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Neurological
1. A 68-year-old male patient who had a left-sided
stroke is admitted to the hospital. The patient has
right-sided weakness and is unable to perform
activities of daily living without assistance. The nurse
is providing oral hygiene to the patient and is
preparing to use a padded tongue blade to open the
patient’s mouth. Which nursing measure
is inappropriate when providing oral hygiene to the
patient who had a stroke?
a) Placing the client on the back with a small
pillow under the head.
b) Keeping portable suctioning equipment at
the bedside.
c) Opening the client’s mouth with a padded
tongue blade.
d) Cleaning the client’s mouth and teeth with a
toothbrush.
2. A 64-year-old client with a history of hypertension is
admitted to the emergency department with sudden
onset right-sided weakness, facial droop, and
difficulty speaking. Which nursing intervention is the
highest priority in the initial management of this
client?
a) Prepare to administer recombinant tissue
plasminogen activator (rt-PA).
b) Discuss the precipitating factors that caused
the symptoms.
c) Schedule for A STAT computer
tomography (CT) scan of the head.
d) Notify the speech pathologist for an
emergency consultation.
3. A client arrives in the emergency department with an
ischemic stroke and receives tissue plasminogen
activator (t-PA) administration. Which is the priority
nursing assessment?
a) Time of onset of current stroke
b) Complete physical and history
c) Current medications
d) Upcoming surgical procedures
4. During the first 24 hours after thrombolytic therapy
for ischemic stroke, the primary goal is to control the
client’s:
a) Pulse
b) Respirations
c) Blood pressure
d) Temperature
5. What is a priority nursing assessment in the first 24
hours after admission of the client with a thrombotic
stroke?
a) Cholesterol level
b) Pupil size and pupillary response
c) Bowel sounds
d) Echocardiogram
6. What is the expected outcome of thrombolytic drug
therapy?
a) Increased vascular permeability
b) Vasoconstriction
c) Dissolved emboli
d) Prevention of hemorrhage
7. The client diagnosed with atrial fibrillation has
experienced a transient ischemic attack (TIA). Which
medication would the nurse anticipate being
ordered for the client on discharge?
a) A thrombolytic medication
b) A beta-blocker medication
c) An anti-hyperuricemic medication
d) An oral anticoagulant medication
8. Which client would the nurse identify as being most
at risk for experiencing a CVA?
a) A 39-year-old pregnant female.
b) A 67-year-old Caucasian male.
c) An 84-year-old Japanese female.
d) A 55-year-old African American male.
9. Which assessment data would indicate to the nurse
that the client would be at risk for a hemorrhagic
stroke?
a) A blood glucose level of 480 mg/dl.
b) A right-sided carotid bruit.
c) A blood pressure of 220/120 mmHg.
d) The presence of bronchogenic carcinoma.
10. The nurse and unlicensed assistive personnel (UAP)
are caring for a client with right-sided paralysis.
Which action by the UAP requires the nurse to
intervene?
a) The assistant places a gait belt around the
client’s waist prior to ambulating.
b) The assistant places the client on the back
with the client’s head to the side.
c) The assistant places her hand under the
client’s right axilla to help him/her move
up in bed.
d) The assistant praises the client for
attempting to perform ADL’s independently.
11. A client admitted to the hospital with a subarachnoid
hemorrhage has complaints of severe headache,
nuchal rigidity, and projectile vomiting. The nurse
knows lumbar puncture (LP) would be
contraindicated in this client in which of the
following circumstances?
a) Vomiting continues.
b) Intracranial pressure (ICP) is increased.
c) The client needs mechanical ventilation.
d) Blood is anticipated in the cerebrospinal
fluid (CSF).
12. A client with a subdural hematoma becomes restless
and confused, with dilation of the ipsilateral pupil.
The physician orders mannitol for which of the
following reasons?
a) To reduce 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
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13. A client with subdural hematoma was given mannitol

to decrease intracranial pressure (ICP). Which of the 21. A nurse is assisting with caloric testing of the
following results would best show the mannitol was oculovestibular reflex of an unconscious client. Cold
effective? water is injected into the left auditory canal. The
a) Urine output increases. client exhibits eye conjugate movements toward the
b) Pupils are 8 mm and nonreactive. left followed by a rapid nystagmus toward the right.
c) Systolic blood pressure remains at 150 mm The nurse understands that this indicates the client
Hg. has:
d) BUN and creatinine levels return to normal. a) A cerebral lesion
b) A temporal lesion
14. Which of the following values is considered normal c) An intact brainstem
for ICP? d) Brain death
a) 0 to 15 mm Hg
b) 25 mm Hg 22. The nurse is caring for the client with increased
c) 35 to 45 mm Hg intracranial pressure. The nurse would note which of
d) 120/80 mm Hg the following trends in vital signs if the ICP is rising?
a) Increasing temperature, increasing pulse,
15. Which of the following symptoms may occur with a increasing respirations, decreasing blood
phenytoin level of 32 mg/dl? pressure.
a) Ataxia and confusion b) Increasing temperature, decreasing pulse,
b) Sodium depletion decreasing respirations, increasing blood
c) Tonic-clonic seizure pressure.
d) Urinary incontinence c) Decreasing temperature, decreasing pulse,
increasing respirations, decreasing blood
16. Which of the following signs and symptoms of pressure.
increased ICP after head trauma would appear first? d) Decreasing temperature, increasing pulse,
a) Bradycardia decreasing respirations, increasing blood
b) Large amounts of very dilute urine pressure.
c) Restlessness and confusion
d) Widened pulse pressure 23. The nurse is evaluating the status of a client who had
a craniotomy 3 days ago. The nurse would suspect
17. Problems with memory and learning would relate to the client is developing meningitis as a complication
which of the following lobes? of surgery if the client exhibits:
a) Frontal a) A negative Kernig’s sign.
b) Occipital b) A positive Brudzinski’s sign.
c) Parietal c) Absence of nuchal rigidity.
d) Temporal d) A Glascow Coma Scale score of 15.

