APRN ACCNS(AG) - Final Test Review(Qns & Ans) - 2025, Exams of Nursing

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APRN ACCNS-AG

Final Test Review

(Questions & Solutions)

1. A 72-year-old male presents with acute ischemic stroke. The CNS APN must determine eligibility for thrombolytic therapy. Which time frame from symptom onset is critical for thrombolytic administration? A) Within 12 hours B) Within 3 hours C) Within 6 hours D) Within 24 hours ANS : B) Within 3 hours Rationale: Intravenous tissue plasminogen activator (tPA) is most effective if administered within 3 hours of ischemic stroke onset, improving outcomes by restoring perfusion.
2. In managing an older adult with acute traumatic brain injury (TBI), what ICP (intracranial pressure) threshold typically necessitates intervention? A) >15 mmHg B) >20 mmHg C) >25 mmHg D) >30 mmHg ANS : B) >20 mmHg Rationale: ICP >20 mmHg is considered elevated and usually requires intervention to prevent secondary brain injury.
3. In a patient post severe stroke, which nursing intervention best promotes neurological recovery during the acute phase? A) Early mobilization within 24-48 hours B) Strict bed rest until 7 days post-stroke C) High-dose corticosteroids administration D) Complete sensory deprivation ANS : A) Early mobilization within 24-48 hours

dementia, differentiating it from Alzheimer’s.

7. In the management of acute multiple sclerosis (MS) relapse in an older adult, which medication regimen is considered optimal? A) Oral prednisone 10 mg daily B) IV methylprednisolone 1 g daily for 3-5 days C) Oral interferon beta D) Oral azathioprine ANS : B) IV methylprednisolone 1 g daily for 3-5 days Rationale: High-dose IV steroids reduce inflammation and severity of acute MS exacerbations.
8. A patient with acute stroke experiences sudden deterioration in consciousness. The CNS APN suspects malignant cerebral edema. What is the most urgent intervention? A) Hypertonic saline infusion B) Administration of aspirin C) Early tracheostomy D) Fluid restriction only ANS : A) Hypertonic saline infusion Rationale: Hypertonic saline reduces cerebral edema by promoting osmotic movement of fluid out of the brain tissue.
9. Which scale is best utilized by the CNS APN for early detection of delirium in geriatric patients with acute CNS illness? A) Glasgow Coma Scale B) Confusion Assessment Method (CAM) C) Mini-Mental State Exam (MMSE) D) NIH Stroke Scale ANS : B) Confusion Assessment Method (CAM) Rationale: CAM is validated for rapid evaluation and diagnosis of delirium.

10. In an elderly patient with suspected Guillain-Barré syndrome, what is the primary diagnostic test? A) Nerve conduction studies (NCS) and electromyography (EMG) B) MRI brain C) Serum autoantibodies test D) CSF total protein measurement ANS : D) CSF total protein measurement Rationale: Elevated CSF protein with normal cell count is characteristic of Guillain-Barré syndrome.
11. Which of the following is the most effective neuroprotective strategy in acute ischemic stroke beyond reperfusion therapies? A) Therapeutic hypothermia B) High-dose mannitol C) Prophylactic anticonvulsants D) Controlled hypertension ANS : A) Therapeutic hypothermia Rationale: Hypothermia reduces cerebral metabolic demands and limits ischemic injury.
12. A CNS APN managing a patient with acute bacterial meningitis must initiate empiric antibiotic therapy immediately. Which regimen is most appropriate for a 70-year-old patient? A) Ceftriaxone and vancomycin plus ampicillin B) Cefotaxime alone C) Ciprofloxacin and metronidazole D) Azithromycin and vancomycin ANS : A) Ceftriaxone and vancomycin plus ampicillin Rationale: This regimen covers common CNS pathogens including Listeria monocytogenes in elderly.

management? A) Continue dopaminergic therapy uninterrupted B) Discontinue all Parkinson’s medications during infection C) Use dopamine antagonists to reduce tremors D) Initiate high-dose levodopa therapy ANS : A) Continue dopaminergic therapy uninterrupted Rationale: Abrupt withdrawal of dopaminergic drugs can precipitate Parkinsonian crises.

17. What is the primary goal in the acute care of a patient experiencing myasthenic crisis? A) Airway protection and respiratory support B) High-dose corticosteroids administration C) Immediate plasma exchange D) Fluid restriction ANS : A) Airway protection and respiratory support Rationale: Respiratory muscle weakness leads to failure; securing airway is critical.
18. In acute neurological injury, which biomarker is under study for early detection of CNS cellular damage? A) S100B protein B) Troponin I C) C-reactive protein D) Creatinine kinase ANS : A) S100B protein Rationale: S100B is a calcium-binding protein elevated in CNS cell damage.
19. During acute care for an elderly patient with CNS lymphoma, which treatment modality is prioritized? A) High-dose corticosteroids and chemotherapy

B) Radiation therapy only C) Surgical excision D) Watchful waiting ANS : A) High-dose corticosteroids and chemotherapy Rationale: Corticosteroids reduce edema; chemotherapy targets lymphoma cells.

