CNRN Practice Samples Exam 235 Questions with Verified Answers,100% CORRECT

CNRN Practice Samples Exam 235 Questions with Verified Answers 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 - CORRECT 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 - CORRECT 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. - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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. - CORRECT 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) - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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. - CORRECT 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 - CORRECT 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? A. Simple partial B. Complex partial C. Generalized D. Nonconvulsive - CORRECT ANSWER A Rationale: An aura is a simple partial seizure typically involving somatosensory symptoms such as hallucinations. People are aware of the aura prior to having a generalized seizure. Complex partial seizures result in a loss of awareness and are frequently manifested as motor or automatism behavior. Generalized seizures occur across both hemispheres at once and are most frequently tonic-clonic. Nonconvulsive seizure patients have epileptic EEGs, but no physical signs of a seizure. Your patient presents with the diagnosis of Guillain-Barré syndrome. Which of the following is the priority of care for this patient? A. Assessment of vital capacity B. Reassurance of the patient C. Preparing for electromyography testing D. Obtaining CT scan of the spine - CORRECT ANSWER A Rationale: Airway and breathing are the priorities of care. The ascending loss of muscle contraction can include the diaphragm and respiratory muscles. Vital capacity is commonly used to assess the effectiveness of ventilation in neuromuscular disorders. Electromyogram (EMG) testing may be ordered; the patient should be reassured, but the priority of care is airway and breathing. A CT of the spine may be ordered to rule out cord compression, but is not a priority over assessment of ventilatory capability. A patient sustained cervical fractures at the C4 and C5 level from a motor vehicle collision. In the ED, initially he was moving all extremities equally. He suddenly became hemiplegic on the left side. Which of the following is the most likely cause for this neurological change? A. Carotid artery dissection B. Spinal cord injury C. Spinal epidural hematoma D. Cerebral edema - CORRECT ANSWER A Rationale: Carotid artery dissections are associated with traumatic injuries at the cervical level. The flexion/extension mechanism of injury that causes vertebral fractures and spinal cord injuries can also cause carotid and vertebral dissections. Carotid dissections can cause cerebral infarctions with symptoms of contralateral motor loss of upper and lower extremities. Spinal cord injury and epidural hematoma would result in paralysis bilateral. There is no justification within the scenario to suspect cerebral edema as the cause of the symptoms. Which of the following therapeutic interventions is frequently recommended to manage a cerebrospinal fluid (CSF) leak? A. Drain CSF with a lumbar drain. B. Administer mannitol. C. Limit fluid intake. D. Maintain head-of-the-bed elevation greater than 30 degrees. - CORRECT ANSWER A Rationale: Cerebrospinal fluid (CSF) leak is frequently managed by placing a lumbar drain to remove CSF. This lowers the CSF pressure and decreases the drainage. Mannitol is used to manage cerebral edema and increased intracranial pressure (ICP). Limiting fluid intake does not affect the CSF leak and is not recommended; head of the bed (HOB) is maintained flat, not elevated, to decrease the CSF leak. The mother of a 6-year-old girl just diagnosed with pilocytic astrocytoma asks the nurse what her child's prognosis is. Which of the following would be the best response by the nurse? A. This type of tumor has a good prognosis and can usually be managed with surgery. B. The tumor is malignant and frequently metastasizes to the spine. C. This tumor is associated with poor prognosis. I would encourage you to speak with a palliative care physician. D. The prognosis is not well known. She will probably require long-term chemotherapy. - CORRECT ANSWER A Rationale: The prognosis of pilocytic astrocytoma is good, with over a 90% survival rate in 10 years. It is commonly located in the cerebellum and can be surgically resected. It may not require follow-up radiotherapy if resection is complete. The tumor is not typically malignant. Which of the following cerebral arteries is most likely involved in the presentation of "locked-in" syndrome during a stroke? A. Anterior cerebral artery B. Posterior communicating artery C. Internal carotid artery D. Basilar artery - CORRECT ANSWER D Rationale: The basilar artery provides blood to the ventral portion of the pons. The basilar artery is involved in the stroke, resulting in locked-in syndrome. The internal carotid artery typically presents with unilateral paresis or paralysis. The posterior communicating artery or anterior cerebral artery does not present with quadriplegia. Following a minor brain injury (concussion), the patient may experience which of the following symptoms over the next 6 months? A. Periods of aphasia B. Swallowing deficits C. Difficulty concentrating D. Ataxia - CORRECT ANSWER C Rationale: Following a minor brain injury (concussion), patients may experience postconcussion syndrome. This is self-limiting, with neurological deficits that may last 6 months to a year after injury. Symptoms of postconcussion syndrome include (but not limited to) memory deficits, emotional outbursts, and difficulty concentrating. Periods of aphasia would be more likely transient ischemia attack. Swallowing deficit and ataxia are not associated with postconcussion syndrome and may indicate another neurological issue. A patient presents with signs of occipital headache and abnormal motor strength. The MRI found herniation of the cerebellar tonsils, vermis, and fourth ventricle. How would this Chiari malformation be classified? A. Type I B. Type II C. Type III D. Type IV - CORRECT ANSWER B Rationale: A type II Chiari malformation is the downward displacement of cerebellar tonsils and inferior vermis, fourth ventricle, choroid plexus, and medulla. The patient presents in the ED with expressive aphasia and paralysis of the right arm and leg. He has a decreased level of consciousness and rapid respiration. Which of the following is your priority of care? A. Obtain