A 29-year-old woman, 2 weeks postpartum, had 4 days of worsening headache and then a seizure. Papilledema is present. CT venography shows superior sagittal sinus thrombosis with a small hemorrhagic venous infarct, and a heparin infusion is ordered. Her husband asks why a blood thinner is being given when there is bleeding. Which response by the nurse is accurate?

The clot blocks venous drainage and caused the bleed, so treating the clot treats the cause

Blood thinners are used only when the seizure is controlled, so the order will likely be changed

Heparin will be stopped as soon as the bleeding is seen on CT, so the risk lasts only a few hours

The bleeding is from the delivery, so heparin is safe because it only acts on clots in the legs

A 76-year-old with gait difficulty, urinary urgency with incontinence, and slowed thinking undergoes a large-volume lumbar tap test. CT shows ventricles enlarged out of proportion to sulcal atrophy. A timed 10-meter walk and a cognitive screen are recorded before and 3 hours after removal of 40 mL of CSF. Measure Before tap 3 hours after tap Time to walk 10 meters (seconds) 26 15 Number of steps 34 21 Montreal Cognitive Assessment score 21 23 How should the nurse interpret these results?

Gait improved markedly after CSF removal, which predicts benefit from a shunt

Gait shows no meaningful change, so shunting is unlikely to help this patient

The improvement shows obstructive hydrocephalus that needs an urgent ETV

The small cognitive change rules out normal pressure hydrocephalus as a cause

A 61-year-old woman is receiving targeted temperature management after cardiac arrest. She begins shivering, and her core temperature is drifting upward. Which action should the nurse take first?

Apply skin counterwarming to the hands and feet and give first-line agents

Give a neuromuscular blocker as the first measure to control shivering

Turn off the cooling device until all of the shivering has completely stopped

Raise the target temperature by 3 degrees Celsius to stop the shivering

A 9-year-old girl being treated for a concussion in the pediatric unit quietly tells the nurse that her mother's boyfriend pushed her down the stairs, and she begs the nurse not to tell anyone. Which response by the nurse is most appropriate?

Explain that she must tell people whose job is to keep her safe, and file a report

Wait to report until the boyfriend can be asked for his account of the injury

Ask the girl's mother whether the story is true before deciding what to do next

Promise to keep the secret so that she will keep trusting the nurse with problems

A 58-year-old woman with a large right hemisphere hemorrhage is mechanically ventilated on a mode that allows spontaneous breaths. The nurse documents the following respiratory findings over 4 hours. Her pupils are now midsized and poorly reactive. Time Pattern RR (breaths/min) PaCO2 (mm Hg) PaO2 (mm Hg) 09:00 Regular, rhythmic 16 39 104 11:00 Regular, deep 26 31 110 13:00 Sustained, deep, rapid, regular 34 24 112 Which interpretation of the 13:00 findings is most accurate?

Central neurogenic hyperventilation, suggesting dysfunction at the midbrain or upper pons

Cheyne-Stokes respiration, suggesting bilateral hemisphere or diencephalic dysfunction

Compensatory hyperventilation, suggesting worsening hypoxemia from pneumonia

Ataxic breathing, suggesting medullary damage and imminent respiratory arrest

A 12-year-old is comatose in the pediatric ICU after a drowning with return of spontaneous circulation. The order is to maintain a core temperature of 36 to 37.5 C with a surface cooling device. Six hours later, the core temperature is 38.3 C. Which action is most appropriate?

Adjust the cooling device per protocol and treat the fever promptly

Hold any temperature change until blood culture results are back

Remove the device so the child's own temperature control can resume

Document the fever as an expected response after cardiac arrest

A 38-year-old man comes to the emergency department during his third attack this week of excruciating pain behind the left eye with tearing, nasal congestion, and drooping of the left eyelid. He is pacing the room. The attacks last about 45 minutes and often wake him at night. Which treatment should the nurse anticipate first?

100% oxygen by nonrebreather mask at 12 to 15 L/min for 15 minutes

IV morphine titrated to pain relief with continuous pulse oximetry

A dark, quiet room with the patient lying still until the pain subsides

Oral ibuprofen 400 mg with a light snack and reassessment in 2 hours

A 50-year-old woman is on day 5 after aneurysmal subarachnoid hemorrhage. Her temperature is 38.7 C. Which nursing action is most appropriate?

