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Certified Neuroscience Registered Nurse Study Questions

Ischemic Stroke 1. A patient presents to the hospital with an acute ischemic stroke at 7:00 pm. The patient may be a candidate for IV rt-PA if her symptoms began at? A. 8:00 am B. 11:00 pm C. 2:00 pm D. 5:00 pm D. 5:00 pm Correct The FDA has approved IV-rtPA for eligible patients within 3 hrs of s/s onset. In 2009 the ASA recommended 4.5 hours for patients who meet eligibility criteria.
Ischemic Stroke 2. A patient presents with an anterior cerebral artery (ACA) ischemic stroke. What symptom would the nurse most expect this patient to exhibit? A. LLE weakness B. RUE weakness C. Ataxia D. Broca’s aphasia A. Left lower extremity weakness Correct ACA stroke will most likely present with paralysis/weakness of the contralateral foot and leg. Leg weakness will be more pronounced than arm weakness.
Cerebroovascular Anatomy and Acute Ischemic Stroke 3. Expressive aphasia can be the result of an occlusion of which cerebral artery? A. Basilar artery B. MCA C. Posterior inferior cerebellar artery D. Anterior inferior cerebellar artery B. Middle cerebral artery Correct MCA major vessel supplying the anterior cerebral circulation. Expressive and receptive aphasia poss w/ MCA involvement
Ischemic Stroke 4. When performing teaching to a patient who has suffered a stroke, which teaching point is considered a modifiable risk factor? A. Age B. Hypertension C. Gender D. Race B. Hypertension Correct Modifiable risk factors can be changed and include things such as hypertension, smoking, diabetes, and carotid stenosis. Age, gender, and race are considered unmodifiable risk factors of stroke.
Ischemic Stroke 5. An acute ischemic stroke pt baseline NIHSS score of 4. 15 min later NIHSS score is 11. What is MOST likely? A. improvement in neuro status B. expected with thrombolytic therapy C. decline in neuro status D. now hemorrhagic stroke C. A decline in neurological status Correct Decline in neurological status most likely due to worsening of the occlusion. Lower NIHSS score associated w/ better neuro exam & improved outcomes. A higher score - worse neurological exam and poor outcomes.
Ischemic Stroke 6. A patient presents with stroke-like symptoms that began 45 minutes earlier. What diagnostic test is anticipated? A. Magnetic resonance angiogram (MRA) B. MRI C. CT scan without contrast D. Cerebral angiogram C. CT scan without contrast Correct In acute phase r/o hemorrhagic stroke & exclude from thrombolytic therapy. If radiographic changes seen; tissue ischemia has already occurred.
Ischemic Stroke 7.A 56 year-old male presents to the ED with complaints of acute onset of dizziness, dysarthria and diplopia. The CNRN recognizes this could be due to ischemia to what area of the brain? A. Basilar artery B. MCA C. PCA D. ACA A. Basilar artery Correct Rationale: Basilar artery insufficiency may present with dizziness, diplopia, dysarthria, in addition to dysphonia and dysmetria.
Ischemic Stroke 8.A 78 year-old patient presents to the hospital with acute onset of homonymous hemianopia. Where is the stroke most likely occurring? A. Frontal lobe B. Parietal lobe C. Occipital lobe D. Temporal lobe C. Occipital lobe Correct Rationale: Homonymous hemianopia is associated with an occipital lobe stroke.
Ischemic Stroke 9. A 68 year-old male presents with acute onset of cortical blindness. The nurse knows this is caused by occlusion to what cerebral blood vessel or vessels? A. ACA B. MCA C. Bilateral PCAs D. Anterior inferior cerebellar artery C. Bilateral posterior cerebral arteries Correct Rationale: Occlusion of the bilateral posterior cerebral arteries can cause cortical blindness
Ischemic Stroke 10. Pontine perforators off which cerebral blood vessel perfuse the pons? A. Basilar artery B. MCA C. Posterior inferior cerebellar artery D. Anterior inferior cerebellar artery A. Basilar artery Correct Rationale: The basilar artery has small blood vessels called perforators that perfuse the pons.
