Free CNRN Practice Test
The Certified Neuroscience Registered Nurse examination, commonly known as the CNRN exam, is a comprehensive and detailed assessment for men and women hoping to enter this challenging field of healthcare. The content of this examination can be divided into six domains. Domain 1, which comprises 24% of the CNRN exam, has to do with basic physiological issues. Within this domain, the following subjects are covered: activity/exercise management, elimination management, immobility management, nutritional support, physical comfort promotion, and self-care facilitation. Domain 2, which comprises 36% of the exam, covers complex physiological issues, including the following topics: electrolyte and acid-base management, drug management, neurological management, perioperative care, respiratory management, skin/wound management, thermoregulation, and tissue perfusion management. In Domain 3, which makes up 15% of the CNRN exam, behavioral issues are covered, including the following topics: behavior therapy, cognitive therapy, communication enhancement, coping assistance, patient education, and psychological comfort promotion. Domain 4 covers family issues. It makes up 7% of the exam and includes questions about lifespan care. Domain 5, which comprises 9% of the exam, is about safety and includes discussion of crisis management and risk management. Finally, Domain 6, which comprises 9% of the CNRN exam, pertains to health systems. The questions drawn from this domain relate to health system mediation, health system management, and information management. The CNRN Exam was developed by the American Association of Neuroscience Nurses.
1. A college student is brought to the emergency room by a dormitory roommate because of severe headache, fever, and strange behavior over the last couple of hours. There are petechiae on the skin and conjunctivae. While the patient is being prepared for lumbar puncture, what supportive measure is MOST urgent?
a. Preparing for endotracheal intubation
b. Providing adequate intravenous access
c. Administering an antipyretic
d. Educating the patient and roommate about vaccination for meningitis
2. The MOST effective way for a patient with multiple sclerosis to cool core body temperature during exercise is to:
a. Take antipyretics, such as acetaminophen, prior to exercising
b. Drink cool liquids
c. Wear a cooling vest
d. Dress lightly
3. The MOST important element of assessment of the patient hospitalized for care of worsening myasthenia is:
a. Comprehensive assessment of respiratory function
b. Evaluation of voice quality and volume
c. Evaluation of extraocular muscle function
d. Avoidance of neuromuscular-blocking drugs
4. The best dietary advice for patients with myasthenia is to:
a. Follow a liquid diet on days when the muscles of mastication feel weak
b. Take anticholinergic medication well in advance of every meal
c. Never eat when fatigued
d. Eat a mechanical soft diet and take small meals
5. Pro-active decision making about life supports such as gastrostomy for feeding or tracheostomy for ventilation is essential for patients with amyotrophic lateral sclerosis (ALS) because:
a. Death in ALS most commonly occurs because of aspiration or respiratory failure
b. When terminal, an ALS patient may be unable to communicate
c. ALS is a progressive disease, and 50% of the patients die within 3 years of diagnosis
d. For ALS patients, feeding tubes and artificial ventilation are not temporary life-saving measures that can be instituted and then withdrawn when a crisis resolves
1. B: Given her symptoms and signs, this patient likely has meningitis. She will certainly need IV antibiotics as soon as possible. Given her age and close living quarters, meningococcal meningitis (caused by Neisseria meningitidis) is the likely pathogen; her rapid course and the presence of petechiae suggest she is at risk for a fulminant presentation, which can include circulatory collapse. IV access may be needed not only for antibiotics, but also for fluids and pressors. Although she may ultimately require intubation, the IV is urgent immediately. Meningococcal meningitis is largely preventable by immunization, but immunization will not prevent disease in persons who have already been exposed. Close contacts should receive chemoprophylaxis with antibiotics. Vaccination is still appropriate for others in the environment beyond the immediate contacts, as vaccination may prevent a secondary outbreak.
2. B: Exercise is at least as important for individuals with multiple sclerosis as for others to maintain cardiovascular health, skeletal integrity, and bone strength and exercise confers psychological benefits as well. Because elevated core temperature can temporarily worsen MS symptoms, some people with MS are reluctant to exercise. The fastest way to lower core body temperature is by ingesting cool liquids. External cooling, as with vests, is costly and cumbersome. Dressing lightly throughout exercise is sensible, but to actually reduce core temperature, drinking cool liquids is the most effective approach.
3. A: In any patient whose myasthenia gravis is rapidly deteriorating, the most life-threatening development is respiratory failure. This is restrictive rather than obstructive respiratory failure, based on inability of the muscles of respiration to contract sufficiently to move air into the chest. Unlike obstructive failure, restrictive failure is not accompanied by overt respiratory symptoms, such as wheezing or gasping, and the patient may not be particularly hypoxic or even feel short of breath until complete respiratory failure is imminent. For this reason, the physical examination and arterial blood gases are inadequate measures of pulmonary function, and regular measurement of vital capacity is mandatory. The physician should determine in advance a value at which semi-elective intubation will be instituted in order to avoid a respiratory emergency. It is also important to evaluate other muscle groups, particularly the muscles of swallowing, as aspiration of secretions is also a very serious event. All patients should be carefully monitored for possible adverse events when they start a new medication. A wide range of drugs can worsen myasthenia, and while these are to be avoided, they may sometimes be watchfully given when the potential benefit is judged to outweigh the risk.
4. D: For myasthenic patients with difficulty swallowing, a liquid diet poses more risk of aspiration than does a mechanical soft diet. The mechanical soft diet includes foods that are easily chewed, such as scrambled eggs, pasta, and cooked vegetables. Foods to avoid include tough meats, nuts, crusty breads, and raw fruits. While anticholinergic medications should be timed for maximum effectiveness during essential activities such as eating, the use of sustained-release medications makes it unnecessary to medicate before every meal or snack. Small meals make fatigue of the muscles of mastication less likely. It is best not to eat when at risk for aspiration, but it is usually not necessary to go hungry in the face of mild fatigue. Patients should be encouraged to know and honor their own body's signals.
5. D: The key issue is that once a patient loses the ability to swallow or breathe because of ALS, that ability will not return, and intervention is not temporary. Some ALS patients will want to take advantage of every life-saving measure and some will reject prolonged ventilatory support at the end of life. Many will be ambivalent and need consultation with family members, ethicists, clergy, or other advisors. There may be disagreement among family members. The discussion should be initiated early, respectfully, and supportively.
Last Updated: 11/21/2017