a STAT CT scan. B. Administer alteplase immediately. C. Perform a baseline National Institutes of Health Stroke Scale (NIHSS). D. Secure an airway and ensure ventilation. - CORRECT ANSWER D Rationale: Priority of care is always airway and breathing. Patients presenting with a decreased level of consciousness (LOC) may be unable to maintain an airway, requiring the airway to be secured. The patient will need a CT scan and a National Institutes of Health Stroke Scale (NIHSS) assessment and may be a candidate for thrombolytic therapy, but airway and breathing are the priorities of care. A patient presents with low-back pain. Upon review of the spinal radiographs, multiple levels of osteophytes are noted. Which of the following best describes an osteophyte? A. Inflammation of synovial joints B. Degeneration of vertebral body with increased bone formation C. Stenosis of the nerve root as exits lateral foramen D. Compression of lumbar disc - CORRECT ANSWER B Rationale: The degeneration of the vertebral body includes increased bone formation of the subchondral bone adjacent to endplate and is called sclerosis. It is less able to absorb loads and causes formation of osteophytes, bony projections also known as spurs. These may compress on neurological structures and cause symptoms. Synovitis is inflammation of synovial joints. Foraminal stenosis causes the compression of exiting nerve roots. Lumbar disc compression can cause symptoms but is not an osteophyte. Anticholinesterase agents are used to improve myasthenia gravis muscle function through which of the following actions? A. Increase secretion of acetylcholine. B. Prevent breakdown of acetylcholine. C. Increase sensitization postsynaptic receptors. D. Increase number of postsynaptic muscle receptors. - CORRECT ANSWER B Rationale: Anticholinesterase agents prevent the breakdown of acetylcholine by acetylcholinesterase. The effect of the anticholinesterase agents is to prolong the effect of the neurotransmitter acetylcholine. The agents do not increase secretion of the neurotransmitter acetylcholine or sensitize the receptors of acetylcholine. The postsynaptic muscle receptors are destroyed and cannot be regenerated. Which of the following diagnostic studies is considered the most reliable to identify spinal cord and soft-tissue injuries? A. Lateral cervical spine radiographs B. CT scan C. MRI D. Flexion/extension radiographs - CORRECT ANSWER C Rationale: The benefits of MRI in evaluating acute spinal cord injury (SCI) are its ability to identify cord compression, soft-tissue injuries such as herniated disc and epidural hematoma, ligament instability, and intramedullary hematomas. Lateral C-spine radiographic studies can identify vertebral fractures and can assess for misalignment of the cervical spine but cannot identify cord or soft-tissue injuries. CT scans are not considered as beneficial as MRI in identifying injury to the spinal cord, soft tissue, or ligaments. Flexion/extension radiographs are used in certain patients to identify misalignment of the spine (ligament injury) but are not able to identify actual injury to the cord, soft tissues, or ligaments. A patient reports he or she experiences irritability and mood changes days prior to a seizure. What is this period called? A. Preictal B. Aura C. Intraictal D. Postictal - CORRECT ANSWER A Rationale: The preictal state is the "warning" sign of an impending seizure that may occur days prior to the seizure. This may include feelings of general irritability or depression, mood changes, anxiety, headaches, lethargy, change in appetite, and light-headedness. An aura is the actual start of the seizure. Intraictal is the period of time during the seizure. Postictal is after the seizure. Which of the following secondary injuries would be the most important determinants of outcomes in patients following traumatic brain injuries? A. Hyponatremia and tachycardia B. Hypoxia and hypotension C. Hyperglycemia and hypothermia D. Hyperthermia and metabolic acidosis - CORRECT ANSWER B Rationale: Current research has found the two most important determinants of outcome following a traumatic brain injury are hypoxia and hypotension. They both are considered secondary injuries and determine cerebral perfusion. Hyperglycemia, hyperthermia, hyponatremia, and metabolic acidosis are secondary injuries and can affect outcomes but are not as severe as secondary injuries affecting cerebral perfusion. Which of the following would be a contraindication for administering a thrombolytic? A. Patient's home medications include Eliquis B. National Institutes of Health Stroke Scale score of 10 C. Patient on a daily aspirin D. Negative CT scan - CORRECT ANSWER A Rationale: Eliquis is classified as a novel anticoagulant. A National Institutes of Health Stroke Scale (NIHSS) score of 10 is not a contraindication for alteplase. Depending upon other criteria, it would be an indication. Antiplatelet agents, such as aspirin, are not a contraindication to alteplase in acute stroke. An acute ischemic stroke will have a negative CT scan initially. Your patient has a sudden loss of consciousness. An emergency CT is obtained and an intracerebral hemorrhage (ICH) is seen. Which of the following would be the LEAST common cause of an ICH? A. Anticoagulation therapy B. Hypertensive crisis C. Aneurysm rupture D. Vascular tumor - CORRECT ANSWER C Rationale: Aneurysm rupture results in subarachnoid hemorrhages (SAH) and intraventricular hemorrhage (IVH), not primarily intracerebral bleeds. Anticoagulated patients, hypertensive crisis, and vascular tumors will typically cause bleeding into the parenchyma and are called intracerebral hemorrhage (ICH). Which of the following statements is a true regarding cerebral palsy (CP)? A. CP is not preventable. B. CP is a disease found in children but can be cured. C. Most children with CP will die by the age of 10 years. D. CP has no cure. - CORRECT ANSWER D Rationale: There is no cure for cerebral palsy (CP). It is preventable in some cases such as those due to maternal infections (vaccinations) or Rh incompatibility (use of Rhogam). CP can be at birth or acquired at a very young age. CP may shorten life expectancy, but many children with CP live into adult ages. Plasmapheresis is treatment commonly used in managing Guillain-Barré. It involves the: A. Complete exchange of red blood cells B. Removal of antibodies with plasma exchange C. Washing of the white blood cells to clear allergens D. Filtering of the immunoglobulins - CORRECT ANSWER B Rationale: Guillain-Barré is an