CNRN Practice 2023 Questions and Answers (ALL Correct)

Which of the following tumor types will have a higher incidence in pediatric populations and have a decreased incidence with age? A. Glioblastoma B. Pilocytic astrocytoma C. Central nervous system lymphoma D. Metastatic brain tumor - ANSWER B Rationale: Both pilocytic astrocytoma and medulloblastoma brain tumors are more commonly found in the younger population. The incidence of these tumors will decrease with age. Glioblastomas are more frequently found in young adults. CNS lymphoma and metastasis will have an increased incidence with age. A patient presents with progressive neurological deficits and has a recent history of transient neurological attack. This patient is most likely experiencing which of the following types of stroke? A. Thrombotic stroke B. Embolic stroke C. Subarachnoid hemorrhage D. Vasospasms - ANSWER A Rationale: Thrombotic strokes frequently present as a worsening neurological status over a short period of time. Patients may have experienced episodes of transient ischemic attacks (TIAs) before the onset of the ischemic strokes. Embolic strokes tend to have a more sudden onset without progression in symptoms. Subarachnoid hemorrhages (SAHs) are a sudden onset of headache without the history of transient neurological deficits. Vasospasms are associated with SAH, and symptoms occur most commonly between 7 and 10 days after the SAH. Which of the following best describes a coup injury? A. Injury occurs at the point of impact. B. Injury occurs on the contralateral side of impact. C. It is an acceleration injury. D. It is a deceleration injury. - ANSWER A Rationale: A coup injury occurs at the point of impact, and a contracoup injury occurs on the contralateral side. The mechanism of injury for acceleration injuries is commonly defined as a moving object hitting a stationary head, whereas a deceleration injury involves a moving head hitting a stationary object. A patient is admitted to the ICU with persistent epileptic seizures lasting beyond 90 minutes. Which of the following best describes the seizure activity? A. Epileptic seizure B. Epilepsy C. Refractory seizure D. Nonepileptic seizure - ANSWER C Rationale: An epileptic seizure, which persists for greater than 90 minutes despite administration of anticonvulsants is called a refractory seizure. An epileptic seizure indicates the presence of EEG wave changes during the seizure activity. Epilepsy refers to repetitive seizures without a reversible cause such as hyponatremia. Nonepileptic seizure is the presence of seizure activity without the EEG changes. Which of the following would be the best technique to use to assess for cerebrospinal fluid in bloody drainage from the nose following a traumatic brain injury? A. Glucose test B. Halo test C. Send to lab for hemoglobin level D. Litmus test - ANSWER B Rationale: Halo test (a positive result produces a yellow ring) is more accurate than a glucose test, especially with the presence of bloody drainage. A glucose test has been used to distinguish between sinus drainage and cerebrospinal fluid (CSF) because CSF has glucose but sinus drainage does not. But in this scenario, the drainage was "bloody," and blood has glucose. Bloody drainage may give a false positive with a glucose test. Testing for hemoglobin in the drainage does not determine the presence of CSF. Litmus test is used to test a pH of a fluid and is not used to distinguish CSF from nasal drainage. Which of the following is the most common cause of an embolic stroke? A. Atrial septal defect B. Atrial fibrillation C. Calcified lesion D. Angioplasty - ANSWER B Rationale: Atrial fibrillation (AF) is the most common cause of an embolic stroke. Atrial septic defect (ASD) and calcified lesions can also result in embolic strokes but are significantly less common than AF. A complication of angioplasty can be distal embolization but again is not the most common cause of an embolic stroke. Cranial nerve (CN) VII (facial nerve) is commonly involved with Bell's palsy. Where does this CN originate? A. Pons B. Medulla C. Midbrain D. Basal ganglia - ANSWER A Rationale: Cranial nerve (CN) V (trigeminal nerve), VI (abducens nerve), VII (facial nerve), and VIII (acoustic nerve) originate from the pons. CNs IX (hypoglossal nerve), X (vagus), XI (spinal accessory nerve), and XII (hypoglossal nerve) originate from medulla. CNs III (oculomotor nerve) and IV (glossopharyngeal nerve) originate from the midbrain. No cranial nerves originate from the basal ganglia. Which of the following electrolyte abnormalities is LESS likely to result in a seizure? A. Hyponatremia B. Hyperkalemia C. Hypocalcemia D. Hypomagnesemia - ANSWER B Rationale: Hyponatremia is one of the most common electrolyte abnormalities that can cause a seizure. Hypocalcemia and hypomagnesemia can also cause seizures. Potassium is more likely to affect the myocardial electrical system, resulting in arrhythmias. A patient in the ICU following a severe traumatic brain injury suddenly demonstrates profuse sweating, sustained tachycardia, hypertension, and fever. Which of the following is the most likely cause? A. Neurogenic fever B. Diencephalic seizure C. Paroxysmal sympathetic hyperactivity D. Cerebral salt wasting syndrome - ANSWER C Rationale: Traumatic brain injury (TBI) patients can experience "sympathetic storms" called paroxysmal sympathetic hyperactivity. The symptoms include fever, tachycardia, hypertension, profuse sweating, agitation, and increase respiratory rate. The "storm" is thought to be due to intermittent stimulation of the sympathoexcitatory centers located in upper brainstem and diencephalon. Diencephalic seizure is an incorrect term for the symptoms because the EEG is negative. Neurogenic fevers can occur following TBI but is not associated with the other symptoms of hypertension and tachycardia. Cerebral salt wasting syndrome (CSWS) is the loss of sodium through the kidneys and results in hypovolemic hyponatremia. In severe cases of cerebral palsy, there may be a delay in growth and development. Which of the following conditions can occur in these cases? A. Coagulopathy B. Immunocompromise C. Failure to thrive D. Locked-in