18. While cooking, your client couldn’t feel the 24. A client is arousing from a coma and keeps saying,
temperature of a hot oven. Which lobe could be “Just stop the pain.” The nurse responds based on
dysfunctional? the knowledge that the human body typically and
a) Frontal automatically responds to pain first with attempts to:
b) Occipital a) Tolerate the pain.
c) Parietal b) Decrease the perception of pain.
d) Temporal c) Escape the source of pain.
d) Divert attention from the source of pain.
19. The nurse is assessing the motor function of an
unconscious client. The nurse would plan to use 25. During the acute stage of meningitis, a 3-year-old
which of the following to test the client’s peripheral child is restless and irritable. Which of the following
response to pain? would be most appropriate to institute?
a) Sternal rub a) Limiting conversation with the child.
b) Pressure on the orbital rim b) Allowing the child to play in the bathtub.
c) Squeezing the sternocleidomastoid muscle c) Keeping extraneous noise to a minimum.
d) Nail bed pressure d) Performing treatments quickly.

20. The client is having a lumbar puncture performed. 26. Which of the following would lead the nurse to
The nurse would plan to place the client in which suspect that a child with meningitis has developed
position for the procedure? disseminated intravascular coagulation?
a) Side-lying, with legs pulled up and head a) Hemorrhagic skin rash
bent down onto the chest. b) Edema
b) Side-lying, with a pillow under the hip. c) Cyanosis
c) Prone, in a slight Trendelenburg’s position. d) Dyspnea on exertion
d) Prone, with a pillow under the abdomen.

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27. When interviewing the parents of a 2-year-old child,
a history of which of the following illnesses would
lead the nurse to suspect pneumococcal meningitis?
a) Bladder infection
b) Middle ear infection
c) Fractured clavicle
d) Septic arthritis
28. The nurse is assessing a child diagnosed with a brain
tumor. Which of the following signs and symptoms
would the nurse expect the child to
demonstrate? Select all that apply.
a) Increased appetite
b) Vomiting
c) Polydipsia
d) Lethargy
e) Head tilt
f) Increased pulse
29. A lumbar puncture is performed on a child
suspected of having bacterial meningitis. CSF is
obtained for analysis. A nurse reviews the results of
the CSF analysis and determines which of the
following results would verify the diagnosis?
a) Cloudy CSF, decreased protein, and
decreased glucose.
b) Cloudy CSF, elevated protein, and
decreased glucose.
c) Clear CSF, elevated protein, and decreased
glucose.
d) Clear CSF, decreased pressure, and elevated
protein.
30. A nurse is planning care for a child with acute
bacterial meningitis. Based on the mode of
transmission of this infection, which of the following
would be included in the plan of care?
a) No precautions are required as long as
antibiotics have been started.
b) Maintain enteric precautions.
c) Maintain respiratory isolation precautions
for at least 24 hours after the initiation of
antibiotics.
d) Maintain neutropenic precautions.
31. A nurse is reviewing the record of a child with
increased ICP and notes that the child has exhibited
signs of decerebrate posturing. On assessment of
the child, the nurse would expect to note which of
the following if this type of posturing was present?
a) Abnormal flexion of the upper extremities
and extension of the lower extremities.
b) Rigid extension and pronation of the
arms and legs.
c) Rigid pronation of all extremities.
d) Flaccid paralysis of all extremities.
32. Which of the following assessment data indicated
nuchal rigidity?
a) Positive Kernig’s sign
b) Negative Brudzinski’s sign
c) Positive homan’s sign
d) Negative Kernig’s sign
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33. Meningitis occurs as an extension of a variety of
bacterial infections due to which of the following
conditions?
a) Congenital anatomic abnormality of the
meninges.
b) Lack of acquired resistance to the various
etiologic organisms.
c) Occlusion or narrowing of the CSF pathway.
d) Natural affinity of the CNS to certain
pathogens.
34. Which of the following pathologic processes is often
associated with aseptic meningitis?
a) Ischemic infarction of cerebral tissue.
b) Childhood diseases of viral causation such
as mumps.
c) Brain abscesses caused by a variety of
pyogenic organisms.
d) Cerebral ventricular irritation from a
traumatic brain injury.
35. You are preparing to admit a patient with a seizure
disorder. Which of the following actions can you
delegate to LPN/LVN?
a) Complete admission assessment.
b) Place a padded tongue blade at the bedside.
c) Set up oxygen and suction equipment.
d) Pad the side rails before the patient arrives.
36. If a male client experienced a cerebrovascular
accident (CVA) that damaged the hypothalamus, the
nurse would anticipate that the client has problems
with:
a) Body temperature control
b) Balance and equilibrium
c) Visual acuity
d) Thinking and reasoning
37. A female client admitted to an acute care facility
after a car accident develops signs and symptoms of
increased intracranial pressure (ICP). The client is
intubated and placed on mechanical ventilation to
help reduce ICP. To prevent a further rise in ICP
caused by suctioning, the nurse anticipates
administering which drug endotracheally before
suctioning?
a) phenytoin (Dilantin)
b) mannitol (Osmitrol)
c) lidocaine (Xylocaine)
d) furosemide (Lasix)
38. After striking his head on a tree while falling from a
ladder, a young man age 18 is admitted to the
emergency department. He’s unconscious and his
pupils are nonreactive. Which intervention would be
the most dangerous for the client?
a) Give him a barbiturate.
b) Place him on mechanical ventilation.
c) Perform a lumbar puncture.
d) Elevate the head of his bed.
