Free CNRN Practice Test: 50 Questions With Rationales

Correct answer: C. 13

Score each part separately. Eyes open to your voice: E3. Coherent conversation that is not oriented: V4 (confused). Follows a two-part command: M6. E3 + V4 + M6 = 13. With the verbal and motor scores unchanged, a total of 14 would require spontaneous eye opening (E4), which is not what happened here. With the eye and motor scores unchanged, 12 would require isolated words (V3), not confused conversation. A total of 11 could come from E2 + V3 + M6, but neither the eye nor verbal response in that combination matches this patient. Chart the components (E3 V4 M6), not just the total, because different patterns can produce the same number.

Domain: Patient Management · Topic: Physiological Interventions: Neurological Assessment and Management · Item ID: CNRN-II-01
Source: Military Health System, Glasgow Coma Scale reference

Correct answer: B. Treat blood pressure per protocol and start thrombolysis only once it is below 185/110 mm Hg.

Current stroke guidelines keep blood pressure below 185/110 mm Hg before IV thrombolysis starts and below 180/105 mm Hg during and for at least 24 hours after. Higher pressure is linked to more symptomatic bleeding, so the drug waits until the pressure is controlled. Starting now (A) skips that safety gate. A high reading is a problem to fix, not an automatic exclusion (C). Pushing systolic pressure below 140 before treatment (D) is not the required pretreatment target.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-05
Source: AHA/ASA 2026 acute ischemic stroke guideline, blood pressure recommendations

Correct answer: A. Notify the organ procurement organization (OPO) now, following hospital protocol.

Federal hospital rules (42 CFR 482.45) require timely notification of the OPO about patients whose death is imminent or who have died. This patient already meets the hospital’s imminent-death criteria, so notification should not wait for withdrawal or a death declaration. The OPO, not the bedside team, decides medical suitability. Waiting until after withdrawal (B) can close the window. The donation request is made by an OPO representative or a trained designated requestor, not as an unplanned bedside question (C). Referral does not depend on the family raising the subject (D). Your hospital's written policy defines 'imminent death,' so follow it.

Domain: Multidisciplinary Care · Topic: Quality of Life: Organ Donation · Item ID: CNRN-III-01
Source: 42 CFR 482.45(a)(1) and (a)(3), organ procurement responsibilities (eCFR)

Correct answer: B. Acute epidural hematoma from arterial bleeding

A blow to the temple, a period of near-normal alertness (a lucid interval), and then rapid decline with a one-sided pupil change is the classic pattern of an epidural hematoma. It usually comes from a torn middle meningeal artery, often with a temporal bone fracture, and needs fast diagnosis and neurosurgical care to prevent herniation. Concussion (A) does not explain a new dilating pupil or a falling GCS. A chronic subdural hematoma (C) develops over weeks, not an hour. Diffuse axonal injury (D) does not fit a stretch of normal alertness followed by a new focal sign of mass effect.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Trauma: Hematoma/Hemorrhage · Item ID: CNRN-I-01
Source: MSD Manual Professional, Traumatic Brain Injury

Correct answer: D. Sit the patient upright and loosen any tight clothing or devices.

This is autonomic dysreflexia, a medical emergency in people with spinal cord injury at T6 or above. The first moves are to sit the person up, which lets blood pool in the legs and lowers pressure, and to loosen anything constricting. Get urgent help and monitor blood pressure and pulse every 1–2 minutes while searching for the trigger, starting with the bladder (full bladder or a kinked catheter), then the bowel. With systolic pressure at or above 150 mm Hg, the current spinal cord medicine guideline advises considering an ordered rapid-onset, short-duration antihypertensive before catheterization or rectal manipulation, which can raise pressure further. Lying flat with legs up (A) raises pressure further. Fluids (B) treat low blood pressure, not this. A rectal check (C) belongs in the trigger search, but positioning comes first and the bladder is usually checked before the bowel.

Domain: Patient Management · Topic: Physiological Interventions: Cardiovascular Management · Item ID: CNRN-II-09
Source: Consortium for Spinal Cord Medicine / PVA, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions

Correct answer: A. Raised white cells, mostly neutrophils; low glucose; raised protein

Bacterial meningitis classically shows neutrophils (polys), a CSF glucose well below the blood glucose, and high protein. Option B is the usual viral pattern. Option C, lymphocytes with low glucose, points more toward tuberculous or fungal meningitis. Option D is normal CSF. Early in illness the patterns can overlap. Gram stain, culture, and PCR help identify the cause; negative results do not by themselves exclude bacterial meningitis.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Infection and Immune Complications: Meningitis · Item ID: CNRN-I-14
Source: MSD Manual Professional, Acute Bacterial Meningitis: CSF findings

Correct answer: C. Use a validated behavioral pain tool such as the CPOT or the BPS.

