CCRN NEURO EXAM QUESTIONS AND
CORRECT ANSWERS 2025.
A 23-year-old man has sustained a diffuse axonal injury. He has been
admitted to the critical care unit after being resuscitated in the emergency
department. His current Glasgow Coma Scale score is 5. Vital signs include
blood pressure of 120/84 mm Hg, heart rate of 92 beats/min, and
temperature of 36° C. The patient is on a ventilator on control mode, with a
tidal volume of 700 ml, rate of 18 breaths/min, and FiO2 of 0.45. An
intraventricular catheter is inserted via a burr hole, and the intracranial
pressure (ICP) is 30 mm Hg. Which of the following nursing measures
optimize cerebral perfusion pressure (CPP)?
A.
Turning the patient every hour
B.
Routine suctioning every hour
C.
Maintaining neutral head position
D.
Maintaining PaCO2 below 30 mm Hg - correct answer>>C.
Routine nursing measures may increase ICP and, therefore, decrease CPP
because CPP = mean arterial pressure (MAP) - ICP. The patient needs to be
turned; every 2 hours is sufficient. The patient may need to have secretions
suctioned; only suction the patient if indications, such as rhonchi, are
present and never suction routinely. Hyperoxygenation before suctioning is
,important in preventing the detrimental effects of suctioning on ICP.
Administration of lidocaine (intravenously or by endotracheal tube) before
suctioning helps to prevent coughing and the increase in ICP caused by
suctioning. Keeping the patient alkalotic through hyperventilation therapy
causes the cerebral vessels to constrict and decreases intracranial volume
and pressure. This is an intervention that is only used in extreme crisis such
as impending herniation because it is likely to cause ischemia. PaCO2 usually
is kept at the lower end of the normal 35 to 45 mm Hg range to decrease the
ICP but not cause cerebral ischemia. Hyperventilation is a short-term
treatment only. Keeping the head and neck in a neutral position allows
optimal venous drainage through the jugular veins.
Test Taking Tip
Which of the following options is normal management for all patients?
Routine turning procedure is every 2 hours. Nothing in this case study
suggests that skin breakdown or pulmonary complications require hourly
turning. Routine suctioning is not recommended today. Suctioning should be
done when indicated. Maintaining the PaCO2 at less than 30 mm Hg is likely
to constrict the cerebral vessels and decrease intracranial volume and
pressure but also cause cerebral ischemia. Maintaining the head in a neutral
position is a good idea for all patients but especially those with neurologic
injury. Include "Maintaining neutral head position" in the plan for this
patient
A 76-year-old woman is admitted to the critical care unit after a right
cerebral hemisphere hemorrhage. Assessment would reveal which of the
following?
A.
Dilated left pupil and paresis or plegia on the left side
B.
,Dilated left pupil and paresis or plegia on the right side
C.
Dilated right pupil and paresis or plegia on the right side
D.
Dilated right pupil and paresis or plegia on the left side - correct answer>>D.
When there is pressure on cranial nerve III, the ipsilateral pupil loses the
ability to constrict in response to light and becomes dilated. The motor area
controls the opposite side of the body.
Test Taking Tip
Remember that brain injury causes ipsilateral pupil changes and
contralateral motor changes. Because the injury is on the right, the right
(ipsilateral) pupil becomes dilated and nonreactive and the left
(contralateral) side of the body becomes weak or paralyzed.
A 44-year-old man is a patient in the critical care unit after a gunshot wound
to the head. His right pupil is dilated and nonreactive. This indicates damage
to cranial nerve:
A.
II.
B.
III.
C.
IV.
D.
VI. - correct answer>>B.
, Cranial nerve III controls the ability of the pupil to constrict. As intracranial
pressure (ICP) rises, changes in pupil size and reactivity occur, with the pupil
on the side of the pressure dilating and becoming sluggish in response to
light and finally nonreactive to light.
Test Taking Tip
All of these cranial nerves involve the eyes. Cranial nerve II is responsible for
vision. Cranial nerves III, IV, and VI all are involved in eye movement. Cranial
nerve III is the cranial nerve that controls the ciliary response and
constriction of the pupil. Choose "III."
A 42-year-old woman is admitted with "the worst headache I've ever had."
Computed tomography reveals an aneurysm in the circle of Willis. Which of
the following clinical presentations describes a Hunt and Hess grade I
aneurysm?
A.
Minimal headache; no neurologic deficits
B.
Mild to severe headache; minimal neurologic deficits
C.
Stuporous; mild to severe hemiparesis
D.
Comatose; decerebrate posturing - correct answer>>A.
A grade I on the Hunt and Hess aneurysm grading scale indicates minimal
bleeding with no neurologic deficits. Aneurysm rupture may be classified
from grade I to grade V. The highest classification indicates a severe bleed
and a comatose patient.