Hemorrhagic Stroke 1. Pt has sudden, severe onset of acute headache & loses consciousness. After intubating, what next? A. Emergent head CT B. 67mg of IV-rtPA with 10% given as a bolus C. Mechanical thrombectomy D. NIHSS score A. Emergent head CT Correct Classic signs of a SAH. This requires an emergent CT scan to determine if blood is present, severity and determine a plan. The other options would be appropriate for a patient experiencing an acute ischemic stroke.
Hemorrhagic Stroke 2. The patient asks what a berry aneurysm is. This type of aneurysm: A. Is very rare B. Has a broad neck C. Is typically fixed with a procedure called “coiling” D. Is caused by an infection C. Is typically fixed with a procedure called “coiling” Correct Berry (saccular) aneurysms are the most common type of aneurysm. Due to their sac like appearance and small neck, this type is typically fixed with endovascular coiling.
Hemorrhagic Stroke 3. A pt presented w/ SAH Hunt Hess II/Fisher grade III. What is the highest priority? A. Frequent neuro exams B. Tylenol to keep pt afebrile C. Frequent coagulation labs D. 10mg labetolol (trandate) IV for a BP of 172/87 D. labetolol During the first 24 hours after SAH the highest priority is to control bp to decrease the risk of rebleeding. To reduce the risk of rebleeding the aneurysm needs to be secured through either endovascular coiling or surgically clipping.
Hemorrhagic Stroke 4. Pt asks why he has to take nimodipine. A. helps to lower his blood pressure B. improves outcomes following a SAH C. acts as a diuretic decreasing risk of cerebral edema D. helps to lower his cholesterol B. Nimodipine during the vasospasm period , 60 mg PO every four hours for 21 day, to improve neurologic outcomes by reducing the incidence and severity of ischemia associated w cerebral vasospasm. If hypotension occurs, the dose can be adjusted or d/c'd.
Hemorrhagic Stroke 5. A patient post bleed day 4 develops a right-sided pronator drift indicating right arm weakness. What does the nurse suspect? A. Hydrocephalus B. Vasospasm C. Extension of the hemorrhagic stroke D. Migration of the aneurysm coils B. Cerebral vasospasm can occur post-bleed day 3-14 and may occur up to 21 days after initial bleed. An early indicator of vasospasm is weakness. Checking for a pronator drift is an easy way to monitor for vasospasm.
Hemorrhagic Stroke 6. Pt with a mild headache and photophobia. The CT negative for blood. Lumbar puncture. What would indicate SAH may be present? A. Elevated protein levels B. Xanthochromia C. High glucose levels D. Low white blood cell count B. Xanthochromia is caused by bilirubin due to bleeding during previous 2-36 hours. If CT negative for blood, but pt has s/s of SAH lumbar puncture for CSF analysis can be useful. If pt is showing s/s of elevated ICP, a lumbar puncture is contraindicated.
Hemorrhagic Stroke 7. What is the number one modifiable risk factor to decrease the risk of intracerebral hemorrhage? A. Hyperlipidemia B. Obesity C. Diabetes mellitus D. Hypertension D, Hypertension Correct Hypertension is the number one modifiable risk factor for decreasing the risk of an intracerebral hemorrhage.
Hemorrhagic Stroke 8. A 76 year-old m w/ R sided weakness and a severe headache, vomited earlier today. What type of stroke is this most indicative of? A. Large vessel occlusion B. Cardioembolic stroke C. Hemorrhagic stroke D. Small vessel occlusion C. Hemorrhagic stroke Correct Pts who present w/ severe HA with focal symptoms such as weakness need immediate CT scan of head without contrast to assess for hemorrhagic stroke. Severe hypertension and vomiting is commonly seen in these patients.
Hemorrhagic Stroke 9. Admitting pt with a large L hemispheric ICH. The neurosurgeons note states ICH score of 4. You would explain that this score predicts: A. Mortality B. Morbidity C. Volume of blood D. Rehabilitation potential B. The ICH score is a predictor of mortality at 30 days following an intracerebral hemorrhage. An ICH score of 4 is associated with a 97% mortality rate.
