Certified Neuroscience Registered Nurse (CNRN) — Questions and Answers

Question 1: Which Glasgow Coma Scale (GCS) component score indicates the greatest severity of neurological impairment?

E2V2M3 (GCS 7)
E3V3M4 (GCS 10)
E1V2M4 (GCS 7)
E1V1M1 (GCS 3) (Correct answer)

Correct answer: E1V1M1 (GCS 3)

A GCS of 3 (E1V1M1) is the lowest possible score, indicating no eye opening, no verbal response, and no motor response — consistent with deep coma or brain death.

Question 2: Status epilepticus is defined as continuous seizure activity lasting longer than:

2 minutes
15 minutes
5 minutes (Correct answer)
30 minutes

Correct answer: 5 minutes

Status epilepticus is defined as seizure activity lasting ≥5 minutes or two or more seizures without return to baseline consciousness between them.

Question 3: Which clinical sign distinguishes central herniation from uncal herniation in a deteriorating patient?

Contralateral Babinski sign in central herniation only
Fixed dilated pupils bilaterally in uncal herniation
Bilateral pinpoint pupils early in central herniation vs. ipsilateral blown pupil in uncal herniation (Correct answer)
Decorticate posturing exclusive to uncal herniation

Correct answer: Bilateral pinpoint pupils early in central herniation vs. ipsilateral blown pupil in uncal herniation

Central herniation causes early bilateral small pupils and gradual rostral-caudal deterioration, while uncal herniation classically presents with an ipsilateral dilated fixed pupil from CN III compression.

Question 4: Which clinical feature best differentiates early Alzheimer's disease from other dementias?

Rapid progression with myoclonus and cerebellar ataxia
Prominent visual hallucinations occurring early in the disease course
Stepwise cognitive decline following repeated small strokes
Insidious onset with predominant short-term memory impairment (Correct answer)

Correct answer: Insidious onset with predominant short-term memory impairment

Alzheimer's disease characteristically presents with insidious onset where short-term memory impairment is the predominant early feature.

Question 5: A nurse caring for a patient with a spinal cord injury at T6 notes the patient has not had a bowel movement in 4 days. The most appropriate intervention is:

Initiate a scheduled bowel program with digital stimulation and rectal suppository (Correct answer)
Administer oral laxatives and increase fluid intake
Perform a saline enema immediately
Obtain an abdominal X-ray to rule out obstruction

Correct answer: Initiate a scheduled bowel program with digital stimulation and rectal suppository

Neurogenic bowel in SCI requires a structured bowel program using reflex bowel techniques (digital stimulation, suppositories) timed to exploit the gastrocolic reflex for effective evacuation.

Question 6: A patient with ALS is admitted with declining respiratory status. Which finding MOST urgently requires intervention?

Mild exertional dyspnea with an FVC of 65% predicted
Occasional coughing episodes during meals
Morning headaches, frequent nighttime awakenings, and orthopnea (Correct answer)
Mild post-physical therapy fatigue

Correct answer: Morning headaches, frequent nighttime awakenings, and orthopnea

Morning headaches, nighttime awakenings, and orthopnea indicate nocturnal hypoventilation in ALS, signaling significant respiratory muscle weakness that requires urgent evaluation for non-invasive ventilation.

Question 7: When caring for a patient in a barbiturate coma for refractory ICP, which monitoring parameter guides therapy titration?

Daily serum barbiturate levels
Continuous EEG monitoring for burst-suppression pattern (Correct answer)
Hourly neurological assessments
Serial ICP waveform analysis

Correct answer: Continuous EEG monitoring for burst-suppression pattern

Burst-suppression on continuous EEG is the target endpoint for barbiturate coma therapy, indicating maximal metabolic suppression with minimal risk of overdose.

Question 8: A patient with epilepsy is prescribed a ketogenic diet. The nurse understands this diet works primarily by:

Increasing serotonin levels
Reducing sodium intake to lower neural excitability
Producing ketone bodies that have antiseizure effects (Correct answer)
Increasing GABA synthesis through protein restriction

Correct answer: Producing ketone bodies that have antiseizure effects

The ketogenic diet induces a state of ketosis; ketone bodies have antiseizure effects through multiple mechanisms including altered neuronal metabolism.

Question 9: Which classification system stratifies ischemic stroke etiology into large-artery atherosclerosis, cardioembolism, small-vessel occlusion, other determined cause, and undetermined cause?

Modified Rankin classification
TOAST classification (Correct answer)
Oxford (Bamford) classification
NIHSS classification

Correct answer: TOAST classification

The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification categorizes ischemic stroke into five etiological subtypes to guide treatment.

Question 10: A 36-year-old man complains of low back pain when he visits the pain clinic. His symptoms started suddenly two weeks ago after he attempted to raise a hefty piece of furniture. According to him, the discomfort "shoots down" his left leg. What physical examination signs are most indicative of L4 radiculopathy?

Positive Babinski sign on the left
Bilateral wasting of extensor digitorum brevis
Diminished left Achilles reflex
Left foot drop (Correct answer)

Correct answer: Left foot drop

L4 radiculopathy typically affects the L4 nerve root, which innervates muscles responsible for dorsiflexion of the foot. A 'foot drop' on the left side, characterized by weakness in lifting the front part of the foot, is a classic sign of L4 nerve root compression. Other options like Babinski sign relate to upper motor neuron lesions, and Achilles reflex (S1) or extensor digitorum brevis wasting (L5/S1) are associated with different nerve root levels.

Question 11: A nurse is teaching a patient with MS about fatigue management. Which strategy is MOST evidence-based?

Use stimulant medications continuously to counteract fatigue
Avoid all physical activity to fully conserve energy throughout the day
Schedule activities during peak energy periods and incorporate planned rest breaks (Correct answer)
Exercise intensely in the afternoon to build energy reserves over time

Correct answer: Schedule activities during peak energy periods and incorporate planned rest breaks

Energy conservation through activity pacing — scheduling tasks during peak energy periods and incorporating planned rest — is the core evidence-based strategy for managing MS-related fatigue.

Question 12: After a stroke, a patient will be given aspirin (Ecotrin) and ticagrelor (Brilinta) to take home. Which of the following side effects of these drugs ought to be explained to the family?

Nystagmus.
Ataxia.
Bleeding (Correct answer)
Tardive dyskinesia.

Correct answer: Bleeding

Both aspirin and ticagrelor are antiplatelet medications prescribed to prevent blood clots after a stroke. Their primary mechanism of action involves inhibiting platelet aggregation, which significantly increases the risk of bleeding. Patients and their families must be educated about potential signs of bleeding, such as easy bruising, nosebleeds, or blood in urine or stools, to ensure prompt recognition and management.

Question 13: A nurse notes Cushing's triad in a neuroscience patient. Which set of findings is characteristic?

Hypotension, tachycardia, irregular respirations
Hypotension, bradycardia, tachypnea
Hypertension, bradycardia, irregular respirations (Correct answer)
Hypertension, tachycardia, apnea

Correct answer: Hypertension, bradycardia, irregular respirations

Cushing's triad consists of hypertension (widening pulse pressure), bradycardia, and irregular respirations, signaling impending brainstem herniation.

Question 14: A patient is admitted with suspected ischemic stroke. CT head is negative. The next most appropriate diagnostic study to detect early infarction is:

MRI brain with DWI sequence (Correct answer)
CT angiography of head and neck
Repeat CT head in 24 hours
Carotid duplex ultrasound

Correct answer: MRI brain with DWI sequence

DWI-MRI detects acute ischemic changes within minutes of onset with far greater sensitivity than CT, making it the gold standard for early stroke diagnosis.

Question 15: A patient with SAH develops delayed cerebral ischemia. The nurse implements 'Triple-H therapy.' This refers to:

Hypertension, hemodilution, hyperventilation
Hyperventilation, hemodilution, hypothermia
Hypotension, hypervolemia, hyperoxia
Hypertension, hypervolemia, hemodilution (Correct answer)

Correct answer: Hypertension, hypervolemia, hemodilution

Triple-H therapy (hypertension, hypervolemia, hemodilution) aims to increase cerebral perfusion in vasospasm-related delayed ischemia.

Question 16: A patient presents with sudden-onset unilateral facial drooping, arm weakness, and speech difficulty that completely resolved within 45 minutes. This presentation best describes:

Transient ischemic attack (TIA) (Correct answer)
Hemiplegic migraine
Completed ischemic stroke
Todd's paralysis

Correct answer: Transient ischemic attack (TIA)

A TIA presents with focal neurological deficits that resolve completely, typically within 24 hours (often <1 hour), without evidence of acute infarction on imaging.

Question 17: Which set of signs represents the four cardinal motor features of Parkinson's disease?

Flaccidity, fasciculations, atrophy, and areflexia
Spasticity, hyperreflexia, clonus, and ataxia
Chorea, dystonia, athetosis, and ballismus
Tremor, rigidity, bradykinesia, and postural instability (Correct answer)

Correct answer: Tremor, rigidity, bradykinesia, and postural instability

The four cardinal signs of Parkinson's disease are resting tremor, rigidity, bradykinesia (slowness of movement), and postural instability.

Question 18: A patient with a C4 spinal cord injury develops a sudden headache (9/10), diaphoresis above the injury level, and hypertension of 210/118 mmHg. The nurse's first action is:

Call the physician for antihypertensive orders
Sit the patient upright and search for a noxious stimulus below the injury level (Correct answer)
Administer prescribed IV antihypertensive immediately
Obtain a 12-lead ECG

Correct answer: Sit the patient upright and search for a noxious stimulus below the injury level

Autonomic dysreflexia requires immediate upright positioning to use orthostatic hypotension as a rapid intervention while simultaneously identifying and removing the offending stimulus (most commonly a full bladder).

Question 19: A transient ischemic attack (TIA) is defined as a focal neurological deficit that resolves within:

48 hours regardless of imaging
30 minutes with no infarction on imaging
72 hours with imaging confirmation
24 hours with no infarction on imaging (Correct answer)

Correct answer: 24 hours with no infarction on imaging

A TIA is a focal neurological deficit lasting less than 24 hours with no evidence of acute infarction on imaging.

