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NCLEX Neuro

Subjects : nclex, health-sciences, nursing

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. Myoclonic Seizure
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
An 18-year - old client was hit in the head with a baseball during practice. When discharging him to the care of his mother - the nurse gives which of the following instructions?
Dural and arachnoid membranes and their associated blood vessels are readily torn by the impact and fractured bone fragments

2. Put the client in the high - Fowler's position
A gentleman from Peru is brought by his wife to the clinic. He does not speak English and she is translating for him. You learn that he was a manganese miner for over twenty years. This gentleman is at particular risk of developing symptoms of which
A patient in the hospital for observation after a presumed seizure is found thrashing about in his room. Which of the following would be an improper intervention?
Head is suddenly forced to stop or start moving - or to turn rapidly.
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?

3. Limiting bladder catherization to once every 12 hours
Which of the following clients on the rehab unit is most likely to develop autonomic dysreflexia?
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?
Which neurotransmitter is responsible for may of the functions of the frontal lobe?
Sudden and general loss of muscle tone - particularly in the arms and legs - which often results in a fall.

4. Rapid dilantin administration can cause cardiac arrhythmias
Muscle stiffness - rigidity
Which of the following nursing interventions is appropriate for a client with an ICP of 20 mm Hg?
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?
A client with a subarachnoid hemorrhage is prescribed a 1 -000- mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?

5. 'The lens is normally transparent
Dural and arachnoid membranes and their associated blood vessels are readily torn by the impact and fractured bone fragments
The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. It would be most accurate for the nurse to tell family members that the test measures which o
A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.

6. 'Wake him every hour and assess his orientation to person - time - and place
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.
Muscle stiffness - rigidity
An 18-year - old client was hit in the head with a baseball during practice. When discharging him to the care of his mother - the nurse gives which of the following instructions?
A 78-year - old client is admitted to the Emergency Department (ED) via emergency medical service (EMS) with complaints of severe diarrhea with resultant weakness and signs of dehydration. Discussion with the significant other reveals that the patien

7. Wrap her hands in soft 'mitten' restraints
Blunt trauma
A client who is regaining consciousness after a craniotomy becomes restless and attempts to pull out her IV line. Which nursing intervention protects the client without increasing her ICP?
are produced (at least initially) by electrical impulses in a relatively small part of the brain.
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.

8. Subdural hemorrhage
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?
Gap between the dura and the cortical surface of the brain.
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.

9. Intracranial hemorrhages
Seizures are divided into two broad categories:
Dural and arachnoid membranes and their associated blood vessels are readily torn by the impact and fractured bone fragments
A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?
A 23-year - old client has been hit on the head with a baseball bat. The nurse notes clear fluid draining from his ears and nose. Which of the following nursing interventions should be done first?

10. Linear skull fractures
A client comes into the ER after hitting his head in an MVA. He's alert and oriented. Which of the following nursing interventions should be done first?
Vitals/turn freq/call light close/ ROM
Dural and arachnoid membranes and their associated blood vessels are readily torn by the impact and fractured bone fragments
Blunt trauma

11. deceleration injury
High - energy transfer - such as a blow from a baseball bat
The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action - knowing this i
Head is suddenly forced to stop or start moving - or to turn rapidly.
Collision between a rapidly moving body part and a stationary object

12. 4 things that protect the brain
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.
Meningies - csf - blood - brain barrier - skull
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
Collision between a rapidly moving body part and a stationary object

13. partial seizures
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?
Whiplash - shaken baby
are produced (at least initially) by electrical impulses in a relatively small part of the brain.

14. A client with a high cervical spine injury
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?
A client with head trauma develops a urine output of 300 ml/hr - dry skin - and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
Which of the following clients on the rehab unit is most likely to develop autonomic dysreflexia?
Seizures are divided into two broad categories:

15. Loss of lens elasticity
A gentleman from Peru is brought by his wife to the clinic. He does not speak English and she is translating for him. You learn that he was a manganese miner for over twenty years. This gentleman is at particular risk of developing symptoms of which
Blunt trauma
Which of the following physiologic changes would be expected in a patient with presbyopia?
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?

