Musculoskeletal and Neuro CCRN Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

Toddler w meningitis. Resistance when the lower legs are extended. She also cries when her legs are raised to change her diaper. Documents this as which of the following? a. Kernigs sign b. Brudinski sign c. Nuchal rigidity d. Battle sign - A. Kernig sign - back pain and resistance to lower leg extension is referred to as kernig sign. Brudinski's sign occurs when hips and knees flex in response to neck flexion. Nuchal rigidity is neck stiffness. Battle sign is basilar skull fracture. At change of shift nurse describes the child's seizure to the oncoming nurse. Which of the following best describes the clonic phase? a. Staring straight ahead and seemed to be daydreaming b. Said she tasted metal c. Very stiff and rigid d. Rhythmic contractions and relaxation of her arms and legs - d. rhythmic contractions and relaxations of arms and legs. - experiencing a taste or sensation is an aura. Rigidity occurs during tonic phase. Child admitted w TBI. Nurse notes CSF leaking from her ear, bruising below her eyes, and swelling behind her ear. Which of the following bones was most likely fractured in the injury. a. The mandible b. The frontal bone c. The parietal bone d. The sphenoid bone - d. the sphenoid bone - leakage of CSF from the ear, bruising below the eyes, and a hematoma behind the ear are manifestations of a basilar skull fracture that typically involves the temporal, occipital, sphenoid, and/or ethmoid bones.Closed head injury. When nurse stimulates her, the child flexes her arms, clenches her fists, and extends her legs. which of the following is accurate? a. Child is demonstrating decorticate posturing which indicates cerebral damage. b. Child is demonstrating decorticate posturing which indicates damage to the midbrain c. Child is demonstrating deceberate posturing which indicates cerebral damage d. Child is demonstrating deceberate posturing which indicates damage to the midbrain. - a. child is demonstrating decorticate posturing which indicates cerebral damage. - deceberate posturing is extension of the arms which indicates damage to the mid brain. Which of the following is an early sign of a basilar skull fracture? a. Irritability b. Raccoon's eyes c. Battle sign d. leakage of CSF from ear - d. leakage of CSF from ear - Battle sign and raccoon's eyes LATE signs TBI. Unresponsive and intubated. Nurse initiates ETCO2 monitoring. Which of the following statements is FALSE? a. Increased ICP can be caused from decreased CO2 levels which promote cerebral vasodilation b. Cerebral perfusion is optimal in the presence of normally to mildly reduced CO2. c. Markedly decreased CO2 levels can lead to ischemia d. Decreased CO2 levels promote cerebral vasoconstriction. - a. Increased icp can be caused from decreased CO2 levels which promote vasodilation - increased ICP can be caused from INCREASED CO2 levels which promote vasodilation. Cerebral perfusion is optimal in the presence of normal to mildly reduced CO2 where a small degree of vasoconstriction can be maintained. Markedly decreased CO2 levels cause vasoconstriction which can lead to ischemia. Which of the following is true of an AVM?a. It is a tangled mass of thin vessels that are under perfused b. Most AVMs develop during the later school age years c. AVMs can be caused by hyrdrocephalus d. AVMs can hemorrhage into the epidural space - . a. It is a tangled mass of this vessels that are under perfused - tangled mass of thin vessels that dont have support of capillary bed leading to inadequate perfusion. Most AVMs present at birth. Can leak into subarachnoid space and can lead to hydropcephalus. 2 year old recently had febrile seizure. Toddler is playful and interactive. Mother expresses concern that her seizure may result in long term learning disorder. Which of the following is the nurses response based on? a. No evidence to suggest that febrile seizures result in long term learning disorder b. Most seizures result in a degree of brain anoxia which can lead to long term disability. c. Most seizures occur due to pre-existing cerebral abnormality which could lead to long term disability d. If febrile seizure reoccurs, there is increased likelihood that long term disability will result. - a. No evidence to suggest that febrile seizures result in long term learning disorder. 1 week old infant CVA. Which of the following manifestations would the nurse NOT expect to see in the infant? a. Hypotonia b. Seizures c. Resp distress d. Hemiplegia - d. Hemiplegia - Hypotonia, seizures, and resp distress are common manifestations of neonate CVA. Hemiplegia is not seen in the neonate due to developmental maturity. After obtaining an LP on a child the diagnosis of bacterial meningitis is made. Which of the following would likely had been seen in the child's CSF? a. Increased WBC w mostly lymphocytes b. Decreased protein levelsc. Decreased glucose levels d. Negative gram stain - c. Decreased glucose levels - Although WBC levels are increased, polymorphonuclear cells are in abundance not lymphocytes which are elevated in viral meningitis. Protein levels are increased and the gram stain is positive in bacterial meningitis.