Question 20: A patient with myasthenia gravis crisis is admitted with dysphagia and respiratory distress. The nurse should prioritize:

Assessing respiratory function and preparing for possible intubation (Correct answer)
Administering pyridostigmine per the home schedule
Performing a Tensilon (edrophonium) test
Initiating IVIG infusion immediately

Correct answer: Assessing respiratory function and preparing for possible intubation

In myasthenic crisis, airway and respiratory status are the immediate priority; intubation may be necessary before disease-specific treatment.

Question 21: A patient who had a transsphenoidal hypophysectomy for pituitary adenoma develops polyuria (output 500 mL/hour) and hypernatremia. The nurse suspects:

Cerebral salt-wasting syndrome
Diabetes insipidus (DI) (Correct answer)
Postoperative fluid mobilization
Syndrome of inappropriate ADH (SIADH)

Correct answer: Diabetes insipidus (DI)

Diabetes insipidus after pituitary surgery results from ADH deficiency, causing large volumes of dilute urine and hypernatremia.

Question 22: The Uhthoff phenomenon in multiple sclerosis refers to:

Sudden severe spasticity triggered by a urinary tract infection
Monocular vision loss lasting more than 24 hours
Paroxysmal tonic spasms of the limbs during remission
Temporary worsening of neurological symptoms with increased body temperature (Correct answer)

Correct answer: Temporary worsening of neurological symptoms with increased body temperature

The Uhthoff phenomenon is the temporary worsening of MS symptoms that occurs with a rise in body temperature, due to impaired conduction in already-demyelinated nerve fibers.

Question 23: Which symptom is typically the FIRST neurological manifestation of multiple sclerosis?

Significant cognitive impairment and memory loss
Intractable focal seizures
Complete paraplegia of both lower extremities
Optic neuritis causing painful unilateral visual loss (Correct answer)

Correct answer: Optic neuritis causing painful unilateral visual loss

Optic neuritis, presenting as painful monocular visual loss with color desaturation, is one of the most common initial presentations of MS and often the first demyelinating event.

Question 24: A nurse caring for a patient with advanced Parkinson's disease observes excessive drooling (sialorrhea). This is BEST explained by:

Increased saliva production stimulated by elevated dopamine levels
Direct destruction of salivary gland tissue by the disease process
Anticholinergic medication side effects increasing salivary secretion
Impaired automatic swallowing frequency due to bradykinesia (Correct answer)

Correct answer: Impaired automatic swallowing frequency due to bradykinesia

Sialorrhea in Parkinson's disease results from impaired and infrequent automatic swallowing due to bradykinesia — saliva production is not increased, but clearance is reduced.

Question 25: Which postictal finding is highly suggestive that a patient just experienced a tonic-clonic seizure rather than a syncopal episode?

Todd's paralysis (transient focal weakness) (Correct answer)
Pallor
Brief loss of consciousness
Transient hypotension

Correct answer: Todd's paralysis (transient focal weakness)

Todd's paralysis — transient focal weakness lasting minutes to hours after a seizure — strongly suggests preceding focal motor or tonic-clonic seizure activity.

Question 26: A patient on phenytoin therapy has a level of 8 mcg/mL. The therapeutic range for phenytoin is:

10–20 mcg/mL (Correct answer)
20–30 mcg/mL
30–40 mcg/mL
5–10 mcg/mL

Correct answer: 10–20 mcg/mL

The therapeutic serum level for phenytoin is 10–20 mcg/mL; a level of 8 mcg/mL is subtherapeutic.

Question 27: A patient post-craniotomy reports sudden-onset severe headache and vomiting 6 hours after surgery. The nurse's priority action is to:

Administer prescribed PRN antiemetic
Obtain a STAT non-contrast CT head
Notify the neurosurgeon immediately (Correct answer)
Reposition to 30-degree HOB elevation

Correct answer: Notify the neurosurgeon immediately

Sudden severe headache and vomiting post-craniotomy suggest intracranial hemorrhage; immediate neurosurgeon notification precedes any other intervention.

Question 28: Which herniation syndrome occurs when the cerebellar tonsils herniate through the foramen magnum, compressing the medulla?

Tonsillar herniation (Correct answer)
Central herniation
Subfalcine herniation
Uncal herniation

Correct answer: Tonsillar herniation

Tonsillar herniation (downward herniation) occurs when cerebellar tonsils are pushed through the foramen magnum, causing rapid medullary compression and cardiorespiratory arrest.

Question 29: Which EEG pattern is pathognomonic of herpes simplex encephalitis?

Periodic lateralized epileptiform discharges (PLEDs) in the temporal region (Correct answer)
Burst-suppression pattern diffusely
Triphasic waves over frontal regions
Generalized 3 Hz spike-and-wave complexes

Correct answer: Periodic lateralized epileptiform discharges (PLEDs) in the temporal region

HSV encephalitis characteristically produces periodic lateralized epileptiform discharges (PLEDs) maximal in the temporal lobes, correlating with its predilection for temporal lobe involvement.

Question 30: The nurse caring for a patient post-endoscopic third ventriculostomy (ETV) monitors closely for which early sign of procedure failure?

Mild fever within 24 hours
Incisional pain
Worsening headache, nausea, and decreased level of consciousness (Correct answer)
Hypertension and tachycardia

Correct answer: Worsening headache, nausea, and decreased level of consciousness

Worsening headache, nausea, and declining LOC after ETV suggest closure of the ventriculostomy with return of hydrocephalus.

Question 31: A patient with a ventriculoperitoneal (VP) shunt develops fever, headache, and stiff neck. The priority nursing intervention is to:

Administer acetaminophen and reassess in 2 hours
Perform a CT head immediately without notifying the surgeon
Pump the shunt reservoir to assess function
Notify the neurosurgeon immediately for suspected shunt infection (Correct answer)

Correct answer: Notify the neurosurgeon immediately for suspected shunt infection

Fever, headache, and nuchal rigidity in a VP shunt patient suggests shunt infection/meningitis, a neurosurgical emergency requiring immediate notification.

Question 32: A patient with myasthenia gravis develops sudden respiratory distress and profound muscle weakness after starting a new antibiotic. This presentation is MOST consistent with:

Cholinergic crisis from acetylcholinesterase inhibitor overdose
Myasthenic crisis precipitated by the antibiotic (Correct answer)
Acute Guillain-Barré syndrome
Lambert-Eaton myasthenic syndrome

Correct answer: Myasthenic crisis precipitated by the antibiotic

Myasthenic crisis — severe muscle weakness and respiratory failure — can be precipitated by certain antibiotics (e.g., aminoglycosides, fluoroquinolones) that impair neuromuscular transmission.

Question 33: A patient with ALS is experiencing dysphagia. Which nursing intervention is the HIGHEST priority?

Administer antiemetics before all meals
Encourage three large meals per day to maintain caloric intake
Place the patient on a regular diet to prevent nutritional deficits
Assess swallowing function and implement aspiration precautions (Correct answer)

Correct answer: Assess swallowing function and implement aspiration precautions

Dysphagia in ALS creates significant aspiration risk; assessing swallowing and implementing aspiration precautions is the priority to prevent life-threatening aspiration pneumonia.

Question 34: A CNRN nurse notes that a patient's pupils are 6 mm and non-reactive bilaterally. This finding is MOST consistent with:

Cerebral contusion
Metabolic encephalopathy
Midbrain herniation (Correct answer)
Pontine lesion

Correct answer: Midbrain herniation

Bilateral fixed and dilated pupils indicate midbrain herniation due to compression of the oculomotor (CN III) nerves.

Question 35: Which scale is commonly used by CNRN nurses to grade subarachnoid hemorrhage severity based on clinical presentation?

Barthel Index
NIHSS
Rankin Scale
Hunt and Hess Scale (Correct answer)

Correct answer: Hunt and Hess Scale

The Hunt and Hess Scale grades subarachnoid hemorrhage severity from I (mild headache) to V (deep coma), guiding surgical timing.

Question 36: Which artery occlusion typically produces the syndrome of contralateral hemiplegia, hemisensory loss, homonymous hemianopia, and aphasia (dominant hemisphere)?

Basilar artery
Posterior cerebral artery
Anterior cerebral artery
Middle cerebral artery (Correct answer)

Correct answer: Middle cerebral artery

Middle cerebral artery (MCA) occlusion produces contralateral hemiplegia, hemisensory loss, hemianopia, and aphasia if the dominant hemisphere is affected.

Question 37: A patient's neurological examination has been deteriorating after a severe occurrence that may have caused hypoxic brain injury. She does not respond to unpleasant stimuli, take spontaneous breaths while on the ventilator, or dilate in response to light. If the family declines a palliative care consultation, which of the following is appropriate?

Remove the patient from the ventilator.
Call palliative care anyway.
Initiate brain death protocol. (Correct answer)
Continue to monitor the patient.

Correct answer: Initiate brain death protocol.

The patient's neurological examination findings—no response to noxious stimuli, no spontaneous respirations while on the ventilator, and fixed pupils—are consistent with brain death. Even if the family declines palliative care, it is medically and ethically appropriate to initiate a brain death protocol to formally determine if brain death has occurred, as this has significant implications for care and prognosis.

Question 38: The ICP of a patient with an EVD has been steadily rising. Which drugs should the nurse anticipate administering to this patient?

Hydralazine.
Mannitol (Osmitrol). (Correct answer)
Hydrochlorothiazide (Microzide).
Furosemide (Lasix).

Correct answer: Mannitol (Osmitrol).

Mannitol is an osmotic diuretic commonly administered to rapidly reduce elevated intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the vascular space, thereby decreasing cerebral edema and subsequently lowering ICP. This makes it the appropriate drug to anticipate for a patient with steadily rising ICP.

Question 39: Which reflex, when absent, suggests dysfunction at the level of the medulla?

Babinski sign
Plantar reflex
Gag reflex (Correct answer)
Corneal reflex

Correct answer: Gag reflex

The gag reflex (CN IX and X) is mediated at the medulla; its absence indicates medullary dysfunction.

Question 40: An elderly guy worries about his wife who has Alzheimer's disease and spends the entire day sitting in front of the TV without doing anything else. He's looking for things they can both do together. What exercise should the nurse advise the patient to do?

