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CNRN exam with complete solutions 2024_2025
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CNRN exam with complete solutions 2024_2025
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CNRN Practice exam with completesolutions 2024/2025
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 - ANSWER-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 - ANSWER-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. - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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 - ANSWER-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.
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