Give the ordered antipyretic, start surface cooling, and assess for infection

Wait until her temperature is above 39.5 C before starting any kind of treatment

Allow the fever to continue, because it helps the body fight off infection

Apply a hypothermia blanket set to bring her temperature down to 33 C

A 31-year-old woman is in the ED with a concussion that she says happened when she "walked into a door." Her partner stays at the bedside and declines to step out. Which approach should the nurse use to screen for intimate partner violence?

Find a reason to see her alone, then ask directly and privately about her safety

Skip the screening, since she gave a clear explanation of how the injury happened

Ask about violence at the bedside, because her partner's presence may comfort her

Give her partner a pamphlet on domestic violence resources to take home with them

CNRN Exam

Free CNRN Practice Questions

10 sample questions for the CNRN Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Neuroanatomy and Diagnostics, Trauma, Neuro-Oncology, Infection, Immune and Neurodegenerative Disorders, Cerebrovascular Disorders, Behavioral Interventions, Safety Interventions, Quality of Life.

Question 1 · Neuroanatomy and Diagnostics

A 47-year-old man is brought to the emergency department after a motorcycle crash. The nurse records the following best responses during the first neurological assessment.

Component	Best response observed
Eye opening	Opens eyes only to fingertip pressure on the nail bed
Verbal	Moans and groans with no recognizable words
Motor	Flexes arms slowly toward the chest with wrists bent and legs extended

Based on the findings, which interpretation is accurate?

A.GCS 9, in the severe range; prepare for intubation to protect the airway
B.GCS 7, in the moderate range; repeat the check in one hour before acting
C.GCS 8, in the moderate range; continue hourly checks and supplemental oxygen
D.GCS 7, in the severe range; prepare for intubation to protect the airway

Show answer and explanation

Answer: D. GCS 7, in the severe range; prepare for intubation to protect the airway

Eye opening to pressure scores 2, incomprehensible sounds score 2, and abnormal (decorticate) flexion scores 3, for a total of 7. A GCS of 8 or less defines severe traumatic brain injury and signals loss of airway protection, so intubation is anticipated. Withdrawal would score 4, and a GCS of 9 to 12 is moderate, not severe.

