Certified Neuroscience Registered Nurse (CNRN) — Questions and Answers

Question 1: Status epilepticus is defined as continuous seizure activity lasting longer than:

15 minutes
2 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 2: 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:

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

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

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

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

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

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

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

Correct answer: Hypertension, bradycardia, irregular respirations

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

Question 6: A patient undergoes clipping of an intracranial aneurysm. The most serious immediate postoperative complication the CNRN nurse monitors for is:

Cerebral vasospasm and delayed cerebral ischemia (Correct answer)
Urinary retention
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 7: Which scale is commonly used by CNRN nurses to grade subarachnoid hemorrhage severity based on clinical presentation?

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

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

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

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

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
Decrease ventilator rate to promote CO2 retention

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 10: 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?

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

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

Tizanidine
Diazepam
Baclofen (Correct answer)
Dantrolene sodium

Correct answer: Baclofen

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

Question 12: Which set of signs represents the four cardinal motor features of Parkinson's disease?

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

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

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

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

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

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 15: 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:

Brudzinski's sign
Lhermitte's sign
Kernig's sign (Correct answer)
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 16: Which stroke scale is used at the bedside by nurses to quantify stroke severity and guide acute treatment decisions?

Modified Rankin Scale (mRS)
NIH Stroke Scale (NIHSS) (Correct answer)
Barthel Index
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 17: Which medication is used to treat central diabetes insipidus after pituitary surgery?

Furosemide
Hydrocortisone
Desmopressin (DDAVP) (Correct answer)
Fludrocortisone

Correct answer: Desmopressin (DDAVP)

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

Question 18: Which test confirms the diagnosis of carpal tunnel syndrome and is considered the gold standard?

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

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

Contralateral hemiplegia
Expressive aphasia
Neglect syndrome
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 20: 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 21: 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
Apply soft wrist restraints
Keep padded side rails raised and suction at bedside (Correct answer)
Keep room lights bright to detect aura

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 22: 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?

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

Correct answer: Smoking cessation

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

Question 23: A patient with normal pressure hydrocephalus (NPH) classically presents with which triad of symptoms?

Gait disturbance, urinary incontinence, and dementia (Hakim's triad) (Correct answer)
Seizures, focal weakness, and confusion
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 24: 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)
Autonomic dysfunction and orthostatic hypotension
Olfactory loss and depression
Cognitive decline and dementia

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 25: 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:

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

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

Within 12 hours of symptom onset
Within 2 hours of symptom onset
Within 3 hours of symptom onset (up to 4.5 hours per extended guidelines) (Correct answer)
Within 6 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 27: A patient with hemorrhagic stroke has a serum sodium of 126 mEq/L. The nurse identifies this as:

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

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

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

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

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

Correct answer: Hypertension, hypervolemia, hemodilution

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

Question 30: A nurse is teaching a patient with MS about fatigue management. Which strategy is MOST evidence-based?

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

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.

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.

Questions

35 min

Time Limit

70%

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