administration B) High-flow nasal cannula C) Continuous pulse oximetry monitoring D) Intravenous fluids

Correct ANS : A) Caffeine citrate administration Rationale: Caffeine citrate is commonly used to stimulate respiratory drive and reduce apnea episodes in premature infants. In the context of neonatal hypercapnia, which clinical sign is most indicative? A) Bradycardia B) Increased work of breathing C) Irritability D) Hypotonia Correct ANS : B) Increased work of breathing Rationale: Hypercapnia often presents with increased respiratory effort as the body attempts to compensate for elevated carbon dioxide levels. What is the recommended follow-up for infants discharged from the NICU with a history of prematurity? A) Routine pediatric visits only B) Developmental assessments and follow-up with a specialist C) No follow-up is necessary D) Only assessments for weight gain Correct ANS : B) Developmental assessments and follow-up with a specialist Rationale: Infants born prematurely require ongoing developmental assessments to monitor growth and neurodevelopmental outcomes

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1. Transition Physiology A term infant arrives to the NICU after an unremarkable vaginal delivery. At 15 minutes of life the SpO₂ is 84 % despite 21 % FiO₂; the pre-/post- ductal gradient is 7 %. Which FIRST intervention best supports physiologic transition? A. Begin 40 % FiO₂ by oxy-hood B. Place the infant prone in skin-to-skin with mother