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WorksheetsCNRN Exam 2 Part 5
Total questions: 50
Worksheet time: 25mins
The definitive treatment for a high-flow spinal arteriovenous fistula is:
Steroids only
Endovascular embolization or surgical ligation of feeding arteries
Chronic anticoagulation
Physical therapy alone
Low-back pain referrals should include all EXCEPT:
Weight-bearing X-rays if red-flag signs are present
Early MRI for any chronic pain > 2 weeks
Discogram only for surgical planning
Conservative management for most acute pain
Which is a primary brain injury?
Cerebral edema from hypoxia
Subdural hematoma from torn bridging veins at impact
Ischemia from hypotension hours later
Neurotoxicity from free radicals
A GCS of 7 after resuscitation indicates:
Mild TBI
Moderate TBI
Severe TBI
Concussion only
The leading cause of TBI in people over 65 in the U.S. is:
Motor vehicle crashes
Falls
Sports injuries
Assault
Coup-contrecoup contusions result from:
Rotational forces only
Direct impact and rebound-impact injuries
Penetrating trauma
Post-traumatic seizures
An epidural hematoma typically arises from:
Tearing of bridging veins
Rupture of the middle meningeal artery
Cavernoma bleed
Dural venous sinus tear
The classic “talk-and-die” lucid interval occurs in:
Acute SDH
EDH
SAH
Contusion
Diffuse axonal injury is best detected by:
Noncontrast CT
Conventional MRI
Diffusion-tensor MRI
Angiography
Initial management in severe TBI includes maintaining PaO₂ > 100 mmHg and PaCO₂:
< 25 mmHg
25–35 mmHg
35–45 mmHg
45 mmHg
ICP monitoring is indicated when GCS ≤ 8 PLUS:
Normal head CT
Age < 40 and stable vitals
Abnormal CT or two risk factors (e.g., older than 40, SBP < 90)
Single focal deficit only
For ICP > 20 mmHg, first-tier interventions include all EXCEPT:
Elevate the head to 30°
Neutral neck alignment
Mannitol or hypertonic saline
Barbiturate coma
Prolonged prophylactic hyperventilation (PaCO₂ < 25 mmHg) in TBI:
Improves long-term outcome
Risks cerebral ischemia
It is recommended for the first 48 hours
Reduces ICP without risk
Fever after TBI worsens outcome by:
Increasing CMRO₂ and ICP
Lowering PaO₂
Raising seizure threshold
Reducing cerebral blood volume
The Bedside Shivering Assessment Scale (BSAS) grade 3 indicates:
No shivering
Mild, neck/torso only
Moderate, upper limbs
Severe, whole-body
VTE prophylaxis in acute TBI should include:
Early LMWH plus pneumatic compression
No prophylaxis until day 14
IPC devices only
IVC filter in all cases
Paroxysmal sympathetic hyperactivity (“storming”) presents with all EXCEPT:
Intermittent hypertension
Bradypnea
Tachycardia
Hyperthermia
Post-concussion syndrome lasting > 3 months is best managed by:
High-dose steroids
Cognitive and vestibular rehabilitation
No treatment—prognosis is poor
Immediate re-imaging every week
Second-impact syndrome refers to:
Re-bleeding of a contusion at day 2
Rapid, fatal cerebral edema after the second concussion, before full recovery
New hemorrhage from an anticoagulated stroke patient
Late seizure recurrence
Decompressive craniectomy in refractory intracranial hypertension:
Does not affect the outcome
Lowers mortality but increases severe disability
Is contraindicated
Works immediately as an osmotic agent
The fracture pattern characterized by failure of the posterior elements under axial load and retropulsion of bone into the canal is a:
Compression (wedge) fracture
Burst fracture
Flexion–distraction fracture
Fracture-dislocation
A flexion-distraction injury (Chance fracture) most often results from:
High-speed head-on MVC with lap belt restraint
Hyperextension from a rear-end collision
A fall onto the buttocks
Rotational torque in sports injury
In the initial prehospital management of suspected spine injury, the priority is to:
Log-roll onto a backboard, then apply a cervical collar
Secure airway, breathing, and circulation, then maintain immobilization
Splint femur fractures to prevent movement
Obtain radiographs in the field
Neurogenic shock from a high cervical injury is characterized by all EXCEPT:
Hypotension
Bradycardia
Warm, dry skin
Edema and third-spacing
Spinal shock is best defined as:
Hypotension and bradycardia from cord transection
Temporary loss of all spinal reflexes below the lesion
Permanent autonomic dysfunction after injury
Secondary hemorrhagic cord swelling
The ASIA Impairment Scale “B” means:
Normal motor and sensory function
Sensory preservation only, no motor function below the injury
Some motor function is preserved below the level, but not functional
Complete motor but no sensory preservation
Definitive surgical decompression of a central cord syndrome is indicated when:
The patient can walk independently
Bony fragments or hematoma compress the cord
There is only transient sensory loss
The patient has peripheral neuropathy
Which immobilization device allows early mobilization in a mid-cervical fracture?
