A 1-month-old female presents to the clinic for a follow-up appointment. The infant was recently diagnosed with spina bifida at birth. During physical assessment, the nurse practitioner measures the infant’s head circumference to assess for:
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✓ Correct answer: C. HydrocephalusThe correct answer is C) Hydrocephalus.<br/><br/>Spina bifida is a midline neural tube defect where the osseous spine fails to close. Spina bifida is categorized by spina bifida occulta and spina bifida cystica. Spina bifida occulta is when the spinal defect is not externally visible. Spina bifida cystica is when the spinal defect forms an external saclike protrusion<strong>.</strong> Children with minor defects of spina bifida are asymptomatic. However, neurological complications of spina bifida include hydrocephalus, differing degrees of paralysis and sensory deficits, and decreased rectal tone.<br/><br/><img src="asset:assets/questions/b7979320fde99b10.png"><br/><br/><strong><em>Spina bifida</em></strong><em> Image Source: https://en.wikipedia.org/wiki/Spina_bifida#/media/File:Spina-bifida.jpg</em><br/><br/>Hydrocephalus is an accumulation of excessive amounts of CSF in the ventricular system of the brain. It can cause cerebral ventricular enlargement and/or increased intracranial pressure. Head circumference is measured to check for the development of hydrocephalus. Cranial imaging such as CT scan, MRI, or ultrasound is used to further monitor the progression of hydrocephalus.<br/><br/><img src="asset:assets/questions/d7c38ac319bd64e5.png"><br/><br/><strong><em>Hydrocephalus </em></strong><em>Image Source: </em><a href="https://en.wikipedia.org/wiki/Hydrocephalus#/media/File:Hydrocephalus_CDC.png" style="color: rgb(5, 99, 193);"><em>https://en.wikipedia.org/wiki/Hydrocephalus#/media/File:Hydrocephalus_CDC.png</em></a><br/><br/><strong>Choice A is incorrect.</strong> Microcephaly is defined as the head being disproportionately smaller compared to the rest of the body. Microcephaly is caused by chromosomal disorders and environmental causes such as prenatal alcohol, drug, or radiation exposure and prenatal infections.<br/><br/>Macrocephaly can be seen in hydrocephalus.<br/><br/><strong>Choice B is incorrect.</strong> Subdural hematoma is intracranial bleeding that occurs under the dura matter. In infants, subdural hematomas can occur due to falls, assaults, birth trauma, or violent shaking. Subdural hematomas develop slowly in a span of days or weeks after the injury.<br/><br/><strong>Choice C is incorrect. </strong>Spina bifida cystica<strong> </strong>is when the spinal defect forms an external saclike protrusion<strong>. </strong>Spina bifida cystica refers to two forms: myelomeningocele (can also be referred to as meningomyelocele) and meningocele. Myelomeningocele contains meninges, spinal fluid, and nerves. Meningocele contains meninges and spinal fluid.<br/><br/>Spina bifida occulta is when the spinal defect is not outwardly visible. It occurs more commonly in the lumbosacral area. Physical examination of spina bifida occulta includes asymmetry of the gluteal cleft, hyperpigmented areas, and tufts of hair at the site.<br/><br/><img src="asset:assets/questions/faa139783bf2916c.png"><br/><br/><strong><em>Forms of spina bifida </em></strong><em>Image Source: </em><em>https://en.wikipedia.org/wiki/Spina_bifida#/media/File:Typesofspinabifida.jpg</em>
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