Stringing beads or winding yarn (Correct answer)
Doing crossword puzzles together
Making brownies
Traveling new places

Correct answer: Stringing beads or winding yarn

For a patient with Alzheimer's disease, activities that are simple, repetitive, and engage fine motor skills are often most beneficial and manageable. Stringing beads or winding yarn provides a structured, low-stress activity that can be done together, promoting engagement and cognitive stimulation without being overwhelming. More complex activities like traveling or crossword puzzles might be too challenging or frustrating for someone with advanced Alzheimer's.

Question 41: A patient with TBI is receiving mannitol for ICP reduction. The nurse monitors serum osmolality, knowing the maximum safe osmolality is:

310–320 mOsm/kg
320 mOsm/kg (Correct answer)
295–300 mOsm/kg
Greater than 340 mOsm/kg

Correct answer: 320 mOsm/kg

Serum osmolality should not exceed 320 mOsm/kg during mannitol therapy to avoid renal toxicity and rebound cerebral edema.

Question 42: Which nursing intervention is contraindicated in a patient with a basilar skull fracture?

Elevating the head of the bed 30 degrees
Oral suctioning
Nasogastric tube insertion (Correct answer)
Applying ice to periorbital ecchymosis

Correct answer: Nasogastric tube insertion

Nasogastric tube insertion is contraindicated in basilar skull fractures due to the risk of inadvertent intracranial placement through the fractured base.

Question 43: Which imaging modality is MOST sensitive for detecting acute ischemic stroke within the first hours of onset?

Cerebral angiography
Diffusion-weighted MRI (DWI) (Correct answer)
Non-contrast CT scan
CT angiography

Correct answer: Diffusion-weighted MRI (DWI)

Diffusion-weighted MRI (DWI) detects cytotoxic edema within minutes of ischemic injury and is far more sensitive than CT in the hyperacute phase.

Question 44: A patient with epilepsy is admitted after a breakthrough seizure. Which factor should the nurse assess FIRST as the most common cause of breakthrough seizures?

Stress
Alcohol consumption
Antiseizure medication non-compliance (Correct answer)
Sleep deprivation

Correct answer: Antiseizure medication non-compliance

Non-compliance with antiseizure medication is the most common cause of breakthrough seizures in patients with established epilepsy.

Question 45: Which type of intracranial hematoma is caused by arterial bleeding, typically from rupture of the middle meningeal artery, and presents with a lucid interval?

Subdural hematoma
Epidural hematoma (Correct answer)
Subarachnoid hemorrhage
Intracerebral hematoma

Correct answer: Epidural hematoma

Epidural hematoma results from arterial (middle meningeal artery) bleeding, often showing a classic lucid interval before rapid neurological deterioration.

Question 46: Which stroke scale is used at the bedside by nurses to quantify stroke severity and guide acute treatment decisions?

NIH Stroke Scale (NIHSS) (Correct answer)
Barthel Index
Modified Rankin Scale (mRS)
Hunt and Hess Scale

Correct answer: NIH Stroke Scale (NIHSS)

The NIH Stroke Scale (NIHSS) is the standardized bedside tool used to quantify acute stroke severity across 15 neurological domains.

Question 47: The nurse is preparing a patient for lumbar puncture to assess for meningitis after TBI. Before performing the LP, the priority is to:

Place the patient in prone position
Administer empiric antibiotics and obtain CT head to rule out elevated ICP (Correct answer)
Obtain informed consent only
Perform the LP immediately to avoid treatment delay

Correct answer: Administer empiric antibiotics and obtain CT head to rule out elevated ICP

CT head must be obtained first to rule out elevated ICP before LP; antibiotics should be started empirically without delaying treatment pending imaging.

Question 48: A patient with hemorrhagic stroke has a serum sodium of 126 mEq/L. The nurse identifies this as:

Normal post-stroke electrolyte pattern
Diabetes insipidus
Hyperaldosteronism
Cerebral salt-wasting syndrome (CSWS) or SIADH, both causing hyponatremia (Correct answer)

Correct answer: Cerebral salt-wasting syndrome (CSWS) or SIADH, both causing hyponatremia

Both CSWS and SIADH cause hyponatremia after hemorrhagic stroke; distinguishing them by volume status guides treatment.

Question 49: Which cerebrospinal fluid (CSF) finding is characteristically associated with Guillain-Barré syndrome?

Decreased glucose with elevated lymphocyte count
Elevated protein with normal or near-normal cell count (albuminocytological dissociation) (Correct answer)
Markedly elevated white blood cell count with normal protein level
Completely normal CSF in all parameters

Correct answer: Elevated protein with normal or near-normal cell count (albuminocytological dissociation)

The classic CSF finding in Guillain-Barré syndrome is albuminocytological dissociation — elevated protein without a corresponding increase in white blood cells, reflecting demyelination without significant inflammation.

Question 50: The nurse is caring for a patient in refractory status epilepticus requiring continuous EEG monitoring. The therapeutic goal of treatment is to achieve:

Burst suppression pattern (Correct answer)
Delta wave predominance
Sleep spindles and K complexes
Normal alpha rhythm

Correct answer: Burst suppression pattern

In refractory status epilepticus, treatment with anesthetic agents aims to achieve burst suppression on EEG, indicating adequate seizure suppression.

Question 51: Which of the following best describes the primary mechanism of secondary brain injury following TBI?

Brainstem contusion from contrecoup forces
Ischemia from disrupted autoregulation, excitotoxicity, and inflammatory cascade (Correct answer)
Direct neuronal shearing from rotational acceleration
Epidural hematoma expansion compressing underlying cortex

Correct answer: Ischemia from disrupted autoregulation, excitotoxicity, and inflammatory cascade

Secondary brain injury occurs hours to days after TBI through ischemia, glutamate excitotoxicity, calcium influx, mitochondrial dysfunction, and neuroinflammation — all potentially modifiable targets.

Question 52: A patient with ischemic stroke is being monitored post-tPA. The nurse notes the patient's BP is 195/110 mmHg. The priority action is to:

Place the patient in Trendelenburg position
Stop the tPA infusion immediately
Administer antihypertensive to keep BP below 180/105 mmHg (Correct answer)
Continue monitoring per routine schedule

Correct answer: Administer antihypertensive to keep BP below 180/105 mmHg

Post-tPA guidelines require maintaining BP below 180/105 mmHg to reduce the risk of hemorrhagic transformation.

Question 53: A patient with a C5 spinal cord injury develops sudden severe headache, sweating above the level of injury, hypertension, and bradycardia. The nurse immediately suspects:

Autonomic dysreflexia (Correct answer)
Ischemic stroke
Orthostatic hypotension
Pulmonary embolism

Correct answer: Autonomic dysreflexia

Autonomic dysreflexia is a life-threatening syndrome in patients with SCI at T6 or above, triggered by noxious stimuli below the injury level causing uncontrolled hypertension.

Question 54: Before administering IV phenytoin, the nurse must flush the IV line with:

Normal saline (0.9% NaCl) (Correct answer)
Sterile water
Lactated Ringer's solution
Dextrose 5% in water (D5W)

Correct answer: Normal saline (0.9% NaCl)

Phenytoin is incompatible with dextrose-containing solutions and must be administered with and flushed using normal saline only.

Question 55: Which intervention is most appropriate for a patient with increased ICP who has a PaCO2 of 52 mmHg?

Decrease ventilator rate to promote CO2 retention
Increase ventilator rate to target PaCO2 35–40 mmHg (Correct answer)
Administer sodium bicarbonate to correct respiratory acidosis
Obtain a chest X-ray to evaluate for pneumothorax

Correct answer: Increase ventilator rate to target PaCO2 35–40 mmHg

Hypercapnia causes cerebral vasodilation and worsens ICP; controlled ventilation targeting PaCO2 35–40 mmHg reduces ICP by promoting mild vasoconstriction.

Question 56: Which type of multiple sclerosis is characterized by steadily worsening neurologic function from disease onset without distinct relapses or remissions?

Primary progressive MS (Correct answer)
Progressive-relapsing MS
Secondary progressive MS
Relapsing-remitting MS

Correct answer: Primary progressive MS

Primary progressive MS (PPMS) is characterized by continuous neurological decline from disease onset without distinct relapses or remissions.

Question 57: In which of the following injuries is a percutaneous gastrostomy (PEG) tube most likely required?

C7
T2
T7
C2 (Correct answer)

Correct answer: C2

A C2 spinal cord injury is a very high cervical injury that typically results in complete paralysis, including diaphragmatic paralysis, requiring mechanical ventilation. Patients with such severe injuries often lose the ability to swallow safely and effectively, making a percutaneous gastrostomy (PEG) tube necessary for long-term nutritional support and to prevent aspiration.

Question 58: The nurse is monitoring a patient post-craniotomy and notes the Jackson-Pratt drain output is 300 mL of bright red blood over 1 hour. The priority action is to:

Document and reassess in 30 minutes
Apply a pressure dressing over the drain site
Immediately notify the neurosurgeon (Correct answer)
Empty the drain bulb and continue monitoring

Correct answer: Immediately notify the neurosurgeon

Sudden large-volume bright red blood output from a post-craniotomy drain indicates active hemorrhage requiring immediate neurosurgical notification.

Question 59: 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)
Hoffmann's sign
Brudzinski's sign
Lhermitte'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 60: Which type of brain herniation results in ipsilateral CN III palsy and contralateral hemiplegia?

Central (transtentorial) herniation
Subfalcine herniation
Tonsillar herniation
Uncal herniation (Correct answer)

Correct answer: Uncal herniation

Uncal herniation compresses the ipsilateral oculomotor nerve (CN III) and contralateral corticospinal tract, producing these classic deficits.