Hemorrhagic Stroke 10.A 73 year-old m w/ HA and R sided deficits. BP 235/119. CT shows large L frontal ICH. Most urgent intervention? A. fluid bolus B. paralytics for intubation C. permissive hypertension D. anti-hypertensive agent D. Anti-hypertensive agent to decrease blood pressure Correct Rationale: Immediate blood pressure reduction is necessary in this patient population to prevent extension of the hemorrhage.
Developmental and Degenerative Disease 1.A patient underwent a posterior fossa craniotomy for an Arnold-chiari malformation. Common post-operative problem? A. Expressive aphasia B. Hemi-sensory loss C. Nausea/Vomiting D. Agraphia C. Nausea/Vomiting Correct Cerebellum is located in the posterior fossa. Disorders affecting the cerebellum cause problems with balance and equilibrium therefore, nausea is a very common post-operative problem. Prepare anti-emetics post-operatively.
Developmental and Degenerative Disease 2. Irritable infant, fontanels bulging and the infant has a downward gaze. Baby has not been taking his bottle. Suspect what condition? A. Downs syndrome B. Cerebral palsy C. Meningitis D. Hydrocephalus D. Hydrocepehalus Correct Hydrocephalus in an infant, bulging appearance. Classic signs of hydrocephalus include lethargy, irritability, difficult to console, and poor appetite. Can cause delayed development and immediate action must be taken.
Developmental and Degenerative Disease 3. The child with hydrocephalus will require permanent cerebrospinal fluid diversion by what type of device? A. Lumbar drain B. Lumbar puncture C. Ventriculoperitoneal shunt D. External ventriculostomy C. Ventriculoperitoneal shunt Correct Ventriculopertioneal shunt is the only permanent method of cerebrospinal fluid diversion listed. The other devices are for acute diversion and are not used to treat chronic hydrocephalus.
Developmental and Degenerative Disease 4 A child with a history of a VP shunt presents to the clinic with lethargy, anorexia, nausea and vomiting. Likely complication? A. Obstruction B. Infection C. Disconnection D. Catheter migration A. Obstruction of the shunt will present with signs of hydrocephalus including lethargy, anorexia, nausea and vomiting.
Developmental and Degenerative Disease 5. A baby is born with downs syndrome. The nurse explains to the parents the baby is at high risk for what type of health problems? A. Respiratory B. Cardiovascular C. Genitourinary D. Gastrointestinal B. Cardiovascular Correct It is important to make the parents aware the child is at high risk for cardiovascular problems. In a downs syndrome patient, the heart does not form normally leading to heart defects and cardiovascular complications.
Developmental and Degenerative Disease 6.What type of dementia is a patient with a past medical history of small strokes and hypertension at risk for? A. Alzheimer's B. Lewy body dementia C. Vascular dementia D. Encephalopathic dementia C. Vascular dementia Correct Vascular dementia is also termed multi-infarct dementia. There is an increased risk in patients with previous small strokes or TIA’s. Athersoclerosis and hypertension are also thought to be risk factors.
Developmental and Degenerative Disease 7. 28 year-old male with hx of cerebral palsy & numerous VP shunt revisions present with lethargy, fever and leukocytosis. Suspect? A. Infection B. Obstruction C. Dislodgment D. Catheter migration A. Infection Correct This patient is presenting with fever and leukocytosis. This patient will most likely require intrathecal antibiotics and externalization of the VP shunt until the infection has cleared.
Developmental and Degenerative Disease 8. A baby is born with a myelomeningocele. The nurse knows that surgical repair will likely occur within what time frame? A. Within one year B. Within 6 weeks C. Within 4 weeks D. Within 24 hours D. Within 24 hours Correct A myelomeningocele is associated with a high risk for infection. These are most often surgically repaired within the first 24 hours of birth to limit complications.
Developmental and Degenerative Disease 9. What lab tests should be included in a workup of reversible causes of dementia? A. Hypercoaguability panel B. Vitamin B12 C. Troponin D. Vitamin D B. Vitamin B12 deficiency is associated with memory loss and is considered a reversible cause of dementia.
Developmental and Degenerative Disease 10. What type of cognitive test to a patient with symptoms of dementia? A. NIHSS B. Mini Mental State Examination (MMSE) C. GCS D. Stroke Vision, Aphasia, Neglect screening tool (Stroke VAN) B. MMSE is frequently administered to patients with symptoms of dementia. It is best performed prior to onset of symptoms in order to monitor cognitive changes over time.