For critically ill adults who cannot self-report but whose behaviors can be observed, the Critical-Care Pain Observation Tool (CPOT) and Behavioral Pain Scale (BPS) are the most valid and reliable tools, per the SCCM PADIS guideline. The grimacing and tensing are exactly what these tools score. Vital signs (A) are not valid pain measures on their own; a change should only prompt a proper assessment. A numeric rating (B) requires self-report, which this patient cannot give. Sedation (D) does not mean the patient is pain-free.

Domain: Patient Management · Topic: Behavioral Interventions: Pain · Item ID: CNRN-II-12
Source: SCCM, PADIS guideline (pain assessment and delirium statements)

Correct answer: B. Give the dose through the NG tube, following the product label and pharmacy instructions.

Nimodipine is given enterally, and the capsule label describes giving the contents through an NG tube and flushing with saline. The label's boxed warning says never to give it IV or by any other parenteral route: deaths, cardiac arrest, and severe hypotension have occurred when capsule contents were injected (A). Guidelines call early enteral nimodipine beneficial for preventing delayed cerebral ischemia after aSAH, so holding doses (C) delays a proven treatment. Swapping in a different IV drug (D) gives up that benefit and is not what the order calls for. Use an oral syringe labeled not-for-IV use, per your pharmacy's process.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-07
Source: Nimodipine capsule label, boxed warning and Dosage and Administration (DailyMed); AHA, 2023 Aneurysmal Subarachnoid Hemorrhage Guideline: Top Things to Know

Correct answer: D. Arrange a qualified medical interpreter and speak directly to the patient.

Under the Section 1557 rules (45 CFR 92.201), covered health programs must offer a qualified interpreter when interpretation is needed and must not rely on a minor child to interpret except as a temporary step in an emergency with an imminent threat. That rules out the son (A). A staff member who happens to speak Spanish is not automatically a qualified interpreter (B). Simple English and gestures (C) do not resolve this patient’s inability to understand the consent discussion. Talking directly to the patient, not the interpreter, keeps the patient at the center of the decision.

Domain: Multidisciplinary Care · Topic: Quality of Life: Culture and Socioeconomic Considerations (including Social Determinants of Health) · Item ID: CNRN-III-04
Source: 45 CFR 92.201(c) and (e), language assistance under Section 1557 (eCFR)

Correct answer: B. Neurogenic shock from loss of sympathetic tone

Injury to the cervical or upper thoracic cord (typically above T6) can cut the sympathetic pathways. Blood vessels dilate, so pressure falls, and the vagus nerve acts on the heart unopposed, so the rate slows. Warm, pink skin fits vasodilation. No bleeding source has been found, but occult blood loss still needs ongoing assessment; this pattern does not prove that hemorrhage has been excluded. Hypovolemic shock (A) usually brings a fast heart rate. Spinal shock (C) describes the temporary loss of cord function and reflexes below the injury, not this blood-pressure picture. Nothing suggests infection one hour after injury (D).

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Trauma: Spinal Cord Injury · Item ID: CNRN-I-03
Source: MSD Manual Professional, Spinal Trauma

Correct answer: A. 55 mm Hg, below the 60–70 mm Hg target range

CPP = MAP − ICP, so 80 − 25 = 55 mm Hg. The Brain Trauma Foundation's 4th-edition guideline gives 60 to 70 mm Hg as the target range for survival and good outcomes, so 55 is low. The ICP of 25 is also above the guideline's 22 mm Hg treatment threshold. Option B uses the wrong arithmetic. Option C adds the numbers instead of subtracting. Option D divides them; CPP is a difference, not a ratio.

Domain: Patient Management · Topic: Physiological Interventions: Neurological Assessment and Management · Item ID: CNRN-II-03
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, 4th ed.; MSD Manual Professional, Traumatic Brain Injury

Correct answer: C. Clarify the order, because fluoroquinolones can worsen myasthenia gravis weakness.

Ciprofloxacin's FDA boxed warning says fluoroquinolones may worsen muscle weakness in people with myasthenia gravis and tells prescribers to avoid them in patients with a known history. Worsening can include breathing problems, so the nurse raises it before the first dose. Food (A) and dose timing (D) do not address the real risk. Tendon problems are also in the boxed warning, but monitoring only for tendons (B) misses the danger most specific to this patient.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-16
Source: Ciprofloxacin tablets label, boxed warning and §5.5 (DailyMed)

Correct answer: D. Screen for delirium with a validated tool and look for causes such as infection, pain, medications, or sleep loss.