syndrome - ANSWER C Rationale: Failure to thrive is a complication of moderate to severe cerebral palsy (CP). It can result in malnutrition and death. CP is not associated with immunocompromise or coagulopathies. CP involves abnormal motor movements associated with spasticity or flaccidity, but does not develop locked-in syndrome. Which of the following best describes the penumbra in an ischemic stroke? A. Irreversibly damaged tissue B. Normal healthy tissue C. Presence of vasogenic cerebral edema D. Reversible ischemic tissue - ANSWER D Rationale: The penumbra is the area surrounding an infarction that is ischemic or reversible ischemic tissue. Irreversibly damaged tissue is the area of tissue infarction and is the core of the infarction. Vasogenic cerebral edema is an increase in interstitial edema or fluid and is typically found surrounding the penumbra. Normal, healthy tissue is the area of brain tissue not affected by the ischemia or injury. A patient is admitted to the trauma ICU following a traumatic brain injury due to vehicle rollover. The patient is hypotensive and tachycardic. Which of the following is the most accurate statement? A. Hypotension following traumatic brain injury (TBI) indicates presence of epidural hematoma. B. Hypotension is sign of blood loss but is not considered a sign of TBI. C. Scalp lacerations can be easily controlled with direct compression. D. Neurogenic shock following TBI results in hypotension. - ANSWER B Rationale: Traumatic brain injury (TBI) patients can experience additional systemic injuries. Hypotension indicates hypovolemia from blood loss in trauma patients, but cerebral injury, even epidural hematoma, cannot account for the volume of blood loss. Scalp lacerations bleed profusely and may require sutures or staples to stop the bleeding. Neurogenic shock is associated with spinal cord injuries. Symptoms include hypotension and bradycardia (not tachycardia). Which of the following has been found to be the most effective in preventing embolic strokes due to atrial fibrillation? A. Aspirin B. Low-molecular-weight heparin C. Warfarin (Coumadin) D. Clopidogrel (Plavix) - ANSWER C Rationale: Studies have shown warfarin is the best at preventing an embolic stroke but is associated with a greater risk of bleeding. Aspirin is also used in primary prevention of embolic strokes but has less efficacy in preventing embolic strokes. Aspirin has a lower risk of bleeding than anticoagulation therapy. Low-molecular-weight heparin (LMWH) and Plavix are not currently recommended in preventing embolic strokes. Which of the following scales are used to determine the overall prognosis in patients with a brain tumor? A. PedsQL B. Functional Independence Measure C. CHADS2 score D. Karnofsky Performance Status Scale - ANSWER D Rationale: Karnofsky Performance Status Scale (KPS) is used to determine overall prognosis in patients with a brain tumor. It is used along with histopathology of the tumor, completeness of resection, presence of necrosis, and tumor size and location. CHADS2 score is used to determine the stroke risk of atrial fibrillation. Functional Independence Measure (FIM) is used to evaluate stroke patients in rehabilitation. PedsQL is a tool used to assess quality of life in pediatric patients with brain tumors but is not used for overall prognosis. Which of the following best describes a radiculopathy? A. Compression of the cord with central stenosis B. Inflammation of bone and cartilage of joint C. Compression of nerve roots with foraminal stenosis D. Symptomatic degenerative changes of osteoarthritis - ANSWER C Rationale: Radiculopathy is compression of nerve roots due to the narrowing of foraminal processes. Osteoarthritis is the inflammation of bone and cartilage of the spinal joints. Myelopathy is compression of the spinal cord due to central stenosis. Spondylosis is the symptomatic degenerative change that occurs in osteoarthritis. Your patient presents with left upper extremity weakness and facial droop. Which of the following vessels is most likely involved in this stroke? A. Anterior cerebral artery B. Middle cerebral artery C. Posterior cerebral artery D. Basilar artery - ANSWER B Rationale: The middle cerebral artery (MCA) supplies blood to the lateral portion of the cerebral cortex, which is where the motor strip for the upper extremities and face is located. The anterior cerebral artery (ACA) supplies blood to the medial portion of the cerebral cortex, which is where the motor strip for the lower extremities is located (results in lower-extremity weakness). The posterior cerebral artery (PCA) supplies blood to the occipital lobe, which results in visual deficits. The basilar artery is in the posterior circulation (brainstem) and may present with quadriplegia or "locked-in" syndrome. Your patient has sustained a traumatic brain injury and a basilar skull fracture. The physician has ordered a nasogastric tube (NG) be placed. Which of the following is your best response? A. Place the NG according to the physician's order. B. Discuss with the physician the need to place an enteral feeding tube. C. Insert the gastric tube orally. D. Ask the physician to place the NG. - ANSWER C Rationale: Never place a gastric tube nasally in a patient with a basilar skull fracture. The nasogastric (NG) tube may go through the cribriform fracture and enter the brain. A gastric tube can be placed orally, just not nasally. An enteral feeding tube may not be indicated at this time. Having the physician place the NG tube is not appropriate because the tube should not be placed nasally. During a stroke assessment, the patient has been found to have a deviated gaze. Which of the following would be the most correct statement regarding the gaze? A. Dysconjugate gaze B. Upward gaze C. Gaze toward the affected side D. Gaze away from affected side - ANSWER C Rationale: The gaze abnormality in a middle cerebral artery (MCA) stroke is deviated toward the affected side. Seizures result in gaze away from the affected side. A dysconjugate or upward gaze is frequently associated with cranial nerve abnormalities but not commonly associated with strokes. What type of seizure is an aura classified as?