Neurologic NCLEX Questions

A patient is suspected of having a brain tumor. The signs and symptoms include memory defecits, visual disturbances, weakness of right upper and lower extremities, and personality changes. The nurse recognizes that the tumor is most likely located in the A. Frontal lobe B. Parietal lobe C. Occipital lobe D. Temporal lobe

A. Frontal lobe

The client with a stroke has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following? A. Giving the client thin liquids B. Assessing gag reflex before feeding the client C. Allowing plenty of time for chewing and swallowing D. Placing food on the unaffected side of the mouth

A. Giving the client thin liquids Rationale: You want to give the client thicccc liquids boi. All other interventions should be performed

The nurse is teaching family members of a patient with a concussion about the early signs of increased ICP. Which of the following would she cite as an early sign of increased ICP? A. Headache and vomiting (This is an EARLY sign all the other signs come later if ICP continues for a longer period of time) B. Dilated pupils C. Inability to wake patient with noxious stimuli D. Decreased systolic BP

A. Headache and vomiting Rationale: This is the EARLIEST sign of increased ICP. Although C is the most *reliable* indicator of increased ICP, it is not the earliest sign. A and B occur after prolonged increased ICP

The healthcare provider is assessing a patient admitted with a diagnosis of hemorrhagic stroke affecting the right cranial hemisphere. Which assessment finding is consistent with this diagnosis? A. Left sided flaccidity B. Right-sided spasticity C. Bilateral Babinski sign D. Kerning's sign

A. Left sided flaccidity Rationale: Right-sided strokes effect the LEFT side of the body, and and left-sided strokes effect the RIGHT side

During admission of a patient with a severe head injury to the emergency department, the nurse places the highest priority on assessment for A. Patency of the airway B. Presence of a neck injury C. Neurologic status with the GCS D. CSF leakage from ears or nose

A. Patency of the airway Rationale: ABCs!!

A patient tells the healthcare provider "Yesterday I felt numbness in my right hand, my vision became blurry and I felt like I was losing my balance, but after I laid down for about an hour it went away." What is the healthcare provider's best response? A. This may be a warning sign of a stroke B. Did you feel any nausea at the time? C. Call us if this happens again D. Were you drinking alcohol at the time?

A. This may be a warning sign of a stroke Rationale: This patient had a TIA, which increases the risk for a stroke

When a family member is suspected of having a stroke, which of the following should you do immediately? SELECT ALL THAT APPLY A. Write down the time that symptoms started B. Call 911 C. Ask your family member to smile and assess for any facial drooping D. Give the family member one baby aspirin

A. Write down the time that symptoms started B. Call 911 C. Ask your family member to smile and assess for any facial drooping Rationale: You want to write down what time the symptoms started so that if it is an ischemic stroke, they can administer tPA in time. You DO NOT want to give them a baby aspirin because if it's a hemorrhagic stroke, it could cause greater hemorrhagic damage

Vasogenic cerebral edema increases intracranial pressure by A. Shifting fluid in the gray matter B. Altering the endothelial lining of cerebral capillaries C. Leading molecules from the intracellular fluid to the capillaires D. Altering the osmotic gradient flow into the intravascular component

B. Altering the endothelial lining of cerebral capillaries

A patient has been diagnosed with an embolic stroke. Which of the following in the patient history would you expect to see? A. History of acute MI B. Aspirin in the medication list to treat atrial fibrillation C. LDL level at 84 mg/dL D. History of COPD

B. Aspirin in the medication list to treat atrial fibrillation Rationale: An embolic stroke is commonly caused by cardiac problems, such as a-fib

A patient in the ED comes in with a change in LOC. Which of the following is of most concern? A. Heart rate of 95 beats per minute B. Blood pressure increased from 150/84 to 165/68 C. Oxygen saturations at 93% D. Pupils measuring 2mm bilaterally

B. Blood pressure increased from 150/84 to 165/68 Rationale: A widening pulse pressure is indicative of Cushing's triad which is a medical emergency! If the SBP increases and the DBP decreases, that is not good!

A client with a spinal cord injury (SCI) reports a sudden severe throbbing headache that started a short time ago. Assessment of the client reveals increased blood pressure (168/94) and decreased heart rate (48 bpm), diaphoresis and flushing of the face and neck. What action should you take first? A. Administer the ordered acetaminophen B. Check the Foley tubing for kinks or obstruction C. Adjust the temperature in the clients room D. Notify the physician about the change in status

B. Check the Foley tubing for kinks or obstruction Rationale: This is autonomic reflexia, which is most commonly caused by bladder distention. The first action should be to check the foley catheter for any kinks or obstruction. If there is no foley catheter, insert a straight catheter to empty the bladder. Remove all restrictive clothing, elevate HOB to 45, check for fecal impaction, and notify the HCP!

