CCRN Neurological & Musculoskeletal Practice Questions
Neurological & Musculoskeletal makes up 6 of every 50 questions on a Tigertest CCRN practice test. Here are 10 of the 24 questions on it, each with the answer and the reason.
Updated by the Tigertest team. Based on the AACN Adult CCRN test plan. Original questions; 50 per test, weighted like the real exam. Not affiliated with AACN or AACN Certification Corporation.
1. After a tibial fracture is casted, which finding is the earliest sign of compartment syndrome?
- A.Pale, cool skin on the foot
- B.Pain on passive stretch
- C.An absent distal pulse
- D.Paralysis of the foot
Answer: B. Pain out of proportion to the injury and pain when the muscles of the compartment are passively stretched come first. Pulses often stay present until late, and paralysis means damage may already be permanent.
2. How should a limb with suspected compartment syndrome be positioned while the surgeon is called?
- A.Hanging below the heart
- B.Raised well above the heart
- C.Wrapped firmly in elastic
- D.Level with the heart
Answer: D. Raising the limb lowers arterial inflow and can worsen ischemia, so it is kept at heart level with tight dressings or casts loosened. Fasciotomy is the definitive treatment.
3. Two days after a femur fracture, a patient becomes confused and hypoxemic with petechiae across the chest and axillae. What is most likely?
- A.Fat embolism syndrome
- B.A pulmonary contusion
- C.Alcohol withdrawal
- D.A tension pneumothorax
Answer: A. Respiratory distress, neurologic changes and petechiae 24 to 72 hours after a long bone or pelvic fracture are the classic triad of fat embolism syndrome. Early fixation of fractures lowers the risk.
4. A patient with a new cervical spinal cord injury is hypotensive. Which findings point to neurogenic shock rather than hemorrhage?
- A.Bradycardia with cold, mottled skin
- B.Tachycardia with cool, pale skin
- C.Bradycardia with warm, dry skin
- D.Tachycardia with warm skin
Answer: C. Loss of sympathetic tone below the injury dilates vessels and leaves vagal tone unopposed, so the patient is hypotensive, bradycardic and warm. Hemorrhage causes tachycardia and cool, pale skin.
5. A patient with a T4 spinal cord injury has a pounding headache, BP 210/110, flushing above the injury and a heart rate of 48. What should the nurse do first?
- A.Give a fast IV fluid bolus
- B.Apply a warming blanket now
- C.Sit them up; check the bladder
- D.Lay them flat, legs raised
Answer: C. This is autonomic dysreflexia, triggered by a stimulus below the injury, most often a full bladder or bowel. Sitting the patient up lowers BP while the cause is found and removed; antihypertensives follow if it persists.
6. A spinal cord injury at which level most threatens diaphragm function?
- A.C3 to C5
- B.T1 to T4
- C.T10 to T12
- D.L1 to L3
Answer: A. The phrenic nerve arises from C3, C4 and C5, so injuries at or above these levels can paralyze the diaphragm and need ventilatory support.
7. A patient with a head injury has a MAP of 80 mm Hg and an ICP of 20 mm Hg. What is the cerebral perfusion pressure?
- A.100 mm Hg
- B.40 mm Hg
- C.4 mm Hg
- D.60 mm Hg
Answer: D. CPP = MAP - ICP, so 80 - 20 = 60 mm Hg. Adding the two gives 100 and dividing gives 4; both are common slips.
8. Which set of findings is Cushing's triad of rising intracranial pressure?
- A.Tachycardia and hypotension
- B.Bradycardia, wide pulse pressure
- C.Tachycardia, narrow pulse pressure
- D.Bradycardia and hypotension
Answer: B. Late in rising ICP, systolic pressure climbs with a widening pulse pressure, the heart rate slows and breathing becomes irregular. It signals brainstem compression and needs immediate action.
9. Where is the transducer of an external ventricular drain usually leveled?
- A.At the sternal notch
- B.At the tragus of the ear
- C.At the iliac crest
- D.At the phlebostatic axis
Answer: B. The tragus approximates the foramen of Monro, the zero point for ICP. Leveling at the heart's phlebostatic axis is for hemodynamic lines and would give a false ICP and wrong drainage.
10. A patient has an external ventricular drain open to drainage. What should the nurse do before moving the patient up in bed?
- A.Flush the catheter
- B.Open the drain fully
- C.Lower the drip chamber
- D.Clamp the drain
Answer: D. Clamping before a change in head height prevents a sudden over-drainage of CSF, which can cause ventricular collapse or bleeding. The drain is releveled and reopened right after the move.
Practice all 24 neurological & musculoskeletal questions, and the rest of the 200-question bank, in the free CCRN training sets. Questions you miss come back until you have mastered them.
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