NNP 2 QUIZ 3 (2025) COMPREHENSIVE
EXAM 2025 QUESTIONS AND ANSWERS
Surgical intervention for brachial plexus injury is best done at which age? - ANS 4 months of
age; A brachial plexus injury occurs when there is mechanical trauma to the spinal roots of the
5th cervical through the 1st thoracic nerves. The injury results in paralysis, with the precise
location dependent on the spinal nerve roots damaged. It typically occurs due to birth trauma
or in utero position secondary to compression force on the fetal arms and thorax. The most
common type is Ducehnne-Erb paralysis, which causes upper arm paralysis. Klumpke paralysis
involves the lower arm. Entire arm paralysis can also occur. Infants with brachial plexus injury
are initially treated conservatively and are monitored monthly. However, if surgical intervention
is determined to be necessary it should be done around four months of age, as the success rate
decreases over time
The best predictors of outcome from neonatal seizures include underlying etiology, gestational
age and: - ANS Interictal EEG pattern; The interictal EEG patterns seen in-between seizures
can be highly predictive of outcome. Major background abnormalities like burst suppression are
highly predictive of poor outcome, especially if present on serial studies. Abnormal EEG
patterns during seizures alone are not as accurate at predicting outcome.
In the neurologic portion of the neonatal physical exam, assessment of the scarf sign is used in
evaluating: - ANS Phasic tone; Part of a thorough neurologic exam is evaluation of tone
through examining resting posture, passive tone and active tone. Examining phasic tone by
performing the scarf sign and deep tendon reflexes provides information on passive tone and
tests the resistance of the upper extremities to movement. Postural tone is tested by response
to traction (pull-to-sit maneuver). An acutely encephalopathic infant often has poor tone and
absent reflexes initially, which then improves. Later it can become increased or significantly
exaggerated.
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, The anterior fontanel normally closes by what age? - ANS 24 months; normal newborn
findings include an open, soft and flat anterior fontanel. Bulging may indicate increased
intracranial pressure. Depression may be indicative of dehydration. The anterior fontanel
normally closes at 6-24 months of age.
The optimal time to perform a neurological assessment of a 32 week GA infant is: - ANS 30-
60 minutes before a feeding; The infant's state is important in performing a neurologic exam,
with the quiet alert state optimal for the exam. Timing the exam to 30-60 minutes before an
exam may increase the chance of the infant being in a quiet alert state. Note that the
premature infant does not have predictable sleep-awake cycles prior to 28 weeks. Sleep-wake
cycles become more apparent from 28 weeks on, with clear sleep-awake cycles by 32 weeks.
The most common type of seizure seen in premature infants is: - ANS Subtle seizures; subtle
seizures are the most common type of seizure seen in neonates, particularly among premature
infants. This type of seizure is often missed because the clinical manifestations may be difficult
to recognize. Behaviors most often seen with subtle seizures are (1) tonic, horizontal deviations
of the eyes with or without nystagmoid jerking; (2) repetitive blinking or fluttering of the
eyelids; (3) drooling, sucking, and/or tongue thrusting; and (4) swimming or rowing movements
of the legs. Apnea may occur but is usually the result of the underlying cause of the seizure
rather than of the seizure and rarely occurs as an isolated seizure event. The types of seizures
seen in the neonate are, (1) subtle, (2) tonic, (3) clonic (multifocal and focal), and (4) myoclonic
The best time to obtain an ultrasound to confidently identify periventricular-intraventricular
hemorrhage is: - ANS Seven days of age; The onset of periventricular-intraventricular
hemorrhage occurs within 1 week of age in more than 90% of affected infants, many within 24
hours of birth. Thus, the optimal time to screen for hemorrhage is 7 days of age. Otherwise,
serial ultrasounds would need to be done over the first week of life. If hemorrhage is detected,
ventricular dilation appears between 10-20 days after the bleeding. The presence of ventricular
dilation is optimally ascertained at 2-4 weeks of age. If present, weekly serial scans are useful in
delineating whether the ventricular dilation is transient, static, or progressive.