autoimmune disorder. Plasmapheresis involves the exchange of serum plasma to remove the antibodies. Plasmapheresis does not exchange red blood cells, wash white blood cells, or filter immunoglobulins. Which of the following best describes Moyamoya disease? A. Small, multiple aneurysms in the microcirculation B. Arteriovenous malformations C. Hyperlipidemia deposits of fat in the cerebral vessel wall D. Progressive occlusion of the intracranial internal carotid artery with collateral flow - CORRECT ANSWER D Rationale: Moyamoya disease is the progressive narrowing or occlusion of the internal carotid artery with the development of collateral circulation called Moyamoya vessels. Presence of multiple, small aneurysms in the microcirculation is called Charcot-Bouchard. Hyperlipidemia results in the formation of plaque and the narrowing of the vessel but is not called Moyamoya vessels. Arteriovenous malformations (AVMs) are congenital vascular anomalies in which the arteries feed directly into draining veins. When clearing a cervical spine injury in the acute period following a traumatic event, which of the following is NOT required? A. Maintain cervical immobilization until cleared of ligament injury B. Flexion/extension evaluation in an awake, asymptomatic patient C. Visualization of C1 through T1 on lateral cervical radiographs D. MRI of cervical spine - CORRECT ANSWER D Rationale: MRI of cervical spine can be used to clear a cervical spine injury (C-spine) in certain circumstances but is not required. Maintaining cervical immobilization until ligament injuries can be cleared is required to prevent subluxation and cord compression if an injury is present. Awake, asymptomatic patients require evaluation (radiographs or physical assessment) of flexion and extension capability to determine if potential ligament injury since plain radiographs cannot identify ligament unless some degree of subluxation is noted. Lateral C-spines require visualization of C1-C7 and the tip of T1 to clear the C-spine of bony fractures. Which of the following is a known risk factor for a brain tumor? A. Use of cellular phones B. Exposure to ionized radiation C. Consumption of fish with high mercury levels D. Use of microwaves - CORRECT ANSWER B Rationale: Overall, causes of brain tumors are unknown. Exposure to ionized radiation is a known risk factor, which can be modified. Cell phones produce a very low magnetic radiation and have not been found to increase the risk of brain tumor. Environmental risks such as ingestion of high mercury and food cooked in microwave have not been found to increase risk of brain tumors. Lobar intracerebral hemorrhage frequently presents with which neurological symptom? A. Cranial nerve deficits B. Decreased level of consciousness C. Pinpoint pupils D. Horner's syndrome - CORRECT ANSWER B Rationale: A decrease in level of consciousness is frequently associated with lobar intracerebral hemorrhage. A bleed within the brainstem frequently presents with cranial nerve deficits, pinpoint pupils, and Horner's syndrome. Patients with Mèniére's disease often complain of feelings of aural fullness accompanied by which of the following other symptoms? A. Worst headache of their lives B. Urinary incontinence C. Roaring sound in ears D. Frequent ear infections - CORRECT ANSWER C Rationale: A common complaint by patients is a "roaring" sound in their ears as well as aural fullness. Urinary incontinence is associated with normal-pressure hydrocephalus (NPH). Subarachnoid hemorrhage (SAH) presents with the "worst headache of their life." M`eniére's disease is not associated with frequent ear infections but can have hearing losses. A patient is experiencing a tonic-clonic seizure on the floor next to the bed. To prevent injury during the seizure, which of the following is the most appropriate intervention by the nurse? A. Move the bed and any other objects away from the patient to prevent injury. B. Just monitor the patient and do not attempt to make any interventions during the seizure. C. Move the patient away from the bed and to the middle of the floor. D. Restrain the patient to prevent injury. - CORRECT ANSWER A Rationale: The goal to prevent injury of the patient is to move objects that can potentially injure the patient away from the patient. Restraining or attempting to move the patient can cause injury to the patient. Just monitoring without attempting to protect the patient is incorrect and can cause great injury to the patient. Which of the following is NOT considered a cholinergic side effect of anticholinesterase medications used in managing myasthenia gravis? A. Diarrhea B. Nausea and vomiting C. Increased salivation D. Urinary retention - CORRECT ANSWER D Rationale: Cholinergic side effects of anticholinesterase medications include diarrhea, increased salivation, and nausea and vomiting. Urinary retention is not considered a side effect of anticholinesterase agents. Intracellular swelling in the brain occurred following an anoxic brain injury. What is this called? A. "Steal" phenomenon B. Neurogenic cerebral edema C. Vasogenic cerebral edema D. Cytotoxic cerebral edema - CORRECT ANSWER D Rationale: Cerebral edema is classified as vasogenic and cytotoxic. Cytotoxic cerebral edema involves intracellular swelling and is caused by hypoxic and/or anoxic brain injuries. Vasogenic cerebral edema is interstitial swelling and is usually caused direct trauma or injury to the brain tissue. The "steal" phenomenon involves inappropriate distribution of blood flow to areas of injury following traumatic brain injury. Neurogenic cerebral edema is not a classification of brain swelling. Which of the following frequently presents with nausea, vomiting, and ataxia? A. Cerebellar hemorrhage B. Thalamic hemorrhage C. Pituitary hemorrhage D. Frontal lobe hemorrhage - CORRECT ANSWER A Rationale: Cerebellar hemorrhage frequently presents with nausea, vomiting, and ataxia. Thalamic hemorrhage presents with loss motor and/or sensory. Headache and sudden loss of consciousness is sign of lobar (frontal lobe) hemorrhage. Pituitary hemorrhage causes sudden onset of headache and visual field deficits. Which of the following radiographs is best used to identify spinal segmental instability in an awake, nontraumatic patient? A. Cervical CT scan B. Diffusion-weighted imagery C. Myelogram D. Flexion extension x-rays - CORRECT ANSWER D Rationale: Cervical flexion extension radiographs are used to evaluate vertebral segmental stability. Diffusion weighted imagery is used to identify brain hypoperfusion