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39. When obtaining the health history from a male client
with retinal detachment, the nurse expects the client
to report:
a) Light flashes and floaters in front of the
eye.
b) A recent driving accident while changing
lanes.
c) Headaches, nausea, and redness of the eyes.
d) Frequent episodes of double vision.
40. Which nursing diagnosis takes highest priority for a
client with Parkinson’s crisis?
a) Imbalanced nutrition: Less than body
requirements
b) Ineffective airway clearance
c) Impaired urinary elimination
d) Risk for injury
41. The nurse has given the male client with Bell’s palsy
instructions on preserving muscle tone in the face
and preventing denervation. The nurse determines
that the client needs additional information if the
client states that he or she will:
a) Wrinkle the forehead, blow out the cheeks,
and whistle.
b) Massage the face with a gentle upward
motion.
c) Perform facial exercises.
d) Exposure to cold and drafts.
42. A female client is admitted to the hospital with a
diagnosis of Guillain-Barre syndrome. The nurse
inquires during the nursing admission interview if
the client has a history of:
a) Seizures or trauma to the brain.
b) Meningitis during the last five (5 years).
c) Back injury or trauma to the spinal cord.
d) Respiratory or gastrointestinal infection
during the previous month.
43. A female client with Guillain-Barre syndrome has
ascending paralysis and is intubated and receiving
mechanical ventilation. Which of the following
strategies would the nurse incorporate in the plan of
care to help the client cope with this illness?
a) Giving the client full control over care
decisions and restricting visitors.
b) Providing positive feedback and
encouraging active range of motion.
c) Providing information, giving positive
feedback and encouraging relaxation.
d) Providing intravenously administered
sedatives, reducing distractions and limiting
visitors.
44. A male client has an impairment of cranial nerve II.
Specific to this impairment, the nurse would plan to
do which of the following to ensure the client to
ensure client safety?
a) Speak loudly to the client.
b) Test the temperature of the shower water.
c) Check the temperature of the food on the
delivery tray.
d) Provide a clear path for ambulation
without obstacles.
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45. A female client has a neurological deficit involving
the limbic system. Specific to this type of deficit, the
nurse would document which of the following
information related to the client’s behavior.
a) Is disoriented to person, place, and time.
b) Affect is flat, with periods of emotional
lability.
c) Cannot recall what was eaten for breakfast
today.
d) Demonstrate inability to add and subtract;
does not know who is the president.
46. A client is admitted with a diagnosis of Sturge-
Weber syndrome. Which of the following
information would you expect to find in this client?
a) It is a dysfunction of the trigeminal nerve
causing a severe sharp pain in the nose, lips,
gums, or across the cheeks.
b) It is a non-progressive neurological disorder
of the seventh cranial nerve causing
paralysis of one of the sides of the face.
c) It is a rare degenerative brain disorder
characterized by sudden development of
progressive neurological and neuromuscular
symptoms.
d) It is a neurocutaneous disorder with
angiomas causing abnormalities in the
skin, brain, and eyes from birth.
47. A client is admitted to the emergency room with a
spinal cord injury. The client is complaining of
lightheadedness, flushed skin above the level of the
injury, and headache. The client’s blood pressure is
160/90 mm Hg. Which of the following is a priority
action for the nurse to take?
a) Loosen tight clothing or accessories
b) Assess for any bladder distention
c) Raise the head of the bed
d) Administer antihypertensive
48. A client who had a stroke is seen bumping into
things on the side and is having difficulty picking up
the beginning of the next line of what he is reading.
The client is experiencing which of the following
conditions?
a) Visual neglect
b) Astigmatism
c) Blepharitis
d) Homonymous Hemianopsia
49. Which of the following medical treatments should
the nurse anticipate administering to a client with
increased intracranial pressure due to brain
hemorrhage, except?
a) acetaminophen (Tylenol)
b) dexamethasone (Decadron)
c) mannitol (Osmitrol)
d) phenytoin (Dilantin)
e) nitroglycerin (Nitrostat)
50. Which of the following symptoms would you expect
to a client with a phenytoin level of 35 mg/dL?
a) Ataxia
b) Potassium deficit
c) Neglect syndrome
d) Tetraplegia
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51. To encourage adequate nutritional intake for a
female client with Alzheimer’s disease, the nurse
should:
a) Stay with the client and encourage him to
eat.
b) Help the client fill out his menu.
c) Give the client privacy during meals.
d) Fill out the menu for the client.
52. The nurse is performing a mental status examination
on a male client diagnosed with a subdural
hematoma. This test assesses which of the following?
a) Cerebellar function
b) Intellectual function
c) Cerebral function
d) Sensory function
53. Shortly after admission to an acute care facility, a
male client with a seizure disorder develops status
epilepticus. The physician orders diazepam (Valium)
10 mg I.V. stat. How soon can the nurse administer
the second dose of diazepam, if needed and
prescribed?
a) In 30 to 45 seconds
b) In 10 to 15 minutes
c) In 30 to 45 minutes
d) In 1 to 2 hours
54. A female client complains of periorbital aching,
tearing, blurred vision, and photophobia in her right
eye. Ophthalmologic examination reveals a small,
irregular, nonreactive pupil — a condition resulting
from acute iris inflammation (iritis). As part of the
client’s therapeutic regimen, the physician prescribes
atropine sulfate (Atropisol), two drops of 0.5%
solution in the right eye twice daily. Atropine sulfate
belongs to which drug classification?
a) Parasympathomimetic agent
b) Sympatholytic agent
c) Adrenergic blocker
d) Cholinergic blocker
55. Emergency medical technicians transport a 27-year-
old ironworker to the emergency department. They
tell the nurse, “He fell from a two-story building. He
has a large contusion on his left chest and a
hematoma in the left parietal area. He has a
compound fracture of his left femur and he’s
comatose. We intubated him and he’s maintaining
an arterial oxygen saturation of 92% by pulse
oximeter with a manual resuscitation bag.” Which
intervention by the nurse has the highest priority?
a. Assessing the left leg.
b. Assessing the pupils.
c. Placing the client in Trendelenburg’s
position.
d. Assessing level of consciousness.