Following a severe intraventricular hemorrhage (IVH), the most common sequelae is: -
ANS Hemiparesis on the side contralateral to the hemorrhage; The mortality rate for infants
with severe hemorrhage is high, thus data on developmental outcomes of these infants are
meager. Overall, approximately 80% of infants with severe hemorrhage manifest a major
neurodevelopmental disability. Hemiparesis on the side contralateral to the hemorrhage is the
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EXAM 2025 QUESTIONS AND ANSWERS
Surgical intervention for brachial plexus injury is best done at which age? - ANS 4 months of
age; A brachial plexus injury occurs when there is mechanical trauma to the spinal roots of the
5th cervical through the 1st thoracic nerves. The injury results in paralysis, with the precise
location dependent on the spinal nerve roots damaged. It typically occurs due to birth trauma
or in utero position secondary to compression force on the fetal arms and thorax. The most
common type is Ducehnne-Erb paralysis, which causes upper arm paralysis. Klumpke paralysis
involves the lower arm. Entire arm paralysis can also occur. Infants with brachial plexus injury
are initially treated conservatively and are monitored monthly. However, if surgical intervention
is determined to be necessary it should be done around four months of age, as the success rate
decreases over time
The best predictors of outcome from neonatal seizures include underlying etiology, gestational
age and: - ANS Interictal EEG pattern; The interictal EEG patterns seen in-between seizures
can be highly predictive of outcome. Major background abnormalities like burst suppression are
highly predictive of poor outcome, especially if present on serial studies. Abnormal EEG
patterns during seizures alone are not as accurate at predicting outcome.
In the neurologic portion of the neonatal physical exam, assessment of the scarf sign is used in
evaluating: - ANS Phasic tone; Part of a thorough neurologic exam is evaluation of tone
through examining resting posture, passive tone and active tone. Examining phasic tone by
performing the scarf sign and deep tendon reflexes provides information on passive tone and
tests the resistance of the upper extremities to movement. Postural tone is tested by response
to traction (pull-to-sit maneuver). An acutely encephalopathic infant often has poor tone and
absent reflexes initially, which then improves. Later it can become increased or significantly
exaggerated.
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 1
, The anterior fontanel normally closes by what age? - ANS 24 months; normal newborn
findings include an open, soft and flat anterior fontanel. Bulging may indicate increased
intracranial pressure. Depression may be indicative of dehydration. The anterior fontanel
normally closes at 6-24 months of age.
The optimal time to perform a neurological assessment of a 32 week GA infant is: - ANS 30-
60 minutes before a feeding; The infant's state is important in performing a neurologic exam,
with the quiet alert state optimal for the exam. Timing the exam to 30-60 minutes before an
exam may increase the chance of the infant being in a quiet alert state. Note that the
premature infant does not have predictable sleep-awake cycles prior to 28 weeks. Sleep-wake
cycles become more apparent from 28 weeks on, with clear sleep-awake cycles by 32 weeks.
The most common type of seizure seen in premature infants is: - ANS Subtle seizures; subtle
seizures are the most common type of seizure seen in neonates, particularly among premature
infants. This type of seizure is often missed because the clinical manifestations may be difficult
to recognize. Behaviors most often seen with subtle seizures are (1) tonic, horizontal deviations
of the eyes with or without nystagmoid jerking; (2) repetitive blinking or fluttering of the
eyelids; (3) drooling, sucking, and/or tongue thrusting; and (4) swimming or rowing movements
of the legs. Apnea may occur but is usually the result of the underlying cause of the seizure
rather than of the seizure and rarely occurs as an isolated seizure event. The types of seizures
seen in the neonate are, (1) subtle, (2) tonic, (3) clonic (multifocal and focal), and (4) myoclonic
The best time to obtain an ultrasound to confidently identify periventricular-intraventricular
hemorrhage is: - ANS Seven days of age; The onset of periventricular-intraventricular
hemorrhage occurs within 1 week of age in more than 90% of affected infants, many within 24
hours of birth. Thus, the optimal time to screen for hemorrhage is 7 days of age. Otherwise,
serial ultrasounds would need to be done over the first week of life. If hemorrhage is detected,
ventricular dilation appears between 10-20 days after the bleeding. The presence of ventricular
dilation is optimally ascertained at 2-4 weeks of age. If present, weekly serial scans are useful in
delineating whether the ventricular dilation is transient, static, or progressive.
Following a severe intraventricular hemorrhage (IVH), the most common sequelae is: -
ANS Hemiparesis on the side contralateral to the hemorrhage; The mortality rate for infants
with severe hemorrhage is high, thus data on developmental outcomes of these infants are
meager. Overall, approximately 80% of infants with severe hemorrhage manifest a major
neurodevelopmental disability. Hemiparesis on the side contralateral to the hemorrhage is the
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 2
