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Neurology CCRN Practice Questions

10 free CCRN-style neurology practice questions with full rationales. Perfect for last-minute review or rapid drilling on high-yield concepts.

Question Index

  1. Q1: A patient with acute ischemic stroke is a candidate for IV tPA if symptoms began…
  2. Q2: Cushing triad (hypertension, bradycardia, irregular respirations) is a LATE sign…
  3. Q3: The target cerebral perfusion pressure (CPP) for patients with severe TBI is:
  4. Q4: First-line treatment for status epilepticus is:
  5. Q5: An NIHSS score of 18 indicates:
  6. Q6: Decorticate posturing involves:
  7. Q7: The apnea test for brain death determination requires the PaCO2 to rise to at le…
  8. Q8: A unilateral fixed and dilated pupil in a trauma patient most likely indicates:
  9. Q9: Blood pressure management in hemorrhagic stroke should target SBP of:
  10. Q10: A TBI patient has MAP 82 and ICP 28. CPP is:
Question 1

A patient with acute ischemic stroke is a candidate for IV tPA if symptoms began:

  1. Within 1 hour
  2. Within 4.5 hours
  3. Within 6 hours
  4. Within 12 hours

Correct Answer: B. Within 4.5 hours

Rationale: IV tPA (Alteplase) is indicated for acute ischemic stroke within 4.5 hours of symptom onset. The earlier the treatment, the better the outcomes. BP must be <185/110 before administration and <180/105 after. Mechanical thrombectomy may be considered for large vessel occlusion up to 24 hours in select patients.
Question 2

Cushing triad (hypertension, bradycardia, irregular respirations) is a LATE sign of:

  1. Stroke
  2. Increased intracranial pressure
  3. Meningitis
  4. Myasthenia gravis

Correct Answer: B. Increased intracranial pressure

Rationale: Cushing triad is a LATE sign of critically elevated ICP indicating impending herniation. The body attempts to maintain cerebral perfusion by increasing BP (hypertension), while brainstem compression causes bradycardia and irregular respirations. This requires immediate intervention including osmotic therapy and possible surgical decompression.
Question 3

The target cerebral perfusion pressure (CPP) for patients with severe TBI is:

  1. 30-40 mmHg
  2. 40-50 mmHg
  3. 60-70 mmHg
  4. 80-90 mmHg

Correct Answer: C. 60-70 mmHg

Rationale: Target CPP is 60-70 mmHg for severe TBI patients. CPP = MAP - ICP. Adequate CPP maintains cerebral blood flow while avoiding excessive BP that could worsen cerebral edema. ICP should be maintained <20-22 mmHg. The balance between preventing secondary injury and avoiding hyperperfusion is critical.
Question 4

First-line treatment for status epilepticus is:

  1. Phenytoin
  2. Valproate
  3. Benzodiazepines
  4. Propofol

Correct Answer: C. Benzodiazepines

Rationale: Benzodiazepines (Lorazepam 4mg IV or Midazolam IM) are first-line for status epilepticus. They work rapidly by enhancing GABA inhibition. If seizures persist, second-line agents include fosphenytoin, valproate, or levetiracetam. Refractory status may require propofol, midazolam infusion, or pentobarbital with continuous EEG monitoring.
Question 5

An NIHSS score of 18 indicates:

  1. No stroke
  2. Minor stroke
  3. Moderate stroke
  4. Moderate to severe stroke

Correct Answer: D. Moderate to severe stroke

Rationale: NIHSS scoring: 0 = no stroke, 1-4 = minor, 5-15 = moderate, 16-20 = moderate to severe, 21-42 = severe. A score of 18 indicates moderate to severe stroke with significant neurological deficits. NIHSS guides treatment decisions and helps predict functional outcomes and prognosis.
Question 6

Decorticate posturing involves:

  1. Extension of all extremities
  2. Flexion of arms, extension of legs
  3. Extension of arms, flexion of legs
  4. Flexion of all extremities