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56. An auto mechanic accidentally has battery acid
splashed in his eyes. His coworkers irrigate his eyes
with water for 20 minutes, and then take him to the
emergency department of a nearby hospital, where
he receives emergency care for the corneal injury.
The physician prescribes dexamethasone (Maxidex
Ophthalmic Suspension), two drops of 0.1% solution
to be instilled initially into the conjunctival sacs of
both eyes every hour; and polymyxin B sulfate
(Neosporin Ophthalmic), 0.5% ointment to be placed
in the conjunctival sacs of both eyes every 3 hours.
Dexamethasone exerts its therapeutic effect by:
a) Increasing the exudative reaction of ocular
tissue.
b) Decreasing leukocyte infiltration at the
site of ocular inflammation.
c) Inhibiting the action of carbonic anhydrase.
d) Producing a miotic reaction by stimulating
and contracting the sphincter muscles of the
iris.
57. Nurse Amber is caring for a client who underwent a
lumbar laminectomy two (2) days ago. Which of the
following findings should the nurse consider
abnormal?
a) More back pain than the first postoperative
day.
b) Paresthesia in the dermatomes near the
wounds.
c) Urine retention or incontinence.
d) Temperature of 99.2° F (37.3° C).
58. After an eye examination, a male client is diagnosed
with open-angle glaucoma. The physician prescribes
Pilocarpine ophthalmic solution (Pilocar), 0.25% gtt i,
OU q.i.D. Based on this prescription, the nurse
should teach the client or a family member to
administer the drug by:
a) Instilling one drop of pilocarpine 0.25% into
both eyes daily.
b) Instilling one drop of pilocarpine 0.25%
into both eyes four times daily.
c) Instilling one drop of pilocarpine 0.25% into
the right eye daily.
d) Instilling one drop of pilocarpine 0.25% into
the left eye four times daily
59. A female client who’s paralyzed on the left side has
been receiving physical therapy and attending
teaching sessions about safety. Which behavior
indicates that the client accurately understands
safety measures related to paralysis?
a) The client leaves the side rails down.
b) The client uses a mirror to inspect the
skin.
c) The client repositions only after being
reminded to do so.
d) The client hangs the left arm over the side
of the wheelchair.
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60. A male client in the emergency department has a
suspected neurologic disorder. To assess gait, the
nurse asks the client to take a few steps; with each
step, the client’s feet make a half-circle. To
document the client’s gait, the nurse should use
which term?
a) Ataxic
b) Dystrophic
c) Helicopod
d) Steppage
61. A client, age 22, is admitted with bacterial
meningitis. Which hospital room would be
the best choice for this client?
a) A private room down the hall from the
nurses’ station.
b) An isolation room three doors from the
nurses’ station.
c) A semi-private room with a 32-year-old
client who has viral meningitis.
d) A two-bedroom with a client who previously
had bacterial meningitis.
62. A physician diagnoses a client with myasthenia
gravis, prescribing pyridostigmine (Mestinon), 60 mg
P.O. every 3 hours. Before administering this
anticholinesterase agent, the nurse reviews the
client’s history. Which preexisting condition would
contraindicate the use of pyridostigmine?
a) Ulcerative colitis
b) Blood dyscrasia
c) Intestinal obstruction
d) Spinal cord injury
63. A female client is admitted to the facility for
investigation of balance and coordination problems,
including possible Ménière’s disease. When
assessing this client, the nurse expects to note:
a. Vertigo, tinnitus, and hearing loss.
b. Vertigo, vomiting, and nystagmus.
c. Vertigo, pain, and hearing impairment.
d. Vertigo, blurred vision, and fever.
64. A male client with a conductive hearing disorder
caused by ankylosis of the stapes in the oval window
undergoes a stapedectomy to remove the stapes
and replace the impaired bone with a prosthesis.
After the stapedectomy, the nurse should provide
which client instruction?
a) “Lie in bed with your head elevated, and
refrain from blowing your nose for 24
hours.”
b) “Try to ambulate independently after about
24 hours.”
c) “Shampoo your hair every day for ten (10)
days to help prevent ear infection.”
d) “Don’t fly in an airplane, climb to high
altitudes, make sudden movements, or
expose yourself to loud sounds for 30
days.”
65. Nurse Marty is monitoring a client for adverse
reactions to dantrolene (Dantrium). Which adverse
reaction is most common?
a) Excessive tearing
b) Urine retention
c) Muscle weakness
d) Slurred speech
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66. The nurse is monitoring a male client for adverse
reactions to atropine sulfate (Atropine Care)
eyedrops. Systemic absorption of atropine sulfate
through the conjunctiva can cause which adverse
reaction?
a) Tachycardia
b) Increased salivation
c) Hypotension
d) Apnea
67. A male client has a history of painful, continuous
muscle spasms. He has taken several skeletal muscle
relaxants without experiencing relief. His physician
prescribes diazepam (Valium), two (2) mg P.O. twice
daily. In addition to being used to relieve painful
muscle spasms, Diazepam also is recommended for:
a) Long-term treatment of epilepsy.
b) Postoperative pain management of
laminectomy clients.
c) Postoperative pain management of
diskectomy clients.
d) Treatment of spasticity associated with
spinal cord lesions.