in stroke patients. Myelogram is utilized to view central and lateral recesses and can visualize compression of individual nerve roots. Which of the following is a TRUE statement about rehabilitation with spinal cord-injured (SCI) patients? A. Rehabilitation begins after the patient is stabilized in the acute period. B. The goal of rehabilitation in SCI patients is to return the patient to his or her prior level of functioning. C. Preventing secondary injuries in SCI patients is a component of rehabilitation. D. It provides long-term assistance to patients with SCI. - CORRECT ANSWER C Rationale: Rehabilitation begins on admission into an acute care facility. A major component of rehabilitation is the prevention of secondary injuries that can adversely affect outcome. A goal of rehabilitation is to improve the patient's independence in activities of daily living, but it is not realistic to have the goal of returning to their prior level of function in spinal cord-injured (SCI) patients. Rehabilitation is to assist with reintegration of the patient into society with good resources, but it is not to provide long-term care and assistance to the patient. The cardinal feature of Guillain-Barré includes which of the following? A. Unilateral ascending paralysis B. Descending bilateral paresthesia C. Bilateral ascending paralysis D. Bilateral spasticity in upper extremities - CORRECT ANSWER C Rationale: The primary characteristic of paralysis in Guillain-Barré (GB) is bilateral, ascending paralysis. It may or may not involve ventilatory muscles and requirement for mechanical ventilation. It is bilateral, not unilateral, paralysis. GB presents in an ascending manner, not in a descending manner. Which of the following has been associated with a genetic increase in risk of brain tumor? A. Down syndrome B. Autoimmune disorders C. Glioblastoma gene D. Neurofibromatosis - CORRECT ANSWER D Rationale: Genetic syndromes, such as neurofibromatosis types I and II, have been associated with brain tumor risk in families. Glioblastoma has a less than 1% with a genetic predisposition. Allergies and immune disorders may protect against brain tumors. Down syndrome has a very low association with brain tumors. Which of the following is the priority of care of a patient following a seizure? A. Reorient the patient to place and time. B. Determine whether the patient has a recollection of the seizure. C. Maintain the patient's airway and breathing. D. Assess for the presence of Todd's paralysis. - CORRECT ANSWER C Rationale: Airway and breathing are always the priorities. Following a seizure, patients may have altered mentation and are unable to maintain airway. All of the other answers are interventions following a seizure, but the priority is airway. When assessing a patient with meningitis, you passively flex the patient's neck and his or her knees automatically flex upward. What is this called? A. Brudzinski's sign B. Romberg sign C. Kernig's sign D. Kehr's sign - CORRECT ANSWER A Rationale: Brudzinski's and Kernig's signs are both signs of meningeal irritation and can be present in patients with meningitis. The Brudzinski's sign is seen when the flexion of the neck causes knees to passively flex. The Kernig's sign is pain or hamstring spasm upon straightening the bent leg. Romberg's sign is found in patients with vertigo. Kehr's sign is found in splenic injuries. A patient presents to your unit with the diagnosis of an intracerebral hemorrhage. Which of the following blood pressure (BP) parameters orders would be expected? A. Keep systolic BP >220 mmHg. B. Maintain systolic BP <100 mmHg. C. Maintain systolic BP between 130 and 150 mmHg. D. Treat BP only if patient rebleeds. - CORRECT ANSWER C Rationale: The goal in a hemorrhagic stroke is to keep the systolic blood pressure (SBP) low to prevent a rebleed but high enough for perfusion of the brain tissue. Frequently, the BP will be ordered as a range such as between 130 and 150 mmHg. An SBP > 220 mmHg will increase incidence of rebleeding. Less than 100 mmHg will increase ischemic injury. The BP should be managed to prevent complications such as rebleeds, not to treat them only when they occur. Postoperative management of carotid endarterectomy (CE) includes monitoring of neurological assessment. Which of the following physiological changes is NOT considered a common cause for the neurological deterioration following the CE? A. Reperfusion injury with cerebral edema B. Embolic showers C. Cerebral ischemia D. Subdural hematoma - CORRECT ANSWER D Rationale: The procedure of carotid endarterectomy (CE) involves clamping of the carotid artery, which can lead to cerebral ischemia. Placing a catheter into the carotid artery to perform the CE can cause embolic showers. When the carotid artery is opened and perfusing, reperfusion hyperemia can predispose the patient to brain edema. Subdural hematoma is not a common complication of CE. Which of the following patients is LEAST likely to experience a chronic subdural hematoma? A. An 85-year-old male patient B. A patient with severe dementia C. Patient on anticoagulation therapy D. An alcoholic patient - CORRECT ANSWER C Rationale: The elderly, alcoholics, and dementia patients are prone to experiencing chronic subdural hematomas. These patient populations have atrophy of brain, resulting in a greater capacity to hold the volume of venous blood, delaying the onset of symptoms. Patients on anticoagulation are more likely to experience an intracerebral hemorrhage or an acute to subacute bleed. Which of the following types of headache may be accompanied by an aura? A. Cluster headaches B. Migraine headaches C. Stress headaches D. Daily headaches - CORRECT ANSWER B Rationale: An aura has been found to frequent migraine headaches. It is not associated with cluster, stress, or daily headaches. Which of the following is LESS meaningful when talking to the patient about the brain tumor pathology and prognosis? A. Malignant or benign B. Tumor growth C. Location of tumor D. Patient's comorbidities - CORRECT ANSWER A Rationale: A benign tumor in the brain may be more life-threatening than a malignancy due to several factors. The location is very important because the tumor may be benign but is present in an eloquent area of the brain or a difficult location to reach with surgery or radiation. Tumor behavior or growth is important to the development of symptoms. Patient's comorbidities, including health and age, play a significant role in outcomes with brain tumors. Aneurysms can be classified based on the