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

Increased intracranial pressure. 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.

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

60-70 mmHg. 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.

Q: First-line treatment for status epilepticus is:

Benzodiazepines. 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.

Q: An NIHSS score of 18 indicates:

Moderate to severe stroke. 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.

Q: Decorticate posturing involves:

Flexion of arms, extension of legs. 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.

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

60 mmHg. 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.

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

Ipsilateral uncal herniation. 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.

Q: Blood pressure management in hemorrhagic stroke should target SBP of:

<140 mmHg. 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.

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

54. 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.

Question 1

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

Accepted Answer

Within 4.5 hours. 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:

Accepted Answer

Increased intracranial pressure. 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:

Accepted Answer

60-70 mmHg. 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:

Accepted Answer

Benzodiazepines. 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:

Accepted Answer

Moderate to severe stroke. 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:

Accepted Answer

Flexion of arms, extension of legs. 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:

Accepted Answer

60 mmHg. 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:

Accepted Answer

Ipsilateral uncal herniation. 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:

Accepted Answer

<140 mmHg. 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:

Accepted Answer

54. 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.

Neurology CCRN Practice Questions

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