Question 61: A man who had suffered a stroke was admitted to the hospital. He has a history of using cocaine. His vital signs and lab results are as follows: blood pressure is 20/89, an EKG reveals atrial fibrillation with 110 beats per minute, his hemoglobin A1c is 5.6%, and his complete blood count and basic metabolic panel are unremarkable. How many potential causes of a stroke did this patient have?

two
four (Correct answer)
three
one

Correct answer: four

This patient presents with four distinct potential causes for a stroke. These include a history of cocaine use (vasoconstriction, arrhythmias), atrial fibrillation (a major source of cardioembolic stroke), an abnormal blood pressure (whether it's hypertension or severe hypotension, both are stroke risks), and prediabetes (indicated by an Hgb A1c of 5.6%), which increases the risk of atherosclerosis and stroke.

Question 62: A patient with Parkinson's disease is NPO post-operatively and cannot take oral carbidopa-levodopa. The nurse recognizes the greatest risk is:

Aspiration pneumonia from dysphagia
Neuroleptic malignant-like syndrome from abrupt dopaminergic withdrawal (Correct answer)
Severe constipation from reduced motility
Orthostatic hypotension from anesthesia interaction

Correct answer: Neuroleptic malignant-like syndrome from abrupt dopaminergic withdrawal

Abrupt withdrawal of dopaminergic therapy in Parkinson's disease can precipitate a potentially fatal neuroleptic malignant-like syndrome with hyperthermia, rigidity, and altered consciousness.

Question 63: Which pharmacological agent is recommended to reduce spasticity in patients with chronic spinal cord injury, delivered intrathecally for severe cases?

Dantrolene sodium
Diazepam
Baclofen (Correct answer)
Tizanidine

Correct answer: Baclofen

Intrathecal baclofen (ITB) therapy via an implanted pump is used for severe spasticity in SCI when oral medications are insufficient.

Question 64: Which positioning intervention is standard for patients at risk for increased ICP?

Left lateral decubitus to reduce aspiration risk
Head of bed elevated 30 degrees with head midline (Correct answer)
Head of bed flat to promote venous return
Trendelenburg position to increase CPP

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.

Question 65: A patient with Guillain-Barré syndrome has a forced vital capacity (FVC) of 15 mL/kg. The nurse anticipates:

Elective intubation for airway protection (Correct answer)
Urgent lumbar puncture
Administration of IV immunoglobulin
Initiation of plasmapheresis

Correct answer: Elective intubation for airway protection

FVC <20 mL/kg (or <1L) in GBS indicates impending respiratory failure and is the threshold for elective intubation before crisis occurs.

Question 66: A patient is admitted for a craniotomy for resection of a right temporal lobe glioblastoma. Preoperatively, the nurse anticipates the patient may have deficits in:

Frontal executive function
Receptive language (Wernicke's aphasia) if dominant hemisphere (Correct answer)
Left visual field loss only
Expressive language (Broca's aphasia)

Correct answer: Receptive language (Wernicke's aphasia) if dominant hemisphere

In most people, the left temporal lobe contains Wernicke's area; if the right hemisphere is dominant or if the dominant temporal lobe is affected, receptive aphasia may occur.

Question 67: A 65-year-old man comes in with a bad headache that started suddenly. His medical history is crucial for both diabetes and high blood pressure. The results of the cranial nerve evaluation are normal. There are no visible motor or sensory abnormalities, although there is bilateral Babinski sign and positive nuchal rigidity. The right Sylvian fissure and basal cisterns show hyperdensity on a brain CT scan. Which of the following, given the expected diagnosis, is the most frequent complication and the main reason for postponed morbidity and mortality?

Rebleeding
Hydrocephalus
Seizure
Vasospasm (Correct answer)

Correct answer: Vasospasm

The CT findings (hyperdensity in Sylvian fissure and basal cisterns) and symptoms are highly indicative of a subarachnoid hemorrhage (SAH). While rebleeding is an immediate concern, cerebral vasospasm is the most frequent and devastating delayed complication of SAH, typically occurring 3-14 days after the initial bleed. It leads to delayed cerebral ischemia and is the primary cause of postponed morbidity and mortality in SAH survivors.

Question 68: A patient develops worsening headache, confusion, and right-sided weakness 24 hours after a craniotomy for AVM resection. The most likely complication is:

Hyponatremia
Normal post-operative pain
Normal perfusion pressure breakthrough bleeding (Correct answer)
Meningitis

Correct answer: Normal perfusion pressure breakthrough bleeding

Normal perfusion pressure breakthrough (NPPB) hemorrhage occurs when chronically hypoperfused vessels cannot autoregulate after AVM removal.

Question 69: In Guillain-Barré syndrome, which pattern of weakness is MOST characteristic?

Isolated proximal muscle weakness with distal sparing
Descending weakness beginning in the facial and bulbar muscles
Ascending symmetrical weakness beginning in the legs and progressing upward (Correct answer)
Unilateral hemiparesis corresponding to a focal cerebral lesion

Correct answer: Ascending symmetrical weakness beginning in the legs and progressing upward

Guillain-Barré syndrome classically presents with ascending symmetrical weakness starting in the lower extremities and progressing upward, potentially reaching the respiratory muscles.

Question 70: The nurse observes a patient staring blankly for 15 seconds with lip-smacking and hand automatisms, then returning to baseline confused. This describes:

Simple focal seizure
Focal impaired awareness seizure (complex partial) (Correct answer)
Absence (petit mal) seizure
Generalized tonic-clonic seizure

Correct answer: Focal impaired awareness seizure (complex partial)

Focal impaired awareness seizures (formerly complex partial) involve altered consciousness with automatisms and postictal confusion, arising from one hemisphere.

Question 71: Which post-operative position is recommended after infratentorial (posterior fossa) craniotomy to minimize cerebellar and brainstem edema?

Lateral decubitus position
Trendelenburg position
Head of bed elevated 30–45 degrees, head midline (Correct answer)
Flat with no pillow

Correct answer: Head of bed elevated 30–45 degrees, head midline

Head elevation at 30–45 degrees with midline head positioning promotes venous drainage and reduces posterior fossa edema after infratentorial craniotomy.

Question 72: A patient who is attempting to get pregnant asks what she may do to help prevent spina bifida from occurring in her unborn child. What is the best course of action?

Eating a low-sugar diet.
Eating several oranges daily. (Correct answer)
Drinking 3 glasses of milk per day.
Having 1 or 2 glasses of red wine a night.

Correct answer: Eating several oranges daily.

Spina bifida is a neural tube defect that can be largely prevented by adequate folic acid intake before and during early pregnancy. Oranges are a good natural source of folate (folic acid), making this a beneficial dietary recommendation for preventing spina bifida. Other options like alcohol, low-sugar diets, or milk intake do not directly address folic acid needs.

Question 73: A patient with normal pressure hydrocephalus (NPH) classically presents with which triad of symptoms?

Seizures, focal weakness, and confusion
Gait disturbance, urinary incontinence, and dementia (Hakim's triad) (Correct answer)
Rigidity, tremor, and bradykinesia
Headache, papilledema, diplopia

Correct answer: Gait disturbance, urinary incontinence, and dementia (Hakim's triad)

Normal pressure hydrocephalus presents with Hakim's triad: gait apraxia (magnetic gait), urinary incontinence, and cognitive decline (dementia).

Question 74: A nurse is caring for a patient receiving hypertonic saline (3% NaCl) for cerebral edema. Which lab value requires the most immediate intervention?

Serum sodium of 162 mEq/L (Correct answer)
Serum sodium of 148 mEq/L
Serum potassium of 3.2 mEq/L
Serum osmolality of 310 mOsm/kg

Correct answer: Serum sodium of 162 mEq/L

Serum sodium >160 mEq/L during hypertonic saline therapy indicates hypernatremia beyond the intended therapeutic range and risks central pontine myelinolysis and renal injury.

Question 75: Symptoms of a fever, headaches, and confusion have been present for two days in a 33-year-old lady. Her vital signs are normal. It is typical for her to receive an immediate non-contrast head CT. Her medical team believes she may have viral encephalitis. What diagnostic procedure is most suitable?

Carotid artery doppler
Electroencephalography
Lumbar puncture (Correct answer)
Brain MRI

Correct answer: Lumbar puncture

Viral encephalitis is an inflammation of the brain, often diagnosed by analyzing cerebrospinal fluid (CSF). A lumbar puncture (spinal tap) is the most suitable diagnostic procedure as it allows for collection of CSF, which can then be tested for viral markers, cell count, protein, and glucose to confirm the diagnosis and rule out other conditions. While a brain MRI can show inflammation, CSF analysis is often definitive for identifying the pathogen.

Question 76: Lethargy, anorexia, vomiting, and a high-grade fever appear in an inmate with a history of HIV. The patient shows a positive Brudzinski sign during physical examination. In order to confirm the diagnosis, which of the following tests would not be used?

CT scan of the abdomen and pelvis. (Correct answer)
Erythrocyte sedimentation rate.
Blood cultures
Lumbar Puncture

Correct answer: CT scan of the abdomen and pelvis.

The patient's symptoms (lethargy, high fever, positive Brudzinski sign) strongly suggest meningitis, especially given their history of HIV. Tests like lumbar puncture (for CSF analysis), blood cultures, and erythrocyte sedimentation rate (ESR) are directly relevant to diagnosing meningitis and systemic infection. A CT scan of the abdomen and pelvis is unrelated to a neurological infection and would not be used to confirm this diagnosis.

Question 77: The nurse is reviewing a patient's MRI report that states 'diffusion restriction in the left MCA territory.' This finding is most consistent with:

Chronic lacunar infarction
Vasogenic edema from a tumor
Acute ischemic stroke within hours of onset (Correct answer)
Subacute infarction 2–3 weeks old

Correct answer: Acute ischemic stroke within hours of onset

Diffusion-weighted imaging (DWI) restriction indicates cytotoxic edema from acute ischemia, appearing within minutes and persisting for approximately 10–14 days.

Question 78: Which medication regimen is standard to reduce vasospasm-related ischemia after subarachnoid hemorrhage?

Amlodipine 5 mg daily for 30 days
Nimodipine 60 mg orally every 4 hours for 21 days (Correct answer)
Verapamil IV infusion for 14 days
Nifedipine 10 mg orally three times daily

Correct answer: Nimodipine 60 mg orally every 4 hours for 21 days

Nimodipine 60 mg orally every 4 hours for 21 days is the evidence-based standard to reduce vasospasm-related cerebral ischemia after SAH.

