CNRN Neurological Assessment and Monitoring 2 — Questions and Answers
Question 1: The nurse is monitoring a patient's cerebral perfusion pressure (CPP). Which formula is used to calculate CPP?
- CPP = MAP + ICP
- CPP = MAP − ICP (Correct answer)
- CPP = SBP − ICP
- CPP = SBP + DBP − ICP
Correct answer: CPP = MAP − ICP
Cerebral perfusion pressure is calculated as mean arterial pressure minus intracranial pressure (CPP = MAP − ICP).
Question 2: Which reflex, when absent, suggests dysfunction at the level of the medulla?
- Gag reflex (Correct answer)
- Corneal reflex
- Plantar reflex
- Babinski sign
Correct answer: Gag reflex
The gag reflex (CN IX and X) is mediated at the medulla; its absence indicates medullary dysfunction.
Question 3: A positive Romberg test (patient sways when eyes are closed) indicates impairment in which system?
- Cerebellar function
- Proprioceptive or vestibular function (Correct answer)
- Corticospinal tract
- Frontal lobe executive function
Correct answer: Proprioceptive or vestibular function
A positive Romberg test indicates impaired proprioception or vestibular function, as the patient cannot maintain balance without visual input.
Question 4: When assessing for meningeal irritation, the nurse flexes the patient's hip and knee, then extends the knee. The patient reports pain and resists extension. This describes:
- Kernig's sign (Correct answer)
- Brudzinski's sign
- Lhermitte's sign
- Hoffmann's sign
Correct answer: Kernig's sign
Kernig's sign is positive when the patient resists or experiences pain with knee extension after hip flexion, indicating meningeal irritation.
Question 5: In continuous EEG monitoring, which finding requires the nurse to immediately notify the neurologist?
- Alpha waves at 8–13 Hz
- Nonconvulsive status epilepticus pattern (Correct answer)
- Sleep spindles
- K complexes
Correct answer: Nonconvulsive status epilepticus pattern
Nonconvulsive status epilepticus (NCSE) on continuous EEG is a medical emergency requiring immediate neurologist notification and treatment.
Question 6: Which positioning intervention is standard for patients at risk for increased ICP?
- Head of bed flat to promote venous return
- Head of bed elevated 30 degrees with head midline (Correct answer)
- Trendelenburg position to increase CPP
- Left lateral decubitus to reduce aspiration risk
Correct answer: Head of bed elevated 30 degrees with head midline
Elevating the head of bed to 30 degrees with the head in midline promotes cerebral venous drainage and reduces ICP.
CNRN Neurological Assessment and Monitoring 2
The nurse is monitoring a patient's cerebral perfusion pressure (CPP).
Which formula is used to calculate CPP?