Question 2 · Neuro-Oncology
A 29-year-old woman, 2 weeks postpartum, had 4 days of worsening headache and then a seizure. Papilledema is present. CT venography shows superior sagittal sinus thrombosis with a small hemorrhagic venous infarct, and a heparin infusion is ordered. Her husband asks why a blood thinner is being given when there is bleeding. Which response by the nurse is accurate?
- A.The clot blocks venous drainage and caused the bleed, so treating the clot treats the cause
- B.Blood thinners are used only when the seizure is controlled, so the order will likely be changed
- C.Heparin will be stopped as soon as the bleeding is seen on CT, so the risk lasts only a few hours
- D.The bleeding is from the delivery, so heparin is safe because it only acts on clots in the legs
Show answer and explanation
Answer: A. The clot blocks venous drainage and caused the bleed, so treating the clot treats the cause
In cerebral venous sinus thrombosis, the hemorrhage results from venous congestion behind the occluded sinus. Current guidelines support anticoagulation with heparin even when a hemorrhagic venous infarct is present, because it halts clot propagation and relieves the cause. Postpartum and other prothrombotic states are common risk factors.
Question 3 · Infection, Immune and Neurodegenerative Disorders
A 76-year-old with gait difficulty, urinary urgency with incontinence, and slowed thinking undergoes a large-volume lumbar tap test. CT shows ventricles enlarged out of proportion to sulcal atrophy. A timed 10-meter walk and a cognitive screen are recorded before and 3 hours after removal of 40 mL of CSF.
Measure Before tap 3 hours after tap
Time to walk 10 meters (seconds) 26 15
Number of steps 34 21
Montreal Cognitive Assessment score 21 23
How should the nurse interpret these results?
- A.Gait shows no meaningful change, so shunting is unlikely to help this patient
- B.The improvement shows obstructive hydrocephalus that needs an urgent ETV
- C.Gait improved markedly after CSF removal, which predicts benefit from a shunt
- D.The small cognitive change rules out normal pressure hydrocephalus as a cause
Show answer and explanation
Answer: C. Gait improved markedly after CSF removal, which predicts benefit from a shunt
Walking time fell from 26 to 15 seconds (about 42% faster) with 13 fewer steps, a clear positive tap test that predicts response to ventriculoperitoneal shunting in normal pressure hydrocephalus. Gait responds earliest and most reliably, so a modest cognitive change does not exclude the diagnosis. NPH is a communicating hydrocephalus, whereas endoscopic third ventriculostomy is used for obstructive (noncommunicating) hydrocephalus.
Question 4 · Behavioral Interventions
A 61-year-old woman is receiving targeted temperature management after cardiac arrest. She begins shivering, and her core temperature is drifting upward. Which action should the nurse take first?
- A.Apply skin counterwarming to the hands and feet and give first-line agents
- B.Give a neuromuscular blocker as the first measure to control shivering
- C.Turn off the cooling device until all of the shivering has completely stopped
- D.Raise the target temperature by 3 degrees Celsius to stop the shivering
Show answer and explanation
Answer: A. Apply skin counterwarming to the hands and feet and give first-line agents
Shivering raises metabolic demand and fights the target temperature. A stepwise protocol starts with skin counterwarming plus first-line agents such as acetaminophen, buspirone and magnesium, then escalates to sedation, opioids such as meperidine, and finally neuromuscular blockade. Stopping cooling or changing the target without an order abandons the treatment plan.
Question 5 · Safety Interventions
A 9-year-old girl being treated for a concussion in the pediatric unit quietly tells the nurse that her mother's boyfriend pushed her down the stairs, and she begs the nurse not to tell anyone. Which response by the nurse is most appropriate?
- A.Explain that she must tell people whose job is to keep her safe, and file a report
- B.Wait to report until the boyfriend can be asked for his account of the injury
- C.Ask the girl's mother whether the story is true before deciding what to do next
- D.Promise to keep the secret so that she will keep trusting the nurse with problems
Show answer and explanation
Answer: A. Explain that she must tell people whose job is to keep her safe, and file a report
A child's disclosure creates reasonable suspicion, and nurses are mandatory reporters, so the nurse reports to child protective services per law and policy and tells the child honestly that safety helpers must be told. Promising secrecy cannot be kept and breaks trust later. Questioning the suspected abuser or the mother first can put the child at greater risk, and the nurse's duty to report cannot be delayed or handed off.
Question 6 · Neuroanatomy and Diagnostics
A 58-year-old woman with a large right hemisphere hemorrhage is mechanically ventilated on a mode that allows spontaneous breaths. The nurse documents the following respiratory findings over 4 hours. Her pupils are now midsized and poorly reactive.
Time Pattern RR (breaths/min) PaCO2 (mm Hg) PaO2 (mm Hg)
09:00 Regular, rhythmic 16 39 104
11:00 Regular, deep 26 31 110
13:00 Sustained, deep, rapid, regular 34 24 112
Which interpretation of the 13:00 findings is most accurate?
- A.Cheyne-Stokes respiration, suggesting bilateral hemisphere or diencephalic dysfunction
