CCRN Neuro, Musculoskeletal and Behavioral Practice Questions
Updated October 30, 2026
Neurological, musculoskeletal and behavioral problems gained the most ground in the 2025 Adult test plan, rising from 14% to 18% of the scored questions. That makes this area bigger than cardiovascular on the current exam, and it is where older review material is thinnest.
The 12 questions below are original, written for this page in the style of the real exam. They are independent practice and are not official AACN material.
This area on the CCRN at a glance
| Item | Details |
|---|---|
| Share of the exam | 18% of the scored questions, about 22 to 23 of 125 |
| Test plan | Adult CCRN test plan for exams on or after November 12, 2025 |
| Split by system | AACN does not publish separate weights for neuro, musculoskeletal and behavioral |
| Previous share | 14% under the 2020 plan |
What this area covers
| System | Test plan topics |
|---|---|
| Neurological | Spinal cord injury, brain death, encephalopathy, ischemic and hemorrhagic stroke, hydrocephalus, neurogenic shock, neurologic infections, neurological storming, neuromuscular disorders, neurosurgery and spinal surgery, neurovascular abnormalities, seizures, space-occupying lesions, traumatic brain injury |
| Musculoskeletal | Compartment syndrome, fractures, muscular deconditioning, musculoskeletal trauma |
| Behavioral and psychosocial | Agitation, aggression and violence, delirium, medical non-adherence, mood disorders, post-intensive care syndrome, PTSD, self-harm, substance use disorder, suicidal ideation |
The nursing actions include managing ICP monitors and ventricular drains, continuous EEG, thrombectomy and coiling, craniotomy and craniectomy, seizure and spinal precautions, swallow evaluation, early mobility, de-escalation, and assessment tools for delirium and alcohol withdrawal.
Tips for this area
- Look for the trend in level of consciousness. A patient who talks and then deteriorates, or a new focal deficit days after a bleed, is the clue in many neuro stems.
- Know the timing. Vasospasm, withdrawal and hematoma growth each have a typical window after the event.
- Remove the trigger first. Autonomic dysreflexia, agitation and delirium questions often reward fixing a cause over adding a drug.
- Ask directly. For suicide and self-harm questions, a direct, safety-first answer usually beats reassurance.
CCRN neuro, musculoskeletal and behavioral practice questions
-
Thirty minutes into an alteplase infusion for acute ischemic stroke, a patient reports a sudden severe headache, vomits and becomes harder to arouse. BP is 192/108 mm Hg. Which action should the nurse take FIRST?Answer: BNew headache, vomiting and a falling level of consciousness during thrombolysis suggest intracranial hemorrhage. The infusion is stopped at once and an emergency CT is obtained; treating symptoms or completing the dose risks extending the bleed.
-
A patient with a severe traumatic brain injury has a ventricular drain. ICP has stayed at 28 mm Hg for 10 minutes and the cerebral perfusion pressure is 52 mm Hg. Which nursing action is MOST appropriate?Answer: CRaising the head of the bed and keeping the neck straight helps venous drainage from the brain and lowers ICP. Aggressive hyperventilation causes cerebral vasoconstriction and ischemia, long clusters of care raise ICP, and lying flat impairs venous outflow.
-
A patient struck on the side of the head lost consciousness briefly, then woke and talked normally for an hour. The patient now responds only to pain, and the right pupil is fixed and dilated. Which injury is MOST LIKELY?Answer: AA brief loss of consciousness, a lucid interval, then rapid decline with a dilated pupil on the side of the blow is the classic course of an arterial epidural hematoma, often from the middle meningeal artery. It needs emergency surgery. A chronic subdural develops over days to weeks, and diffuse axonal injury causes coma from the start.
-
Seven days after a ruptured cerebral aneurysm was coiled, a patient with a functioning ventricular drain becomes newly confused and develops right arm weakness. Which complication is MOST LIKELY?Answer: DVasospasm with delayed cerebral ischemia typically appears days 3 to 14 after subarachnoid hemorrhage and causes new confusion or focal deficits. Rebleeding is unlikely once the aneurysm is secured, and a working ventricular drain makes hydrocephalus less likely.