68. A female client who was found unconscious at home
is brought to the hospital by a rescue squad. In the
intensive care unit, the nurse checks the client’s
oculocephalic (doll’s eye) response by:
a) Introducing ice water into the external
auditory canal.
b) Touching the cornea with a wisp of cotton.
c) Turning the client’s head suddenly while
holding the eyelids open.
d) Shining a bright light into the pupil.
69. While reviewing a client’s chart, the nurse notices
that the female client has myasthenia gravis. Which
of the following statements about neuromuscular
blocking agents is true for a client with this
condition?
a) The client may be less sensitive to the effects
of a neuromuscular blocking agent.
b) Succinylcholine shouldn’t be used;
pancuronium may be used in a lower dosage.
c) Pancuronium shouldn’t be used;
succinylcholine may be used in a lower
dosage.
d) Pancuronium and succinylcholine both
require cautious administration.
70. A male client is color blind. The nurse understands
that this client has a problem with:
a) Rods.
b) Cones.
c) Lens.
d) Aqueous humor.
71. A female client who was trapped inside a car for
hours after a head-on collision is rushed to the
emergency department with multiple injuries. During
the neurologic examination, the client responds to
painful stimuli with decerebrate posturing. This
finding indicates damage to which part of the brain?
a) Diencephalon
b) Medulla
c) Midbrain
d) Cortex
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72. The nurse is assessing a 37-year-old client diagnosed
with multiple sclerosis. Which of the following
symptoms would the nurse expect to find?
a) Vision changes
b) Absent deep tendon reflexes
c) Tremors at rest
d) Flaccid muscles
73. The nurse is caring for a male client diagnosed with a
cerebral aneurysm who reports a severe headache.
Which action should the nurse perform?
a) Sit with the client for a few minutes.
b) Administer an analgesic.
c) Inform the nurse manager.
d) Call the physician immediately.
74. During recovery from a cerebrovascular accident
(CVA), a female client is given nothing by mouth, to
help prevent aspiration. To determine when the
client is ready for a liquid diet, the nurse assesses the
client’s swallowing ability once each shift. This
assessment evaluates:
a) Cranial nerves I and II.
b) Cranial nerves III and V.
c) Cranial nerves VI and VIII.
d) Cranial nerves IX and X.
75. 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) Bronchial asthma
76. The nurse is teaching a female client with multiple
sclerosis. When teaching the client how to reduce
fatigue, the nurse should tell the client to:
a) Take a hot bath.
b) Rest in an air-conditioned room.
c) Increase the dose of muscle relaxants.
d) Avoid naps during the day.
77. A male client is having tonic-clonic seizures. What
should the nurse do first?
a) Elevate the head of the bed.
b) Restrain the client’s arms and legs.
c) Place a tongue blade in the client’s mouth.
d) Take measures to prevent injury.
78. A female client with Guillain-Barré syndrome has
paralysis affecting the respiratory muscles and
requires mechanical ventilation. When the client asks
the nurse about the paralysis, how should the nurse
respond?
a) “You may have difficulty believing this,
but the paralysis caused by this disease is
temporary.”
b) “You’ll have to accept the fact that you’re
permanently paralyzed. However, you won’t
have any sensory loss.”
c) “It must be hard to accept the permanency
of your paralysis.”
d) “You’ll first regain use of your legs and then
your arms.”
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79. The nurse is working on a surgical floor. The nurse
must log roll a male client following a:
a) Laminectomy.
b) Thoracotomy.
c) Hemorrhoidectomy.
d) Cystectomy.
80. A female client with a suspected brain tumor is
scheduled for computed tomography (CT). What
should the nurse do when preparing the client for
this test?
a) Immobilize the neck before the client is
moved onto a stretcher.
b) Determine whether the client is allergic
to iodine, contrast dyes, or shellfish.
c) Place a cap on the client’s head.
d) Administer a sedative as ordered.
81. During a routine physical examination to assess a
male client’s deep tendon reflexes, the nurse should
make sure to:
a) Use the pointed end of the reflex hammer
when striking the Achilles' tendon.
b) Support the joint where the tendon is
being tested.
c) Tap the tendon slowly and softly.
d) Hold the reflex hammer tightly.
82. A female client is admitted in a disoriented and
restless state after sustaining a concussion during a
car accident. Which nursing diagnosis
takes highest priority for this client’s plan of care?
a) Disturbed sensory perception (visual)
b) Self-care deficit: Dressing/grooming
c) Impaired verbal communication
d) Risk for injury
83. A female client with amyotrophic lateral sclerosis
(ALS) tells the nurse, “Sometimes I feel so frustrated.
I can’t do anything without help!” This comment best
supports which nursing diagnosis?
a) Anxiety
b) Powerlessness
c) Ineffective denial
d) Risk for disuse syndrome
84. For a male client with suspected increased
intracranial pressure (ICP), a most appropriate
respiratory goal is to:
a) Prevent respiratory alkalosis.
b) Lower arterial pH.
c) Promote carbon dioxide elimination.
d) Maintain partial pressure of arterial oxygen
(PaO2) above 80 mm Hg.