A sudden change from a documented baseline, with attention that comes and goes over hours, is the picture of delirium, which usually has a treatable cause. The PADIS guideline supports regular screening with a valid tool, and the key treatment is finding and fixing the cause. Calling it normal aging (A) misses an acute problem. Restraints (B) do not address the cause and are not a first step. Reorienting helps, but waiting for the next routine check (C) delays the workup.

Domain: Patient Management · Topic: Safety Interventions: Delirium · Item ID: CNRN-II-15
Source: SCCM, PADIS guideline (pain assessment and delirium statements); MedlinePlus, Delirium

Correct answer: A. A bulging, tense fontanelle and eyes that look fixed downward

In infants, rising pressure from excess CSF shows up as fast head growth, a bulging or tense soft spot, and eyes fixed downward ('sunsetting'), often with vomiting, irritability, or sleepiness. A sunken fontanelle and dry mucosa (B) suggest dehydration rather than this hydrocephalus pattern. A small head (C) does not fit rapid growth. Jaundice (D) points to a liver or bilirubin problem.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Neurodevelopmental Conditions: Hydrocephalus · Item ID: CNRN-I-19
Source: Mayo Clinic, Hydrocephalus: symptoms

Correct answer: C. Helping a stable patient with morning hygiene and dressing

The NCSBN–ANA National Guidelines for Nursing Delegation say the nurse cannot delegate nursing judgment or any activity involving clinical reasoning or critical decision-making. Routine help with hygiene and dressing for a stable patient is predictable and appropriate to delegate, with the RN accountable for the delegation decision and appropriate supervision. The delegatee remains accountable for performing the accepted task. Swallow screening (A) requires a trained professional using a validated tool. Patient teaching (B) and deciding whether a deficit is new (D) both depend on nursing judgment. State rules and facility policy still apply.

Domain: Multidisciplinary Care · Topic: Health Care Management: Scope of Practice, Professional Competence, and Delegation · Item ID: CNRN-III-05
Source: NCSBN and ANA, National Guidelines for Nursing Delegation (2019); Canadian Stroke Best Practices, Swallowing, Nutrition and Oral Care

Correct answer: B. Continue the thrombolysis evaluation, because disabling deficits persist after glucose is corrected.

The 2026 AHA/ASA guideline says to check blood glucose before IV thrombolysis because severe hypoglycemia or hyperglycemia can mimic stroke. It also says that if disabling stroke symptoms persist after glucose is corrected to normal, IV thrombolysis is recommended for otherwise eligible patients. Stopping the workup (A) would treat this as a mimic even though the deficits did not clear. Waiting 24 hours (C) wastes the treatment window. Oral glucose (D) is unsafe with an unscreened swallow and unnecessary once glucose is 118.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-09
Source: 2026 AHA/ASA AIS guideline, section 4.6.1 Thrombolysis Decision-Making, recommendations 5–6 (Guideline Central edition); Canadian Stroke Best Practices, Swallowing, Nutrition and Oral Care

Correct answer: D. Give IM midazolam per protocol.

The American Epilepsy Society guideline names IM midazolam, IV lorazepam, and IV diazepam as effective first treatments for convulsive seizures lasting at least 5 minutes, and found IM midazolam more effective than IV lorazepam when IV access is not established. Waiting for a line (A) delays the first dose. Nothing should go by mouth during a seizure (B). Treating possible fever (C) does not stop the seizure.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-II-05
Source: American Epilepsy Society guideline, convulsive status epilepticus (Epilepsy Currents, 2016); CDC, First Aid for Seizures

Correct answer: A. Central diabetes insipidus

Antidiuretic hormone (ADH, vasopressin) is made in the hypothalamus and stored and released from the posterior pituitary. Surgery in that area is the most common cause of central diabetes insipidus: without ADH, the kidneys cannot concentrate urine, so large volumes of dilute urine pour out and sodium rises. SIADH (B) and cerebral salt wasting (C) both cause low sodium, not high. Normal glucose rules out a sugar-driven diuresis (D).

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Neuro-oncology: Neuro-endocrine Disorders · Item ID: CNRN-I-12
Source: MedlinePlus, Diabetes insipidus

Correct answer: C. Keep the patient NPO, including pills, until a validated swallow screen is done and passed.

Stroke best-practice guidance calls for a swallow screen by an appropriately trained professional before any oral intake: food, fluids, or medication. Being awake and asking for water does not prove a safe swallow. A 'test sip' outside the screening process (A) exposes the patient to aspiration risk before that risk has been assessed. Changing texture (B, D) is a decision that follows screening and, if needed, a full swallowing assessment. It is not a substitute for screening.

