CNRN PRACTICE EXAM WITH VERIFIED QUESTIONS AND ANSWERS| 2026
LATEST UPLOAD| GRADED A+
A patient with a known seizure disorder is admitted to the hospital with altered mental
status. His phenytoin (Dilantin) level is 35.6. What is the most appropriate action? -
correct answer-Hold phenytoin and rec heck a level the next day; a normal level 10-20
mcg/mL. Supratherapeutic levels can cause confusion, nausea, urticaria, nystagmus,
hypotension, and cardiac arrhythmias.
Which of the following are sources of an embolic stroke? - correct answer-Patent
foramen ovale; A patent foramen ovale (PFO) is a hole between the left and right atria
of the heart. It normally closes shortly after birth. This condition may cause the
formation of clots which can travel to the brain leading to a transient ischemic attack or
stroke. Tx-antiplatelet meds or blood thinners. HTN, obesity and HDL are risk factors for
thrombotic stroke.
A patient c/o of a headache for the past several wks is dx with a subacute subdural
hematoma. Which of the following is not an appropriate course of action? - correct
answer-Administer levetiracetam (Keppra); Antiepileptic drugs are not indicated for
subacute hemorrhagic brain injuries. The greatest risk of seizure is in the first two
weeks following the incident. If no seizure has occurred during this time then
antiepileptic drugs do not need to be prescribed for the patient.
Which of the following regarding astrocytomas is NOT correct? - correct answer-Grace
IV astrocytomas are benign; Astrocytomas arise from astrocytes, which are a type of
glial cell; they are the most common glial tumor. Surgical resection in conjunction with
chemotherapy and radiation are common treatments. Grade I and II are generally
benign slow growing tumors seen in children, whereas grades III and IV are malignant
and typically seen in adults.
A pt is dx with amyotrophic lateral sclerosis (ALS) and the pt's wife is concerned abt
their children developing this condition. Which of the following is an appropriate
response? - correct answer-Its etiology is unknown; this neuromuscular degenerative
disease occurs at random with no clearly associated risk factors. Individuals with this
sporadic form of the disease do not have a family history of ALS, and their family
members not considered to be at increased risk for developing it. In a small majority of
cases occur with a family hx of this disease. Multiple gene mutations are involved with
developing this condition.
A pt presents with unilateral sharp, throbbing HA associated with eye pain and watering.
What is the most likely dx? - correct answer-Cluster headache; due to unknown
etiology. They are characterized by unilateral symptoms that may involve the eye on the
ipsilateral side. Tx-triptan drugs, calcium channel blockers, and steroids.
A child is born with dozens of cafe-au-lait spots and axillary freckling. What is the most
likely dx? - correct answer-Neurofibromatosis; occurs d/t a genetic defect, which causes
, tumors to arise from nerve cells. Complications that may occur from this disorder
include deafness, HTN, seizures, hydrocephalus, scoliosis, pathologic fxs, kyphosis,
and vision problems. Common signs and symptoms include light brown spots on the
skin alled cafe-au-lait spots, abnormal development of the spin, skull, or long bones,
freckling in the are of the armpit or the groin. and disturbances in balance.
A child with spinal bifida develops worsening headaches and visual problems. An MRI
of the brain reveals herniation of the brainstem and lower part of the cerebellum
extending into the foramen magnum. Which type of Chiari malformation does this
condition describe? - correct answer-Type II; the most common type of Chiari
malformation. Type I is where the lower part of the cerebellum, but not the brainstem
extends into the foramen magnum. Type III is where part of the cerebellum and the
brainstem extend through the foramen magnum into the spinal cord causing severe
neurologic impairment. Chiari malformation type IV is not associated with herniation of
the brain through the foramen magnum; it involves an underdeveloped cerebellum. This
type is usually fatal in infancy.
Which of the following is the most common presenting symptom for Chiari
malformation? - correct answer-Occipital headaches; caused by the herniation of the
brain through the skull base. Other signs and symptoms include diplopia, nystagmus,
visual changes, and balance difficulties.
A pt presenting with dysarthria and lethargy is being evaluated in the ER for possible
stroke. The pt has Glasgow Coma Scale (GCS) of 12, BP of 150/72, pulse ox of 96% on
room air, BG of 43, and pt scores a 9 on the NIHSS. What is the best next step in
intervention? - correct answer-Administer D50; if the pt's neurological exam doesn't
improve once the BG normalizes, then obtaining a CT of the head would be appropriate.
If the CT of the head is negative then administering tPA would be the next step if there
are no contraindications (and the BG has stabilized). The pt's GCS is 12; not sufficiently
low enough to warrant intubation.
Which of the following is true regarding multiple sclerosis (MS)? - correct answer-MS is
an autoimmune disease; A chronic progressive autoimmune disease that attacks the
myelin sheath of nerve cells. It can occur at any point in life but is most common in the
third and fifth decades of life. It can affect either sex, but affects women more than men.
There is no cure but immunosuppressive meds, muscle relaxers, and steroids may help
with symptomatic relief of acute flare-ups. For unknown reasons it is more common to
people indigenous to temperate climates such as the United States and Europe.
Which of the following conditions involves chronic widespread pain and a heightened
response to pressure? - correct answer-Fibromyalgia; with unknown etiology
characterized by chronic pain. Other s/s may include dysphagia, sleep disturbances,
and bowel and bladder disturbances. Labs and imaging studies are normal. This
condition is often associated with depression and anxiety. There a wide range of txs for
this disorder including anti-depressant and anti-anxiety meds, lifestyle changes to limit
stress, bowel regiments, elimination of gluten, acupuncture, and sleep aids.