85. Nurse Mary witnesses a neighbor’s husband sustain
a fall from the roof of his house. The nurse rushes to
the victim and determines the need to open the
airway in this victim by using which method?
a) Flexed position
b) Head tilt-chin lift
c) Jaw-thrust maneuver
d) Modified head tilt-chin lift
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86. The nurse is assessing the motor function of an
unconscious male client. The nurse would plan to
use which of the following to test the client’s
peripheral response to pain?
a) Sternal rub
b) Nail bed pressure
c) Pressure on the orbital rim
d) Squeezing of the sternocleidomastoid
muscle
87. A female client admitted to the hospital with a
neurological problem asks the nurse whether
magnetic resonance imaging may be done. The
nurse interprets that the client may be ineligible for
this diagnostic procedure based on the client’s
history of:
a) Hypertension
b) Heart failure
c) Prosthetic valve replacement
d) Chronic obstructive pulmonary disorder
88. A male client is having a lumbar puncture
performed. The nurse would plan to place the client
in which position?
a) Side-lying, with a pillow under the hip.
b) Prone, with a pillow under the abdomen.
c) Prone, in slight-Trendelenburg’s position.
d) Side-lying, with the legs, pulled up and
head bent down onto the chest.
89. The nurse is positioning the female client with
increased intracranial pressure. Which of the
following positions would the nurse avoid?
a) Head midline
b) Head turned to the side
c) Neck in neutral position
d) Head of bed elevated 30 to 45 degrees
90. A female client has clear fluid leaking from the nose
following a basilar skull fracture. The nurse assesses
that this is cerebrospinal fluid if the fluid:
a) Is clear and tests negative for glucose.
b) Is grossly bloody in appearance and has a
pH of 6.
c) Clumps together on the dressing and has a
pH of 7.
d) Separates into concentric rings and tests
positive for glucose.
91. A male 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) Strict adherence to a bowel retraining
program.
b) Keeping the linen wrinkle-free under the
client.
c) Preventing unnecessary pressure on the
lower limbs.
d) Limiting bladder catheterization to once
every 12 hours.
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92. The nurse is caring for the male client who begins to
experience seizure activity while in bed. Which of the
following actions by the nurse would be
contraindicated?
a) Loosening restrictive clothing.
b) Restraining the client’s limbs.
c) Removing the pillow and raising padded
side rails.
d) Positioning the client to the side, if possible,
with the head flexed forward.
93. The nurse is assigned to care for a female client with
complete right-sided hemiparesis. The nurse plans
care knowing that this condition:
a) The client has complete bilateral paralysis of
the arms and legs.
b) The client has weakness on the right side
of the body, including the face and
tongue.
c) The client has lost the ability to move the
right arm but can walk independently.
d) The client has lost the ability to move the
right arm but can walk independently.
94. The client with a brain attack (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) Thickening liquids to the consistency of
oatmeal.
c) Placing food on the unaffected side of the
mouth.
d) Allowing plenty of time for chewing and
swallowing.
95. The nurse is assessing the adaptation of the female
client to changes in functional status after a brain
attack (stroke). The nurse assesses that the client is
adapting most successfully if the client:
a) Gets angry with family if they interrupt a
task.
b) Experiences bouts of depression and
irritability.
c) Has difficulty with using modified feeding
utensils.
d) Consistently uses adaptive equipment in
dressing self.
96. Nurse Kristine is trying to communicate with a client
with brain attack (stroke) and 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.
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.
97. A female client has experienced an episode of
myasthenic crisis. The nurse would assess whether
the client has precipitating factors such as:
a) Getting too little exercise.
b) Taking excess medication.
c) Omitting doses of medication.
d) Increasing intake of fatty foods.
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98. The nurse is teaching the female client with
myasthenia gravis about the prevention of
myasthenic and cholinergic crisis. The nurse tells the
client that this is most effectively done by:
a) Eating large, well-balanced meals.
b) Doing muscle-strengthening exercises.
c) Doing all chores early in the day while less
fatigued.
d) Taking medications on time to maintain
therapeutic blood levels.
99. A male client with Bell’s Palsy asks the nurse what
has caused this problem. The nurse’s response is
based on an understanding that the cause is:
a) Unknown, but possibly includes ischemia,
viral infection, or an autoimmune
problem.
b) Unknown, but possibly includes long-term
tissue malnutrition and cellular hypoxia.
c) Primary genetic in origin, triggered by
exposure to meningitis.
d) Primarily genetic in origin, triggered by
exposure to neurotoxins.
100. 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?
a) Reposition the client to avoid neck
flexion.
b) Administer 1 g Mannitol IV as ordered.
c) Increase the ventilator’s respiratory rate to
20 breaths/minute.
d) Administer 100 mg of pentobarbital IV as
ordered.
101. 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) Therapeutic drug levels should be
maintained between 20 to 30 mg/ml.
b) Rapid Dilantin administration can cause
cardiac arrhythmias.
c) Dilantin should be mixed in dextrose in
water before administration.
d) Dilantin should be administered through
an IV catheter in the client’s hand.
102. 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) Evaluate urine specific gravity.
b) Anticipate treatment for renal failure.
c) Provide emollients to the skin to prevent
breakdown.
d) Slow down the IV fluids and notify the
physician.
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103. When evaluating an ABG from a client with a
subdural hematoma, the nurse notes the PaCO2 is
30 mm Hg. Which of the following responses best
describes this result?
a) Appropriate; lowering carbon dioxide
(CO2) reduces intracranial pressure
(ICP).
b) Emergent; the client is poorly oxygenated.
c) Normal
d) Significant; the client has alveolar
hypoventilation.
104. A client who had a transsphenoidal
hypophysectomy should be watched carefully for
hemorrhage, which may be shown by which of the
following signs?
a) Bloody drainage from the ears
b) Frequent swallowing
c) Guaiac-positive stools
d) Hematuria
105. After a hypophysectomy, vasopressin is given IM
for which of the following reasons?
a) To treat growth failure.
b) To prevent syndrome of inappropriate
antidiuretic hormone (SIADH).
c) To reduce cerebral edema and lower
intracranial pressure.
d) To replace antidiuretic hormone (ADH)
normally secreted by the pituitary.