Domain: Patient Management · Topic: Physiological Interventions: Nutrition · Item ID: CNRN-II-07
Source: Canadian Stroke Best Practices, Swallowing, Nutrition and Oral Care

Correct answer: D. Raised intracranial pressure threatening her vision, which needs urgent neurologic and visual assessment

Headache, pulse-synchronous tinnitus, transient visual obscurations, and papilledema are the classic signs of raised intracranial pressure seen in idiopathic intracranial hypertension. Permanent vision loss can be severe if untreated, so urgent neurologic and visual assessment is the priority. Secondary causes of raised pressure must be excluded before calling it idiopathic intracranial hypertension. Treating it as migraine (A), tension headache (B), or sinusitis (C) ignores the papilledema and leaves the optic nerves at risk.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Neurological Disorders: Pseudotumor Cerebri/Idiopathic Intracranial Hypertension · Item ID: CNRN-I-22
Source: European Headache Federation guideline on idiopathic intracranial hypertension

Correct answer: B. "Death by neurologic criteria means permanent loss of brain function, including brainstem function, has been confirmed. He has died. The ventilator provides breaths; a heartbeat does not mean he can wake up."

The 2023 national consensus guideline (AAN, AAP, CNS, SCCM) defines brain death, or death by neurologic criteria, as permanent loss of function of the entire brain, including the brainstem. It is death, not a type of coma. Calling it a coma (A) or a vegetative state (C) gives false hope and confuses the family. The nurse can reinforce the team's determination in plain words and bring in the physician for further questions. Refusing to answer (D) leaves the family alone at a critical moment.

Domain: Multidisciplinary Care · Topic: Quality of Life: Hospice/End of Life · Item ID: CNRN-III-02
Source: AAN/AAP/CNS/SCCM, Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Guideline (2023); AAN, New Guideline on Brain Death; MSD Manual Professional, Brain Death

Correct answer: C. Clarify the order and ask about an orogastric route instead.

Periorbital bruising (raccoon eyes) and clear rhinorrhea suggest a basilar skull fracture with a CSF leak. Disruption of the skull base, including the cribriform plate, can allow a nasogastric tube to pass intracranially and injure the brain. That is why the nasal route is avoided and an oral route is requested. An x-ray after insertion (A) comes too late to prevent that harm. Nasal suctioning (B) and nose-blowing (D) do not address the need to avoid nasal instrumentation in a suspected skull-base injury.

Domain: Patient Management · Topic: Physiological Interventions: Surgical/Procedural Treatment and Management · Item ID: CNRN-I-02
Source: MSD Manual Professional, Traumatic Brain Injury; MSD Manual Professional, How To Insert a Nasogastric Tube

Correct answer: A. Clarify the order: hyponatremia with clinical volume depletion needs assessment for appropriate fluid and sodium replacement, not routine fluid restriction.

Low sodium with high urine sodium and signs of volume loss (weight loss, dry mucosa, orthostasis) warrants reassessment of the cause and of the fluid order. These findings suggest clinically important volume depletion; they do not establish cerebral salt wasting on their own. Restricting fluids (B) would deepen the volume loss, which matters after aSAH because guidelines stress maintaining euvolemia. Fluid and sodium replacement must be tailored to the patient’s volume status and sodium trend. Free water alone (C) can worsen hyponatremia. Desmopressin (D) is not the routine response to this presentation. Clarify the restriction promptly rather than apply a diagnosis-based shortcut.

Domain: Patient Management · Topic: Physiological Interventions: Metabolic Management · Item ID: CNRN-II-08
Source: AHA, 2023 Aneurysmal Subarachnoid Hemorrhage Guideline: Top Things to Know; MSD Manual Professional, Hyponatremia

Correct answer: D. Temporary heat-related worsening of existing symptoms (Uhthoff's phenomenon)

A small rise in body temperature, from exercise, a hot bath or shower, or fever, can temporarily slow signals along demyelinated nerves and make existing symptoms worse. Blurred vision, fatigue, and weakness are common, and they ease once the person cools down. Symptoms that flare with heat and settle with cooling fit this temporary pseudo-exacerbation, not a relapse (A), which reflects new disease activity. The heat-triggered return of familiar symptoms, followed by a return to baseline with cooling, favors a pseudo-exacerbation over a new stroke (B); cooling is not a test that rules stroke out. Nothing here points to a drug effect (C). Teach cooling strategies, and to seek assessment for new, different, or persistent neurologic symptoms.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Infection and Immune Complications: Neurodegenerative Disorders · Item ID: CNRN-I-17
Source: Multiple Sclerosis Association of America, Heat Sensitivity

Correct answer: B. Try less restrictive measures first, such as covering the IV site, addressing pain and toileting, and observing more closely.

Under the CMS patient-rights rule (42 CFR 482.13(e)), restraint may be used only to keep the patient or others physically safe, only when less restrictive measures have been judged ineffective, and it must be the least restrictive effective option. Restraining now (A) skips alternatives that were never tried. Restraint orders cannot be written as standing or as-needed (PRN) orders (C). A vest restraint 'for falls' (D) is not a routine fall-prevention tool. Also look for why the patient is confused.

