RPN - Nervous System Practice Test (A)..
CRNE - Central Nervous System Practice Test
(A) Case Study
Mrs. Aileen Troy is a 42-year-old housewife who lives with her husband and four (4) children. Her
husband is the vice-president of Citibank, 72nd St. and York Avenue. Her children 2 boys and 2 girls, range
in ages 4 to 17. The family enjoys being together and they usually spend their leisure time doing family
activities such as traveling within the country and abroad, skiing, and other sports.
One afternoon while all the children were still in school, Mrs. Troy visited her girlfriend who lives few
houses away from their house. While drinking coffee with her girlfriend, Mrs. Troy experienced headache
which she described as severe and pounding. She was very pale and sweaty. She then collapsed and hit her
head on the wooden chair. She was taken by ambulance to the nearest hospital. She has a history of mild
hypertension for which she is on water pills, occasional headaches, and some visual disturbances.
On admission to the acute medical unit, she is conscious, but confused and drowsy. She is unable to
express herself well verbally. She is very frustrated and cries very easily. Corneal reflexes are present, gag
reflex is positive. Pupils are unequal in size, reactive. Her extremities on the right side are weak;
extremities on the left side are within normal power. She has right-sided Babinski sign. She’s noted to have
difficulty seeing things placed on her right side. Her vital signs are as follows: BP 175/100; P 90; RR 18; T
37.9°C.
Mrs. Troy’s physician orders a stat CT scan of the head, which reveals cerebrovascular accident (CVA).
The admitting diagnosis is CVA and increased intracranial pressure (ICP).
Questions 1 to 19 refer to this case:
1. Mrs. Troy has possibly injured her head from the fall. Which symptom is most reliable as
early indication of increasing ICP?
a. Changes in the level of consciousness (LOC)
b. Changes in the respiratory pattern – a sign of increased ICP but not early sign
c. Decreased heart rate – not an early signs
d. Changes in the pupil size – second early sign
Answer: A –changes in the LOC is the most reliable sign of increased ICP.
2. Mrs. Troy is noted to have worsening condition. She is now unconscious and responds only to
painful stimuli. The neurologist’s orders include ‘close watch’ and frequent vital signs including the
Glasgow Coma Scale (GCS) to accurately assess her level of consciousness. The GCS determines the
client’s best:
a. Sensory response, motor response, and eye opening – sensory is not a part of GCS
b. Motor activity, eye movement, and vital signs – vital signs are part of GCS
c. Sensory, motor, and verbal response – sensory is not a part of GCS
d. Eye opening, motor response, and verbal response
Answer: D – these are the components of GCS.
3. Later, you are assessing Mrs. Troy and discovered otorrhea. Which of the following
nursing interventions is appropriate at this time?
a. Apply pressure to the site – this may increase ICP further
b. Check the client for bowel sounds – this is not related to ICP
c. Assess the drainage for the presence of glucose
d. Pack the ear very firmly with sterile dressing – this may result to further increased in ICP
Answer: C—the patient may have suffered from skull fracture due to fall and banging of head on the
chair. Drainage coming from the ear could be CSF.
1
, RPN - Nervous System Practice Test (A)..
4. Following the insertion of the ventricular drain, Mrs. Troy has started to regain consciousness but
suffers from transient lethargy and confusion. Which of the following will be included in the
client’s orientation?
a. Ask the client who is the president of the United States – this is recollection; not an
appropriate question
b. Ask the client to count backward from 10 to 1- this is math question and not included in
the orientation questions
c. Ask the client which is the second month of the year
d. Ask the client to add 2 + 3 – this is another math questions
Answer: C—orientation to time is appropriate for this patient who is confused.
5. Doctor’s order states that Mrs. Troy should be in a semi-fowler’s position, HOB to 30°. The nurse
is aware that the reason for this position is which of the following?
a. To promote expansion of the lungs – this is not the purpose of fowler’s position in increased ICP
b. To promote good venous drainage
c. To keep the client wide-awake – this is a wrong rationale
d. To promote oxygenation – this is the same with option A
Answer: B—using the principle of gravity, this position promotes venous drainage.