20. A patient with impaired consciousness after CNS infection is evaluated for brain death. Which of the following supports brain death diagnosis? A) Absence of brainstem reflexes plus apnea test positive B) Presence of spontaneous respirations C) Pupillary reaction to light preserved D) Reactive corneal reflexes ANS : A) Absence of brainstem reflexes plus apnea test positive Rationale: Brain death requires no brainstem reflexes and no spontaneous respirations confirmed by apnea test.
21. What is the best preventive strategy to minimize deep vein thrombosis (DVT) in an acutely ill neurological patient? A) Early ambulation plus intermittent pneumatic compression devices B) Bed rest and hydration only C) Prophylactic oral anticoagulants without mechanical devices D) High-dose aspirin ANS : A) Early ambulation plus intermittent pneumatic compression devices Rationale: Combining mechanical prophylaxis with early mobilization prevents DVT risk best.
22. Which electrolyte abnormality is most commonly associated with cranial nerve dysfunction in acute CNS disease? A) Hyponatremia

B) Pulse oximetry C) Respiratory rate D) Blood glucose level ANS : A) Pupillary size and reaction Rationale: Changes in pupil size/reactivity may indicate increased ICP and imminent herniation.

26. For an elderly patient post stroke, which nutrition strategy best supports CNS recovery? A) Early enteral feeding with increased protein B) NPO status until swallowing is fully intact C) High-fat low-carb diet D) Delayed feeding for 72 hours post stroke ANS : A) Early enteral feeding with increased protein Rationale: Early nutritional support with adequate protein promotes healing without aspiration risk.
27. Which neuroprotective agent currently under clinical trial has shown promise in reducing secondary brain injury after acute CNS trauma? A) Minocycline B) Acetaminophen C) Diazepam D) Aspirin ANS : A) Minocycline Rationale: Minocycline exhibits anti-inflammatory and anti-apoptotic effects beneficial in CNS injury.
28. Which physiological parameter is most critical to monitor in acute CNS infections to prevent secondary injury? A) Oxygen saturation B) Blood urea nitrogen C) Liver enzymes

D) Serum glucose ANS : A) Oxygen saturation Rationale: Hypoxia exacerbates cerebral injury; maintaining adequate oxygenation prevents secondary damage.

29. In the acute care of a patient with acute CNS vasculitis, high-dose corticosteroids are initiated. What is the primary rationale? A) Suppress autoimmune inflammation B) Treat coexisting infection C) Correct electrolyte imbalance D) Provide analgesia ANS : A) Suppress autoimmune inflammation Rationale: Corticosteroids decrease vessel inflammation and reduce damage.
30. An older adult with new-onset acute CNS lymphoma presents with seizures. Which anticonvulsant is preferable given minimal CNS drug interactions? A) Levetiracetam B) Phenytoin C) Carbamazepine D) Phenobarbital ANS : A) Levetiracetam Rationale: Levetiracetam has fewer interactions and favorable pharmacokinetics in CNS malignancy.
31. In acute care of the elderly with CNS infection, fever management should aim to keep temperature: A) Below 38.5°C (101.3°F) B) At room temperature C) Above 39°C (102.2°F) to fight infection D) No specific target

ANS : A) Blood pressure control and neurological monitoring Rationale: Controlling BP reduces hemorrhage expansion; close neurological monitoring detects deterioration.

35. In a patient with acute CNS lymphoma receiving high-dose steroids, the CNS APN must monitor for: A) Hyperglycemia and immunosuppression B) Hypoglycemia C) Hyperkalemia D) Hyponatremia ANS : A) Hyperglycemia and immunosuppression Rationale: Corticosteroids increase blood sugar and suppress immune response increasing infection risk.
36. Which of the following best describes the pathophysiology of autonomic dysreflexia in spinal cord injury? A) Exaggerated sympathetic response below the injury level B) Complete loss of sympathetic tone C) Bradycardic response to injury D) Peripheral vasodilation ANS : A) Exaggerated sympathetic response below the injury level Rationale: A noxious stimulus triggers unregulated sympathetic discharge leading to hypertension.
37. A geriatric patient in the ICU develops acute CNS fungal infection. Which antifungal agent has the best CNS penetration? A) Amphotericin B B) Fluconazole C) Itraconazole D) Nystatin ANS : B) Fluconazole Rationale: Fluconazole penetrates CNS effectively, useful for fungal

meningitis.

38. For an elderly patient with acute CNS insult, which strategy most effectively reduces hospital-acquired pneumonia? A) Head-of-bed elevation at 30-45 degrees B) Routine antibiotic prophylaxis C) Strict bed rest D) Mechanical ventilation without sedation ANS : A) Head-of-bed elevation at 30-45 degrees Rationale: Elevating head reduces aspiration risk, preventing pneumonia.
39. What is the optimal CSF finding in a patient undergoing lumbar puncture for diagnosis of viral encephalitis? A) Lymphocytic pleocytosis with normal glucose B) Neutrophilic predominance with low glucose C) High protein with increased RBCs D) Normal cell counts ANS : A) Lymphocytic pleocytosis with normal glucose Rationale: Viral encephalitis typically shows lymphocytic predominance and normal glucose.
40. An elderly patient with suspected acute CNS vasculitis is started on immunosuppressants. Which complication should be closely monitored? A) Infection risk B) Hypertension C) Bradycardia D) Hypoglycemia ANS : A) Infection risk Rationale: Immunosuppressive therapy significantly increases infection susceptibility.