Domain: Patient Management · Topic: Safety Interventions: Physical and Chemical Restraint · Item ID: CNRN-II-17
Source: 42 CFR 482.13(e), restraint or seclusion (eCFR)

Correct answer: C. It is above the post-thrombolysis limit of 180/105 mm Hg; treat per protocol and notify the provider.

For at least the first 24 hours after IV thrombolysis, blood pressure is kept below 180/105 mm Hg. A systolic of 186 is over that limit even though the diastolic is not, so it needs treatment and notification under the protocol. Option A ignores the limit, and option D confuses this with patients who did not get thrombolysis. Option B is not the routine post-thrombolysis target. In patients with mild to moderate stroke treated with IV thrombolysis, the 2026 AHA/ASA guideline does not recommend intensive lowering below 140 mm Hg because it has not improved outcomes.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-06
Source: AHA/ASA 2026 acute ischemic stroke guideline, blood pressure recommendations

Correct answer: A. "We covered a lot. To make sure I explained it clearly, tell me in your own words what you'd watch for and what you'd do."

Teach-back asks the learner to explain, in their own words, what they need to know or do. It is framed as a check on how well the nurse explained, not a test of the learner. If there is a gap, the nurse explains it differently and checks again. A yes/no question (B) rarely uncovers misunderstanding. A handout alone (C) does not confirm anything. Word-for-word repetition (D) tests memory rather than understanding.

Domain: Multidisciplinary Care · Topic: Health Care Management: Education, Support, and Resources for Patient and Caregivers · Item ID: CNRN-III-06
Source: AHRQ Health Literacy Universal Precautions Toolkit, third edition

Correct answer: D. Blood glucose

Corticosteroids such as dexamethasone can raise blood glucose in people with or without diabetes, and the label lists hyperglycemia among its effects. Thirst, frequent urination, and fatigue fit that, so glucose is the first check. Fluid restriction (A) could make things worse if the cause is hyperglycemia. Holding the prescribed steroid before assessing these symptoms (B) does not identify their cause, and dose changes belong to the prescriber. Urine studies (C) may follow, but the likeliest cause here is simple to check first.

Domain: Patient Management · Topic: Physiological Interventions: Metabolic Management · Item ID: CNRN-I-11
Source: Dexamethasone tablets label (DailyMed)

Correct answer: B. Raise the head of the bed per protocol, bring the head to midline, and notify the provider.

The Brain Trauma Foundation recommends treating ICP above 22 mm Hg. Immediate nursing measures in this situation are positional: raising the head of the bed and keeping the neck in a neutral, midline position both help venous blood drain from the head. Then notify the provider, because a sustained high reading needs the team's protocol. Trendelenburg (A) raises ICP. Adding more stimulation now (C) can push ICP higher. Prolonged hyperventilation to 25 mm Hg or lower (D) is not recommended, because it narrows brain blood vessels and can cause ischemia.

Domain: Patient Management · Topic: Physiological Interventions: Neurological Assessment and Management · Item ID: CNRN-II-02
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, 4th ed.; American College of Surgeons, Best Practices Guidelines: Traumatic Brain Injury

Correct answer: C. The cerebellar tonsils extend down through the foramen magnum, the skull opening, and crowd CSF flow; this can cause cough- or strain-triggered headache.

In Chiari I malformation, the cerebellar tonsils herniate down through the foramen magnum into the spinal canal and can obstruct the normal flow of CSF. A headache at the back of the head that worsens with coughing, sneezing, or straining is a hallmark sign. Sinus disease (A) and migraine aura (B) do not explain a strain-triggered occipital headache in someone with a known Chiari malformation. Nothing suggests bleeding (D). Symptoms do not always match how far the tonsils descend, and some people with the finding have no symptoms at all.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Neurodevelopmental Conditions: Chiari Malformation · Item ID: CNRN-I-20
Source: Mayfield Clinic, Chiari I Malformation and Syringomyelia

Correct answer: A. Report it promptly as a possible medication-related impulse-control effect, and advise against stopping the medication suddenly.

Carbidopa-levodopa labels warn about new or increased urges to gamble, spend, or act on other urges, and tell prescribers to ask about them because patients may not recognize the behavior. In some cases the urges eased when the dose was reduced, which is a prescriber decision. Labels also warn that stopping or rapidly cutting dopaminergic therapy can trigger a dangerous syndrome of high fever and confusion, so an abrupt stop (C) is unsafe. Dismissing it as personal choice (B) or normal progression (D) misses a possible medication-related effect.