LATEST UPLOAD| GRADED A+
A patient with a known seizure disorder is admitted to the hospital with altered mental
status. His phenytoin (Dilantin) level is 35.6. What is the most appropriate action? -
correct answer-Hold phenytoin and rec heck a level the next day; a normal level 10-20
mcg/mL. Supratherapeutic levels can cause confusion, nausea, urticaria, nystagmus,
hypotension, and cardiac arrhythmias.
Which of the following are sources of an embolic stroke? - correct answer-Patent
foramen ovale; A patent foramen ovale (PFO) is a hole between the left and right atria
of the heart. It normally closes shortly after birth. This condition may cause the
formation of clots which can travel to the brain leading to a transient ischemic attack or
stroke. Tx-antiplatelet meds or blood thinners. HTN, obesity and HDL are risk factors for
thrombotic stroke.
A patient c/o of a headache for the past several wks is dx with a subacute subdural
hematoma. Which of the following is not an appropriate course of action? - correct
answer-Administer levetiracetam (Keppra); Antiepileptic drugs are not indicated for
subacute hemorrhagic brain injuries. The greatest risk of seizure is in the first two
weeks following the incident. If no seizure has occurred during this time then
antiepileptic drugs do not need to be prescribed for the patient.
Which of the following regarding astrocytomas is NOT correct? - correct answer-Grace
IV astrocytomas are benign; Astrocytomas arise from astrocytes, which are a type of
glial cell; they are the most common glial tumor. Surgical resection in conjunction with
chemotherapy and radiation are common treatments. Grade I and II are generally
benign slow growing tumors seen in children, whereas grades III and IV are malignant
and typically seen in adults.
A pt is dx with amyotrophic lateral sclerosis (ALS) and the pt's wife is concerned abt
their children developing this condition. Which of the following is an appropriate
response? - correct answer-Its etiology is unknown; this neuromuscular degenerative
disease occurs at random with no clearly associated risk factors. Individuals with this
sporadic form of the disease do not have a family history of ALS, and their family
members not considered to be at increased risk for developing it. In a small majority of
cases occur with a family hx of this disease. Multiple gene mutations are involved with
developing this condition.
A pt presents with unilateral sharp, throbbing HA associated with eye pain and watering.
What is the most likely dx? - correct answer-Cluster headache; due to unknown
etiology. They are characterized by unilateral symptoms that may involve the eye on the
ipsilateral side. Tx-triptan drugs, calcium channel blockers, and steroids.
A child is born with dozens of cafe-au-lait spots and axillary freckling. What is the most
likely dx? - correct answer-Neurofibromatosis; occurs d/t a genetic defect, which causes
, tumors to arise from nerve cells. Complications that may occur from this disorder
include deafness, HTN, seizures, hydrocephalus, scoliosis, pathologic fxs, kyphosis,
and vision problems. Common signs and symptoms include light brown spots on the
skin alled cafe-au-lait spots, abnormal development of the spin, skull, or long bones,
freckling in the are of the armpit or the groin. and disturbances in balance.
A child with spinal bifida develops worsening headaches and visual problems. An MRI
of the brain reveals herniation of the brainstem and lower part of the cerebellum
extending into the foramen magnum. Which type of Chiari malformation does this
condition describe? - correct answer-Type II; the most common type of Chiari
malformation. Type I is where the lower part of the cerebellum, but not the brainstem
extends into the foramen magnum. Type III is where part of the cerebellum and the
brainstem extend through the foramen magnum into the spinal cord causing severe
neurologic impairment. Chiari malformation type IV is not associated with herniation of
the brain through the foramen magnum; it involves an underdeveloped cerebellum. This
type is usually fatal in infancy.
Which of the following is the most common presenting symptom for Chiari
malformation? - correct answer-Occipital headaches; caused by the herniation of the
brain through the skull base. Other signs and symptoms include diplopia, nystagmus,
visual changes, and balance difficulties.
A pt presenting with dysarthria and lethargy is being evaluated in the ER for possible
stroke. The pt has Glasgow Coma Scale (GCS) of 12, BP of 150/72, pulse ox of 96% on
room air, BG of 43, and pt scores a 9 on the NIHSS. What is the best next step in
intervention? - correct answer-Administer D50; if the pt's neurological exam doesn't
improve once the BG normalizes, then obtaining a CT of the head would be appropriate.
If the CT of the head is negative then administering tPA would be the next step if there
are no contraindications (and the BG has stabilized). The pt's GCS is 12; not sufficiently
low enough to warrant intubation.
Which of the following is true regarding multiple sclerosis (MS)? - correct answer-MS is
an autoimmune disease; A chronic progressive autoimmune disease that attacks the
myelin sheath of nerve cells. It can occur at any point in life but is most common in the
third and fifth decades of life. It can affect either sex, but affects women more than men.
There is no cure but immunosuppressive meds, muscle relaxers, and steroids may help
with symptomatic relief of acute flare-ups. For unknown reasons it is more common to
people indigenous to temperate climates such as the United States and Europe.
Which of the following conditions involves chronic widespread pain and a heightened
response to pressure? - correct answer-Fibromyalgia; with unknown etiology
characterized by chronic pain. Other s/s may include dysphagia, sleep disturbances,
and bowel and bladder disturbances. Labs and imaging studies are normal. This
condition is often associated with depression and anxiety. There a wide range of txs for
this disorder including anti-depressant and anti-anxiety meds, lifestyle changes to limit
stress, bowel regiments, elimination of gluten, acupuncture, and sleep aids.