CORRECT ANSWERS 2025.
A 23-year-old man has sustained a diffuse axonal injury. He has been
admitted to the critical care unit after being resuscitated in the emergency
department. His current Glasgow Coma Scale score is 5. Vital signs include
blood pressure of 120/84 mm Hg, heart rate of 92 beats/min, and
temperature of 36° C. The patient is on a ventilator on control mode, with a
tidal volume of 700 ml, rate of 18 breaths/min, and FiO2 of 0.45. An
intraventricular catheter is inserted via a burr hole, and the intracranial
pressure (ICP) is 30 mm Hg. Which of the following nursing measures
optimize cerebral perfusion pressure (CPP)?
A.
Turning the patient every hour
B.
Routine suctioning every hour
C.
Maintaining neutral head position
D.
Maintaining PaCO2 below 30 mm Hg - correct answer>>C.
Routine nursing measures may increase ICP and, therefore, decrease CPP
because CPP = mean arterial pressure (MAP) - ICP. The patient needs to be
turned; every 2 hours is sufficient. The patient may need to have secretions
suctioned; only suction the patient if indications, such as rhonchi, are
present and never suction routinely. Hyperoxygenation before suctioning is
,important in preventing the detrimental effects of suctioning on ICP.
Administration of lidocaine (intravenously or by endotracheal tube) before
suctioning helps to prevent coughing and the increase in ICP caused by
suctioning. Keeping the patient alkalotic through hyperventilation therapy
causes the cerebral vessels to constrict and decreases intracranial volume
and pressure. This is an intervention that is only used in extreme crisis such
as impending herniation because it is likely to cause ischemia. PaCO2 usually
is kept at the lower end of the normal 35 to 45 mm Hg range to decrease the
ICP but not cause cerebral ischemia. Hyperventilation is a short-term
treatment only. Keeping the head and neck in a neutral position allows
optimal venous drainage through the jugular veins.
Test Taking Tip
Which of the following options is normal management for all patients?
Routine turning procedure is every 2 hours. Nothing in this case study
suggests that skin breakdown or pulmonary complications require hourly
turning. Routine suctioning is not recommended today. Suctioning should be
done when indicated. Maintaining the PaCO2 at less than 30 mm Hg is likely
to constrict the cerebral vessels and decrease intracranial volume and
pressure but also cause cerebral ischemia. Maintaining the head in a neutral
position is a good idea for all patients but especially those with neurologic
injury. Include "Maintaining neutral head position" in the plan for this
patient
A 76-year-old woman is admitted to the critical care unit after a right
cerebral hemisphere hemorrhage. Assessment would reveal which of the
following?
A.
Dilated left pupil and paresis or plegia on the left side
B.
,Dilated left pupil and paresis or plegia on the right side
C.
Dilated right pupil and paresis or plegia on the right side
D.
Dilated right pupil and paresis or plegia on the left side - correct answer>>D.
When there is pressure on cranial nerve III, the ipsilateral pupil loses the
ability to constrict in response to light and becomes dilated. The motor area
controls the opposite side of the body.
Test Taking Tip
Remember that brain injury causes ipsilateral pupil changes and
contralateral motor changes. Because the injury is on the right, the right
(ipsilateral) pupil becomes dilated and nonreactive and the left
(contralateral) side of the body becomes weak or paralyzed.
A 44-year-old man is a patient in the critical care unit after a gunshot wound
to the head. His right pupil is dilated and nonreactive. This indicates damage
to cranial nerve:
A.
II.
B.
III.
C.
IV.
D.
VI. - correct answer>>B.
, Cranial nerve III controls the ability of the pupil to constrict. As intracranial
pressure (ICP) rises, changes in pupil size and reactivity occur, with the pupil
on the side of the pressure dilating and becoming sluggish in response to
light and finally nonreactive to light.
Test Taking Tip
All of these cranial nerves involve the eyes. Cranial nerve II is responsible for
vision. Cranial nerves III, IV, and VI all are involved in eye movement. Cranial
nerve III is the cranial nerve that controls the ciliary response and
constriction of the pupil. Choose "III."
A 42-year-old woman is admitted with "the worst headache I've ever had."
Computed tomography reveals an aneurysm in the circle of Willis. Which of
the following clinical presentations describes a Hunt and Hess grade I
aneurysm?
A.
Minimal headache; no neurologic deficits
B.
Mild to severe headache; minimal neurologic deficits
C.
Stuporous; mild to severe hemiparesis
D.
Comatose; decerebrate posturing - correct answer>>A.
A grade I on the Hunt and Hess aneurysm grading scale indicates minimal
bleeding with no neurologic deficits. Aneurysm rupture may be classified
from grade I to grade V. The highest classification indicates a severe bleed
and a comatose patient.
