CNRN Neuroscience Registered Nurse Certification 3

Question 1

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

Accepted Answer

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

Answer

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

Question 2

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:

Accepted Answer

Levetiracetam or fosphenytoin IV

Answer

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

Question 3

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

Accepted Answer

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

Answer

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

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:

Accepted Answer

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

Answer

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 5

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

Accepted Answer

Widening pulse pressure with bradycardia

Answer

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

CNRN Test Practice Test

CNRN Test Practice Test

CNRN Neuroscience Registered Nurse Certification 3