Philadelphia collar
Halo vest
Rigid Minerva brace
Halter traction
Autonomic dysreflexia may be triggered by all EXCEPT:
Bladder distention
Fecal impaction
Lower extremity fracture
Intravenous crystalloid bolus
The key nursing maneuver to turn a patient with an unstable spine injury is:
Two-person pivot roll
Log-roll with three or more staff
Use of the trapeze bar
Lift-and-shift method
Deep-vein thrombosis prophylaxis in a patient with high-level SCI should include:
Early low-molecular-weight heparin plus compression boots
Compression boots only—no drugs
No prophylaxis until ambulation
Warfarin with a goal INR 1.5
A C7 quadriplegic patient develops new spasticity and severe headache when repositioned. The nurse should suspect:
Autonomic dysreflexia
Spinal shock
Neurogenic fever
Orthostatic hypotension
A patient who fell asleep with her arm over a chair reports wrist drop upon waking. Motor exam shows inability to extend the wrist but intact triceps function. Which nerve lesion is most likely?
Radial nerve at the spiral groove
Posterior interosseous nerve
C6 root avulsion
Ulnar nerve at the elbow
Which peripheral nerve injury classification is characterized by focal demyelination without axonal disruption and rapid, full recovery?
Neurapraxia
Axonotmesis
Neurotmesis
Neuroma
The “rule of threes” for open nerve injuries states that clean transections should be repaired within:
24 hours
3 days
3 weeks
3 months
Erb–Duchenne palsy features paralysis of C5–C6 roots. The characteristic posture is:
Clawing of the hand
Upper arm adducted and internally rotated, elbow extended (“waiter’s tip”)
Wrist drop
Foot drop
In Klumpke palsy (C8–T1 lesion), you expect:
Wrist drop
Weak shoulder abduction
Claw hand with interossei paralysis
Loss of biceps reflex
A positive Tinel’s test at the wrist and numbness in the thumb, index, and middle fingertips suggest:
Ulnar tunnel syndrome
Carpal tunnel syndrome
Guyon’s canal syndrome
Pronator teres syndrome
Which feature helps distinguish pronator teres syndrome from carpal tunnel?
Nighttime hand numbness
Thenar muscle atrophy
Negative Phalen’s test
Positive Tinel’s at the wrist
Anterior interosseous nerve palsy causes:
Loss of pinch between thumb and index finger (inability to make OK sign)
Hypothenar atrophy
Thenar muscle weakness
Sensory loss over the wrist
In cubital tunnel syndrome (ulnar neuropathy at the elbow), which sign is expected?
Abducted little finger at rest (“Wartenberg’s sign”)
Foot drop
Wrist drop
Loss of biceps reflex
Guyon’s canal syndrome spares sensation on the dorsum of the hand because:
Only pure motor fibers are compressed
The dorsal sensory branch arises proximal to the canal
The ulnar nerve divides distal to the wrist
The radial nerve compensates
Posterior interosseous syndrome presents with:
Finger extension weakness without wrist drop
Sensory loss over the anterolateral thigh
Loss of thumb opposition
Carpal tunnel check
The first-line treatment for mild carpal tunnel is:
Night-time wrist splinting
Immediate surgical release
High-dose steroids
Oral anticoagulation
A C7 quadriplegic who develops severe headache, profuse sweating, and bradycardia when repositioned likely has:
Autonomic dysreflexia
Spinal shock
Neurogenic fever
Orthostatic hypotension
In meralgia paresthetica, entrapment of the lateral femoral cutaneous nerve causes:
Burning pain and numbness over the anterolateral thigh
Foot drop
Weak hip flexion
Paraesthesias in the calf
Neurofibromatosis type 1 is diagnosed when a patient has two or more of the following EXCEPT:
Six café-au-lait spots > 15 mm in adults
Two or more Lisch nodules
Bilateral vestibular schwannomas
Two or more neurofibromas of any type
The WHO grade IV astrocytoma is called:
Pilocytic astrocytoma
Anaplastic astrocytoma
Glioblastoma multiforme
Diffuse astrocytoma
A solitary, dural-based, enhancing intracranial mass in a 50-year-old woman most likely is a:
Oligodendroglioma
Meningioma
Ependymoma
Medulloblastoma
Which primary tumor in adults most often metastasizes to the brain?
Breast carcinoma
Prostate carcinoma
Pancreatic carcinoma
Colon carcinoma