Domain: Patient Management · Topic: Behavioral Interventions: Patient Behavioral Factors and Management · Item ID: CNRN-II-13
Source: SINEMET (carbidopa and levodopa) label (DailyMed)

Correct answer: D. Closely assess breathing and cough strength, and escalate, because the weakness may be reaching the breathing muscles.

Guillain-Barré syndrome often starts in the feet and moves upward. Weakness can reach the breathing muscles, and some patients need a ventilator. Shorter phrases and a weaker cough are warning signs, so close respiratory assessment and escalation come first. Walking (A) is unsafe with progressive weakness. Sensory checks (B) miss the threat to breathing. Most people do recover, but that is no reason for routine 8-hour monitoring (C) during rapid progression.

Domain: Patient Management · Topic: Physiological Interventions: Respiratory Monitoring and Airway Management · Item ID: CNRN-I-15
Source: NHS, Guillain-Barré syndrome

Correct answer: B. "No. Palliative care can be given alongside your cancer treatment to manage symptoms and support your quality of life."

The National Cancer Institute describes palliative care as care that improves quality of life for people with serious illness. It can be given with or without curative treatment, at any age or stage. Hospice (A) is a separate model of care near the end of life. Palliative care is not limited to the final weeks (C) and does not require stopping cancer treatment (D).

Domain: Multidisciplinary Care · Topic: Quality of Life: Palliative Care · Item ID: CNRN-III-03
Source: National Cancer Institute, Palliative Care in Cancer

Correct answer: A. Clarify the order: guidelines support euvolemia and do not recommend prophylactic hypervolemia.

The 2023 AHA/ASA aSAH guideline supports maintaining euvolemia. It says prophylactic hemodynamic augmentation and hypervolemia should not be done, because they add risk without benefit. Raising blood pressure while keeping euvolemia is reserved for patients with symptomatic delayed cerebral ischemia. Giving the boluses (B) follows an outdated practice. The same guideline says routine IV magnesium (C) and routine statins (D) are not recommended. Early enteral nimodipine is the prevention measure the guideline supports.

Domain: Patient Management · Topic: Physiological Interventions: Cardiovascular Management · Item ID: CNRN-I-08
Source: AHA, 2023 Aneurysmal Subarachnoid Hemorrhage Guideline: Top Things to Know

Correct answer: C. Standard plus Droplet precautions until 24 hours after effective therapy starts

CDC isolation guidance calls for Droplet precautions for the first 24 hours of antimicrobial therapy for Neisseria meningitidis meningitis, on top of Standard precautions for all patients. The 24-hour clock starts when effective therapy begins, not at admission. Airborne precautions (A) apply to diseases like tuberculosis. Contact-only (B) or Standard-only (D) would miss droplet spread. This rule is specific to meningococcus, not to every kind of meningitis.

Domain: Patient Management · Topic: Safety Interventions: Neuro-specific Infection Prevention · Item ID: CNRN-II-19
Source: CDC, Appendix A: Type and Duration of Precautions

Correct answer: D. Normal pressure hydrocephalus

Normal pressure hydrocephalus is most common in older adults and affects walking, memory and thinking, and bladder control. This gradual combination of all three is the pattern that should prompt an evaluation, because surgery to drain the extra fluid can help some patients. This pattern warrants evaluation for normal pressure hydrocephalus rather than assuming Alzheimer disease alone (A). An acute ischemic stroke (B) has an acute onset, unlike this months-long progression. A UTI with delirium (C) develops over hours to days.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Neurological Disorders: Hydrocephalus · Item ID: CNRN-I-21
Source: Mayo Clinic, Hydrocephalus: symptoms; MedlinePlus, Delirium

Correct answer: B. Clarify the order: prolonged prophylactic hyperventilation to a PaCO2 of 25 mm Hg or less is not recommended.

The Brain Trauma Foundation's 4th-edition guideline says prolonged prophylactic hyperventilation to a PaCO2 of 25 mm Hg or less is not recommended. Low CO2 narrows brain blood vessels and can cut blood flow to already injured tissue. Hyperventilation can be a brief bridge for a dangerous ICP rise while definitive treatment starts, but not a 48-hour preventive plan (A). Going lower (C) increases the ischemia risk. Option D invents a practice the guideline does not describe.

