Mixed Deck — All CNRN Topics Flashcards
100 cards from real CNRN practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Mixed Deck — All CNRN Topics flashcards as text
The nurse is preparing a patient for lumbar puncture to assess for meningitis after TBI. Before performing the LP, the priority is to:
Answer: Administer empiric antibiotics and obtain CT head to rule out elevated ICP
CT head must be obtained first to rule out elevated ICP before LP; antibiotics should be started empirically without delaying treatment pending imaging.
A nurse notes Cushing's triad in a neuroscience patient. Which set of findings is characteristic?
Answer: Hypertension, bradycardia, irregular respirations
Cushing's triad consists of hypertension (widening pulse pressure), bradycardia, and irregular respirations, signaling impending brainstem herniation.
A nurse caring for a patient with advanced Parkinson's disease observes excessive drooling (sialorrhea). This is BEST explained by:
Answer: Impaired automatic swallowing frequency due to bradykinesia
Sialorrhea in Parkinson's disease results from impaired and infrequent automatic swallowing due to bradykinesia — saliva production is not increased, but clearance is reduced.
Which post-operative position is recommended after infratentorial (posterior fossa) craniotomy to minimize cerebellar and brainstem edema?
Answer: Head of bed elevated 30–45 degrees, head midline
Head elevation at 30–45 degrees with midline head positioning promotes venous drainage and reduces posterior fossa edema after infratentorial craniotomy.
The nurse is caring for a patient in refractory status epilepticus requiring continuous EEG monitoring. The therapeutic goal of treatment is to achieve:
Answer: Burst suppression pattern
In refractory status epilepticus, treatment with anesthetic agents aims to achieve burst suppression on EEG, indicating adequate seizure suppression.
ICP is 30 mm Hg in a patient with an external ventricular drain (EVD). When the drain is opened, the output is extremely slow. What comes after that?
Answer: Call the attending/resident.
An ICP of 30 mmHg is significantly elevated and requires immediate attention. If the external ventricular drain (EVD) is open but output is extremely slow, it suggests a potential malfunction, obstruction, or inadequate drainage, which can lead to further neurological compromise. This situation warrants immediate medical evaluation and intervention from the attending physician or resident.
Which clinical sign distinguishes central herniation from uncal herniation in a deteriorating patient?
Answer: Bilateral pinpoint pupils early in central herniation vs. ipsilateral blown pupil in uncal herniation
Central herniation causes early bilateral small pupils and gradual rostral-caudal deterioration, while uncal herniation classically presents with an ipsilateral dilated fixed pupil from CN III compression.
Which cranial nerve is tested when the nurse asks the patient to shrug their shoulders against resistance?
Answer: CN XI
Cranial nerve XI (spinal accessory nerve) innervates the sternocleidomastoid and trapezius muscles, tested by shoulder shrug resistance.
Lethargy, anorexia, vomiting, and a high-grade fever appear in an inmate with a history of HIV. The patient shows a positive Brudzinski sign during physical examination. In order to confirm the diagnosis, which of the following tests would not be used?
Answer: CT scan of the abdomen and pelvis.
The patient's symptoms (lethargy, high fever, positive Brudzinski sign) strongly suggest meningitis, especially given their history of HIV. Tests like lumbar puncture (for CSF analysis), blood cultures, and erythrocyte sedimentation rate (ESR) are directly relevant to diagnosing meningitis and systemic infection. A CT scan of the abdomen and pelvis is unrelated to a neurological infection and would not be used to confirm this diagnosis.
A patient with Parkinson's disease is evaluated for deep brain stimulation (DBS). Which symptom responds BEST to DBS therapy?
Answer: Motor fluctuations and levodopa-induced dyskinesias
DBS of the subthalamic nucleus or globus pallidus interna most effectively reduces motor fluctuations ('off' periods) and levodopa-induced dyskinesias in Parkinson's disease.
The ICP of a patient with an EVD has been steadily rising. Which drugs should the nurse anticipate administering to this patient?
Answer: Mannitol (Osmitrol).
Mannitol is an osmotic diuretic commonly administered to rapidly reduce elevated intracranial pressure (ICP). It works by drawing fluid from the brain tissue into the vascular space, thereby decreasing cerebral edema and subsequently lowering ICP. This makes it the appropriate drug to anticipate for a patient with steadily rising ICP.
Which intervention is most appropriate for a patient with increased ICP who has a PaCO2 of 52 mmHg?
Answer: Increase ventilator rate to target PaCO2 35–40 mmHg
Hypercapnia causes cerebral vasodilation and worsens ICP; controlled ventilation targeting PaCO2 35–40 mmHg reduces ICP by promoting mild vasoconstriction.
When monitoring intracranial pressure (ICP), which waveform component indicates reduced cerebral compliance?
Answer: Elevated P2 wave exceeding P1
An elevated P2 (tidal) wave that exceeds P1 (percussion) indicates reduced intracranial compliance and impending ICP crisis.
A patient with a C4 spinal cord injury develops a sudden headache (9/10), diaphoresis above the injury level, and hypertension of 210/118 mmHg. The nurse's first action is:
Answer: Sit the patient upright and search for a noxious stimulus below the injury level
Autonomic dysreflexia requires immediate upright positioning to use orthostatic hypotension as a rapid intervention while simultaneously identifying and removing the offending stimulus (most commonly a full bladder).
A patient presents with sudden-onset unilateral facial drooping, arm weakness, and speech difficulty that completely resolved within 45 minutes. This presentation best describes:
Answer: Transient ischemic attack (TIA)
A TIA presents with focal neurological deficits that resolve completely, typically within 24 hours (often <1 hour), without evidence of acute infarction on imaging.
A patient with TBI is receiving mannitol for ICP reduction. The nurse monitors serum osmolality, knowing the maximum safe osmolality is:
Answer: 320 mOsm/kg
Serum osmolality should not exceed 320 mOsm/kg during mannitol therapy to avoid renal toxicity and rebound cerebral edema.
Which spinal cord injury level results in a patient who is ventilator-dependent due to loss of diaphragm function?
Answer: C3 and above
The phrenic nerve (C3, C4, C5 — 'keeps the diaphragm alive') originates at C3–C5; injury at C3 or above disrupts diaphragmatic function, requiring ventilatory support.
A patient with epilepsy is admitted after a breakthrough seizure. Which factor should the nurse assess FIRST as the most common cause of breakthrough seizures?
Answer: Antiseizure medication non-compliance
Non-compliance with antiseizure medication is the most common cause of breakthrough seizures in patients with established epilepsy.
Huntington's disease is caused by which genetic mutation?
Answer: CAG trinucleotide repeat expansion on chromosome 4
Huntington's disease results from an expansion of CAG trinucleotide repeats in the HTT gene on chromosome 4, leading to progressive striatal neurodegeneration.
In Guillain-Barré syndrome, which pattern of weakness is MOST characteristic?
Answer: Ascending symmetrical weakness beginning in the legs and progressing upward
Guillain-Barré syndrome classically presents with ascending symmetrical weakness starting in the lower extremities and progressing upward, potentially reaching the respiratory muscles.