Developmental and Degenerative Disease 11. Parkinson's disease is a neurological movement disorder caused by the loss of? A. Dopamine producing cells B. Myelin sheath C. Norepinephrine producing cells D. Black matter A. Dopamine producing cells Parkinson's disease is a neurotransmitter problem caused by a decrease in dopamine producing cells in the substantia nigra. The loss of dopamine leads to the movement disorder commonly seen in Parkinson's disease.
Developmental and Degenerative Disease 12. Pt's Parkinsons worsening, periods standing in a frozen condition and can't move. A. need CT scan B. need MRI to determine tx C. levodopa medication becomes less effective D. Not sleeping well at night C. "Wearing off” is when pt begins to feel the effects of the levodopa medication gradually losing effectiveness and is not lasting until the next dose of medication is due. “Off time” is when medication has lost its effectiveness and the symptoms return.
Developmental and Degenerative Disease 13. Parkinson’s disease pt, which statement shows teaching effective? A. levodopa with a high protein snack B. levodopa with a protein shake C. levodopa with crackers D. Levodopa does not interfere with food C. I will take my levodopa with crackers Correct Levodopa should not be taken along with dietary protein. Protein can decrease levodopa absorption causing the medication to lose its effectiveness.
Developmental and Degenerative Disease 14. Benign essential tremor most often affects what area of the body? A. Eye lids B. Hands C. Legs D. Feet B. Hands Correct Rationale: Benign essential tremor initially begins with the hands and then can progress to the head and voice. Although a benign condition, this tremor ranges in severity and in severe cases can make ADLs difficult to perform.
Developmental and Degenerative Disease 15. Teaching for a pt with Meniere's disease should include? A. Avoid eating foods high in sugar B. Avoid eating foods high in salt Correct C. Avoid green leafy vegetables D. Avoid high protein meals B. Avoid eating foods high in salt Correct Patients with Meniere's disease should avoid high sodium foods. Long-term management of this disease is directed at decreasing the endolymphatic volume with a low salt diet and diuretics.
Developmental and Degenerative Disease 16.What is a main complaint of a patient with benign positional vertigo? A. Lethargy B. Headaches C. Nausea D. Restlessness C. Nausea Correct Patients with benign positional vertigo often complain of nausea accompanying these episodes. Vomiting is not as common.
Developmental and Degenerative Disease 17.Central nystagmus is associated most often with what condition? A. Brainstem stroke B. Benign positional vertigo C. Meniere's Disease D. Vestibular neuritis A. Central nystagmus - structural defect most likely from a stroke or anoxic brain injury. Brain stem vertigo dizziness & imbalance, double vision, slurred speech and decreased LOC vertebral-basilar circulation - cerebellum, brain stem, or both.
Developmental and Degenerative Disease 18.A patient c/o shock-like pain to the Lside of face and seems to be associated with chewing. Most likely diagnosis? A. Vestibular neuritis B. Trigeminal neuralgia C. Meniere’s disease D. Vestibular neuritis B. Trigeminal neuralgia Correct Trigeminal neuralgia is associated with compression of cranial nerve V and presents with shock-like pain most commonly to one side of the face. Pain can last a few seconds to minutes.
Developmental and Degenerative Disease 19.A 76 yo malein ICU, during the night becomes agitated and tries repeatedly to get out of bed. Pt most likely exhibiting what type of behavior? A. Dementia B. Delirium C. Meningitis D. Creutzfeldt-Jakob B. Delirium Correct This patient is elderly, in an unfamiliar environment and is exhibiting signs of delirium. This condition is transient and reversible.
Developmental and Degenerative Disease 20. The Tinel test is helpful in assessing a patient with what type of diagnosis? A. Chronic regional pain syndrome B. Peripheral neuropathy C. Carpal Tunnel Syndrome D. Brachioplexus injury C. Carpal Tunnel Syndrome Correct The Tinel test is helpful in assessing a patient with suspected carpal tunnel syndrome . A positive sign is tingling or shock like sensation after light tapping over the median nerve in the wrist.
