CNRN Neuroscience Registered Nurse Certification 5 — Questions and Answers
Question 1: A patient with normal pressure hydrocephalus (NPH) classically presents with which triad?
- Gait disturbance, urinary incontinence, and cognitive decline (Correct answer)
- Headache, papilledema, and vomiting
- Tremor, rigidity, and bradykinesia
- Aphasia, agnosia, and apraxia
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 2: Which of the following best describes the primary mechanism of secondary brain injury following TBI?
- Ischemia from disrupted autoregulation, excitotoxicity, and inflammatory cascade (Correct answer)
- Direct neuronal shearing from rotational acceleration
- Epidural hematoma expansion compressing underlying cortex
- Brainstem contusion from contrecoup forces
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 3: A patient with multiple sclerosis reports worsening of symptoms each time she showers. This phenomenon is known as:
- Uhthoff's phenomenon (Correct answer)
- Lhermitte's sign
- Internuclear ophthalmoplegia
- Charcot's triad
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 4: The nurse is caring for a patient after a ventriculostomy (EVD) placement. Which action correctly manages the drainage system?
- 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)
- Zero the transducer at the level of the heart before obtaining ICP readings
- Clamp the EVD for 1 hour after each position change before re-leveling
- 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 5: 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
- Carotid duplex ultrasound
- Repeat CT head in 24 hours
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 6: Which Glasgow Coma Scale (GCS) component score indicates the greatest severity of neurological impairment?
- E1V1M1 (GCS 3) (Correct answer)
- E2V2M3 (GCS 7)
- E3V3M4 (GCS 10)
- E1V2M4 (GCS 7)
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 7: 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
- Obtain an abdominal X-ray to rule out obstruction
- Perform a saline enema immediately
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.
CNRN Neuroscience Registered Nurse Certification 5
A patient with normal pressure hydrocephalus (NPH) classically presents with which triad?