Domain: Patient Management · Topic: Physiological Interventions: Respiratory Monitoring and Airway Management · Item ID: CNRN-II-04
Source: Brain Trauma Foundation, Guidelines for the Management of Severe TBI, 4th ed.; American College of Surgeons, Best Practices Guidelines: Traumatic Brain Injury

Correct answer: C. Central cord syndrome

Central cord syndrome classically follows a hyperextension injury, often a low-energy fall, in an older adult with a narrowed cervical canal. It causes more weakness in the arms than the legs, and bladder dysfunction can occur. Brown-Séquard (A) produces weakness and loss of position sense on the side of the cord injury, with pain and temperature loss on the opposite side below the injury. Anterior cord syndrome (B) causes loss of motor function and pain and temperature sensation below the injury, without an arm-greater-than-leg pattern. Cauda equina (D) affects nerve roots below the cord, not the arms.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Trauma: Spinal Cord Injury · Item ID: CNRN-I-04
Source: American Association of Neurological Surgeons, Central Cord Syndrome; MSD Manual Professional, Spinal Trauma

Correct answer: A. Explore the transportation barrier, connect the patient with transportation help or social work, and follow up on whether the connection worked.

AHRQ’s health-literacy toolkit recommends helping patients connect with non-medical resources, including transportation, and following up on whether they received the help. That means exploring the need, making a real referral, and checking back. Labeling the patient nonadherent (B) blames them for a solvable barrier. A brochure alone (C) does not establish whether the patient can use the service. Leaving the patient to solve it alone (D) does nothing about the barrier.

Domain: Multidisciplinary Care · Topic: Quality of Life: Culture and Socioeconomic Considerations (including Social Determinants of Health) · Item ID: CNRN-III-07
Source: AHRQ Health Literacy Universal Precautions Toolkit, third edition

Correct answer: D. Parenteral anticoagulation, such as heparin

Cerebral venous thrombosis is a clot in the brain's venous drainage. It is more common in pregnant and postpartum women and people with clotting tendencies, and it often presents with headache or seizures. The 2024 AHA scientific statement continues to support initial treatment with parenteral anticoagulation. Thrombolysis (A) is not first-line. Antiplatelet therapy alone (B) and steroids (C) do not treat the venous clot.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-10
Source: Saposnik et al., Diagnosis and Management of Cerebral Venous Thrombosis, AHA Scientific Statement (Stroke, 2024)

Correct answer: B. A full IV loading dose of fosphenytoin, levetiracetam, or valproic acid

In the American Epilepsy Society's time-based approach, a benzodiazepine comes first. If the seizure continues, the second phase is a full IV loading dose of fosphenytoin, valproic acid, or levetiracetam, with IV phenobarbital as an alternative if none of those is available. An oral maintenance dose (A) is too slow and too small. Waiting (C) lets the seizure run on, and later treatments work less well. Naloxone (D) reverses opioids and does not treat status epilepticus.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-II-06
Source: American Epilepsy Society guideline, convulsive status epilepticus (Epilepsy Currents, 2016)

Correct answer: A. Escalate urgently for suspected metastatic spinal cord compression.

Metastatic spinal cord compression is a spinal emergency. Without quick relief, the patient can permanently lose neurologic function. Increasing back pain is the most common early feature, and new leg weakness or bladder trouble in a person with cancer are red flags that need immediate emergency assessment and urgent spinal imaging. Physical therapy (B), home remedies (C), and waiting until tomorrow (D) all risk permanent paralysis.

Domain: Patient Management · Topic: Safety Interventions: Neurological Status and Decline · Item ID: CNRN-I-13
Source: Macmillan Cancer Support, Metastatic spinal cord compression

Correct answer: C. Assess immediate safety, screen for depression with a validated tool, and share the results with the team.

Post-stroke depression is linked to poorer recovery, lower quality of life, and higher mortality, and the AHA/ASA scientific statement addresses screening and treatment. A structured, validated screen turns the concern into something the team can act on, with appropriate assessment, treatment, and follow-up. Ask directly about thoughts of self-harm or suicide; current suicidal thoughts require urgent safety assessment rather than a routine follow-up appointment. Calling it normal (A) delays care. Isolating the patient (B) removes support. A sedative (D) treats neither mood nor its cause.

Domain: Patient Management · Topic: Behavioral Interventions: Psychosocial Considerations · Item ID: CNRN-II-14
Source: Towfighi et al., Poststroke Depression, AHA/ASA Scientific Statement (Stroke, 2017); NIMH, Adult Outpatient Brief Suicide Safety Assessment Guide

Correct answer: D. A lower motor neuron facial-weakness pattern involving CN VII, because the forehead and lower face are involved

Upper facial muscles usually receive motor input from both cerebral hemispheres. A supranuclear lesion therefore often spares forehead movement, whereas a lower motor neuron facial-weakness pattern involves the upper and lower face. This patient cannot wrinkle his forehead, so option A does not describe the observed pattern. Bell palsy can produce this pattern, but the pattern alone does not establish that diagnosis. The trigeminal nerve (B) carries facial sensation and chewing, and the hypoglossal nerve (C) moves the tongue. A pontine stroke can also produce a lower motor neuron facial-weakness pattern. Forehead involvement does not rule out stroke, and evaluation must consider the full presentation. Protect the eye that won't close.