16. Activity of the brain
Head is suddenly forced to stop or start moving - or to turn rapidly.
The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. It would be most accurate for the nurse to tell family members that the test measures which o
A client with a subarachnoid hemorrhage is prescribed a 1 -000- mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?

17. Hypogeusia
Sudden and general loss of muscle tone - particularly in the arms and legs - which often results in a fall.
Which of the following clients on the rehab unit is most likely to develop autonomic dysreflexia?
A patient has a normal sensory change that results in diminished sense of taste. How would this be documented
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?

18. Evaluate urine specific gravity
The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action - knowing this i
A client with head trauma develops a urine output of 300 ml/hr - dry skin - and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
Which of the following clients on the rehab unit is most likely to develop autonomic dysreflexia?
You are the nurse assigned to perform an eye assessment on an 80-year - old client. Which of the following findings during the assessment is considered normal?

19. 'Grand Mal' or Generalized tonic - clonic
are produced by electrical impulses from throughout the entire brain
A client has noticed a decrease in taste sensation. Which of the following cranial nerves are most likely involved
A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?
Unconsciousness - convulsions - muscle rigidity

20. Dopamine
Which neurotransmitter is responsible for may of the functions of the frontal lobe?
A client comes into the ER after hitting his head in an MVA. He's alert and oriented. Which of the following nursing interventions should be done first?
A 78-year - old client is admitted to the Emergency Department (ED) via emergency medical service (EMS) with complaints of severe diarrhea with resultant weakness and signs of dehydration. Discussion with the significant other reveals that the patien
A client receiving vent - assisted mode ventilation begins to experience cluster breathing after recent intracranial occipital bleeding. Which action would be most appropriate?

21. Reposition the client to avoid neck flexion
An 18-year - old client is admitted with a closed head injury sustained in a MVA. His intracranial pressure (ICP) shows an upward trend. Which intervention should the nurse perform first?
Vitals/turn freq/call light close/ ROM
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.

22. Encourage the client to hyperventilate
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
Which of the following nursing interventions is appropriate for a client with an ICP of 20 mm Hg?
are produced by electrical impulses from throughout the entire brain
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?

23. Immobilize the client's head and neck

24. Atonic Seizure
Which of the following nursing interventions is appropriate for a client with an ICP of 20 mm Hg?
Sudden and general loss of muscle tone - particularly in the arms and legs - which often results in a fall.
The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action - knowing this i
During an episode of autonomic dysreflexia in which the client becomes hypertensive - the nurse should perform which of the following interventions?

25. Epidural hematoma
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.
A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?
A gentleman from Peru is brought by his wife to the clinic. He does not speak English and she is translating for him. You learn that he was a manganese miner for over twenty years. This gentleman is at particular risk of developing symptoms of which

26. Noxious stimuli
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?
A patient in the hospital for observation after a presumed seizure is found thrashing about in his room. Which of the following would be an improper intervention?
A gentleman from Peru is brought by his wife to the clinic. He does not speak English and she is translating for him. You learn that he was a manganese miner for over twenty years. This gentleman is at particular risk of developing symptoms of which
A nurse assesses a client who has episodes of autonomic dysreflexia. Which of the following conditions can cause autonomic dysreflexia?

27. The patient should be placed on droplet precautions.
A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.
A client has noticed a decrease in taste sensation. Which of the following cranial nerves are most likely involved

28. A trauma nurse is caring for a patient that sustained trauma to the head. She notices that the patient has a 'blown pupil' (one pupil is fixed a dilated). This is caused by intracranial swelling and brain herniation. A blown pupil is caused by disrup
CN III
A patient has a normal sensory change that results in diminished sense of taste. How would this be documented
A client with history of glaucoma was diagnosed by the community nurse as experiencing Visual Sensory/Perceptual Alterations R/T increased intraocular pressure. The plan of care should focus on:
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?

