Musculoskeletal, Neurological, Behavioral/Psychosocial

18% of the CCRN · blueprint Adult CCRN Test Plan (exams on and after 2025-11-12)

Short answer

This category is 18% of the adult CCRN. It covers ischaemic and haemorrhagic stroke, intracranial hypertension, seizures and status epilepticus, neuromuscular disorders such as Guillain-Barré and myasthenia gravis, traumatic brain and spinal-cord injury including neurogenic and spinal shock, musculoskeletal trauma and compartment syndrome, and behavioural and psychosocial emergencies including delirium, agitation, substance withdrawal and suicidal ideation.

Why it matters on this exam

Neuro items test recognition of deterioration and the order of interventions; behavioural items test judgement under pressure.

Key concepts

ICP and CPP: CPP = MAP − ICP; head of bed elevation and midline alignment, osmotherapy, sedation and analgesia, CSF drainage; avoid hypotension and hypoxaemia.
Herniation signs: Cushing's triad (hypertension, bradycardia, irregular respirations), pupillary changes, posturing.
Stroke: time-critical thrombolysis criteria, blood-pressure limits before and after thrombolysis, dysphagia screening before anything by mouth.
Status epilepticus: benzodiazepine first, then a loading antiseizure drug; protect airway and glucose.
Neurogenic vs spinal shock: neurogenic is hypotension with bradycardia from lost sympathetic tone; spinal shock is transient loss of reflexes below the lesion.
Neuromuscular: ascending weakness in Guillain-Barré with respiratory monitoring by vital capacity and negative inspiratory force; myasthenic vs cholinergic crisis.
Delirium and withdrawal: validated screening (CAM-ICU), non-pharmacological measures first, alcohol-withdrawal protocols.

Common mistakes

Treating hypertension aggressively in acute ischaemic stroke outside the thrombolysis parameters.
Attributing new agitation to personality rather than screening for hypoxaemia, pain, retention or withdrawal.

Worked example

A ventilated patient becomes agitated overnight. Before sedation is increased, check oxygenation, pain, bladder distension, positioning and withdrawal risk — sedating an undiagnosed hypoxaemic patient hides the cause.

Original practice questions

Musculoskeletal, Neurological, Behavioral/PsychosocialDifficulty 3/5

A patient with a traumatic brain injury has an intracranial pressure of 25 mmHg and a mean arterial pressure of 70 mmHg. What is the cerebral perfusion pressure, and why does it matter?

A70 mmHg, which reflects systemic pressure and is sufficient
B95 mmHg, which is adequate and requires no further intervention
C45 mmHg, which is below target and threatens cerebral ischaemia
D25 mmHg, which reflects the intracranial pressure alone

Show answer and rationale

Correct: C. CPP = MAP − ICP = 70 − 25 = 45 mmHg, below the usual target range and associated with secondary ischaemic injury. Management addresses both sides of the equation: lower ICP and support MAP.

B — 95 would be the sum rather than the difference.
D — ICP alone is not perfusion pressure.
A — MAP alone ignores the opposing intracranial pressure.

Musculoskeletal, Neurological, Behavioral/PsychosocialDifficulty 2/5

A previously calm ventilated patient becomes acutely agitated overnight. What should be assessed first?

AApply physical restraints and reassess in the morning with the day team
BRequest an urgent psychiatric consultation for the behavioural change
CIncrease sedation to protect the airway and prevent self-extubation
DScreen for hypoxaemia, pain, bladder distension and withdrawal first

Show answer and rationale

Correct: D. Acute agitation is a symptom. Hypoxaemia, pain, urinary retention, withdrawal and metabolic causes must be screened before sedation, which would otherwise mask a treatable deterioration.

C — Sedating first can conceal hypoxaemia or another emergency.
A — Restraints do not diagnose the cause and carry their own harms.
B — A psychiatric cause is a diagnosis of exclusion in a ventilated ICU patient.

Musculoskeletal, Neurological, Behavioral/PsychosocialDifficulty 3/5

Which set of findings suggests impending herniation in a patient with rising intracranial pressure?

ACushing’s triad with a newly dilated pupil, indicating brainstem compression
BHypotension, tachycardia and rapid shallow breathing with equal pupils
CNormal vital signs with a gradually improving level of consciousness
DFever, tachycardia and hypotension consistent with an early septic response

Show answer and rationale

Correct: A. Cushing's triad — hypertension with a widening pulse pressure, bradycardia and irregular respirations — combined with a unilateral dilated pupil indicates brainstem compression and demands immediate intervention.

B — That pattern suggests hypovolaemia or shock rather than herniation.
C — Improving consciousness is inconsistent with herniation.
D — Those findings describe sepsis.

All 3 Musculoskeletal, Neurological, Behavioral/Psychosocial questions →

2 flashcards for Musculoskeletal, Neurological, Behavioral/Psychosocial

Practice this topic

Blueprint-mapped questions with full rationales for every choice.

Start practice

Primary references

CCRN Exam Handbook — Direct Care (July 2026) — AACN Certification Corporation · primary · retrieved 2026-09-22, verified 2026-09-22

Last reviewed: 2026-09-22Next review by: 2026-11-06Draft — pending editorial reviewHow we verify facts