Question 79: Which assessment finding indicates increasing intracranial pressure in a patient with a traumatic brain injury?

Hypotension with tachypnea
Widening pulse pressure with bradycardia (Correct answer)
Tachycardia with narrowing pulse pressure
Fever with diaphoresis

Correct answer: Widening pulse pressure with bradycardia

Cushing's triad (widening pulse pressure, bradycardia, and irregular respirations) signals critically elevated ICP and impending brainstem herniation.

Question 80: Which spinal cord injury level results in a patient who is ventilator-dependent due to loss of diaphragm function?

C3 and above (Correct answer)
C7–T1
T1–T4
C5–C6

Correct answer: C3 and above

The phrenic nerve (C3, C4, C5 — 'keeps the diaphragm alive') originates at C3–C5; injury at C3 or above disrupts diaphragmatic function, requiring ventilatory support.

Question 81: A patient with multiple sclerosis reports worsening of symptoms each time she showers. This phenomenon is known as:

Uhthoff's phenomenon (Correct answer)
Charcot's triad
Internuclear ophthalmoplegia
Lhermitte's sign

Correct answer: Uhthoff's phenomenon

Uhthoff's phenomenon is a temporary worsening of MS symptoms with increased body temperature (heat, fever, exercise), caused by heat-induced conduction failure in demyelinated axons.

Question 82: Which medication is used to treat central diabetes insipidus after pituitary surgery?

Hydrocortisone
Desmopressin (DDAVP) (Correct answer)
Fludrocortisone
Furosemide

Correct answer: Desmopressin (DDAVP)

Desmopressin (DDAVP) is a synthetic analog of ADH used to treat central diabetes insipidus by reducing urine output.

Question 83: An external ventricular drain is present in a patient. Between 25 and 30 mm Hg is the intracranial pressure (ICP) range. Which of the following traits or symptoms is not a match for these ICPs?

Fixed pupils.
Bradycardia.
Irregular respirations.
Tachycardia. (Correct answer)

Correct answer: Tachycardia.

Significantly elevated intracranial pressure (ICP) typically triggers Cushing's triad, which includes bradycardia (slow heart rate), widening pulse pressure, and irregular respirations. Tachycardia, or a fast heart rate, is generally not a direct sign of high ICP; instead, bradycardia is the expected cardiovascular response as the body attempts to maintain cerebral perfusion.

Question 84: The nurse is monitoring a patient's external ventricular drain (EVD). The drain is set to drain at 10 cmH₂O. The nurse should position the drip chamber reference point at:

The level of the patient's mid-sternum
The level of the patient's shoulder
The level of the patient's chin
The level of the tragus of the ear (foramen of Monro) (Correct answer)

Correct answer: The level of the tragus of the ear (foramen of Monro)

The EVD reference point (zero level) is placed at the tragus of the ear, which corresponds to the level of the foramen of Monro for accurate ICP measurement.

Question 85: Which time window is the FDA-approved limit for IV alteplase (tPA) administration in eligible ischemic stroke patients?

Within 3 hours of symptom onset (up to 4.5 hours per extended guidelines) (Correct answer)
Within 6 hours of symptom onset
Within 12 hours of symptom onset
Within 2 hours of symptom onset

Correct answer: Within 3 hours of symptom onset (up to 4.5 hours per extended guidelines)

IV alteplase is FDA-approved within 3 hours of ischemic stroke onset, with AHA/ASA extending to 4.5 hours for select patients.

Question 86: ICP is 30 mm Hg in a patient with an external ventricular drain (EVD). When the drain is opened, the output is extremely slow. What comes after that?

Flush the drain proximally.
Call the attending/resident. (Correct answer)
Flush the drain distally.
Continue to monitor the ICP.

Correct answer: Call the attending/resident.

An ICP of 30 mmHg is significantly elevated and requires immediate attention. If the external ventricular drain (EVD) is open but output is extremely slow, it suggests a potential malfunction, obstruction, or inadequate drainage, which can lead to further neurological compromise. This situation warrants immediate medical evaluation and intervention from the attending physician or resident.

Question 87: The nurse is preparing seizure precautions for a patient admitted with new-onset seizures. Which intervention is included in standard seizure precautions?

Remove the IV access to prevent self-injury
Keep room lights bright to detect aura
Apply soft wrist restraints
Keep padded side rails raised and suction at bedside (Correct answer)

Correct answer: Keep padded side rails raised and suction at bedside

Padded side rails, suction at bedside, and supplemental oxygen are components of standard seizure precautions to maintain safety and airway.

Question 88: The ASIA Impairment Scale (AIS) Grade A for spinal cord injury means:

Incomplete injury with sensory but no motor function below the level
Incomplete injury with normal motor function
Complete injury with no motor or sensory function below the neurological level (Correct answer)
Normal motor and sensory function

Correct answer: Complete injury with no motor or sensory function below the neurological level

ASIA Impairment Scale Grade A indicates a complete spinal cord injury with no preserved motor or sensory function in the sacral segments S4–S5.

Question 89: A patient with pain behind the right eye and around the right temple attends the clinic. On the same side, he also experiences rhinorrhea and lacrimation. The client has previously experienced a handful of these episodes, which typically lasted 30 to 60 minutes and were labeled as cluster headaches. He took two ibuprofen tablets at home without any alleviation. What would a nurse consider the best course of action with the fewest adverse effects?

Acetaminophen
Triptans
Antidopaminergic agents
100% oxygen (Correct answer)

Correct answer: 100% oxygen

For acute cluster headache attacks, 100% oxygen administered via a non-rebreather mask is a highly effective first-line treatment with minimal side effects. It works by causing cerebral vasoconstriction and inhibiting trigeminal nerve activity, often providing relief within 15-20 minutes. While triptans are also effective, oxygen is generally preferred due to its rapid action and excellent safety profile.

Question 90: A patient with ischemic stroke is being considered for IV alteplase. Which of the following is an absolute contraindication?

Age 85 years
Blood pressure of 195/105 mmHg that does not respond to two antihypertensive doses (Correct answer)
Serum glucose of 55 mg/dL at presentation
Last known well time of 3.5 hours ago

Correct answer: Blood pressure of 195/105 mmHg that does not respond to two antihypertensive doses

BP >185/110 mmHg that cannot be lowered and maintained is an absolute contraindication to IV tPA for acute ischemic stroke.

Question 91: A patient post-transsphenoidal hypophysectomy develops polyuria with urine output of 600 mL/hr, urine specific gravity of 1.001, and serum sodium of 149 mEq/L. The nurse should prepare to administer:

3% normal saline
Desmopressin (DDAVP) (Correct answer)
Furosemide
Vasopressin titration infusion

Correct answer: Desmopressin (DDAVP)

These findings indicate central diabetes insipidus from posterior pituitary damage; DDAVP (synthetic ADH) is the treatment of choice.

Question 92: Which neurological deficit is most characteristic of a cerebellar stroke?

Expressive aphasia
Neglect syndrome
Contralateral hemiplegia
Ipsilateral limb ataxia and gait instability (Correct answer)

Correct answer: Ipsilateral limb ataxia and gait instability

Cerebellar stroke produces ipsilateral limb ataxia, nystagmus, dysarthria, and gait instability due to incoordination of the ipsilateral side.

Question 93: A patient with a VP shunt complains of a new severe headache with blurred vision. Non-contrast CT shows enlarged ventricles compared to prior imaging. The nurse recognizes this indicates:

Normal post-operative changes
Pseudotumor cerebri
Shunt malfunction with hydrocephalus (Correct answer)
Shunt over-drainage

Correct answer: Shunt malfunction with hydrocephalus

Enlarged ventricles on CT with headache and visual symptoms indicate VP shunt malfunction causing obstructive hydrocephalus requiring urgent intervention.

Question 94: A nurse is caring for a patient with relapsing-remitting MS. Which medication class is used as a disease-modifying therapy to reduce relapse frequency?

Corticosteroids
Calcium channel blockers
Beta-interferons (Correct answer)
Anticholinergics

Correct answer: Beta-interferons

Beta-interferons (e.g., interferon beta-1a, beta-1b) are disease-modifying therapies that reduce the frequency and severity of MS relapses by modulating the immune response.

Question 95: The nurse is caring for a patient after a ventriculostomy (EVD) placement. Which action correctly manages the drainage system?

Clamp the EVD for 1 hour after each position change before re-leveling
Zero the transducer at the level of the heart before obtaining ICP readings
Level the air-fluid interface of the drip chamber to the specified reference point (usually tragus of the ear) before opening the drain (Correct answer)
Keep the EVD open to drain continuously regardless of ICP values

Correct answer: Level the air-fluid interface of the drip chamber to the specified reference point (usually tragus of the ear) before opening the drain

The EVD reference point (typically the foramen of Monro, approximated by the tragus) must be leveled before opening drainage to ensure accurate pressure measurement and appropriate drainage rate.

Question 96: A patient with normal pressure hydrocephalus (NPH) classically presents with which triad?

Headache, papilledema, and vomiting
Aphasia, agnosia, and apraxia
Tremor, rigidity, and bradykinesia
Gait disturbance, urinary incontinence, and cognitive decline (Correct answer)

Correct answer: Gait disturbance, urinary incontinence, and cognitive decline

NPH is characterized by the Hakim triad: gait disturbance (magnetic gait), urinary incontinence, and dementia, occurring in the absence of elevated CSF opening pressure.

Question 97: A patient with ALS is experiencing progressive dysarthria. Which augmentative and alternative communication (AAC) intervention should the nurse PRIORITIZE?

Wait until the patient is completely unable to speak before introducing AAC devices
Instruct the patient to rely exclusively on written communication using paper and pen
Introduce AAC devices early while the patient can still provide input on communication preferences (Correct answer)
Advise family members to interpret all communication needs on the patient's behalf

Correct answer: Introduce AAC devices early while the patient can still provide input on communication preferences

AAC devices should be introduced early in ALS while the patient retains sufficient motor function to learn the system and actively participate in selecting preferred communication methods.

Question 98: Which intervention is the priority when a patient with known atrial fibrillation presents with acute ischemic stroke symptoms?