Degenerative Spine Disease 1. The vertebral column consists of how many vertebrae? A. 29 B. 30 C. 32 D. 33 D. 33 Correct The vertebral column consists of 33 vertebrae including seven cervical, twelve thoracic, five lumbar, five sacral, and four coccygeal.
Degenerative Spine Disease 2. The white matter located in the brain and spinal cord is: A. Myelinated nerve fibers B. Unmyelinated nerve fibers C. Unmyelinated cell bodies D. Myelinated cell bodies A. Myelinated nerve fibers Correct White matter of the brain and spinal cord contains myelinated nerve fibers. The myelin is what gives the matter a whitish appearance and increases the speed that nerve signals are transmitted.
Degenerative Spine Disease 3. What is the surgical option available for treatment of trigeminal neuralgia? A. Laminectomy B. Microvascular decompression or rhizotomy C. Posterolateral lumbar fusion D. Posterior lateral interbody fusion Microvascular decompression or Rhizotomy Correct MVD is the treatment of choice for tolerant younger patients and should be recommended for patients who desire no sensory deficit. radio frequency rhizotomy for patients in whom MVD failed.
Degenerative Spine Disease 4. Pt dx Creutzfeldt-Jakob, good q: A. Can you recommend a good rehab center? B. I would like more info on advanced directives. C. At least we have many more years left together. D. I am so glad this is not Alzheimer’s B. I would like more information on advanced directives. Correct No cure for Creutzfeldt-Jakob. Discussing of the pt wishes and preparing an advanced directive shows understanding of rapid progression. Complete dementia can occur in as little as 6 mo
Degenerative Spine Disease 5. What medication is given to a patient with hepatic encephalopathy to lower ammonia levels? A. Sucrulose B. Lactulose C. Reglan D. Magnesium citrate B. Lactulose Correct Lactulose is a medication that binds with ammonia and allows for the excretion of this substance in the stool.
Degenerative Spine Disease 6. Wernicke’s encephalopathy is caused by lack of what vitamin? A. Vitamin C B. Vitamin A C. Vitamin B 1 D. Vitamin B 12 C. Vitamin B 1 Correct Wernicke’s encephalopathy is a toxic encephalopathy caused by a lack of thiamine (Vit B1). This condition is most common in alcoholics or those who are extremely malnourished.
Degenerative Spine Disease 7. Follow up 2 wk after vertebral column fracture A. Ibuprofen good pain reliever B. Ibuprofen promotes fracture healing C. Ibuprofen anti-inflammatory agent and should be avoided D. recommend Naproxen sodium (aleve) C. Ibuprofen is an anti-inflammatory agent and should be avoided Correct Ibuprofen is a (NSAID) and should be minimized or avoided during the first 3 months following a compression fracture to promote bone healing.
Degenerative Spine Disease 8. A 48 year-old female complains of sporadic, electric like shock feeling to the right side of her cheek and forehead. You know this is most commonly associated with impingement of Cranial Nerve: A. V B. VI C. VII D. VIII A. V Correct These sensations are commonly associated with trigeminal neuralgia which can result from impingement of cranial nerve V.
Degenerative Spine Disease 9. 72 yo pt L basal ganglia hemorrhagic stroke 5 days ago. Today febrile , lethargic, worsening weakness. A. Extension of hemorrhage B. Toxic metabolic encephalopathy C. Wernicke’s encephalopathy D. Acute ischemic stroke B. Toxic metabolic encephalopathy Correct Pt’s worsening neuro exam is most likely attributed to a toxic metabolic encephalopathy d/t infection. not common to have extension of stroke at day 7, nor a new stroke causing worsening of the same weakness.
Degenerative Spine Disease 10. 68 year-old who is malnourished and admitted for alcohol withdrawal. Immediately look at med list for what medication? A. Cobalamin (Vitamin B12) B. Versed (Midazolam) C. Thiamine (Vitamin B1) D. Folate (folic acid) C. Thiamine (Vitamin B1) Correct Patients admitted with alcohol withdrawal should be given thiamine replacement to reduce the risk of wernicke’s encephalopathy.
