ADULT CCRN CERTIFICATION
MODULE 5
NEUROLOGICAL
4 PRACTICE TESTS
2024
1. A patient with a severe head injury is admitted to the ICU. The nurse
suspects that the patient has damage to the brainstem based on which of the
following findings?
a) Loss of corneal reflex
b) Decorticate posturing
c) Dilated and fixed pupils *
d) Cheyne-Stokes breathing
Rationale: Dilated and fixed pupils indicate damage to the cranial nerve III,
which originates from the midbrain, a part of the brainstem. Loss of corneal
reflex is due to damage to the cranial nerve V, which originates from the pons,
another part of the brainstem, but it is not as specific as pupil changes.
Decorticate posturing and Cheyne-Stokes breathing are signs of damage to the
cerebral hemispheres or the diencephalon, not the brainstem.
2. A patient with a subarachnoid hemorrhage has a Glasgow Coma Scale score
of 8. The nurse performs a neurologic assessment and finds that the patient
has no response to painful stimuli, except for extension and internal rotation
of the arms and legs. The nurse documents this as:
a) Decerebrate posturing *
b) Decorticate posturing
c) Flaccid paralysis
d) Spastic paralysis
Rationale: Decerebrate posturing is characterized by extension and internal
rotation of the arms and legs in response to painful stimuli. It indicates
,damage to the midbrain or upper pons, which causes loss of cortical inhibition
of the brainstem reflexes. Decorticate posturing is characterized by flexion of
the arms and extension of the legs in response to painful stimuli. It indicates
damage to the cerebral hemispheres or the diencephalon, which causes loss of
cortical inhibition of the red nucleus. Flaccid paralysis is characterized by
absence of any movement in response to painful stimuli. It indicates damage
to the lower motor neurons or peripheral nerves. Spastic paralysis is
characterized by increased muscle tone and exaggerated reflexes in response
to painful stimuli. It indicates damage to the upper motor neurons.
3. A patient with a brain tumor has increased intracranial pressure (ICP) due to
cerebral edema. The nurse monitors the patient's intracranial pressure using a
ventriculostomy device and observes that the pressure waveform shows a
sharp rise during expiration and a sharp fall during inspiration. The nurse
recognizes this as:
a) Normal ICP waveform
b) Plateau wave
c) Lundberg A wave *
d) Lundberg B wave
Rationale: Lundberg A wave, also known as pulse synchronous wave or plateau
wave, is a type of abnormal ICP waveform that shows a sharp rise during
expiration and a sharp fall during inspiration. It reflects increased resistance
to cerebrospinal fluid (CSF) outflow due to impaired compliance of the
intracranial compartment. It indicates severe elevation of ICP and impending
herniation. Normal ICP waveform shows a smooth curve that follows the
cardiac cycle, with a peak during systole and a trough during diastole. Plateau
wave is another term for Lundberg A wave. Lundberg B wave is another type of
abnormal ICP waveform that shows rhythmic oscillations with a frequency of
0.5 to 2 Hz and an amplitude of 5 to 15 mmHg. It reflects fluctuations in
cerebral blood flow due to impaired autoregulation.
4. A patient with a stroke affecting the right cerebral hemisphere has left-
sided hemiplegia and hemianopia. The nurse also notices that the patient has
difficulty recognizing familiar faces and objects. The nurse understands that
this is due to damage to which area of the brain?
a) Broca's area
b) Wernicke's area
c) Occipital lobe
,d) Temporal lobe *
Rationale: The temporal lobe is responsible for processing visual information,
such as faces and objects, and storing it in long-term memory. Damage to this
area can cause prosopagnosia (inability to recognize faces) and visual agnosia
(inability to recognize objects). Broca's area is located in the frontal lobe and
is responsible for speech production. Damage to this area can cause expressive
aphasia (inability to speak fluently). Wernicke's area is located in the temporal
lobe and is responsible for speech comprehension. Damage to this area can
cause receptive aphasia (inability to understand spoken or written language).
