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CCRN NEURO EXAM QUESTIONS AND
CORRECT ANSWERS 2025.
A 23-year-old man has sustained a diffuse axonal injury. He has been admitted to the critical care unit after being resuscitated in the emergency department. His current Glasgow Coma Scale score is 5. Vital signs include blood pressure of 120/84 mm Hg, heart rate of 92 beats/min, and temperature of 36° C. The patient is on a ventilator on control mode, with a tidal volume of 700 ml, rate of 18 breaths/min, and FiO2 of 0.45. An intraventricular catheter is inserted via a burr hole, and the intracranial pressure (ICP) is 30 mm Hg. Which of the following nursing measures optimize cerebral perfusion pressure (CPP)? A. Turning the patient every hour B. Routine suctioning every hour C. Maintaining neutral head position D. Maintaining PaCO2 below 30 mm Hg - correct answer>>C. Routine nursing measures may increase ICP and, therefore, decrease CPP because CPP = mean arterial pressure (MAP) - ICP. The patient needs to be turned; every 2 hours is sufficient. The patient may need to have secretions suctioned; only suction the patient if indications, such as rhonchi, are present and never suction routinely. Hyperoxygenation before suctioning is
important in preventing the detrimental effects of suctioning on ICP. Administration of lidocaine (intravenously or by endotracheal tube) before suctioning helps to prevent coughing and the increase in ICP caused by suctioning. Keeping the patient alkalotic through hyperventilation therapy causes the cerebral vessels to constrict and decreases intracranial volume and pressure. This is an intervention that is only used in extreme crisis such as impending herniation because it is likely to cause ischemia. PaCO2 usually is kept at the lower end of the normal 35 to 45 mm Hg range to decrease the ICP but not cause cerebral ischemia. Hyperventilation is a short-term treatment only. Keeping the head and neck in a neutral position allows optimal venous drainage through the jugular veins. Test Taking Tip Which of the following options is normal management for all patients? Routine turning procedure is every 2 hours. Nothing in this case study suggests that skin breakdown or pulmonary complications require hourly turning. Routine suctioning is not recommended today. Suctioning should be done when indicated. Maintaining the PaCO2 at less than 30 mm Hg is likely to constrict the cerebral vessels and decrease intracranial volume and pressure but also cause cerebral ischemia. Maintaining the head in a neutral position is a good idea for all patients but especially those with neurologic injury. Include "Maintaining neutral head position" in the plan for this patient A 76-year-old woman is admitted to the critical care unit after a right cerebral hemisphere hemorrhage. Assessment would reveal which of the following? A. Dilated left pupil and paresis or plegia on the left side B.
Cranial nerve III controls the ability of the pupil to constrict. As intracranial pressure (ICP) rises, changes in pupil size and reactivity occur, with the pupil on the side of the pressure dilating and becoming sluggish in response to light and finally nonreactive to light. Test Taking Tip All of these cranial nerves involve the eyes. Cranial nerve II is responsible for vision. Cranial nerves III, IV, and VI all are involved in eye movement. Cranial nerve III is the cranial nerve that controls the ciliary response and constriction of the pupil. Choose "III." A 42-year-old woman is admitted with "the worst headache I've ever had." Computed tomography reveals an aneurysm in the circle of Willis. Which of the following clinical presentations describes a Hunt and Hess grade I aneurysm? A. Minimal headache; no neurologic deficits B. Mild to severe headache; minimal neurologic deficits C. Stuporous; mild to severe hemiparesis D. Comatose; decerebrate posturing - correct answer>>A. A grade I on the Hunt and Hess aneurysm grading scale indicates minimal bleeding with no neurologic deficits. Aneurysm rupture may be classified from grade I to grade V. The highest classification indicates a severe bleed and a comatose patient.
