Latest - CNRN Practice Questions and answers 2023
Latest - CNRN Practice Questions and answers 2023
Latest - CNRN Practice Questions and answers 2023
Latest - CNRN Practice Questions and answers 2023
Latest - CNRN Practice Questions and answers 2023
Latest - CNRN Practice Questions and answers...
CNRN Practice Questions and answers 2023
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
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
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.
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
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
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
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
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
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
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
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
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.
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
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