A nursing measure that is indicated to reduce the potential with bacterial meningitis is A. Administering codeine for relief of head and neck pain B. Controlling fever with prescribed drugs and cooling techniques C. Keeping the room dark and quiet to minimize environmental stimulation D. Maintaining the patient on strict bed rest with the head of the bed slightly elevated

B. Controlling fever with prescribed drugs and cooling techniques

After experiencing a stroke, a patient is admitted to the ICU. Which of the following assessments would alert the healthcare provider that the patient is experiencing increased ICP? SELECT ALL THAT APPLY A. Oxygen saturation of 94% B. Decreased pulse rate C. Behavioral changes D. Decreased temperature E. Widened pulse pressure F. Irregular respirations

B. Decreased pulse rate C. Behavioral changes E. Widened pulse pressure F. Irregular respirations Rationale: These are all manifestations of ICP

A nurse plans care for the patient with increased intracranial pressure with the knowledge that the best way to position the patient is to A. Keep the head of the bed flat B. Elevate the head of the bed to 30 degrees C. Maintain patient on the left side with the head supported on a pillow D. Use a continuous-rotation bed to continuously change the patient position

B. Elevate the head of the bed to 30 degrees

Your patient has been diagnosed with increased intracranial pressure (ICP). Which of the following orders would you question? A. Administering Mannitol B. Performing a lumbar puncture C. Keeping the HOB elevated to 30 degrees with neck in midline position D. Hypertonic IV solution rate at 100 mL/hr

B. Performing a lumbar puncture Rationale: Performing a lumbar puncture can actually increase ICP because it could cause brain herniation. Mannitol and hypertonic IV solution will be part of the care plan.

A patient arrives at the ED with slurred speech, right facial droop, and right arm weakness. Which of these actions by the healthcare provider is the priority? A. Transfer the patient to the neurological care unit B. Prepare the patient for a CT scan of the head C. Call the speech pathologist to the ED D. Prepare to administer a thrombolytic medication

B. Prepare the patient for a CT scan of the head Rationale: The first, priority action would be to get a CT scan of the head in order to determine the kind of stroke this patient is having. This will allow the HCP to create an appropriate plan of care

You are providing care for a client with an acute hemorrhagic stroke. The client's spouse tells you that he has been reading a lot about strokes and asks why his wife has not received TPA. What is your best response? A. "Your wife was not admitted within the time frame that TPA is administered." B. "This drug is used primarily for clients who experience an acute heart attack." C. "TPA dissolves clots and may cause more bleeding into your wife's brain." D. "Your wife had gallbladder surgery just 6 months ago, and this prevents the use of TPA."

C. "TPA dissolves clots and may cause more bleeding into your wife's brain." Rationale: tPA is only used for ischemic strokes!!

Nursing management of a patient with a brain tumor includes SELECT ALL THAT APPLY A. Discussing with the patient methods to control inappropriate behavior B. Using diversion techniques to keep the patient stimulated and motivated C. Assisting and supporting the family in understanding any changes in behavior D. Limiting self-care activities until the patient has regained maximum physical functioning E. Planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs

C. Assisting and supporting the family in understanding any changes in behavior E. Planning for seizure precautions and teaching the patient and the caregiver about antiseizure drugs

Nurse Kristine is trying to communicate with a client with a stroke who has aphasia. Which of the following actions by the nurse would be least helpful to the client? A. Speaking to the client at a slower rate with a normal tone B. Allowing plenty of time for the client to respond C. Completing the sentences that the client cannot finish D. Looking directly at the client during attempts at speech

C. Completing the sentences that the client cannot finish Rationale: This will not allow the patient to improve their communication skills

The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the A. Amount of CO B. O2 content of the blood C. Degree of collateral circulation D. Level of CO2 in the blood

C. Degree of collateral circulation

The nurse is alerted to a possible acute subdural hematoma in the patient who A. Has a linear skull fracture cross a major artery B. Has focal symptoms of brain damage with no recollection of a head injury C. Develops decreased LOC and a headache within 48 hours of a head injury D. Has in immediate loss of consciousness with a brief lucid interval followed by a decreased LOC

C. Develops decreased LOC and a headache within 48 hours of a head injury

A health care provider is providing community education on signs and symptoms of stroke. Which of the following best describe the signs and symptoms of a stroke? A. Diaphoresis and jaw pain B. Weakness and edema C. Facial droop and slurred speech D. Indigestion and shortness of breath

