CEN Neurological Emergencies 2

Question 1

Which clinical sign differentiates a herniation syndrome from a metabolic cause of coma?

Accepted Answer

Unilateral fixed and dilated pupil

Answer

A unilateral fixed and dilated pupil (blown pupil) indicates compression of cranial nerve III from uncal herniation, a structural cause, unlike the symmetric findings seen in metabolic coma.

Question 2

A patient with increased intracranial pressure (ICP) is being managed. Which intervention is most appropriate as a temporizing measure?

Accepted Answer

Elevate head of bed to 30 degrees and hyperventilate to PaCO2 35 mmHg

Answer

Head-of-bed elevation to 30 degrees improves venous drainage, and mild hyperventilation (PaCO2 35 mmHg) causes cerebral vasoconstriction to temporize elevated ICP.

Question 3

What is the NIH Stroke Scale (NIHSS) primarily used for in the emergency setting?

Accepted Answer

Quantifying neurological deficits and guiding thrombolysis decisions

Answer

The NIHSS quantifies neurological deficits on a standardized scale and helps guide tPA eligibility and treatment decisions in acute ischemic stroke.

Question 4

A patient post-trauma has a GCS of 8. According to current guidelines, what intervention is most appropriate?

Accepted Answer

Intubate to protect the airway

Answer

A GCS ≤8 is the clinical threshold for airway compromise; endotracheal intubation is indicated to protect the airway and provide controlled ventilation.

Question 5

Which medication is first-line for treatment of an acute hypertensive encephalopathy with a BP of 240/140 mmHg?

Accepted Answer

IV labetalol or nicardipine with goal of 20–25% MAP reduction in 1 hour

Answer

Hypertensive encephalopathy requires controlled BP reduction of 20–25% in the first hour using IV agents like labetalol or nicardipine to prevent cerebral hypoperfusion.

CEN - Certified Emergency Nurse Practice Test

CEN - Certified Emergency Nurse Practice Test

CEN Neurological Emergencies 2