The occipital lobe is responsible for processing visual information, such as
color, shape, and motion. Damage to this area can cause homonymous
hemianopia (loss of vision in the same half of the visual field in both eyes).
5. A patient with a meningioma has a craniotomy to remove the tumor. The
nurse monitors the patient's neurologic status postoperatively and observes
that the patient has difficulty moving the right side of the face, drooling from
the right corner of the mouth, and decreased sensation on the right side of the
tongue. The nurse suspects that the patient has damage to which cranial
nerve?
a) Cranial nerve V (trigeminal)
b) Cranial nerve VII (facial) *
c) Cranial nerve IX (glossopharyngeal)
d) Cranial nerve XII (hypoglossal)
Rationale: Cranial nerve VII (facial) innervates the muscles of facial
expression, the lacrimal and salivary glands, and the anterior two-thirds of the
tongue. Damage to this nerve can cause facial weakness or paralysis, drooling,
dry eye, and decreased taste sensation on the affected side. Cranial nerve V
(trigeminal) innervates the muscles of mastication and provides sensory
innervation to the face, scalp, cornea, and oral cavity. Damage to this nerve
can cause loss of corneal reflex, facial numbness or pain, and difficulty
chewing. Cranial nerve IX (glossopharyngeal) innervates the pharyngeal
muscles, the parotid gland, and the posterior one-third of the tongue. Damage
to this nerve can cause loss of gag reflex, impaired swallowing, dry mouth, and
decreased taste sensation on the affected side. Cranial nerve XII (hypoglossal)
innervates the muscles of the tongue. Damage to this nerve can cause tongue
weakness or atrophy, impaired speech, and deviation of the tongue to the
affected side.
6. A patient with a history of hypertension and diabetes mellitus has a
, transient ischemic attack (TIA) affecting the left middle cerebral artery. The
nurse assesses the patient's neurologic status and finds that the patient has
right-sided weakness, slurred speech, and confusion. The nurse administers
aspirin as prescribed and educates the patient about the risk factors and
prevention of stroke. The nurse explains that a TIA is:
a) A temporary interruption of blood flow to a part of the brain *
b) A permanent damage to a part of the brain due to lack of oxygen
c) A bleeding into or around the brain due to a ruptured vessel
d) A swelling of the brain due to increased fluid accumulation
Rationale: A TIA is a temporary interruption of blood flow to a part of the
brain, resulting in transient neurologic deficits that usually resolve within 24
hours. It is often a warning sign of an impending stroke and requires prompt
medical attention and treatment. A stroke is a permanent damage to a part of
the brain due to lack of oxygen, either from a blocked or a ruptured vessel. It
causes lasting neurologic deficits that may or may not improve over time. A
hemorrhagic stroke is a bleeding into or around the brain due to a ruptured
vessel. It causes increased intracranial pressure and compression of brain
tissue. A cerebral edema is a swelling of the brain due to increased fluid
accumulation. It can be caused by various conditions, such as trauma,
infection, tumor, or stroke.
7. A patient with multiple sclerosis has optic neuritis affecting the left eye.
The nurse performs an ophthalmoscopic examination and observes that the
patient has blurred vision, reduced color perception, and pain with eye
movement. The nurse also performs a pupillary light reflex test and finds that
the patient has an abnormal response in both eyes. The nurse recognizes this
as:
a) Anisocoria
b) Marcus Gunn pupil *
c) Horner's syndrome
d) Argyll Robertson pupil
Rationale: Marcus Gunn pupil, also known as relative afferent pupillary defect
(RAPD), is an abnormal pupillary light reflex that occurs when there is damage
to the optic nerve or retina of one eye. When light is shone into the affected
eye, both pupils constrict less than when light is shone into the unaffected
eye. This is because there is less sensory input from the affected eye to
stimulate the oculomotor nerve, which controls pupillary constriction.