A. IV diltiazem infusion B. IV amiodarone loading dose C. Synchronized cardioversion 200 J D. Metoprolol tartrate 5 mg IV push every 5 min × Rationale: Non-DHP CCBs and β-blockers depress LV function; amiodarone slows rate without negative inotropy in acute HFrEF.

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4. Hypertensive Emergency / Pheochromocytoma A 42-year-old with paroxysmal HTN, headaches, diaphoresis arrives with BP 240/130 mm Hg, HR 128 bpm. CT chest: adrenal mass. Before elective tumor resection, best inpatient regimen? A. Phenoxybenzamine followed by propranolol B. Esmolol infusion only C. Hydralazine PRN D. Nitroprusside alone Rationale: Adequate α-blockade for 10–14 days prevents catecholamine surge; β-blockade is added after α-blockade to avoid unopposed α-adrenergic stimulation.

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5. Post-CABG Tamponade A patient POD 2 CABG is restless, JVP elevated, chest tubes 10 mL/hr serosanguineous. BP 86/60 mm Hg, HR 112 bpm, muffled heart sounds. Next action? A. Increase IV fluids 1 L NS bolus B. Start dopamine 10 μg/kg/min C. Order CT chest with contrast

D. Return to OR for emergent mediastinal exploration Rationale: Classic Beck’s triad suggests cardiac tamponade; definitive relief requires surgical decompression, not imaging delay.

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6. Severe ARDS – Vent Strategy PaO₂/FiO₂ = 70 on FiO₂ 0.8, PEEP 12 cm H₂O, VT 6 ml/kg predicted BW, Plateau 32 cm H₂O. Evidence-based ventilator adjustment? A. Increase VT to 8 mL/kg B. Prone the patient ≥ 16 h/day C. Add inhaled nitric oxide routinely D. Reduce PEEP to 8 cm H₂O Rationale: Early prolonged proning improves oxygenation and mortality when PaO₂/FiO₂ < 150 under lung-protective ventilation.

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7. COPD Exacerbation & Hypercapnia 71 - year-old GOLD IV COPD, ABG: pH 7.28, PaCO₂ 68 mm Hg, PaO₂ 54 mm Hg on 2 L NC. Best initial ventilatory support? A. Intubate, set AC/VC B. BiPAP 12/5 cm H₂O, FiO₂ titrated C. High-flow nasal cannula 60 L/min D. CPAP 5 cm H₂O Rationale: NIV with pressure support reverses hypercapnic respiratory failure, decreases intubation and mortality in AECOPD.

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D. Diabetes insipidus Rationale: High urine sodium/osm with hypovolemic natriuresis after central insult = CSW; managed with salt/fluid replacement, not restriction.

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11. Septic AKI Fluid Strategy 78 - year-old septic shock, creatinine rising 1.0 → 2.1 mg/dL. CVP 12 mm Hg, dynamic indices show no fluid responsiveness. Recommended approach? A. Give additional 30 mL/kg crystalloid B. Initiate norepinephrine to MAP 65 mm Hg and avoid further fluid loading C. Start dopamine renal dose D. Begin forced diuresis Rationale: Once adequately volume-resuscitated and non-responsive, vasopressors preferred; excess fluid worsens renal congestion and mortality.

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12. Preventing Contrast Nephropathy Elderly diabetic with GFR 34 mL/min/1.73 m² scheduled for coronary angiography. Evidence-supported prophylaxis? A. N-acetylcysteine IV B. Sodium bicarbonate drip 3 hrs pre-/post-procedure C. Isotonic saline 1 mL/kg/hr 6 h pre- and 12 h post-contrast D. Stop ACE inhibitor morning of study Rationale: Adequate isotonic hydration is the single most effective,

guideline-endorsed preventive measure.

13. Hepatic Encephalopathy Cirrhotic 63-year-old, grade II encephalopathy, NH₃ 92 μmol/L. First-line therapy? A. IV ceftriaxone B. Oral lactulose titrated to 3 soft stools/day C. IV flumazenil D. Protein-restricted diet < 20 g/day Rationale: Non-absorbable disaccharides lower colonic pH, converting NH₃ to NH₄⁺ for fecal excretion; cornerstone of therapy.

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14. Acute Pancreatitis Severity CT shows necrotizing pancreatitis 48 h after pain onset, APACHE II score
15. Which scoring system predicts organ failure and need for ICU at 24 h ? A. BISAP score B. Modified Marshall organ failure score C. Glasgow-Imrie D. Ranson criteria Rationale: Marshall quantifies respiratory, cardiovascular, renal dysfunction early; persistent scores ≥ 2 indicate severe disease.

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15. Variceal GI Bleed 55 - year-old alcoholic hematemesis; BP 88/52. After resuscitation, which