- B.Compensatory hyperventilation, suggesting worsening hypoxemia from pneumonia
- C.Ataxic breathing, suggesting medullary damage and imminent respiratory arrest
- D.Central neurogenic hyperventilation, suggesting dysfunction at the midbrain or upper pons
Show answer and explanation
Answer: D. Central neurogenic hyperventilation, suggesting dysfunction at the midbrain or upper pons
Sustained, regular, rapid and deep breathing with low PaCO2 despite good oxygenation is central neurogenic hyperventilation, linked to midbrain or upper pontine injury, and with midsized fixed pupils it signals downward herniation. Cheyne-Stokes breathing waxes and wanes with apneic pauses, and ataxic breathing is completely irregular. The rising PaO2 rules out hypoxemia as the driver.
Question 7 · Neuro-Oncology
A 12-year-old is comatose in the pediatric ICU after a drowning with return of spontaneous circulation. The order is to maintain a core temperature of 36 to 37.5 C with a surface cooling device. Six hours later, the core temperature is 38.3 C. Which action is most appropriate?
- A.Hold any temperature change until blood culture results are back
- B.Adjust the cooling device per protocol and treat the fever promptly
- C.Remove the device so the child's own temperature control can resume
- D.Document the fever as an expected response after cardiac arrest
Show answer and explanation
Answer: B. Adjust the cooling device per protocol and treat the fever promptly
After cardiac arrest, fever increases cerebral metabolic demand and worsens secondary anoxic brain injury, so targeted temperature management in children and adults includes strict fever prevention. The nurse adjusts the device per protocol, notifies the team and manages shivering. Cultures may be drawn, but temperature control should not wait for results.
Question 8 · Infection, Immune and Neurodegenerative Disorders
A 38-year-old man comes to the emergency department during his third attack this week of excruciating pain behind the left eye with tearing, nasal congestion, and drooping of the left eyelid. He is pacing the room. The attacks last about 45 minutes and often wake him at night. Which treatment should the nurse anticipate first?
- A.IV morphine titrated to pain relief with continuous pulse oximetry
- B.100% oxygen by nonrebreather mask at 12 to 15 L/min for 15 minutes
- C.A dark, quiet room with the patient lying still until the pain subsides
- D.Oral ibuprofen 400 mg with a light snack and reassessment in 2 hours
Show answer and explanation
Answer: B. 100% oxygen by nonrebreather mask at 12 to 15 L/min for 15 minutes
Unilateral orbital pain with ipsilateral autonomic signs, restlessness, and nocturnal attacks lasting under 3 hours describes cluster headache, and high-flow oxygen (or subcutaneous sumatriptan) is first-line acute therapy. Lying still in a dark room suits migraine, oral analgesics act too slowly for attacks this short, and opioids are not recommended for primary headache disorders.
Question 9 · Behavioral Interventions
A 50-year-old woman is on day 5 after aneurysmal subarachnoid hemorrhage. Her temperature is 38.7 C. Which nursing action is most appropriate?
- A.Give the ordered antipyretic, start surface cooling, and assess for infection
- B.Wait until her temperature is above 39.5 C before starting any kind of treatment
- C.Allow the fever to continue, because it helps the body fight off infection
- D.Apply a hypothermia blanket set to bring her temperature down to 33 C
Show answer and explanation
Answer: A. Give the ordered antipyretic, start surface cooling, and assess for infection
Fever after SAH and other acute brain injuries increases cerebral metabolic demand and ICP and is linked to vasospasm and worse outcomes, so normothermia is the goal: antipyretics, surface or intravascular cooling, and a search for infection. Waiting for higher fever increases fever burden. Inducing 33 C hypothermia is not the goal and causes shivering and other complications.
Question 10 · Safety Interventions
A 31-year-old woman is in the ED with a concussion that she says happened when she "walked into a door." Her partner stays at the bedside and declines to step out. Which approach should the nurse use to screen for intimate partner violence?
- A.Skip the screening, since she gave a clear explanation of how the injury happened
- B.Ask about violence at the bedside, because her partner's presence may comfort her
- C.Find a reason to see her alone, then ask directly and privately about her safety
- D.Give her partner a pamphlet on domestic violence resources to take home with them
Show answer and explanation
Answer: C. Find a reason to see her alone, then ask directly and privately about her safety
Screening for intimate partner violence must be done privately, for example during a procedure, imaging, or a urine collection, because asking in front of a possible abuser endangers the patient and discourages disclosure. Head and facial injuries with a vague explanation call for screening. Resources should go to the patient discreetly, not to the partner.

Measure	Before tap	3 hours after tap
Time to walk 10 meters (seconds)	26	15
Number of steps	34	21
Montreal Cognitive Assessment score	21	23

Time	Pattern	RR (breaths/min)	PaCO2 (mm Hg)	PaO2 (mm Hg)
09:00	Regular, rhythmic	16	39	104
11:00	Regular, deep	26	31	110
13:00	Sustained, deep, rapid, regular	34	24	112

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