Correct Answer: B. Flexion of arms, extension of legs

Rationale: Decorticate posturing involves flexion of arms (held to chest), wrist flexion, and extension of legs. It indicates damage above the brainstem at the cortical level. Decerebrate posturing (extension of arms and legs with internal rotation) indicates brainstem damage and has a worse prognosis.
Question 7

The apnea test for brain death determination requires the PaCO2 to rise to at least:

  1. 40 mmHg
  2. 50 mmHg
  3. 60 mmHg
  4. 70 mmHg

Correct Answer: C. 60 mmHg

Rationale: The apnea test requires PaCO2 to rise to ≥60 mmHg (or 20 mmHg above baseline) to provide adequate respiratory stimulus. The patient is observed for any respiratory effort during 8-10 minutes off the ventilator. A positive test (no breathing despite high CO2) supports brain death diagnosis. The test is aborted if hemodynamic instability or desaturation occurs.
Question 8

A unilateral fixed and dilated pupil in a trauma patient most likely indicates:

  1. Drug overdose
  2. Ipsilateral uncal herniation
  3. Metabolic encephalopathy
  4. Bilateral cortical damage

Correct Answer: B. Ipsilateral uncal herniation

Rationale: A unilateral fixed and dilated pupil in a trauma patient suggests ipsilateral uncal herniation with compression of CN III. This is a neurosurgical emergency requiring immediate intervention (osmotic therapy, possible decompressive craniectomy). The herniation compresses the ipsilateral oculomotor nerve, causing the pupil abnormality.
Question 9

Blood pressure management in hemorrhagic stroke should target SBP of:

  1. <120 mmHg
  2. <140 mmHg
  3. <160 mmHg
  4. <180 mmHg

Correct Answer: B. <140 mmHg

Rationale: Current guidelines recommend SBP target <140 mmHg for hemorrhagic stroke to reduce hematoma expansion while maintaining adequate perfusion. This is more aggressive than ischemic stroke management where permissive hypertension may be allowed initially. Rapid but controlled BP reduction is key.
Question 10

A TBI patient has MAP 82 and ICP 28. CPP is:

  1. 110
  2. 82
  3. 54
  4. 44

Correct Answer: C. 54

Rationale: CPP = 82 − 28 = 54 (low). To improve CPP, you can raise MAP and/or reduce ICP—here the emergent lever is reduce ICP while maintaining MAP.

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Here are 3 questions from our premium bank. The full rationale explains exactly why the right answer is right — and why the 3 distractors trap most test-takers.

Premium Practice Question

A patient has had continuous generalized tonic-clonic seizure activity for 6 minutes. SpO₂ is falling despite nonrebreather. Which intervention is most important first?

  1. Load levetiracetam
  2. Administer benzodiazepine and support airway/oxygenation
  3. Start hypertonic saline
  4. Restrict fluids
Rationale: Seizure >5 minutes = status epilepticus → benzodiazepines first, and simultaneous airway/oxygenation support....
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Premium Practice Question

A subarachnoid hemorrhage patient becomes increasingly confused. Labs: Na 118, serum osmolality 262, urine osmolality 650, urine Na 55, UOP 15 mL/hr, urine specific gravity 1.030. Most likely diagnosis?

  1. Central diabetes insipidus
  2. SIADH
  3. Osmotic diuresis
  4. Prerenal azotemia
Rationale: Low Na + low serum osmolality + concentrated urine + low UOP + high urine Na/osm = SIADH....
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Premium Practice Question

A severe TBI patient has abrupt UOP 900 mL/hr, urine specific gravity 1.002, Na 157, serum osmolality 312, HR 128, BP 92/54. Which action is most appropriate?

  1. Fluid restriction and demeclocycline
  2. Replace free water/volume and consider DDAVP for central DI
  3. Hypertonic saline bolus
  4. Continue diuresis to lower ICP
Rationale: This is DI physiology with hypovolemia and hypernatremia. Priority is restore volume/free water, then DDAVP if central DI....
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