Mrs. Troy’s ICP is now controlled. A diagnosis of L CVA was confirmed.
6. The physician orders CAT scan on Mrs. Troy. Mr. Troy asks the nurse what’s CT scan for. What
would be an appropriate response?
a. To identify previous stroke – this is not the reason why CT scan was ordered
b. To identify cause and to determine treatment
c. To check blood flow in the brain – this is not the purpose of CT scan
d. To check the electrical activity in the brain – this is not the purpose of CT scan in stroke
patient Answer: B – CT scan determines if bleeding occurs and determines if tPA is an appropriate
treatment
7. Dexamethasone may be administered to a patient after a stroke to:
a. Improve renal blood flow – this is not the action of dexamethasone
b. Maintain circulatory volume – dexamethasone is an anti-inflammatory drug (steroid)
c. Reduce intracranial pressure
d. Prevent the development of thrombi – this is not the action of dexamethasone
Answer: C – As an inflammatory agent, dexamethasone helps prevent cerebral edema, which generally
peaks between day 3 and day 5 after a cerebral aneurysm.
8. At the end of the evening shift, the nurse’s aide reports that Mrs. Troy’s BP went up 180/110.
Nursing assessment has also revealed increased lethargy. Which additional assessment finding should
the nurse report immediately to the provider?
a. Slurred speech
b. Incontinence – this may not be related to high BP
c. Muscle weakness – if stroke has occurred, weakness of one side of the body is evident
d. Rapid pulse – this is not a sign of high BP
Answer: A - Changes in speech patterns and level of conscious can be indicators of continued intracranial
bleeding or extension of the stroke. Further diagnostic testing may be indicated.
9. Nurse’s finding shows that Mrs. Troy’s right pupil is reacting more slowly than the left and the
systolic blood pressure is beginning to rise. The nurse recognizes that these adaptations are suggestive
of:
a. Spinal shock – this may occur from high BP
b. Hypovolemic shock – this will not occur from high BP
c. Transtentorial herniation – this is not from high BP
d. Increasing intracranial pressure
Answer: D – increased ICP is manifested by sluggish pupils and elevation of the SBP.
2
CRNE - Central Nervous System Practice Test
(A) Case Study
Mrs. Aileen Troy is a 42-year-old housewife who lives with her husband and four (4) children. Her
husband is the vice-president of Citibank, 72nd St. and York Avenue. Her children 2 boys and 2 girls, range
in ages 4 to 17. The family enjoys being together and they usually spend their leisure time doing family
activities such as traveling within the country and abroad, skiing, and other sports.
One afternoon while all the children were still in school, Mrs. Troy visited her girlfriend who lives few
houses away from their house. While drinking coffee with her girlfriend, Mrs. Troy experienced headache
which she described as severe and pounding. She was very pale and sweaty. She then collapsed and hit her
head on the wooden chair. She was taken by ambulance to the nearest hospital. She has a history of mild
hypertension for which she is on water pills, occasional headaches, and some visual disturbances.
On admission to the acute medical unit, she is conscious, but confused and drowsy. She is unable to
express herself well verbally. She is very frustrated and cries very easily. Corneal reflexes are present, gag
reflex is positive. Pupils are unequal in size, reactive. Her extremities on the right side are weak;
extremities on the left side are within normal power. She has right-sided Babinski sign. She’s noted to have
difficulty seeing things placed on her right side. Her vital signs are as follows: BP 175/100; P 90; RR 18; T
37.9°C.
Mrs. Troy’s physician orders a stat CT scan of the head, which reveals cerebrovascular accident (CVA).
The admitting diagnosis is CVA and increased intracranial pressure (ICP).
Questions 1 to 19 refer to this case:
1. Mrs. Troy has possibly injured her head from the fall. Which symptom is most reliable as
early indication of increasing ICP?
a. Changes in the level of consciousness (LOC)
b. Changes in the respiratory pattern – a sign of increased ICP but not early sign
c. Decreased heart rate – not an early signs
d. Changes in the pupil size – second early sign
Answer: A –changes in the LOC is the most reliable sign of increased ICP.