Start anticoagulation immediately
Obtain non-contrast CT of the head to rule out hemorrhage (Correct answer)
Begin IV heparin infusion
Administer aspirin 325 mg

Correct answer: Obtain non-contrast CT of the head to rule out hemorrhage

Non-contrast CT of the head must be obtained immediately to differentiate ischemic from hemorrhagic stroke before any treatment is initiated.

Question 99: Which seizure type is characterized by sudden loss of muscle tone, causing the patient to fall?

Absence seizure
Myoclonic seizure
Tonic seizure
Atonic (drop) seizure (Correct answer)

Correct answer: Atonic (drop) seizure

Atonic seizures (drop attacks) involve sudden loss of muscle tone leading to falls, often requiring protective headgear.

Question 100: After receiving a trigeminal neuralgia diagnosis and treatment, a patient is leaving the hospital. Which of the following recommendations for the patient should not be made by the nurse?

Chewing gum may help symptoms. (Correct answer)
Eating soft foods may prevent symptoms.
Shaving may precipitate pain.
Drinking room temperature drinks may help prevent pain.

Correct answer: Chewing gum may help symptoms.

Trigeminal neuralgia is characterized by severe facial pain triggered by light touch, chewing, talking, or even a breeze. Chewing gum involves repetitive jaw movement and stimulation of facial muscles, which is a common trigger for pain in patients with trigeminal neuralgia. Therefore, recommending chewing gum would likely exacerbate symptoms rather than provide relief.

Question 101: The nurse is educating a patient discharged after TIA about secondary stroke prevention. Which lifestyle modification has the MOST impact on reducing recurrent stroke risk?

Reducing dietary fat
Smoking cessation (Correct answer)
Limiting caffeine intake
Increasing sleep duration

Correct answer: Smoking cessation

Smoking is a major modifiable risk factor for stroke; cessation substantially reduces the risk of recurrent cerebrovascular events.

Question 102: A 65-year-old woman and her son arrive at the clinic complaining of recent mental and personality changes. Her lack of social interaction, her slowness when executing manual jobs, and her tendency to forget things have all been noted by the son. The patient reports having the occasional headaches but denies having experienced any head trauma. What CT scan finding in this patient might point to a chronic subdural hematoma?

Hyperdense biconcave shaped lesion in the subdural space
Hyperdense crescent-shaped lesion in the subdural space
Isodense biconcave shaped lesion in the subdural space
Hypodense crescent-shaped lesion in the subdural space (Correct answer)

Correct answer: Hypodense crescent-shaped lesion in the subdural space

A chronic subdural hematoma develops slowly over weeks to months, often after minor head trauma that may not be recalled, especially in elderly patients with brain atrophy. On a CT scan, as blood ages and liquefies, it becomes less dense. Therefore, a chronic subdural hematoma typically appears as a hypodense (darker than brain tissue) crescent-shaped collection in the subdural space.

Question 103: A patient with Parkinson's disease reports difficulty swallowing. Which nursing intervention is MOST appropriate?

Encourage the patient to drink thin liquids rapidly to clear the throat
Position the patient supine during all meals to reduce aspiration risk
Provide large bites of food to stimulate the swallowing reflex
Thicken liquids to nectar consistency and refer to speech-language pathology (Correct answer)

Correct answer: Thicken liquids to nectar consistency and refer to speech-language pathology

Thickened liquids reduce aspiration risk in Parkinson's-related dysphagia, and speech-language pathology referral provides individualized swallowing assessment and safe diet recommendations.

Question 104: A patient with a known seizure disorder reports an aura of a strange smell before their seizures. This type of aura localizes to which brain region?

Parietal lobe
Frontal lobe
Occipital lobe
Temporal lobe (uncus) (Correct answer)

Correct answer: Temporal lobe (uncus)

Olfactory auras (strange smells) localize to the medial temporal lobe (uncus), a common focus for temporal lobe epilepsy.

Question 105: Which component of the Glasgow Coma Scale (GCS) assesses the patient's ability to follow commands?

Eye opening
Verbal response
Pupillary reaction
Motor response (Correct answer)

Correct answer: Motor response

The motor response component of the GCS evaluates the patient's best motor function, including the ability to follow commands.

Question 106: For severe TBI management, the Brain Trauma Foundation recommends maintaining ICP below:

10 mmHg
30 mmHg
22 mmHg (Correct answer)
15 mmHg

Correct answer: 22 mmHg

The Brain Trauma Foundation guidelines recommend treating ICP when it exceeds 22 mmHg to reduce mortality in severe TBI.

Question 107: A patient undergoes clipping of an intracranial aneurysm. The most serious immediate postoperative complication the CNRN nurse monitors for is:

Urinary retention
Cerebral vasospasm and delayed cerebral ischemia (Correct answer)
Wound infection
Pneumonia

Correct answer: Cerebral vasospasm and delayed cerebral ischemia

Cerebral vasospasm causing delayed cerebral ischemia is the most serious postoperative complication after aneurysm clipping, occurring days 4–14.

Question 108: A patient exhibits decerebrate posturing. The nurse understands this involves:

Flexion of all extremities
Extension and internal rotation of all extremities (Correct answer)
Flexion of arms and extension of legs
Flaccidity of all extremities

Correct answer: Extension and internal rotation of all extremities

Decerebrate posturing involves rigid extension, adduction, and internal rotation of all extremities, indicating severe brainstem injury.

Question 109: When using the FOUR (Full Outline of UnResponsiveness) scale, which domain is assessed that the GCS does NOT include?

Motor response
Eye opening
Brainstem reflexes (Correct answer)
Verbal response

Correct answer: Brainstem reflexes

The FOUR scale includes brainstem reflexes (corneal, cough, pupillary) as a distinct domain, which the Glasgow Coma Scale does not assess.

Question 110: After a craniotomy, the nurse assesses the patient and finds clear fluid draining from the nose. To determine if this is CSF, the nurse should:

Test for beta-2 transferrin and check for a halo sign on filter paper (Correct answer)
Perform a dipstick urinalysis on the fluid
Observe the color and odor of the fluid
Send fluid for glucose level only

Correct answer: Test for beta-2 transferrin and check for a halo sign on filter paper

Beta-2 transferrin is the most specific test for CSF; the halo (ring) sign on filter paper — a clear ring around a bloody center — also suggests CSF.

Question 111: A patient with Parkinson's disease is evaluated for deep brain stimulation (DBS). Which symptom responds BEST to DBS therapy?

Motor fluctuations and levodopa-induced dyskinesias (Correct answer)
Cognitive decline and dementia
Olfactory loss and depression
Autonomic dysfunction and orthostatic hypotension

Correct answer: Motor fluctuations and levodopa-induced dyskinesias

DBS of the subthalamic nucleus or globus pallidus interna most effectively reduces motor fluctuations ('off' periods) and levodopa-induced dyskinesias in Parkinson's disease.

Question 112: A patient on phenytoin therapy presents with nystagmus, ataxia, and diplopia. The serum phenytoin level is 28 mcg/mL. This presentation is best described as:

Subtherapeutic drug effect
Phenytoin-induced hypersensitivity
Breakthrough seizure activity
Phenytoin toxicity (Correct answer)

Correct answer: Phenytoin toxicity

Nystagmus, ataxia, and diplopia at a level of 28 mcg/mL (therapeutic range 10–20 mcg/mL) indicate phenytoin toxicity (supratherapeutic).

Question 113: After lumbar spinal fusion surgery, the nurse assesses the surgical site and notes a bulge under the wound. The patient reports headache when upright that resolves when lying flat. The nurse suspects:

Surgical hematoma
Seroma formation
CSF leak with pseudomeningocele (Correct answer)
Wound infection

Correct answer: CSF leak with pseudomeningocele

A postural headache (worse upright, better supine) with a bulge under the wound after spinal surgery suggests a CSF leak and pseudomeningocele formation.

Question 114: A patient with acute cervical SCI is maintained in cervical traction using Gardner-Wells tongs. The nurse's priority assessment is:

Daily CBC for blood loss
Respiratory rate only
Pin site inspection for loosening or infection (Correct answer)
Hourly blood pressure for orthostatic changes

Correct answer: Pin site inspection for loosening or infection

Monitoring pin sites for signs of infection, loosening, or skin breakdown is the priority nursing assessment for patients in cervical traction devices.

Question 115: At the bedside, a patient's condition following a car accident is being assessed. The patient is intubated; he withdraws in response to unpleasant stimuli and his eyes open to sternal rub. What is his GCS, or Glasgow Coma Scale?

Seven (Correct answer)
Eight
Five
Six

Correct answer: Seven

The Glasgow Coma Scale (GCS) assesses eye opening, verbal response, and motor response. For this patient: eyes open to sternal rub scores 2 (to pain); verbal response is 1 (intubated, unable to assess); and withdrawing to unpleasant stimuli scores 4 (withdraws to pain). Therefore, the total GCS score is 2 + 1 + 4 = 7.

Question 116: A patient begins having generalized tonic-clonic seizure activity. The nurse's FIRST priority action is to:

Restrain the patient's limbs to prevent injury
Protect the patient from injury and maintain airway patency (Correct answer)
Insert an oral airway device
Administer IV lorazepam immediately

Correct answer: Protect the patient from injury and maintain airway patency

The first priority during a seizure is patient safety — protecting from injury and maintaining airway patency without restraining limb movements.

Question 117: Which vagus nerve stimulator (VNS) feature allows patients or caregivers to deliver an additional stimulation during a seizure?

Magnet-activated stimulation (Correct answer)
Closed-loop responsive stimulation
Auto-stimulation mode
Scheduled stimulation cycles

Correct answer: Magnet-activated stimulation

Swiping a magnet over the VNS device delivers an on-demand stimulation that may abort or shorten a seizure.

Question 118: Dementia with Lewy bodies (DLB) is distinguished from Alzheimer's disease primarily by the presence of:

Memory loss as the predominant early symptom
Fluctuating cognition with recurrent vivid visual hallucinations and parkinsonism (Correct answer)
Stepwise cognitive deterioration following ischemic events
Prominent personality and behavioral changes preceding memory loss

Correct answer: Fluctuating cognition with recurrent vivid visual hallucinations and parkinsonism

DLB is characterized by the triad of fluctuating cognition, vivid recurrent visual hallucinations, and spontaneous parkinsonism — features that distinguish it from Alzheimer's disease.