Domain: Anatomy, Physiology, Pathophysiology, and Diagnosis · Topic: Infection and Immune Complications: Bell’s Palsy/Cranial Nerve Palsy · Item ID: CNRN-I-18
Source: MSD Manual Professional, Facial Nerve Palsy; Agarwal et al., Pontine stroke presenting as isolated facial nerve palsy mimicking Bell’s palsy: a case report; MSD Manual Professional, How To Assess the Cranial Nerves

Correct answer: B. Call for emergency help and the surgeon now, because an expanding hematoma may be compressing the airway.

A hematoma after anterior cervical surgery can compress the airway quickly. Stridor with neck swelling is a sign of acute airway obstruction that needs urgent airway management and surgical evaluation for possible evacuation. Ice (A), analgesia (C), and waiting for rounds (D) all lose the minutes that matter. Know your unit's plan for post-ACDF airway emergencies before you need it.

Domain: Patient Management · Topic: Physiological Interventions: Surgical/Procedural Treatment and Management · Item ID: CNRN-II-10
Source: Song et al., Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion

Correct answer: C. Notify the prescriber urgently about possible withdrawal-emergent hyperpyrexia and confusion, and ask how dopaminergic therapy can be resumed.

Carbidopa-levodopa labels warn of a syndrome resembling neuroleptic malignant syndrome, with high fever, rigidity, altered consciousness, and autonomic instability, after rapid dose reduction or withdrawal of dopaminergic therapy. This is urgent. The prescriber needs to know now, and restarting therapy by a workable route is part of the plan. Acetaminophen alone (A) treats a number, not the cause. Restraints (B) add danger in a rigid, hyperthermic patient. Requesting haloperidol (D) does not address the medication interruption; the label specifically calls for close observation when levodopa is reduced or stopped, particularly in patients receiving neuroleptics.

Domain: Patient Management · Topic: Physiological Interventions: Pharmacological Management · Item ID: CNRN-I-23
Source: SINEMET (carbidopa and levodopa) label (DailyMed)

Correct answer: C. 75%

Use the eligible records as the denominator: 18 ÷ 24 = 0.75, or 75%. Every eligible record was reviewed and none were missing, so no adjustment is needed. Check it by multiplying back: 0.75 × 24 = 18. This is an invented example. The rate measures documentation of a process, not whether patients understood or whether outcomes improved.

Domain: Multidisciplinary Care · Topic: Health Care Management: Multidisciplinary Collaboration, Quality Improvement, and Outcome Evaluation · Item ID: CNRN-III-08
Source: AHRQ Health Literacy Universal Precautions Toolkit, third edition

Correct answer: A. Gently turn the patient onto one side, clear hazards, cushion the head, and time the seizure.

CDC seizure first aid for a generalized seizure: gently turn the person onto one side to keep the airway clear, clear the space around them, put something soft under the head, loosen anything around the neck, and time the seizure. Nothing goes in the mouth (B), because it can injure the teeth or jaw, and people cannot swallow their tongue. Restraining movements (C) can cause injury. Food and drink (D) wait until the person is fully alert.

Domain: Patient Management · Topic: Safety Interventions: Environmental Safety Management · Item ID: CNRN-II-16
Source: CDC, First Aid for Seizures

Correct answer: D. Intermittent pneumatic compression (IPC)

Graduated knee- or thigh-high compression stockings alone are not effective DVT prophylaxis, and intermittent pneumatic compression starting on the day of diagnosis is recommended instead. Bed rest with the legs up (B) is not prophylaxis. Massaging legs (C) is not a recommended prevention method. Decisions about adding anticoagulant prophylaxis later belong to the team.

Domain: Patient Management · Topic: Physiological Interventions: Activity and Self-Care · Item ID: CNRN-II-11
Source: AHA, 2022 Spontaneous ICH Guideline: Top Things to Know; AHA, New guideline refines care for brain bleeds

Correct answer: B. Take the child to an emergency department now for possible shunt malfunction.

Shunts can block or become infected, and a blockage causes the symptoms of hydrocephalus, such as headache, vomiting, and drowsiness. This combination needs emergency assessment now; an obstructed shunt may require urgent surgical repair. Extreme sleepiness and vomiting are among the reasons MedlinePlus lists for emergency care. Assuming a stomach virus (A) or waiting a week (C) risks brain injury. Pressing or pumping the shunt at home (D) cannot replace emergency assessment and neurosurgical evaluation.

Domain: Patient Management · Topic: Safety Interventions: Neurological Status and Decline · Item ID: CNRN-II-18
Source: MedlinePlus, Hydrocephalus: possible complications; NHS, Hydrocephalus: complications