Test Taking Tip Because grade I is usually the lowest point on a scale, choose the option with the least severe deficit. Choose "Minimal headache; no neurologic deficits." A 35-year-old man is admitted to the critical care unit with headache, fever, nuchal rigidity, and Kernig sign. Which diagnostic test would be most useful in confirming bacterial meningitis? A. Electromyelogram B. Lumbar puncture C. Angiogram D. Cisternogram - correct answer>>B. Collection of cerebrospinal fluid (CSF) by lumbar puncture can identify the infective organism. If the organism is a bacterium, the CSF will be cloudy and the glucose level will be decreased. Electromyelogram detects muscle disease, angiogram visualizes the vasculature, and a cisternogram shows CSF flow. Test Taking Tip Consider what areas of the neurologic anatomy each test investigates. A patient is admitted after an ischemic stroke. She articulates well but does not understand what is being said to her. She has damage to:
Connecting low suction to the ear C. Applying loose sterile dressing D. Leaving ear uncovered - correct answer>>C It is important not to obstruct CSF flow because this could increase intracranial pressure. Introducing suction could cause bleeding, infection, or further structural damage. A 48-year-old man is admitted with muscle weakness. Guillain-Barré syndrome (GBS) is suspected. Which of the following statements is correct concerning GBS? A. It involves a deficit in acetylcholine at the myoneural junction. B. It is frequently preceded by a viral illness. C. It results in asymmetric paralysis. D. It is a common outcome of HIV. - correct answer>>B. GBS is an acquired acute inflammatory demyelinating axonal polyneuropathy. It affects motor more than sensory nerves. It frequently follows a viral or bacterial illness or influenza vaccination. Paresis or paralysis is bilateral and ascending. Patients with GBS are admitted to the critical care unit most often for acute respiratory failure.
A patient with an acute head injury was restless during the night. This morning she has exhibited a diminishing level of consciousness and her right pupil has become nonresponsive to light. Now there is a sudden increase in the patient's systolic pressure, a marked decrease in her diastolic pressure, and a slowing of her pulse. These vital sign changes are described as which of the following? A. Battle sign B. Cushing triad C. Kernig sign D. Chvostek sign - correct answer>>B. Cushing reflex or triad is a late sign of increased intracranial pressure (ICP). The patient exhibits an increased systolic blood pressure with a decrease in diastolic blood pressure (widened pulse pressure) and bradycardia. Test Taking Tip Battle sign is bruising of the mastoid, which is indicative of basal skull fracture, so eliminate that option. Kernig sign is a resistance to leg extension with the hip flexed, which is indicative of meningeal irritation, so eliminate that option. Chvostek sign is facial spasm caused by tapping the origin of the facial nerve, which is indicative of hypocalcemia, so eliminate that option as well. Also consider another method: The case presentation includes three vital sign changes, so think and choose triad.
onset of symptoms to administration of fibrinolytics, the time frame is generally no longer than: A. 1 hour. B. 3 hours. C. 6 hours. D. 12 hours. - correct answer>>B. The patient must be assessed, and the fibrinolytic must be initiated within 3 hours of onset of symptoms. If the patient cannot identify the time of the onset of symptoms or the time interval has been greater than 3 hours, the patient is generally not a candidate for fibrinolytic therapy. There is currently consideration of a 4.5-hour window for some patients. A 56-year-old woman is admitted to the surgical intensive care unit after a transsphenoidal hypophysectomy for a pituitary tumor. She has clear fluid dripping from her nose. If the fluid is cerebrospinal fluid (CSF), what should be done? A. Pack the nose with cotton balls. B. Report it immediately.
C.
Tape a 2 × 2-inch or 4 × 4-inch dressing under the nose. D. Monitor her closely for clinical indications of intracranial hypertension. - correct answer>>C. It is normal for a patient to have a CSF leak from the nose for approximately 48 hours after a transsphenoidal hypophysectomy. The fluid should be absorbed by a moustache dressing made with a 2 × 2-inch or 4 × 4-inch dressing. CSF drainage increases the risk of infection, not intracranial hypertension, although all patients should be monitored for intracranial hypertension after any type of craniotomy. Test Taking Tip Consider why you do not have CSF draining from your nose. You have an intact dura. A dural defect increases the risk on intracranial infection and you would want to add an environmental barrier to collect the CSF but you would not pack the nose. The ability of the brain contents to be shifted to prevent intracranial hypertension when intracranial volume increases is referred to as: A. compensati on. B. autoregulat ion. C. normalizati on.
Atrial fibrillation is the most significant cardiac risk factor for ischemic stroke due to mural thrombi which develop in the atria and then embolize from the left atrium to the cerebrovascular system. Test Taking Tip Remember that prevention of stroke is the primary reason that patients with chronic atrial fibrillation are maintained on anticoagulants. A 56-year-old woman is admitted to the surgical intensive care unit after a transsphenoidal hypophysectomy for a pituitary tumor. The head of the bed (HOB) should be kept: A. flat. B. elevated at 10 degrees. C. elevated at 30 degrees. D. elevated at 60 degrees. - correct answer>>C. The HOB usually is maintained at 15 to 30 degrees for all neurologic patients except patients with an infratentorial craniotomy, who should be positioned with the HOB flat. A 52-year-old woman developed an epidural hematoma after being in a motor vehicle collision. She has had a craniotomy to evacuate the clot, and an intraventricular catheter was placed during surgery. Which of the following is important in caring for the patient with an intracranial pressure (ICP) monitoring system?