C. Facial droop and slurred speech Rationale: FAST. Facial drooping, arm weakness, slurred speech, and time!

A male client with a spinal cord injury is prone to expiring autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of reoccurrence? A. Strict adherence to a bowel retraining program B. Keeping the linen wrinkle free beneath him C. Limiting bladder catheterization to once every 12 hours D. Discouraging tight fitting clothing

C. Limiting bladder catheterization to once every 12 hours Rationale: Bladder catheterization should be done every 4-6 hours. All other options are interventions that should be done

A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA? A. Caucasian race B. Female sex C. Obesity D. Asthma

C. Obesity Rationale: Obesity is a modifiable risk factor that increases your risk for stroke. African-American ethnicity and male gender also increase your risk. Asthma is not related.

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? A. Patient with a skull fracture whose nose is bleeding B. Older patient with a stroke who is confused and whose daughter is present C. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale D. Patient who had a craniotomy for a brain tumor and who is now 3 days post-op and has had continued vomiting

C. Patient with meningitis who is suddenly agitated and reporting a headache of 10 on a 0-to-10 scale

The Glasgow Coma Scale (GCS) measures all of the following except: A. Verbal response B. Motor response C. Sensation to extremities D. Eye opening

C. Sensation to extremities Rationale: The GCS includes opening eyes when a verbal or painful stimulus is applies, speaking, and obeying commands

A female client has clear fluid leaking from the nose following a skull fracture. The nurse assess that this is cerebrospinal fluid if the fluid: A. Is clear and tests negative for glucose B. Clumps together on a dressing and has a pH of 7.0 C. Separates into rings and tests positive for glucose D. Tests negative for Beta 2 Transferrin

C. Separates into rings and tests positive for glucose Rationale: A Halo ring and a positive test for glucose will indicate CSF. Beta 2 Transferrin is only present in CSF, so it will be positive.

A client with a subdural hematoma becomes restless and confused with dilation of the pupil. The physician orders Mannitol for which of the following reasons? A. To reduce the intraocular pressure B. To prevent acute tubular necrosis C. To promote osmotic diuresis to decrease ICP D. To draw water into the vascular system to increase blood pressure

C. To promote osmotic diuresis to decrease ICP Rationale: Mannitol causes a rapid decrease in fluid by drawing the fluid into the vascular space by osmosis for excretion.

Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is a(n) A. Obese 45-year-old Native American B. 35-year-old Asian American woman who smokes C. 32-year-old white woman taking oral contraceptives D. 65-year-old African-American man with HTN

D. 65-year-old African-American man with HTN

A patient with ICP monitoring has a pressure of 12 mm Hg. The nurse understands that this pressure reflects A. A severe decrease in cerebral perfusion pressure B. An alteration in the production of CSF C. The loss of autoregulatory control of ICP D. A normal balance between brain tissue, blood, and CSF

D. A normal balance between brain tissue, blood, and CSF

The nurse is positioning the female client with increase ICP. Which of the following position would the nurse avoid? A. Head of bed elevated 30 to 45 degrees B. Neck in the neutral position C. Head midline D. Head turned to the side

D. Head turned to the side Rationale: Any other positions beside a neutral neck position, head midline, and head of bed elevated to 30-45 degrees could actually increase ICP

A health care provider is conducting a community education class on stroke prevention. The teaching plan for this class will include which of these instructions? A. There is no known link between risk of stroke and regular exercise B. There is no correlation between diabetes and risk of stroke C. Foods high in saturated fats can be consumed in moderate amounts. D. It is important to maintain a healthy weight and control your BP.

D. It is important to maintain a healthy weight and control your BP. Rationale: This one is literally just common sense y'all

A client with a SCI at level C3-C4 is being cared for in the emergency department (ED). What is the priority assessment? A. Determine the level at which the client has intact sensation B. Assess the level at which the client has retained mobility C. Check the blood pressure and pulse for signs of spinal shock D. Monitor respiratory effort and oxygen saturation level

D. Monitor respiratory effort and oxygen saturation level Rationale: An SCI above C4 results in complete paralysis of respiratory function. Therefore, this patient needs to be vented and monitored for respiratory function. Remember your ABCs!!

Information provided by the patient that would help differentiate a hemorrhagic stroke from a thrombotic stroke includes A. Sensory disturbances B. A history of HTN C. Presence of motor weakness D. Sudden onset of severe headache

D. Sudden onset of severe headache