CMSRN Neurological and Musculoskeletal Care 1 — Questions and Answers
Question 1: A patient admitted with a suspected stroke has a blood pressure of 185/105 mmHg. Before tPA administration, what is the BP threshold that must be achieved?
- Less than 220/120 mmHg
- Less than 185/110 mmHg (Correct answer)
- Less than 160/90 mmHg
- Less than 140/80 mmHg
Correct answer: Less than 185/110 mmHg
Blood pressure must be below 185/110 mmHg before administering tPA for ischemic stroke to reduce the risk of hemorrhagic transformation.
Question 2: When assessing level of consciousness using the Glasgow Coma Scale (GCS), which three components are evaluated?
- Pupil reaction, verbal response, motor response
- Eye opening, verbal response, motor response (Correct answer)
- Orientation, pupil size, reflex response
- Eye opening, pupillary response, orientation
Correct answer: Eye opening, verbal response, motor response
The GCS assesses eye opening (1–4), verbal response (1–5), and motor response (1–6), with a maximum score of 15 indicating full consciousness.
Question 3: A patient with a traumatic brain injury (TBI) has a GCS of 7 and widening pulse pressure, bradycardia, and irregular respirations. What does this triad indicate?
- Septic shock
- Cushing's triad — sign of increased intracranial pressure (Correct answer)
- Neurogenic shock
- Pulmonary embolism
Correct answer: Cushing's triad — sign of increased intracranial pressure
Cushing's triad (hypertension with widened pulse pressure, bradycardia, and irregular respirations) is a late sign of dangerously elevated intracranial pressure.
Question 4: The nurse is caring for a patient with a C5 spinal cord injury. Which complication should be the priority concern?
- Skin breakdown on heels
- Respiratory compromise due to loss of diaphragmatic function (Correct answer)
- Deep vein thrombosis in lower extremities
- Bowel impaction
Correct answer: Respiratory compromise due to loss of diaphragmatic function
Injuries at or above C4 affect the phrenic nerve and diaphragm; C5 injuries may partially spare diaphragm function but respiratory compromise remains the top priority.
Question 5: A post-operative patient reports numbness and tingling in the fingers and toes, and has a positive Chvostek's sign. What electrolyte imbalance does the nurse suspect?
- Hyperkalemia
- Hypocalcemia (Correct answer)
- Hypermagnesemia
- Hypernatremia
Correct answer: Hypocalcemia
Hypocalcemia causes neuromuscular excitability, peripheral paresthesias, and positive Chvostek's sign (facial muscle twitching with cheek tap).
Question 6: The nurse is positioning a patient following lumbar laminectomy. Which position is most appropriate in the immediate post-operative period?
- Prone with pillows under abdomen
- Log-rolling technique to maintain spinal alignment (Correct answer)
- High Fowler's position
- Trendelenburg to reduce spinal pressure
Correct answer: Log-rolling technique to maintain spinal alignment
Log-rolling maintains spinal alignment and prevents twisting or flexion of the operative site following lumbar laminectomy.
CMSRN Neurological and Musculoskeletal Care 1
A patient admitted with a suspected stroke has a blood pressure of 185/105 mmHg.
Before tPA administration, what is the BP threshold that must be achieved?