29. Call the physician while another nurse checks the vital signs and ascertains the patient's Glasgow Coma score
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.
Seizures are divided into two broad categories:
Head is suddenly forced to stop or start moving - or to turn rapidly.
A client receiving vent - assisted mode ventilation begins to experience cluster breathing after recent intracranial occipital bleeding. Which action would be most appropriate?

30. Tonic Seizure
Muscle stiffness - rigidity
Which of the following respiratory patterns indicate increasing ICP in the brain stem?
Short loss of consciousness (just a few seconds) with few or no symptoms. The patient - most often a child - typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are us
A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence?

31. Laceration of the middle meningeal artery
Head is suddenly forced to stop or start moving - or to turn rapidly.
CN III
A client is admitted to the ER for head trauma is diagnosed with an epidural hematoma. The underlying cause of epidural hematoma is usually related to which of the following conditions?
Short loss of consciousness (just a few seconds) with few or no symptoms. The patient - most often a child - typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are us

32. Basilar skull fractures
A client receiving vent - assisted mode ventilation begins to experience cluster breathing after recent intracranial occipital bleeding. Which action would be most appropriate?
Caused by a blow to the back of the head - characteristic signs: blood in the sinuses; a clear fluid called cerebrospinal fluid (CSF) leaking from the nose or ears; raccoon eyes
A client with head trauma develops a urine output of 300 ml/hr - dry skin - and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?
A client has signs of increased ICP. Which of the following is an early indicator of deterioration in the client's condition?

33. Unequal pupil size
Abnormal posturing that involves rigidity - flexion of the arms - clenched fists - and extended legs.
Sudden and general loss of muscle tone - particularly in the arms and legs - which often results in a fall.
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
CN III

34. To immobilize the surgical spine
Collision between a rapidly moving body part and a stationary object
An 18-year - old client was hit in the head with a baseball during practice. When discharging him to the care of his mother - the nurse gives which of the following instructions?
The nurse is discussing the purpose of an electroencephalogram (EEG) with the family of a client with massive cerebral hemorrhage and loss of consciousness. It would be most accurate for the nurse to tell family members that the test measures which o
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?

35. Inability to elicit a Babinski's reflex
Which of the following nursing interventions is appropriate for a client with an ICP of 20 mm Hg?
Blunt trauma
The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?
A client with head trauma develops a urine output of 300 ml/hr - dry skin - and dry mucous membranes. Which of the following nursing interventions is the most appropriate to perform initially?

36. Epidural hematoma
A client arrives at the ER after slipping on a patch of ice and hitting her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest?
The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action - knowing this i
A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?
Abnormal posturing that involves rigidity - flexion of the arms - clenched fists - and extended legs.

37. Decrease in LOC

38. Artificial tears
Unconsciousness - convulsions - muscle rigidity
Which of the following physiologic changes would be expected in a patient with presbyopia?
Which neurotransmitter is responsible for may of the functions of the frontal lobe?
A patient with glaucoma has medication prescribed to decrease intraocular pressure. Which of the following medication should be questioned by the nurse?

39. generalized and partial (also called local or focal)
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
The nurse is caring for the client in the ER following a head injury. The client momentarily lost consciousness at the time of the injury and then regained it. The client now has lost consciousness again. The nurse takes quick action - knowing this i
Seizures are divided into two broad categories:
CN III

40. Generalized seizures
A patient in the hospital for observation after a presumed seizure is found thrashing about in his room. Which of the following would be an improper intervention?
Gap between the dura and the cortical surface of the brain.
are produced by electrical impulses from throughout the entire brain
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.

41. acceleration injury
Head is suddenly forced to stop or start moving - or to turn rapidly.
A client with a subarachnoid hemorrhage is prescribed a 1 -000- mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
A client who is regaining consciousness after a craniotomy becomes restless and attempts to pull out her IV line. Which nursing intervention protects the client without increasing her ICP?
You are the nurse assigned to perform an eye assessment on an 80-year - old client. Which of the following findings during the assessment is considered normal?