shape, size, and origin of the aneurysm. Which of the following terms best describes an aneurysm with a neck? A. Saccular aneurysm B. Fusiform aneurysm C. Giant aneurysm D. Mycotic aneurysm - CORRECT ANSWER A Rationale: An aneurysm with a neck is called a saccular or berry aneurysm. A fusiform is more of an outpouching of the vessel wall. A giant aneurysm is based upon the size of the aneurysm, measuring greater than 2.5 cm in diameter. A mycotic aneurysm is classified based upon origin being an infectious source such as endocarditis. A patient is diagnosed with disc protrusion (propulsion). Which of the following best describes disc herniation? A. Occurs when nucleus ruptures through innermost fibers of the annulus fibrosus with no disruption to outer annular fibers. B. Rupture of nucleus distorts the outermost fibers of the annulus and causes bulge outward. C. Complete split of annulus allows nuclear material to leak out of surrounding spaces. D. Extruded nuclear substance is no longer attached to material remaining within the disc and fragments may float around the spinal canal. - CORRECT ANSWER B Rationale: Disc protrusion or propulsion involves the rupture of the outermost fibers of the annulus. This results in bulging outward of the disc. Disc nuclear herniation without protrusion involves injury to the inner annulus without disruption of the outer. Nuclear extension is the complete split of the annulus allowing nuclear material to leak into surrounding spaces, but protruded material remains attached. Extruded nuclear substances, which are not attached and float around the spinal cord, are called sequestered nuclei. A paraplegic patient is being taught in rehabilitation to prevent pressure ulcers while sitting in the wheelchair. Which of the following strategies is the MOST important to preventi pressure ulcers? A. Use air cushion pad at all times. B. Perform frequent shifts in the chair. C. Use a Hoyer lift to move in the chair. D. Massage skin frequently to improve skin circulation. - CORRECT ANSWER B Rationale: Paraplegic patients are taught to perform frequent chair shifting to prevent prolonged pressure and pressure ulcers (redistribution techniques). Cushions can be used in chair to lower the risk, but shifting frequently is more important. Hoyer lifts can be used, but paraplegic patients can usually shift themselves with their upper extremities. Massaging can improve circulation to skin but is not a technique to prevent pressure ulcers while sitting in the wheelchair. Hydrocephalus present in Chiari type II malformations is classified as which of the following? A. Communicating hydrocephalus B. Noncommunicating hydrocephalus C. Degenerative hydrocephalus D. Productive hydrocephalus - CORRECT ANSWER B Rationale: When there is an obstruction to cerebrospinal fluid (CSF) flow resulting in hydrocephalus, it is called noncommunicating hydrocephalus. Communicating hydrocephalus is a result of overproduction or decreased reabsorption of the CSF. Degenerative and productive hydrocephalus is not a classification of hydrocephalus. Which of the following autoimmune disorders is most commonly associated with trigeminal neuralgia? A. Lupus B. Multiple sclerosis C. Myasthenia gravis D. CREST syndrome - CORRECT ANSWER B Rationale: When trigeminal neuralgia (TN) is found in the younger population without other risk factors, they will frequently test for multiple sclerosis (MS). TN and MS are associated disorders, which frequently occur together. Lupus, crest syndrome, and myasthenia gravis are autoimmune disorders but are not frequently associated with TN. Which of the following aneurysms is caused by septic emboli associated with bacterial endocarditis? A. Charcot-Bouchard B. Giant aneurysm C. Ehler's aneurysm D. Mycotic aneurysm - CORRECT ANSWER D Rationale: Mycotic aneurysms are a result of a septic source such as endocarditis showering septic emboli. Charcot-Bouchard is the presence of multiple tiny aneurysms within the deep structures of the brain. A giant aneurysm measures greater than 2.5 cm in diameter. Ehlers-Danlos syndrome is a connective tissue disease resulting in formation of aneurysms throughout the vasculature. Hyperventilation with the lowering of PaCO2 causes which of the following physiological effects in the cerebral circulation? A. Cerebral vasodilation B. Cerebral vasoconstriction C. Increased intracranial pressure D. Cerebral edema - CORRECT ANSWER B Rationale: Carbon dioxide (CO2) is a potent vasodilator in the cerebral circulation. A decrease in PaCO2 causes cerebral vasoconstriction, thus lowering ICP. An increase in PaCO2 causes cerebral vasodilation resulting in an increase in the intracranial pressure (ICP). The lowering of the PaCO2 does not increase cerebral edema. Which of the following best describes the pain syndrome associated with trigeminal neuralgia? A. Dull, constant aching pain along the jaw line B. Constant, severe, knifelike facial pain occurs bilaterally C. Muscle spasms along the V1 and V2 branches, which result in cramping-like pain D. Shock-like sensations, intermittent or episodic facial pain that occurs unilaterally - CORRECT ANSWER D Rationale: The pain of trigeminal neuralgia (TN) is neuropathic pain. It is frequently described as shock-like or electrical pain, which comes in volleys, or episodes of pain. It usually occurs unilateral. It is not described as dull, constant, or a cramping-like pain. Which of the following is the most common result of an intracranial aneurysm rupture? A. Subarachnoid hemorrhage B. Epidural hematoma C. Subdural hematoma D. Intracerebral hemorrhage - CORRECT ANSWER A Rationale: Intracranial aneurysm rupture causes bleeding into the subarachnoid and intraventricular spaces. Epidural and subdural hematomas can be caused by trauma to the vascular but are not related to aneurysm rupture. Intracerebral hemorrhage (ICH) is bleeding into the brain parenchyma and is more likely caused by hypertension or anticoagulation. A vaccine has been developed for which of the following types of meningitis? A. Tuberculosis meningitis B. Meningococcal meningitis C. Haemophilus influenzae meningitis D. Listeria - CORRECT ANSWER B Rationale: Meningococcal meningitis is spread through an airborne route and can become an epidemic in close quarters. A vaccination has been developed against one strain of meningococcal meningitis and is recommended in people living in close quarters such as military barracks or college dorms. Which of the following neurotransmitters will inhibit seizure activity? A. Glutamine