Question 119: Which complication of spinal cord injury is the LEADING cause of death in the chronic phase?

Pressure injuries
Deep vein thrombosis
Urinary tract infections and urosepsis (Correct answer)
Respiratory complications

Correct answer: Urinary tract infections and urosepsis

Urinary tract infections progressing to urosepsis are the leading cause of death in the chronic phase of spinal cord injury due to neurogenic bladder dysfunction.

Question 120: A patient with a new diagnosis of juvenile myoclonic epilepsy (JME) asks about seizure triggers. The nurse teaches that the most common trigger is:

Bright flashing lights alone
Cold exposure
High-fat diet
Sleep deprivation, particularly upon awakening (Correct answer)

Correct answer: Sleep deprivation, particularly upon awakening

Seizures in JME are most commonly triggered by sleep deprivation and occur characteristically in the morning upon awakening.

Question 121: Which classification of traumatic brain injury (TBI) is defined by a GCS score of 13–15?

Mild TBI (Correct answer)
Severe TBI
Moderate TBI
Critical TBI

Correct answer: Mild TBI

Mild TBI is defined by a GCS of 13–15, moderate TBI by GCS 9–12, and severe TBI by GCS 8 or below.

Question 122: Which of the following does warfarin users not need to avoid?

Alcohol
Ginger
Iceberg lettuce (Correct answer)
Kale

Correct answer: Iceberg lettuce

Warfarin is an anticoagulant whose effectiveness is highly sensitive to Vitamin K intake, as Vitamin K promotes blood clotting. Foods high in Vitamin K, such as kale and other dark leafy greens, can counteract warfarin's effects and should be consumed consistently or avoided. Iceberg lettuce has a very low Vitamin K content and therefore does not significantly interfere with warfarin's action.

Question 123: When assessing a patient with ALS for respiratory compromise, which measurement is MOST critical for determining the need for ventilatory support?

Oxygen saturation by pulse oximetry
Forced vital capacity (FVC) (Correct answer)
Arterial blood pH
Resting respiratory rate

Correct answer: Forced vital capacity (FVC)

Forced vital capacity (FVC) is the most sensitive early indicator of respiratory muscle weakness in ALS; an FVC below 50% predicted typically prompts discussion of non-invasive ventilatory support.

Question 124: Which intracranial pressure (ICP) waveform component reflects ventricular compliance and is normally the smallest peak?

P4 (notch wave)
P3 (dicrotic wave) (Correct answer)
P1 (percussion wave)
P2 (tidal wave)

Correct answer: P3 (dicrotic wave)

P3 (dicrotic wave) reflects closure of the aortic valve and is normally the smallest of the three ICP waveform peaks.

Question 125: After a patient returns from carotid endarterectomy (CEA), which neurological assessment finding requires immediate notification of the surgeon?

Mild headache
Hoarse voice
New facial droop or arm weakness on the operative side (Correct answer)
Mild throat soreness

Correct answer: New facial droop or arm weakness on the operative side

New focal neurological deficits after CEA suggest stroke from thromboembolism or carotid occlusion, requiring immediate surgical reassessment.

Question 126: A patient with a subarachnoid hemorrhage suddenly develops severe vasospasm on day 4. Which medication is the first-line prophylactic agent?

Mannitol
Nimodipine (Correct answer)
Labetalol
Nicardipine

Correct answer: Nimodipine

Nimodipine (oral calcium channel blocker) is the standard prophylactic agent for cerebral vasospasm after subarachnoid hemorrhage, given for 21 days.

Question 127: A positive Romberg test (patient sways when eyes are closed) indicates impairment in which system?

Frontal lobe executive function
Corticospinal tract
Proprioceptive or vestibular function (Correct answer)
Cerebellar 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 128: Which test confirms the diagnosis of carpal tunnel syndrome and is considered the gold standard?

Tinel's sign
MRI of the wrist
Nerve conduction study (NCS) and electromyography (EMG) (Correct answer)
Phalen's test

Correct answer: Nerve conduction study (NCS) and electromyography (EMG)

Nerve conduction studies (NCS) and EMG are the gold standard for diagnosing carpal tunnel syndrome by demonstrating slowed median nerve conduction across the wrist.

Question 129: A 45-year-old man comes in with weak arms and legs that have been developing gradually. He is having trouble breathing as the weakness has now spread to his chest. He claims the weakness began in his extremities and has progressed to swallowing difficulties. Over the last three months, he has shed around 15 lbs (6.8 kg). His lower limbs have fasciculations, and an examination of his nervous system reveals hyperreflexia in his upper limbs. His gag reaction is lessened, but his jaw jerk is accentuated. Which of the following statements most accurately sums up the patient's clinical pathogenesis?

A retrovirus that targets CD4 T lymphocytes
A genetic mutation that causes degeneration of parts of the basal ganglia
Loss of dopamine in the basal ganglia that control muscle tone and movement
Degeneration and gliosis of axons within the anterior and lateral columns of the spinal cord (Correct answer)

Correct answer: Degeneration and gliosis of axons within the anterior and lateral columns of the spinal cord

The patient's symptoms, including progressive weakness, fasciculations (lower motor neuron signs), hyperreflexia and accentuated jaw jerk (upper motor neuron signs), dysphagia, and respiratory involvement, are classic for Amyotrophic Lateral Sclerosis (ALS). ALS is characterized by the degeneration of both upper and lower motor neurons, specifically affecting the anterior horn cells and the corticospinal tracts in the lateral columns of the spinal cord and brainstem, leading to gliosis.

Question 130: Which first-line medication is recommended for initial treatment of status epilepticus in adults?

Valproic acid IV
Benzodiazepine (lorazepam or diazepam) (Correct answer)
Levetiracetam IV
Phenytoin IV

Correct answer: Benzodiazepine (lorazepam or diazepam)

Benzodiazepines (IV lorazepam preferred, or IM midazolam) are the first-line agents for terminating status epilepticus.

Question 131: Which finding on a lumbar puncture (LP) is most consistent with bacterial meningitis?

Clear CSF with normal glucose and mildly elevated protein
Xanthochromic CSF with elevated RBCs
CSF glucose <40 mg/dL with elevated protein and cloudy appearance (Correct answer)
CSF glucose >60 mg/dL with lymphocytic pleocytosis

Correct answer: CSF glucose <40 mg/dL with elevated protein and cloudy appearance

Bacterial meningitis classically presents with low CSF glucose (<40 mg/dL or <60% serum), elevated protein, PMN pleocytosis, and turbid appearance.

Question 132: When monitoring intracranial pressure (ICP), which waveform component indicates reduced cerebral compliance?

Elevated P2 wave exceeding P1 (Correct answer)
Prominent P1 percussion wave
Low-amplitude P3 wave
Flat baseline between waveforms

Correct answer: Elevated P2 wave exceeding P1

An elevated P2 (tidal) wave that exceeds P1 (percussion) indicates reduced intracranial compliance and impending ICP crisis.

Question 133: In continuous EEG monitoring, which finding requires the nurse to immediately notify the neurologist?

Sleep spindles
Nonconvulsive status epilepticus pattern (Correct answer)
Alpha waves at 8–13 Hz
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 134: A CNRN assesses a patient for papilledema during funduscopic examination. Papilledema is caused by:

Retinal detachment
Central retinal artery occlusion
Increased intracranial pressure transmitted along the optic nerve sheath (Correct answer)
Diabetic retinopathy

Correct answer: Increased intracranial pressure transmitted along the optic nerve sheath

Increased ICP is transmitted along the subarachnoid space surrounding the optic nerve, causing swelling of the optic disc (papilledema).

Question 135: When communicating with a patient in the moderate stage of Alzheimer's disease, which nursing approach is MOST appropriate?

Use complex multi-step instructions to stimulate residual cognitive function
Minimize all conversation to prevent confusion and agitation
Forcefully reorient the patient whenever confabulation occurs
Use simple short sentences, maintain eye contact, and speak in a calm tone (Correct answer)

Correct answer: Use simple short sentences, maintain eye contact, and speak in a calm tone

Simple, clear communication with calm tone and eye contact reduces confusion and agitation in moderate Alzheimer's disease while supporting the patient's remaining communication abilities.

Question 136: The nurse's FIRST action when autonomic dysreflexia is suspected is to:

Sit the patient upright and search for the precipitating stimulus (Correct answer)
Administer sublingual nitroglycerin
Administer IV labetalol immediately
Place the patient in Trendelenburg position

Correct answer: Sit the patient upright and search for the precipitating stimulus

Sitting the patient upright to lower BP and immediately identifying and removing the precipitating noxious stimulus (e.g., full bladder, fecal impaction) is the first priority in autonomic dysreflexia.

Question 137: Vasospasm after subarachnoid hemorrhage peaks at which time frame following the initial bleed?

Days 15–21
Days 1–3
More than 3 weeks
Days 4–14 (peak days 7–10) (Correct answer)

Correct answer: Days 4–14 (peak days 7–10)

Cerebral vasospasm after SAH typically occurs between days 4–14, with the highest incidence around days 7–10.

Question 138: A patient presents with sudden onset of diplopia, dysphagia, ataxia, and ipsilateral facial numbness with contralateral body numbness. The nurse recognizes this as:

Middle cerebral artery syndrome
Anterior cerebral artery syndrome
Weber syndrome
Wallenberg (lateral medullary) syndrome (Correct answer)

Correct answer: Wallenberg (lateral medullary) syndrome

Wallenberg syndrome (lateral medullary infarction) presents with ipsilateral facial sensory loss, contralateral body sensory loss, dysphagia, hoarseness, and ataxia.

Question 139: A patient with a subarachnoid hemorrhage develops a sudden severe headache described as 'the worst headache of my life.' The nurse recognizes this as:

Tension-type headache
Sentinel headache or thunderclap headache (Correct answer)
Migraine aura
Cluster headache

Correct answer: Sentinel headache or thunderclap headache

A sudden, severe 'thunderclap' headache reaching maximum intensity in seconds is the classic presentation of subarachnoid hemorrhage.