Anisocoria is an unequal size of pupils that can be caused by various
MODULE 5
NEUROLOGICAL
4 PRACTICE TESTS
2024
1. A patient with a severe head injury is admitted to the ICU. The nurse
suspects that the patient has damage to the brainstem based on which of the
following findings?
a) Loss of corneal reflex
b) Decorticate posturing
c) Dilated and fixed pupils *
d) Cheyne-Stokes breathing
Rationale: Dilated and fixed pupils indicate damage to the cranial nerve III,
which originates from the midbrain, a part of the brainstem. Loss of corneal
reflex is due to damage to the cranial nerve V, which originates from the pons,
another part of the brainstem, but it is not as specific as pupil changes.
Decorticate posturing and Cheyne-Stokes breathing are signs of damage to the
cerebral hemispheres or the diencephalon, not the brainstem.
2. A patient with a subarachnoid hemorrhage has a Glasgow Coma Scale score
of 8. The nurse performs a neurologic assessment and finds that the patient
has no response to painful stimuli, except for extension and internal rotation
of the arms and legs. The nurse documents this as:
a) Decerebrate posturing *
b) Decorticate posturing
c) Flaccid paralysis
d) Spastic paralysis
Rationale: Decerebrate posturing is characterized by extension and internal
rotation of the arms and legs in response to painful stimuli. It indicates
,damage to the midbrain or upper pons, which causes loss of cortical inhibition
of the brainstem reflexes. Decorticate posturing is characterized by flexion of
the arms and extension of the legs in response to painful stimuli. It indicates
damage to the cerebral hemispheres or the diencephalon, which causes loss of
cortical inhibition of the red nucleus. Flaccid paralysis is characterized by
absence of any movement in response to painful stimuli. It indicates damage
to the lower motor neurons or peripheral nerves. Spastic paralysis is
characterized by increased muscle tone and exaggerated reflexes in response
to painful stimuli. It indicates damage to the upper motor neurons.
3. A patient with a brain tumor has increased intracranial pressure (ICP) due to
cerebral edema. The nurse monitors the patient's intracranial pressure using a
ventriculostomy device and observes that the pressure waveform shows a
sharp rise during expiration and a sharp fall during inspiration. The nurse
recognizes this as:
a) Normal ICP waveform
b) Plateau wave
c) Lundberg A wave *
d) Lundberg B wave
Rationale: Lundberg A wave, also known as pulse synchronous wave or plateau
wave, is a type of abnormal ICP waveform that shows a sharp rise during
expiration and a sharp fall during inspiration. It reflects increased resistance
to cerebrospinal fluid (CSF) outflow due to impaired compliance of the
intracranial compartment. It indicates severe elevation of ICP and impending
herniation. Normal ICP waveform shows a smooth curve that follows the
cardiac cycle, with a peak during systole and a trough during diastole. Plateau
wave is another term for Lundberg A wave. Lundberg B wave is another type of
abnormal ICP waveform that shows rhythmic oscillations with a frequency of
0.5 to 2 Hz and an amplitude of 5 to 15 mmHg. It reflects fluctuations in
cerebral blood flow due to impaired autoregulation.
4. A patient with a stroke affecting the right cerebral hemisphere has left-
sided hemiplegia and hemianopia. The nurse also notices that the patient has
difficulty recognizing familiar faces and objects. The nurse understands that
this is due to damage to which area of the brain?
a) Broca's area
b) Wernicke's area
c) Occipital lobe
,d) Temporal lobe *
Rationale: The temporal lobe is responsible for processing visual information,
such as faces and objects, and storing it in long-term memory. Damage to this
area can cause prosopagnosia (inability to recognize faces) and visual agnosia
(inability to recognize objects). Broca's area is located in the frontal lobe and
is responsible for speech production. Damage to this area can cause expressive
aphasia (inability to speak fluently). Wernicke's area is located in the temporal
lobe and is responsible for speech comprehension. Damage to this area can
cause receptive aphasia (inability to understand spoken or written language).