2. Mrs. Troy is noted to have worsening condition. She is now unconscious and responds only to
painful stimuli. The neurologist’s orders include ‘close watch’ and frequent vital signs including the
Glasgow Coma Scale (GCS) to accurately assess her level of consciousness. The GCS determines the
client’s best:
a. Sensory response, motor response, and eye opening – sensory is not a part of GCS
b. Motor activity, eye movement, and vital signs – vital signs are part of GCS
c. Sensory, motor, and verbal response – sensory is not a part of GCS
d. Eye opening, motor response, and verbal response
Answer: D – these are the components of GCS.
3. Later, you are assessing Mrs. Troy and discovered otorrhea. Which of the following
nursing interventions is appropriate at this time?
a. Apply pressure to the site – this may increase ICP further
b. Check the client for bowel sounds – this is not related to ICP
c. Assess the drainage for the presence of glucose
d. Pack the ear very firmly with sterile dressing – this may result to further increased in ICP
Answer: C—the patient may have suffered from skull fracture due to fall and banging of head on the
chair. Drainage coming from the ear could be CSF.
1
, RPN - Nervous System Practice Test (A)..
4. Following the insertion of the ventricular drain, Mrs. Troy has started to regain consciousness but
suffers from transient lethargy and confusion. Which of the following will be included in the
client’s orientation?
a. Ask the client who is the president of the United States – this is recollection; not an
appropriate question
b. Ask the client to count backward from 10 to 1- this is math question and not included in
the orientation questions
c. Ask the client which is the second month of the year
d. Ask the client to add 2 + 3 – this is another math questions
Answer: C—orientation to time is appropriate for this patient who is confused.
5. Doctor’s order states that Mrs. Troy should be in a semi-fowler’s position, HOB to 30°. The nurse
is aware that the reason for this position is which of the following?
a. To promote expansion of the lungs – this is not the purpose of fowler’s position in increased ICP
b. To promote good venous drainage
c. To keep the client wide-awake – this is a wrong rationale
d. To promote oxygenation – this is the same with option A
Answer: B—using the principle of gravity, this position promotes venous drainage.
Mrs. Troy’s ICP is now controlled. A diagnosis of L CVA was confirmed.
6. The physician orders CAT scan on Mrs. Troy. Mr. Troy asks the nurse what’s CT scan for. What
would be an appropriate response?
a. To identify previous stroke – this is not the reason why CT scan was ordered
b. To identify cause and to determine treatment
c. To check blood flow in the brain – this is not the purpose of CT scan
d. To check the electrical activity in the brain – this is not the purpose of CT scan in stroke
patient Answer: B – CT scan determines if bleeding occurs and determines if tPA is an appropriate
treatment
7. Dexamethasone may be administered to a patient after a stroke to:
a. Improve renal blood flow – this is not the action of dexamethasone
b. Maintain circulatory volume – dexamethasone is an anti-inflammatory drug (steroid)
c. Reduce intracranial pressure
d. Prevent the development of thrombi – this is not the action of dexamethasone
Answer: C – As an inflammatory agent, dexamethasone helps prevent cerebral edema, which generally
peaks between day 3 and day 5 after a cerebral aneurysm.
8. At the end of the evening shift, the nurse’s aide reports that Mrs. Troy’s BP went up 180/110.
Nursing assessment has also revealed increased lethargy. Which additional assessment finding should
the nurse report immediately to the provider?
a. Slurred speech
b. Incontinence – this may not be related to high BP
c. Muscle weakness – if stroke has occurred, weakness of one side of the body is evident
d. Rapid pulse – this is not a sign of high BP
Answer: A - Changes in speech patterns and level of conscious can be indicators of continued intracranial
bleeding or extension of the stroke. Further diagnostic testing may be indicated.
9. Nurse’s finding shows that Mrs. Troy’s right pupil is reacting more slowly than the left and the
systolic blood pressure is beginning to rise. The nurse recognizes that these adaptations are suggestive
of:
a. Spinal shock – this may occur from high BP
b. Hypovolemic shock – this will not occur from high BP
c. Transtentorial herniation – this is not from high BP
d. Increasing intracranial pressure
Answer: D – increased ICP is manifested by sluggish pupils and elevation of the SBP.
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