B. Dopamine C. Acetylcholine D. Gamma-aminobutyric acid - CORRECT ANSWER D Rationale: Gamma-aminobutyric acid is an inhibitory neurotransmitter in the brain and has been found to inhibit seizures. Glutamine is an excitatory neurotransmitter and has been found to stimulate seizures. Dopamine inhibits motor tone and is found to be diminished in Parkinson's disease. Acetylcholine is a neurotransmitter at the level of the neuromuscular junction and is required for muscular contraction. Which of the following types of tremor occur due to a fixed posture against gravity? A. Kinetic intentional tremor B. Postural tremor C. Magnetic gait tremor D. Ataxic tremor - CORRECT ANSWER B Rationale: A postural tremor occurs due to a fixed posture against gravity. Kinetic intentional tremor occurs during goal directed movement. Magnetic gait occurs with normal-pressure hydrocephalus (NPH). Ataxia is an abnormal balance or coordination and is not considered a tremor. When administering an osmotic diuretic, such as mannitol, which of the following laboratory values should be closely monitored? A. Calcium B. Creatinine C. Potassium D. Serum osmolality - CORRECT ANSWER D Rationale: Osmotic diuretics increase serum osmolality, resulting in hemoconcentration. As the serum osmolality increases greater than 320 mmol, neurological injury can occur. As the serum becomes hemoconcentrated, serum Na+ levels increase. Thus, monitoring of both serum osmolality and Na+ levels is recommended. Hgb, hct, Ca+, PO4+, creatinine, and blood urea nitrogen (BUN) may also be ordered but are not as greatly affected. Which of the following is the least severe or mildest form of spina bifida (SB)? A. Myelomeningocele B. SB occulta C. Syrinx D. Meningocele - CORRECT ANSWER B Rationale: Spina bifida occulta is just the identifiable gap between vertebral bodies found on radiographic studies. It does not involve injury to the spinal cord or spinal nerve roots. Meningocele and myelomeningocele are also forms of spina bifida and are more severe due to the involvement of the spinal cord and spinal nerve roots. Syrinx is the fluid accumulation within the central portion of the spinal cord and is not considered a form of spina bifida. Cerebral aneurysms can occur throughout the cerebral circulation. Which of the following is the most common location of a cerebral aneurysm? A. Anterior circulation B. Extracranial internal carotid artery C. Basilar artery D. Vertebral artery - CORRECT ANSWER A Rationale: About 80% of cerebral aneurysms occur within the anterior circulation, including the intracranial portion of the internal carotid artery (ICA), middle cerebral artery (MCA), and anterior cerebral artery (ACA). Of the vessels in the anterior circulation, the intracranial internal carotid artery (ICA) has the highest frequency. Injury to extracranial portion of the ICA is more commonly caused by a traumatic dissection versus an aneurysm formation. The basilar artery and vertebral arteries make up the posterior circulation and account for about 20% of the cerebral aneurysms. Which of the following brain tumors is classified as an extraaxial tumor? A. Oligodendrioglioma B. Astrocytoma C. Pituitary adenoma D. Ependymoma - CORRECT ANSWER C Rationale: An oligodendrioglioma, astrocytoma, and ependymoma all gliomas arise from glial cells. They are classified as intraaxial tumors because they are actually located in brain tissue. A pituitary adenoma is a tumor involving the pituitary gland in the brain but is not composed of brain tissue cells. This is classified as an extraaxial tumor. Trigeminal neuralgia is a type of neuropathic pain. The best treatment for neuropathic pain includes which of the following? A. An antiepileptic B. Opioid C. Nonsteroidal anti-inflammatory drug D. Benzodiazepine - CORRECT ANSWER A Rationale: Neuropathic pain is treated most effectively with antiepileptics (such as gabapentin) or tricyclic antidepressants. Nonsteroid anti-inflammatory drug (NSAID) can be a first-line treatment of neuropathic pain but is not as effective as antiepileptics. Neuropathic pain is not as responsive to opioids or anxiolytics in managing pain. The most common presentation for a subarachnoid hemorrhage is which of the following? A. Sudden development of paralysis B. Ascending bilateral paralysis C. Complaints of "worst headache" of one's life D. Expressive aphasia - CORRECT ANSWER C Rationale: The most common sign of a subarachnoid hemorrhage (SAH) is "the worst headache" of their life. They may also experience some focal neurological deficits and nausea and vomiting. Paralysis is not a common presenting sign of an SAH. Aphasia is more commonly associated with an ischemic stroke. Which of the following cranial nerves (CNs) is most commonly involved in long-term complications of bacterial meningitis? A. CN V (trigeminal nerve) B. CN I (olfactory nerve) C. CN IX (glossopharyngeal nerve) D. CN VIII (acoustic nerve) - CORRECT ANSWER D Rationale: CN VIII (acoustic) is the most commonly damaged cranial nerve (CN) as a result of bacterial meningitis. Hearing loss is a long-term complication of bacterial meningitis. Other CNs frequently injured in meningitis include CN III (oculomotor), IV (trochlear), and VI (abducens), which are involved in extraocular eye movement and CN II (optic). Which of the following would be the most appropriate method used to lower intracranial pressure? A. Elevate the head of the bed. B. Elevate the foot of the bed. C. Perform carotid massage. D. Place rolled towels on either side of the neck. - CORRECT ANSWER A Rationale: Elevating the head of the bed facilitates venous drainage, thus lowering volume and pressure in the intracranium. Elevating the foot of the bed may actually increase the intracranial pressure (ICP). Carotid massage can cause bradycardia but is not used to lower the ICP. Maintaining head alignment is appropriate to facilitate venous drainage, but a rolled towel is not as effective as a soft cervical collar. A patient has a seizure that is localized to the right upper extremity without impairment of consciousness. What is the classification of the seizure? A. Simple partial B. Complex partial C. Generalized seizure D. Nonepileptic seizure - CORRECT ANSWER A Rationale: Simple partial seizures are localized seizures to one area of the brain in which the patient maintains consciousness. Complex partial seizures are also localized seizures but with the loss of consciousness. Generalized seizures occur across both hemispheres at once and are associated with a loss of consciousness. Nonepileptic