,BKAT Stroke and Neurological Emergencies 150 QUESTIONs with
Answers and Rationales PRACTICE EXAM 2026 REVIEWS WITH
COMPLETE ACTUAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
QUESTION 1: What is the standard formula used to calculate Cerebral
Perfusion Pressure (CPP) in a critically ill neurological patient?
• A) 𝐶𝑃𝑃 = 𝑀𝐴𝑃 + 𝐼𝐶𝑃
• B) 𝐶𝑃𝑃 = 𝑀𝐴𝑃 − 𝐼𝐶𝑃
• C) 𝐶𝑃𝑃 = 𝑆𝐵𝑃 − 𝐷𝐵𝑃
• D) 𝐶𝑃𝑃 = 𝐼𝐶𝑃/𝑀𝐴𝑃
Correct Answer: B
Rationale: Cerebral perfusion pressure (CPP) is calculated as the mean
arterial pressure (MAP) minus the intracranial pressure (ICP). It
represents the net pressure gradient driving blood flow to the brain.
QUESTION 2: When monitoring a patient with an External Ventricular
Drain (EVD) for intracranial pressure, where must the zero-reference
point of the transducer (transducer stopcock) be aligned?
• A) The phlebostatic axis (fourth intercostal space, mid-chest)
• B) The tragus of the ear (foramen of Monro)
• C) The suprasternal notch
• D) The tip of the nose
Correct Answer: B
,Rationale: For accurate intracranial pressure monitoring via an EVD, the
transducer must be leveled to the foramen of Monro, which is clinically
referenced to the external auditory meatus (tragus of the ear).
QUESTION 3: According to acute ischemic stroke guidelines, what is the
maximum allowable blood pressure threshold prior to the
administration of intravenous recombinant tissue plasminogen activator
(alteplase)?
• A) Less than 120/80 mmHg
• B) Less than 140/90 mmHg
• C) Less than 185/110 mmHg
• D) Less than 220/120 mmHg
Correct Answer: C
Rationale: Blood pressure must be carefully lowered to below 185/110
mmHg prior to starting IV alteplase to minimize the risk of hemorrhagic
transformation, and maintained below 180/105 mmHg for the first 24
hours post-infusion.
QUESTION 4: Which of the following represents an absolute
contraindication for the administration of intravenous alteplase in an
acute ischemic stroke patient?
• A) Age over 80 years old
• B) History of mild well-controlled hypertension
• C) Recent major intracranial surgery or severe head trauma within
the past 3 months
• D) Serum blood glucose of 150 mg/dL
, Correct Answer: C
Rationale: Recent intracranial surgery, head trauma, or prior intracranial
hemorrhage are major absolute contraindications for thrombolytic
therapy due to the extreme risk of fatal systemic or cerebral bleeding.
QUESTION 5: What is the primary mechanism of action of mannitol
when administered to treat acute intracranial hypertension?
• A) It acts as an osmotic diuretic, drawing free water out of the
cerebral parenchyma and into the intravascular space across an
intact blood-brain barrier.
• B) It permanently destroys cerebrospinal fluid-producing choroid
plexus cells.
• C) It induces profound systemic vasodilation to lower blood
pressure.
• D) It paralyzes skeletal muscle to reduce metabolic demand.
Correct Answer: A
Rationale: Mannitol creates an osmotic gradient, pulling water from the
brain tissue into the vascular space, thereby reducing brain volume and
lowering intracranial pressure.
QUESTION 6: When administering 3% hypertonic saline via a peripheral
or central line for elevated ICP, what primary physiological effect does it
achieve?
• A) It expands intravascular volume and creates a hyperosmolar
gradient that draws water out of swollen brain cells into the
extracellular space.
Answers and Rationales PRACTICE EXAM 2026 REVIEWS WITH
COMPLETE ACTUAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
QUESTION 1: What is the standard formula used to calculate Cerebral
Perfusion Pressure (CPP) in a critically ill neurological patient?
• A) 𝐶𝑃𝑃 = 𝑀𝐴𝑃 + 𝐼𝐶𝑃
• B) 𝐶𝑃𝑃 = 𝑀𝐴𝑃 − 𝐼𝐶𝑃
• C) 𝐶𝑃𝑃 = 𝑆𝐵𝑃 − 𝐷𝐵𝑃
• D) 𝐶𝑃𝑃 = 𝐼𝐶𝑃/𝑀𝐴𝑃
Correct Answer: B
Rationale: Cerebral perfusion pressure (CPP) is calculated as the mean
arterial pressure (MAP) minus the intracranial pressure (ICP). It
represents the net pressure gradient driving blood flow to the brain.
QUESTION 2: When monitoring a patient with an External Ventricular
Drain (EVD) for intracranial pressure, where must the zero-reference
point of the transducer (transducer stopcock) be aligned?
• A) The phlebostatic axis (fourth intercostal space, mid-chest)
• B) The tragus of the ear (foramen of Monro)
• C) The suprasternal notch
• D) The tip of the nose
Correct Answer: B
,Rationale: For accurate intracranial pressure monitoring via an EVD, the
transducer must be leveled to the foramen of Monro, which is clinically
referenced to the external auditory meatus (tragus of the ear).
QUESTION 3: According to acute ischemic stroke guidelines, what is the
maximum allowable blood pressure threshold prior to the
administration of intravenous recombinant tissue plasminogen activator
(alteplase)?
• A) Less than 120/80 mmHg
• B) Less than 140/90 mmHg
• C) Less than 185/110 mmHg
• D) Less than 220/120 mmHg
Correct Answer: C
Rationale: Blood pressure must be carefully lowered to below 185/110
mmHg prior to starting IV alteplase to minimize the risk of hemorrhagic
transformation, and maintained below 180/105 mmHg for the first 24
hours post-infusion.
QUESTION 4: Which of the following represents an absolute
contraindication for the administration of intravenous alteplase in an
acute ischemic stroke patient?
• A) Age over 80 years old
• B) History of mild well-controlled hypertension
• C) Recent major intracranial surgery or severe head trauma within
the past 3 months
• D) Serum blood glucose of 150 mg/dL
, Correct Answer: C
Rationale: Recent intracranial surgery, head trauma, or prior intracranial
hemorrhage are major absolute contraindications for thrombolytic
therapy due to the extreme risk of fatal systemic or cerebral bleeding.
QUESTION 5: What is the primary mechanism of action of mannitol
when administered to treat acute intracranial hypertension?
• A) It acts as an osmotic diuretic, drawing free water out of the
cerebral parenchyma and into the intravascular space across an
intact blood-brain barrier.
• B) It permanently destroys cerebrospinal fluid-producing choroid
plexus cells.
• C) It induces profound systemic vasodilation to lower blood
pressure.
• D) It paralyzes skeletal muscle to reduce metabolic demand.
Correct Answer: A
Rationale: Mannitol creates an osmotic gradient, pulling water from the
brain tissue into the vascular space, thereby reducing brain volume and
lowering intracranial pressure.
QUESTION 6: When administering 3% hypertonic saline via a peripheral
or central line for elevated ICP, what primary physiological effect does it
achieve?
• A) It expands intravascular volume and creates a hyperosmolar
gradient that draws water out of swollen brain cells into the
extracellular space.