The occipital lobe is responsible for processing visual information, such as
color, shape, and motion. Damage to this area can cause homonymous
hemianopia (loss of vision in the same half of the visual field in both eyes).
5. A patient with a meningioma has a craniotomy to remove the tumor. The
nurse monitors the patient's neurologic status postoperatively and observes
that the patient has difficulty moving the right side of the face, drooling from
the right corner of the mouth, and decreased sensation on the right side of the
tongue. The nurse suspects that the patient has damage to which cranial
nerve?
a) Cranial nerve V (trigeminal)
b) Cranial nerve VII (facial) *
c) Cranial nerve IX (glossopharyngeal)
d) Cranial nerve XII (hypoglossal)
Rationale: Cranial nerve VII (facial) innervates the muscles of facial
expression, the lacrimal and salivary glands, and the anterior two-thirds of the
tongue. Damage to this nerve can cause facial weakness or paralysis, drooling,
dry eye, and decreased taste sensation on the affected side. Cranial nerve V
(trigeminal) innervates the muscles of mastication and provides sensory
innervation to the face, scalp, cornea, and oral cavity. Damage to this nerve
can cause loss of corneal reflex, facial numbness or pain, and difficulty
chewing. Cranial nerve IX (glossopharyngeal) innervates the pharyngeal
muscles, the parotid gland, and the posterior one-third of the tongue. Damage
to this nerve can cause loss of gag reflex, impaired swallowing, dry mouth, and
decreased taste sensation on the affected side. Cranial nerve XII (hypoglossal)
innervates the muscles of the tongue. Damage to this nerve can cause tongue
weakness or atrophy, impaired speech, and deviation of the tongue to the
affected side.
6. A patient with a history of hypertension and diabetes mellitus has a
, transient ischemic attack (TIA) affecting the left middle cerebral artery. The
nurse assesses the patient's neurologic status and finds that the patient has
right-sided weakness, slurred speech, and confusion. The nurse administers
aspirin as prescribed and educates the patient about the risk factors and
prevention of stroke. The nurse explains that a TIA is:
a) A temporary interruption of blood flow to a part of the brain *
b) A permanent damage to a part of the brain due to lack of oxygen
c) A bleeding into or around the brain due to a ruptured vessel
d) A swelling of the brain due to increased fluid accumulation
Rationale: A TIA is a temporary interruption of blood flow to a part of the
brain, resulting in transient neurologic deficits that usually resolve within 24
hours. It is often a warning sign of an impending stroke and requires prompt
medical attention and treatment. A stroke is a permanent damage to a part of
the brain due to lack of oxygen, either from a blocked or a ruptured vessel. It
causes lasting neurologic deficits that may or may not improve over time. A
hemorrhagic stroke is a bleeding into or around the brain due to a ruptured
vessel. It causes increased intracranial pressure and compression of brain
tissue. A cerebral edema is a swelling of the brain due to increased fluid
accumulation. It can be caused by various conditions, such as trauma,
infection, tumor, or stroke.
7. A patient with multiple sclerosis has optic neuritis affecting the left eye.
The nurse performs an ophthalmoscopic examination and observes that the
patient has blurred vision, reduced color perception, and pain with eye
movement. The nurse also performs a pupillary light reflex test and finds that
the patient has an abnormal response in both eyes. The nurse recognizes this
as:
a) Anisocoria
b) Marcus Gunn pupil *
c) Horner's syndrome
d) Argyll Robertson pupil
Rationale: Marcus Gunn pupil, also known as relative afferent pupillary defect
(RAPD), is an abnormal pupillary light reflex that occurs when there is damage
to the optic nerve or retina of one eye. When light is shone into the affected
eye, both pupils constrict less than when light is shone into the unaffected
eye. This is because there is less sensory input from the affected eye to
stimulate the oculomotor nerve, which controls pupillary constriction.
Anisocoria is an unequal size of pupils that can be caused by various