Question 140: Levetiracetam (Keppra) is frequently used as an antiseizure medication in neuroscience units. The nurse monitors for which MOST COMMON behavioral side effect?

Visual hallucinations
Irritability, agitation, and mood changes ('Keppra rage') (Correct answer)
Euphoria
Sedation and respiratory depression

Correct answer: Irritability, agitation, and mood changes ('Keppra rage')

Levetiracetam commonly causes irritability, agitation, and mood changes (colloquially called 'Keppra rage'), particularly in patients with prior psychiatric history.

Question 141: The nurse is preparing a patient for IV tPA. Which finding is an absolute contraindication?

Active intracranial hemorrhage on CT (Correct answer)
Blood glucose of 60 mg/dL
BP of 175/95 mmHg
Age greater than 80

Correct answer: Active intracranial hemorrhage on CT

Active intracranial hemorrhage on CT is an absolute contraindication to IV tPA due to the risk of worsening hemorrhage.

Question 142: Which type of TBI is characterized by diffuse white matter damage from rotational acceleration-deceleration forces, often with prolonged unconsciousness despite minimal CT findings?

Epidural hematoma
Diffuse axonal injury (DAI) (Correct answer)
Subdural hematoma
Contusion

Correct answer: Diffuse axonal injury (DAI)

Diffuse axonal injury (DAI) results from shear-strain forces disrupting axons throughout the white matter; CT may appear near-normal despite severe neurological dysfunction.

Question 143: The nurse is caring for a patient with a lumbar drain placed for CSF diversion. The maximum recommended CSF drainage rate per hour is:

50 mL/hour
30 mL/hour
5 mL/hour
10–15 mL/hour (Correct answer)

Correct answer: 10–15 mL/hour

Lumbar drains are typically set to drain 10–15 mL/hour; excessive drainage can cause intracranial hypotension and brainstem herniation.

Question 144: Which cranial nerve is tested when the nurse asks the patient to shrug their shoulders against resistance?

CN IX
CN XI (Correct answer)
CN X
CN XII

Correct answer: CN XI

Cranial nerve XI (spinal accessory nerve) innervates the sternocleidomastoid and trapezius muscles, tested by shoulder shrug resistance.

Question 145: A patient with a basilar skull fracture may exhibit which classic clinical sign involving discoloration around the eyes?

Kernig's sign
Battle's sign
Cullen's sign
Raccoon eyes (periorbital ecchymosis) (Correct answer)

Correct answer: Raccoon eyes (periorbital ecchymosis)

Raccoon eyes (bilateral periorbital ecchymosis) indicate a basilar skull fracture involving the anterior cranial fossa.

Question 146: The intensive care unit is evaluating a patient who was admitted to the hospital with an acute right-sided ischemic stroke. Which of the following would worry the medical staff the most?

The blood glucose level is 303 mg/dL.
The patient’s blood pressure is 159/88.
Patient is no longer able to lift his left arm. (Correct answer)
Patient failed his swallow evaluation.

Correct answer: Patient is no longer able to lift his left arm.

A right-sided ischemic stroke affects the left side of the body. A new or worsening neurological deficit, such as the inability to lift the left arm, indicates stroke progression or a new event. This change is a critical sign of neurological deterioration, requiring immediate medical intervention to prevent further brain damage and improve patient outcomes.

Question 147: Which antiseizure medication requires routine monitoring of sodium levels due to its potential to cause hyponatremia?

Phenobarbital
Levetiracetam
Gabapentin
Carbamazepine (Tegretol) (Correct answer)

Correct answer: Carbamazepine (Tegretol)

Carbamazepine can cause syndrome of inappropriate antidiuretic hormone (SIADH) leading to hyponatremia, requiring regular sodium monitoring.

Question 148: The nurse is assessing a patient with a cervical laminectomy and notices sudden respiratory distress. The most likely cause is:

Pulmonary embolism
Laryngospasm from intubation
Epidural hematoma compressing the cervical cord (Correct answer)
Pneumonia

Correct answer: Epidural hematoma compressing the cervical cord

An epidural hematoma after cervical laminectomy can rapidly compress the spinal cord at the level of the phrenic nerve, causing acute respiratory failure.

Question 149: A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which nursing teaching point is MOST important?

Expect complete elimination of all tremors after the first dose
Take the medication only when tremor symptoms become severe
Take the medication with a high-protein meal to enhance GI absorption
Avoid taking the medication within 30–60 minutes of a high-protein meal (Correct answer)

Correct answer: Avoid taking the medication within 30–60 minutes of a high-protein meal

High-protein meals compete with levodopa for intestinal absorption and blood-brain barrier transport via large neutral amino acid carriers, reducing therapeutic efficacy.

Question 150: The nurse is monitoring a patient's cerebral perfusion pressure (CPP). Which formula is used to calculate CPP?

CPP = SBP + DBP − ICP
CPP = MAP + ICP
CPP = MAP − ICP (Correct answer)
CPP = SBP − ICP

Correct answer: CPP = MAP − ICP

Cerebral perfusion pressure is calculated as mean arterial pressure minus intracranial pressure (CPP = MAP − ICP).

Question 151: A patient with status epilepticus has been taken into the hospital. Right now, the patient is postictal. Which of the following nursing factors is most crucial when managing the patient?

Maintain an airway. (Correct answer)
Insert a central line.
Prepare the patient for a lumbar puncture.
Obtain an electrocardiogram.

Correct answer: Maintain an airway.

During the postictal phase following a seizure, patients are often drowsy, confused, and may have depressed respiratory drive or a relaxed tongue, which can obstruct the airway. Maintaining a patent airway is paramount to ensure adequate oxygenation and prevent aspiration, making it the most critical immediate nursing intervention to prevent further complications.

Question 152: After transsphenoidal surgery, the nurse instructs the patient to avoid which activity to prevent disruption of the surgical repair?

Blowing their nose forcefully (Correct answer)
Sipping liquids through a straw
Deep breathing exercises
Walking in the hallway

Correct answer: Blowing their nose forcefully

Forceful nose blowing increases intracranial pressure and can displace the sellar repair, causing CSF leak after transsphenoidal surgery.

Question 153: The nurse is caring for a patient with a hemorrhagic stroke on anticoagulation. Which medication is used to reverse warfarin toxicity emergently?

4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
Fresh frozen plasma alone
Protamine sulfate
Vitamin K only

Correct answer: 4-factor prothrombin complex concentrate (4F-PCC)

4-factor prothrombin complex concentrate (4F-PCC) provides rapid, complete reversal of warfarin anticoagulation in hemorrhagic emergencies.

Question 154: Which clinical finding differentiates neurogenic shock from spinal shock after acute spinal cord injury?

Hypotension with bradycardia (neurogenic) vs. flaccid areflexia below injury (spinal shock) (Correct answer)
Loss of bowel and bladder function
Presence of flaccid paralysis
Absence of reflexes below the injury level

Correct answer: Hypotension with bradycardia (neurogenic) vs. flaccid areflexia below injury (spinal shock)

Neurogenic shock refers to hemodynamic instability (hypotension and bradycardia) from loss of sympathetic tone, while spinal shock is the physiologic state of flaccid areflexia below the injury level.

Question 155: The nurse is caring for a patient with status epilepticus who has received two doses of lorazepam without seizure cessation. The next priority medication is:

Levetiracetam or fosphenytoin IV (Correct answer)
Phenobarbital IM
Oral valproic acid via NG tube
Propofol infusion

Correct answer: Levetiracetam or fosphenytoin IV

After two benzodiazepine doses fail, second-line agents (fosphenytoin, levetiracetam, or valproate IV) are indicated per status epilepticus protocols.

Question 156: Which antiseizure medication is absolutely contraindicated in women of childbearing age with epilepsy due to the highest teratogenic risk?

Levetiracetam
Carbamazepine
Valproic acid (valproate) (Correct answer)
Lamotrigine

Correct answer: Valproic acid (valproate)

Valproic acid carries the highest teratogenic risk among antiseizure medications, with major congenital malformations and neurodevelopmental effects in offspring.

Question 157: When performing a neurological assessment, the nurse tests the patient's ability to identify objects by touch alone. This evaluates which sensory function?

Proprioception
Stereognosis (Correct answer)
Two-point discrimination
Graphesthesia

Correct answer: Stereognosis

Stereognosis is the ability to identify objects by touch without visual input, testing parietal lobe sensory integration.

Question 158: The nurse is caring for a patient with severe TBI receiving hypertonic saline for ICP management. The MOST important parameter to monitor is:

Blood glucose
Serum sodium and osmolality (Correct answer)
Serum potassium
Liver function tests

Correct answer: Serum sodium and osmolality

Hypertonic saline can cause hypernatremia and hyperosmolality; serum sodium and osmolality must be monitored to prevent complications.

Question 159: Huntington's disease is caused by which genetic mutation?

CAG trinucleotide repeat expansion on chromosome 4 (Correct answer)
Deletion of chromosome 22q11
Trisomy of chromosome 21
Point mutation in the PARK2 gene on chromosome 6

Correct answer: CAG trinucleotide repeat expansion on chromosome 4

Huntington's disease results from an expansion of CAG trinucleotide repeats in the HTT gene on chromosome 4, leading to progressive striatal neurodegeneration.

Question 160: A patient with acute SCI is at high risk for deep vein thrombosis. Pharmacological prophylaxis should be initiated:

Only after surgical stabilization
Immediately upon diagnosis
Not until the patient is ambulating
After 24 hours if no active bleeding (Correct answer)

Correct answer: After 24 hours if no active bleeding

DVT prophylaxis with low-molecular-weight heparin should be initiated within 24 hours in SCI patients if there is no contraindication such as active bleeding.

Certified Neuroscience Registered Nurse (CNRN)

The CNRN certification, administered by the American Board of Neuroscience Nursing (ABNN), validates expertise in neuroscience nursing practice across seven clinical domains including cerebrovascular disorders, neurotrauma, critical care, seizures, and neurodegenerative diseases. It is offered three times yearly via computer-based testing at PSI centers.

220

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240 min

Time Limit

70%

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