seizures may be caused by subclinical or psychological seizures. A patient is admitted with an acute ischemic stroke with a current history of sleep apnea. Which of the following would be the most appropriate intervention to improve outcomes? A. Continuous positive airway pressure B. Monitor end-tidal carbon dioxide levels C. Intubation and mechanical ventilation D. Place patient on ketogenic diet - CORRECT ANSWER A Rationale: Treatment of sleep apnea improves the outcomes of stroke patients with sleep apnea. Treatment of sleep apnea includes the use of continuous positive airway pressure. Intubation and mechanical ventilation is invasive management of an airway but is not indicated to treat sleep apnea. Monitoring EtCO2 can be used to assess for CO2 retention but is not an intervention to improve outcomes. A ketogenic diet is not a known therapy for sleep apnea. Neuroleptic agents are most commonly used to suppress symptoms of Tourette's syndrome. Which of the following is the most common neurological side effect of neuroleptic agents? A. Dystonic movements B. Weight loss C. Acute renal failure D. Angioedema - CORRECT ANSWER A Rationale: The most common neurological side effects of neuroleptic agents are dystonic movements (twisting or posturing), tremors, and involuntary movements. Weight loss is also a side effect of neuroleptic agents but it is not a neurological side effect. Acute renal failure and angioedema are not common side effects of neuroleptic agents. Which of the following pituitary adenomas is most amendable to medical management? A. Adrenocorticotropic-secreting adenoma B. Nonsecreting adenoma C. Growth hormone-secreting adenoma D. Prolactinoma - CORRECT ANSWER D Rationale: Prolactinoma is a pituitary adenoma, which secretes prolactin. Medical management is recommended to shrink the tumor. All of the other pituitary adenomas typically require surgical resection. Mechanism of hyperflexion of the neck during a trauma can result in which of the following patterns of injury? A. Disruption of anterior ligament with posterior vertebral fracture B. Central cord syndrome C. Brown-Sequard cord syndrome D. Disruption of the posterior ligament and fractures of the anterior vertebral body - CORRECT ANSWER D Rationale: A hyperflexion injury in the cervical region causes stretching of the posterior ligament with ligament disruption. The compressed area is anterior, causing anterior vertebral body fractures. Anterior ligament disruption with posterior vertebral body fracture is caused by cervical hyperextension injuries. Central cord injuries are usually a result of hyperextension and may not be associated with vertebral fractures. Brown-Sequard cord syndrome is caused by an injury resulting in hemisection of the spinal cord. Which of the following forms of spina bifida has the highest risk for experiencing complications from the time of birth? A. Meningocele B. Chiari malformation type I C. Spina bifida occulta D. Myelomeningocele - CORRECT ANSWER D Rationale: In myelomeningocele cases, the fetus's spinal canal remains open along several vertebrae in the low to middle back with protrusion of meninges and spinal cord. The cord compression and spinal nerve root injuries result in greater number and severity of complications over the other forms of spina bifida. Chiari malformation type I is not a form of spina bifida. A patient is admitted with the diagnosis of a Hunt and Hess scale grade III subarachnoid hemorrhage. You would expect the patient to have which of the following symptoms on neurological examination? A. Asymptomatic presentation B. Unresponsive with Glasgow Coma Scale score of 5 C. Abnormal posturing D. Drowsy or confused - CORRECT ANSWER D Rationale: A grade III subarachnoid hemorrhage (SAH) based upon the Hunt and Hess scale includes a patient presenting with an altered mental status, including being drowsy or confused. Asymptomatic presentation would be a grade 0, and the unruptured aneurysm may be found incidentally. Posturing is a grade IV, and unresponsive is a grade V. In benign essential tremor (BET), the tremor occurs when? A. During rest B. At night C. During intentional activity D. Only during stress - CORRECT ANSWER C Rationale: In benign essential tremor (BET), the tremors occur with intentional activity, not at rest. This is different than Parkinson's disease, in which tremors occur at rest and improve during intentional activity. Stress will worsen tremors, but it is not the only time when the tremors occur in BET. A burst fracture of the vertebral body is most commonly associated with which mechanism of injury? A. Hyperflexion B. Hyperextension C. Torsion injury D. Axial loading - CORRECT ANSWER D Rationale: Axial loading or vertical compression of the spine causes the vertebral body to burst. Hyperflexion injuries cause posterior ligament disruptions and anterior vertebral compression fractures. Hyperextension injuries cause fracture of posterior vertebral body components and disruption of anterior longitudinal ligament. Torsion injury is associated with sprain or muscle injury of the neck. Which of the following radiographic studies is considered the gold standard used to identify the location and characteristic of a central nervous system tumor? A. CT without contrast B. CT with contrast C. MRI D. Magnetic resonance arteriogram - CORRECT ANSWER C Rationale: MRI with and without contrast is considered the gold standard in diagnosing central nervous system tumors, including determining the location and characteristic of the tumor. CT with and without contrast is typically a screening and can identify mass lesions and shifts. Magnetic resonance angiography (MRA) is used more to identify vascular anomalies such as a cerebral aneurysm or arteriovenous malformation (AVM). Following an injury to the spinal cord, your patient exhibits the following symptoms: bilateral loss of motor function, pain, and temperature, but the patient maintains proprioception and light touch. Which of the following spinal cord syndromes does he or she exhibit? A. Anterior cord syndrome B. Central cord syndrome C. Brown-Sequard cord syndrome D. Complete cord injury - CORRECT ANSWER A Rationale: Anterior cord syndrome results in the loss of motor, pain, and temperature but spares some of the sensory tracts such as proprioception and light touch. Central cord syndrome results in greater upper-extremity than lower-extremity weakness. Brown-Sequard cord syndrome is a hemisection of the cord and results in ipsilateral loss of motor and contralateral loss of pain and