-
A patient with a known seizure disorder has a generalized tonic-clonic seizure that has lasted 6 minutes. An IV line is in place, and oxygen and suction are ready. Which medication should the nurse anticipate FIRST?Answer: CA seizure lasting 5 minutes or more is treated as status epilepticus, and a benzodiazepine such as IV lorazepam is the first-line drug. A second agent such as levetiracetam or fosphenytoin follows if seizures continue, and anesthetic infusions are reserved for refractory cases.
-
A patient with a T4 spinal cord injury suddenly reports a pounding headache. BP is 210/110 mm Hg, HR 48, and the face is flushed and sweaty above the level of injury. Which action should the nurse take FIRST?Answer: AThis is autonomic dysreflexia. Sitting the patient up lowers the blood pressure right away, and the nurse then looks for the trigger, most often a full bladder or bowel. Medication is used if the pressure stays high after the cause is removed.
-
A patient with a new C5 spinal cord injury has BP 78/40 mm Hg, HR 48 and warm, dry, pink skin below the injury. There is no sign of bleeding. Which type of shock is MOST LIKELY?Answer: BInjury above T6 can cut off sympathetic outflow, leaving unopposed vagal tone: hypotension with bradycardia and warm, dry skin from vasodilation. Hypovolemic and cardiogenic shock cause tachycardia and cool skin, and nothing here suggests infection.
-
The team is preparing to perform a clinical brain death examination on a patient with a catastrophic brain injury. Which finding must be corrected before the examination can proceed?Answer: DHypothermia can depress brainstem reflexes, so the patient must be warmed to normal temperature before brain death can be determined. Absent corneal reflexes are an expected finding of the exam, and a normal sodium and an adequate MAP meet the prerequisites.
-
A ventilated patient screens positive for delirium, pulls at lines and does not sleep at night. Pain is controlled and no new medical cause is found. Which strategy is MOST appropriate?Answer: DMulticomponent nonpharmacologic measures are the foundation of delirium care in the ICU. Benzodiazepines are linked to more delirium, restraints can increase agitation and injury, and routine antipsychotics have not been shown to shorten delirium.
-
Sixty hours after the last drink, a patient admitted for pancreatitis has a coarse tremor, diaphoresis, HR 132, BP 168/98 mm Hg and visual hallucinations, with a high score on a withdrawal scale. Which medication should the nurse anticipate?Answer: CBenzodiazepines are first-line for alcohol withdrawal because they act on the same GABA receptors as alcohol and prevent seizures and delirium tremens. Haloperidol and dexmedetomidine may be added for agitation, but neither prevents withdrawal seizures on its own, and naloxone has no role.
-
Twelve hours after a tibial fracture was splinted, a patient has severe leg pain that does not respond to opioids, pain when the toes are passively stretched, and a tense calf. The surgeon has been called. What should the nurse do while waiting?Answer: BThese are signs of acute compartment syndrome. Keeping the limb at heart level preserves arterial inflow without adding venous pressure, and loosening a splint or dressing relieves outside pressure. High elevation reduces perfusion, and waiting on pain medication delays a fasciotomy.
-
A patient admitted after an intentional overdose is now medically stable. While the nurse checks the IV, the patient says quietly, "There is no point in any of this anymore." Which action should the nurse take FIRST?Answer: AA statement of hopelessness after a suicide attempt needs a direct question about current thoughts, intent and plan. Asking does not plant the idea, and the answer guides the level of observation and urgency. Reassurance and delay leave the risk unassessed.
Keep practicing
Our practice exam for this area has 23 questions, close to its share of the real exam, and the full practice exams mix all six areas into 125 scored questions with 83 to pass. Start from the home page.
Next, try the endocrine, heme, GI and renal questions or the professional caring and ethics questions, or see the CCRN exam guide.
Pass the CCRN exam on your first try
- All 338 questions across every area of the 2025 Adult CCRN test plan
- A rationale for every answer, including why the tempting choice is wrong
- Unlimited full 125-question practice exams, scored like the real one (83 to pass)