42. nsg intervention for spinal injury
Unconsciousness - convulsions - muscle rigidity
A 78-year - old client is admitted to the Emergency Department (ED) via emergency medical service (EMS) with complaints of severe diarrhea with resultant weakness and signs of dehydration. Discussion with the significant other reveals that the patien
A 22-year - old client with quadriplegia is apprehensive and flushed - with a blood pressure of 210/100 and a heart rate of 50 bpm. Which of the following nursing interventions should be done first?
Vitals/turn freq/call light close/ ROM

43. Raise the head of the bed immediately to 90 degrees
Meningies - csf - blood - brain barrier - skull
A client receiving vent - assisted mode ventilation begins to experience cluster breathing after recent intracranial occipital bleeding. Which action would be most appropriate?
A 22-year - old client with quadriplegia is apprehensive and flushed - with a blood pressure of 210/100 and a heart rate of 50 bpm. Which of the following nursing interventions should be done first?
Sporadic jerks - usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent - these seizures may result in dropping or involuntarily throwing objects.

44. Clonic Seizure
A patient with glaucoma has medication prescribed to decrease intraocular pressure. Which of the following medication should be questioned by the nurse?
You are working in the emergency department when a college freshman is brought in by his roommate. The freshman has a severe headache - stiff neck - subjective fever and his roommate had to pull over en route to the hospital to let the patient vomit.
Repetitive - rhythmic jerks that involve both sides of the body at the same time.
Caused by a blow to the back of the head - characteristic signs: blood in the sinuses; a clear fluid called cerebrospinal fluid (CSF) leaking from the nose or ears; raccoon eyes

45. Equal pupillary constriction in response to light
Which of the following physiologic changes would be expected in a patient with presbyopia?
You are the nurse assigned to perform an eye assessment on an 80-year - old client. Which of the following findings during the assessment is considered normal?
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?
A patient has a normal sensory change that results in diminished sense of taste. How would this be documented

46. Place a tongue - blade in the patient's mouth to prevent blockage of the airway.
Which of the following respiratory patterns indicate increasing ICP in the brain stem?
Dural and arachnoid membranes and their associated blood vessels are readily torn by the impact and fractured bone fragments
A patient in the hospital for observation after a presumed seizure is found thrashing about in his room. Which of the following would be an improper intervention?
A client who is regaining consciousness after a craniotomy becomes restless and attempts to pull out her IV line. Which nursing intervention protects the client without increasing her ICP?

47. Back arched; rigid extension of all four extremities.
Which of the following describes decerebrate posturing?
Collision between a rapidly moving body part and a stationary object
A nurse assesses a client who has episodes of autonomic dysreflexia. Which of the following conditions can cause autonomic dysreflexia?
A patient has a normal sensory change that results in diminished sense of taste. How would this be documented

48. Parkinson's disease
A client with a subarachnoid hemorrhage is prescribed a 1 -000- mg loading dose of Dilantin IV. Which consideration is most important when administering this dose?
A gentleman from Peru is brought by his wife to the clinic. He does not speak English and she is translating for him. You learn that he was a manganese miner for over twenty years. This gentleman is at particular risk of developing symptoms of which
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?
Abnormal posturing that involves rigidity - flexion of the arms - clenched fists - and extended legs.

49. Absence Seizure
CN III
A 23-year - old client has been hit on the head with a baseball bat. The nurse notes clear fluid draining from his ears and nose. Which of the following nursing interventions should be done first?
Short loss of consciousness (just a few seconds) with few or no symptoms. The patient - most often a child - typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are us
A client with a cervical spine injury has Gardner - Wells tongs inserted for which of the following reasons?

50. Depressed skull fractures
High - energy transfer - such as a blow from a baseball bat
Meningies - csf - blood - brain barrier - skull
A client is at risk for increased ICP. Which of the following would be a priority for the nurse to monitor?
A patient has a question about a recent eye exam. Which of the following statements would be an accurate response to inquiry?