temperature. A complete cord injury is a loss of all motor and sensory below the level of injury. Creutzfeldt-Jakob disease is a spongiform encephalopathy, which is considered a prion disease. Which of the following is a prion disease? A. Abnormal version of infectious protein B. Protozoa infection found in stagnant water C. Bovine tapeworm that invades brain tissue D. Tick-borne disease that infects meninges - CORRECT ANSWER A Rationale: A prion disease is an abnormal infectious protein. It results in a fatal encephalopathy. Prion diseases are not related to protozoa infections and tapeworm and are not transmitted by ticks. Which of the following is NOT classified as a simple partial seizure? A. Somatosensory seizure B. Psychogenic seizure C. Autonomic seizure D. Atonic seizure - CORRECT ANSWER D Rationale: Atonic seizures are classified as generalized seizures. The epileptic focus initiates throughout both hemispheres. Somatosensory, psychic, and autonomic seizures are classified as simple partial seizures due to epileptic focus occurring within a focal area of the brain. Which of the following may be a complication of a lumbar puncture in a patient with a subarachnoid hemorrhage? A. Herniation syndrome B. Development of aphasia C. Kernig's sign D. Brudizinski's sign - CORRECT ANSWER A Rationale: Following a lumbar puncture, herniation can occur if the patient has an increased intracranial pressure (ICP). The positive pressure in the brain can herniate brain structures following a negative pressure in the lumbar region caused by the lumbar puncture. Kernig's and Brudizinski's signs are associated with meningitis or meningeal irritation. Aphasia is associated more commonly with ischemic strokes. A patient requiring a posterior cervical fusion is placed in the prone position for a prolonged period of time and experiences significant blood loss and hypotension. Which of the following is the most likely complication of this scenario? A. Visual losses B. Mesenteric ischemia C. Acute kidney injury D. Intracerebral hemorrhage - CORRECT ANSWER A Rationale: Prone positioning for spine surgery puts one at a high risk for visual losses. The addition of the patient experiencing a significant blood loss and who is hypotensive increases the risk of visual losses. Blood loss and hypotension can cause mesenteric ischemia and acute kidney injury, but in this scenario with the patient being in the prone position for a prolonged period of time, it is more likely to cause visual losses. A complication would more likely be an ischemic versus a hemorrhagic stroke. Vasospasm is the focal narrowing of cerebral vessels. This is most likely to appear during which of the following time periods after the subarachnoid hemorrhage (SAH)? A. 2 to 3 days post SAH B. 14 days post SAH C. 7 to 10 days post SAH D. 3 months post SAH - CORRECT ANSWER C Rationale: Subarachnoid hemorrhage (SAH) complication of vasospasms has its highest incidence 7 to 10 days post SAH. Vasospasms are not typically seen before day 4 or after day 21 post SAH. Which of the following is most commonly used to manage the vasogenic cerebral edema surrounding a brain tumor? A. Corticosteroids B. Mannitol C. Hypertonic saline D. Hypothermia - CORRECT ANSWER A Rationale: Corticosteroids are commonly used to manage the vasogenic edema surrounding cerebral tumors. Dexamethasone (Decadron) is the drug of choice. In severe edema and increased intracranial pressure (ICP), osmotic diuretics (such as mannitol and hypertonic saline) may be used to lower the ICP. Therapeutic hypothermia is used in patients with cytotoxic cerebral edema caused by an anoxic brain injury (postresuscitation). Which of the following is a recognized management of vasospasm following subarachnoid hemorrhage? A. Hypervolemia B. Hypertension C. Hypothermia D. Hemodilution - CORRECT ANSWER B Rationale: Hypertension is used to provide perfusion to the brain tissue distal to the narrowed vessel experiencing vasospasm. Hypervolemia is no longer recommended due to situations of volume overload. It is recommended to optimize hemodynamic parameters and assure euvolemic status. Hypothermia is not recommended for subarachnoid hemorrhage (SAH) patients. Hemodilution is not recommended because of the effect on ability to carry oxygen to the tissues. The goal of medical treatment for benign essential tremor is best described as which of the following? A. Cessation of all tremor activity B. Decreasing the frequency of the tremors C. Decreasing the amplitude of the tremors D. Treating the emotional effects of the tremors - CORRECT ANSWER C Rationale: The treatment of benign essential tremor (BET) does not cure or stop the tremors. The goal of treatment is to decrease the amplitude of the tremors. Improvement of the emotional side may occur following the reduction in amplitude but is not the primary goal of treatment. A cerebrospinal fluid analysis of bacterial meningitis includes all of the following except? A. Elevated protein B. Elevated glucose C. Increased lactate D. Elevated neutrophils - CORRECT ANSWER B Rationale: In bacterial meningitis, cerebrospinal fluid (CSF) analysis results in elevated protein, elevated white blood cell (WBC) neutrophils, increased lactate, and low glucose. Bacterial meningitis causes low glucose, not high. Viral meningitis typically has a normal CSF glucose level. Which of the following can increase the risk of spina bifida during fetal development? A. Exercise B. Maternal trauma C. Vitamin C deficiency D. Exposure to high temperatures - CORRECT ANSWER D Rationale: Evidence suggests that increased body temperature in the early months of pregnancy may increase the risk of spina bifida (SB). Elevated core body temperature by about 2°C (about 3-4°F) above normal caused by fever or the use of saunas and hot tubs can result in development of SB. Vitamin B9 deficiency, not vitamin C, may increase the risk of SB. Maternal trauma is not as known of a risk for SB as for cerebral palsy. Exercise is not a risk for SB. Which of the following electrolyte abnormality most commonly follows subarachnoid hemorrhage? A. Hyperphosphatemia B. Hyponatremia C. Hyperkalemia D. Hypocalcemia - CORRECT ANSWER B Rationale: Hyponatremia is the most common electrolyte abnormality following subarachnoid hemorrhage. It can be due to cerebral salt wasting syndrome or syndrome of inappropriate antidiuretic hormone. A patient presents with neurological deficits lasting 20 minutes followed by complete resolution of symptoms. During the transient ischemic attack workup, the intra