106. 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) Assess full ROM to determine extent of
injuries.
b) Call for an immediate chest x-ray.
c) Immobilize the client’s head and neck.
d) Open the airway with the head-tilt-chin-
lift maneuver.
107. A client with a C6 spinal injury would most likely
have which of the following symptoms?
a. Aphasia
b. Hemiparesis
c. Paraplegia
d. Tetraplegia
108. A 30-year-old was admitted to the progressive
care unit with a C5 fracture from a motorcycle
accident. Which of the following assessments would
take priority?
a. Bladder distension
b. Neurological deficit
c. Pulse ox readings
d. The client’s feelings about the injury
109. While in the ER, a client with C8 tetraplegia
develops a blood pressure of 80/40, pulse 48, and RR
of 18. The nurse suspects which of the following
conditions?
a) Autonomic dysreflexia
b) Hemorrhagic shock
c) Neurogenic shock
d) Pulmonary embolism
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110. A client is admitted with a spinal cord injury at
the level of T12. He has limited movement of his
upper extremities. Which of the following
medications would be used to control edema of the
spinal cord?
a) acetazolamide (Diamox)
b) furosemide (Lasix)
c) methylprednisolone (Solu-Medrol)
d) sodium bicarbonate
111. 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?
a) Place the client flat in bed.
b) Assess patency of the indwelling urinary
catheter.
c) Give one SL nitroglycerin tablet.
d) Raise the head of the bed immediately to
90 degrees.
112. A client with a cervical spine injury has Gardner-
Wells tongs inserted for which of the following
reasons?
a) To hasten wound healing.
b) To immobilize the cervical spine.
c) To prevent autonomic dysreflexia.
d) To hold bony fragments of the skull
together.
113. Which of the following interventions describes
an appropriate bladder program for a client in
rehabilitation for spinal cord injury?
a) Insert an indwelling urinary catheter to
straight drainage.
b) Schedule intermittent catheterization
every 2 to 4 hours.
c) Perform a straight catheterization every 8
hours while awake.
d) Perform Crede’s maneuver to the lower
abdomen before the client voids.
114. A client who 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?
a) Laceration of the middle meningeal
artery.
b) Rupture of the carotid artery.
c) Thromboembolism from a carotid artery.
d) Venous bleeding from the arachnoid space.
115. 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?
a) Position the client flat in bed.
b) Check the fluid for dextrose with a
dipstick.
c) Suction the nose to maintain airway patency.
d) Insert nasal and ear packing with sterile
gauze.
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116. When discharging a client from the ER after. An
interval when the client’s speech is garbled head
trauma, the nurse teaches the guardian to observe
for a lucid interval. Which of the following
statements best describes a lucid interval?
a) An interval when the client’s speech is
garbled.
b) An interval when the client is alert but can’t
recall recent events.
c) An interval when the client is oriented but
then becomes somnolent.
d) An interval when the client has a “warning”
symptom, such as an odor or visual
disturbance.
117. Which of the following clients on the rehab unit
is most likely to develop autonomic dysreflexia?
a) A client with a brain injury.
b) A client with a herniated nucleus pulposus.
c) A client with a high cervical spine injury.
d) A client with a stroke.
118. Which of the following conditions indicates that
spinal shock is resolving in a client with C7
quadriplegia?
a) Absence of pain sensation in chest
b) Spasticity
c) Spontaneous respirations
d) Urinary continence
119. A nurse assesses a client who has episodes of
autonomic dysreflexia. Which of the following
conditions can cause autonomic dysreflexia?
a) Headache
b) Lumbar spinal cord injury
c) Neurogenic shock
d) Noxious stimuli
120. During an episode of autonomic dysreflexia in
which the client becomes hypertensive, the nurse
should perform which of the following interventions?
a) Elevate the client’s legs.
b) Put the client flat in bed.
c) Put the client in Trendelenburg's position.
d) Put the client in the high-Fowler’s
position.
121. A client with a T1 spinal cord injury arrives at the
emergency department with a BP of 82/40, pulse 34,
dry skin, and flaccid paralysis of the lower
extremities. Which of the following conditions
would most likely be suspected?
a) Autonomic dysreflexia
b) Hypervolemia
c) Neurogenic shock
d) Sepsis
122. A client has a cervical spine injury at the level of
C5. Which of the following conditions would the
nurse anticipate during the acute phase?
a) Absent corneal reflex.
b) Decerebrate posturing.
c) Movement of only the right or left half of
the body.
d) The need for mechanical ventilation.
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123. A client with C7 quadriplegia is flushed and
anxious and complains of a pounding headache.
Which of the following symptoms would also be
anticipated?
a) Decreased urine output or oliguria
b) Hypertension and bradycardia
c) Respiratory depression
d) Symptoms of shock
124. A 40-year-old paraplegic must perform
intermittent catheterization of the bladder. Which of
the following instructions should be given?
a) “Clean the meatus from back to front.”
b) “Measure the quantity of urine.”
c) “Gently rotate the catheter during removal.”
d) “Clean the meatus with soap and water.
125. 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) “Watch him for a keyhole pupil the next 24
hours.”
b) “Expect profuse vomiting for 24 hours after
the injury.”
c) “Wake him every hour and assess his
orientation to person, time, and place.”
d) “Notify the physician immediately if he has a
headache.”
126. Which neurotransmitter is responsible for many
of the functions of the frontal lobe?
a. Dopamine
b. GABA
c. Histamine
d. Norepinephrine
127. 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 of the following conditions?
a) Extent of intracranial bleeding.
b) Sites of brain injury.
c) Activity of the brain.
d) Percent of functional brain tissue.