Tumors and Headaches 1. Pt w/ acoustic neuroma, dying? A. W chemo chance of survival very good B. Benign, slow growing tumor can be surgically removed C. Tumor most responsive to radiation therapy D.No cure but remission can be as long as five years B. benign, slow growing tumor, can be surgically removed Correct Acoustic neuroma (vestibular schwannoma) is a benign, slow growing tumor that commonly causes unilateral hearing loss and balance problems, no Radiation and/or chemo
Tumors and Headaches 2. A patient is diagnosed with a Glioblastoma multiforme (GBM). A. Rapidly growing, no cure B. High remission rate with proper treatment regimen C. Very rare primary brain tumor D. Most common pediatric brain tumor A. Rapidly growing, no cure Correct A GBM most common primary brain tumor in adults. Aggressive tumor, rapidly growing, highly proliferative. No cure although tx options to prolong life. Tumor causes a mass effect & pts become symptomatic very quickly
Tumors and Headaches 3. After transsphenoidal hypophysectomy for pituitary tumor large UO. DI? A. Hyper Na+ low u osmo & low SG B. Hypo Na+, low u osmo & high SG C. Hyper Na+, low serum osmo& low serum creat D. Hypo Na+, high serum osmo & high creat A. DI is a post-op complication following a transsphenoidal hypophysectomy. decreased ADH from the pituitary gland. Large UO can lead to dehydration as seen by a hypernatremic state. In DI the urinediluted low urine osmo & low urine specific gravity.
Tumors and Headaches 4. Pt w/ ependymoma slightly lethargic & “a little off.” What should the nurse suspect is MOST likely causing s/s? A. Cerebral edema B. Enlargement of the tumor C. Side effects of the chemotherapy D. Hydrocephalus D. Hydrocephalus Correct Ependymomas arise from ependymal cells lining the ventricles and spinal cord. d/t location, hydrocephalus may result d/t obstruction of CSF. VP shunt may be necessary to divert the CSF. Ependymomas may be surgically resected.
Tumors and Headaches 5. Pt c/o periodic attacks of sharp, severe, unilateral head pain that is most felt in the orbital region. Sometimes the eyelid droops and the eye tears. Type of headache? A. Tension B. Cluster C. Migraine D. Sinus Incorrect B. Cluster Correct This patient is describing the typical symptoms associated with a cluster headache, which include periodic attacks of sharp, severe, unilateral head pain along with eye tearing and eyelid drooping.
Tumors and Headaches 6.Patient teaching avoiding certain foods that trigger migraines. The patient names four of his favorite foods. Which one should the nurse recommend he avoid? A. Bread B. Green, leafy vegetables C. Bacon D. Bananas C. Bacon Correct Many foods can trigger migraines. Meats containing nitrates such as bacon and hot dogs should be avoided. Green, leafy vegetables should be avoided in patients taking Coumadin (warfarin) but do not typically trigger migraines.
Tumors and Headaches 7. A patient is recently diagnosed with a metastatic brain tumor. What is the most common primary site? A. Lungs B. Kidney C. Heart D. Breast A. Lungs Correct The most common primary site for tumors are the lungs.
Tumors and Headaches 8. The CNRN is educating a patient on their recent meningioma diagnosis. The nurse knows that which of the following is considered a malignant tumor? A. Meningioma B. Schwannoma C. Adenoma D. Astrocytoma D. Astrocytoma Correct An astrocytoma is named after astrocytes, resembling star shaped cells from which they grow and are staged according to their degree of abnormality. This is most commonly considered a malignant tumor.
Tumors and Headaches 9. What is the most common site for a pediatric brain tumor? A. Cerebellum B. Frontal lobe C. Temporal lobe D. Occipital lobe A. Cerebellum Correct Pediatric brain tumors are most commonly found in the posterior fossa and presenting symptoms are associated with the tumor location.
Tumors and Headaches 10. Pt c/o of progressive unilateral hearing loss and posterior headache. What may this patient be presenting with? A. Stroke B. Cerebellopontine Angle (CPA) Tumor C. Trigeminal neuralgia D. Astrocytoma B. Cerebellopontine Angle (CPA) Tumor Correct Unilateral hearing loss is a common presentation of a CPA tumor. This patient is most likely presenting with an acoustic neuroma.
Created by: cskrivanek
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