A.
Use heparin to maintain integrity of the line. B. Use preservative-free isotonic saline. C. Use a flush system. D. Use a pressure bag. - correct answer>>B. ICP monitoring systems are closed systems. A flush system with heparin and a pressure bag with an intermittent flush device is appropriate for vascular pressure monitoring (e.g., arterial catheters and pulmonary artery catheters) but not for intracranial pressure monitoring systems. Preservatives in saline vials can cause meningeal irritation or brain tissue necrosis. Only preservative-free saline should be used to prime the system. A patient has had an ischemic stroke and is currently dysphagic. What measure would increase his risk of aspiration when he is eating? A. Having him sit upright B. Giving him primarily liquids until he can swallow C. Placing foods on the unaffected side of his mouth
Dysprosody B. Wernicke aphasia C. Broca aphasia D. Dysphagia - correct answer>>C. Broca aphasia is the inability to express oneself. Broca aphasia is also called motor or expressive aphasia and is caused by a problem in Broca area of the frontal lobe. Wernicke aphasia is also called sensory or receptive aphasia and is caused by a problem in Wernicke area of the temporal lobe. Dysprosody is lack of inflection during speech. Dysphagia is difficulty swallowing. Test Taking Tip Dys- means difficult and this question says "unable," so narrow the options to the two aphasias. Now you must remember Broca in frontal = expressive (i.e., motor) aphasia and Wernicke in temporal = receptive (i.e., sensory) aphasia. A 78-year-old man is admitted to the critical care unit with left-sided hemiplegia and a dilated right pupil. He cannot remember falling and has no signs of physical trauma. His family tells you that he is an alcoholic but that he has been "acting differently" for approximately 1 month. Based on this information, he probably has: A. an epidural hematoma.
B. a subdural hematoma. C. a subarachnoid hemorrhage. D. a cerebral embolism. - correct answer>>B. This patient probably has a chronic subdural hematoma. This is a venous bleed. Signs and symptoms may not occur for weeks to months after trauma. Many patients cannot remember a precipitating trauma, and it may occur spontaneously, especially in elderly patients, alcoholics, and patients taking anticoagulants. Test Taking Tip All of these options are acute except "a subdural hematoma," which may be acute, subacute, or chronic. Considering the family's description of "acting differently," this is probably a chronic subdural hematoma. Choose "a subdural hematoma. A 68-year-old woman is admitted with ischemic stroke. When the bottom of her foot is stroked, the great toe moves upward and the other toes fan out. This finding indicates which of the following? A. Upper motor neuron lesion B. Lower motor neuron lesion
Test Taking Tip Only "Herniation" directly results in death. A patient is admitted with subarachnoid hemorrhage. In order to maximize venous return and reduce intracranial pressure (ICP), the patient should be positioned: A. flat with a pillow. B. prone with the head turned to the side. C. with the head of the bed elevated 30 degrees. D. in high Fowler with the knee gatch raised. Submit - correct answer>>C. Care must be taken to avoid any compression of the jugular veins. Both options "flat with a pillow" and "prone with the head turned to the side" would likely reduce venous drainage from the head. High Fowler position would likely increase the intra-abdominal pressure and, resultantly, the intracranial pressure. Test Taking Tip Most patients with neurologic conditions are positioned with the HOB elevated 30 degrees. The most notable exception is infratentorial craniotomy; those patients are positioned flat on their nonoperative side postoperatively.
Which of the following are the major sources of intracranial hypertension after craniocerebral trauma? A. Cerebral edema and expanding lesions B. Hypervolemia and hyperthermia C. Hypovolemia and hypothermia D. Hydrocephalous and infection - correct answer>>A. Cerebral edema and expanding lesions (e.g., hematoma) are the two major sources of increased intracranial pressure. Test Taking Tip Look for the option that is neurologic specific. Choose "Cerebral edema and expanding lesions." A 32-year-old man is admitted with raccoon eyes. You notice clear fluid dripping from his nose. What would be an appropriate nursing intervention? A. Insert a nasogastric tube to prevent vomiting. B. Suction the nasopharynx as needed. C. Insert nasal packing until the physician arrives.