128. 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) Subdural hematoma
b) Subarachnoid hemorrhage
c) Epidural hematoma
d) Contusion
129. After falling 20’, a 36-year-old man sustains a C6
fracture with spinal cord transaction. Which other
findings should the nurse expect?
a) Quadriplegia with gross arm movement
and diaphragmatic breathing.
b) Quadriplegia and loss of respiratory
function.
c) Paraplegia with intercostal muscle loss.
d) Loss of bowel and bladder control.
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130. A 20-year-old client who fell approximately 30’ is
unresponsive and breathless. A cervical spine injury
is suspected. How should the first-responder open
the client’s airway for rescue breathing?
a) By inserting a nasopharyngeal airway.
b) By inserting an oropharyngeal airway.
c) By performing a jaw thrust maneuver.
d) By performing the head-tilt, chin-lift
maneuver.
131. The nurse is caring for a client with a T5
complete spinal cord injury. Upon assessment, the
nurse notes flushed skin, diaphoresis above the T5,
and a blood pressure of 162/96. The client reports a
severe, pounding headache. Which of the following
nursing interventions would be appropriate for this
client? Select all that apply.
a) Elevate the HOB to 90 degrees.
b) Loosen constrictive clothing.
c) Use a fan to reduce diaphoresis.
d) Assess for bladder distention and
bowel impaction.
e) Administer antihypertensive
medication.
f) Place the client in a supine position with
legs elevated.
132. The client with a head injury has been urinating
copious amounts of dilute urine through the Foley
catheter. The client’s urine output for the previous
shift was 3000 ml. The nurse implements a new
physician order to administer:
a) desmopressin (DDAVP, Stimate)
b) Dexamethasone (Decadron)
c) Dexamethasone (Decadron) C. ethacrynic
acid (Edecrin)
d) mannitol (Osmitrol)
133. 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 is
compatible with:
a) Skull fracture
b) Concussion
c) Subdural hematoma
d) Epidural hematoma
134. The nurse is caring for a client who suffered a
spinal cord injury 48 hours ago. The nurse monitors
for GI complications by assessing for:
a) A flattened abdomen.
b) Hematest positive nasogastric tube
drainage.
c) Hyperactive bowel sounds.
d) A history of diarrhea.
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135. 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) Strict adherence to a bowel retraining
program.
b) Limiting bladder catheterization to once
every 12 hours.
c) Keeping the linen wrinkle-free under the
client.
d) Preventing unnecessary pressure on the
lower limbs.
136. The nurse is planning care for the client in spinal
shock. Which of the following actions would be least
helpful in minimizing the effects of vasodilation
below the level of the injury?
a) Monitoring vital signs before and during
position changes.
b) Using vasopressor medications as
prescribed.
c) Moving the client quickly as one unit.
d) Applying Teds or compression stockings.
137. The nurse is caring for a client admitted with
spinal cord injury. The nurse minimizes the risk of
compounding the injury most effectively by:
a) Keeping the client on a stretcher.
b) Logrolling the client on a firm mattress.
c) Logrolling the client on a soft mattress.
d) Placing the client on a Stryker frame.
138. 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) Positive reflexes
b) Hyperreflexia
c) Inability to elicit a Babinski’s reflex.
d) Reflex emptying of the bladder.
139. A client with a spinal cord injury suddenly
experiences an episode of autonomic dysreflexia.
After checking the client’s vital signs, list in order of
priority, the nurse’s actions (Number 1 being the
first priority and number 5 being the last priority).
1. Raise the head of the bed.
2. Loosen tight clothing on the client.
3. Check for bladder distention.
4. Contact the physician.
5. Administer an antihypertensive medication.
140. A client is at risk for increased ICP. Which of the
following would be a priority for the nurse to
monitor?
a) Unequal pupil size
b) Decreasing systolic blood pressure
c) Tachycardia
d) Decreasing body temperature
141. Which of the following respiratory patterns
indicate increasing ICP in the brain stem?
a) Slow, irregular respirations
b) Rapid, shallow respirations
c) Asymmetric chest expansion
d) Nasal flaring
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142. Which of the following nursing interventions is
appropriate for a client with an ICP of 20 mm Hg?
a. Give the client a warming blanket.
b. Administer low-dose barbiturate.
c. Encourage the client to hyperventilate.
d. Restrict fluids.
143. A client has signs of increased ICP. Which of the
following is an early indicator of deterioration in the
client’s condition?
a) Widening pulse pressure
b) Decrease in the pulse rate
c) Dilated, fixed pupil
d) Decrease in LOC
144. 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?
a) Place her in a jacket restraint.
b) Wrap her hands in soft “mitten”
restraints.
c) Tuck her arms and hands under the draw
sheet.
d) Apply a wrist restraint to each arm.
145. Which of the following describes decerebrate
posturing?
a) Internal rotation and adduction of arms with
flexion of elbows, wrists, and fingers.
b) Back hunched over, rigid flexion of all four
extremities with supination of arms and
plantar flexion of the feet.
c) Supination of arms, dorsiflexion of feet.
d) Back arched; rigid extension of all four
extremities.
146. A client receiving vent-assisted mode ventilation
begins to experience cluster breathing after recent
intracranial occipital bleeding. Which action would
be most appropriate?
a) Count the rate to be sure the ventilations
are deep enough to be sufficient.
b) Call the physician while another nurse
checks the vital signs and ascertains the
patient’s Glasgow Coma score.
c) Call the physician to adjust the ventilator
settings.
d) Check deep tendon reflexes to determine
the best motor response.
147. In planning the care for a client who has had a
posterior fossa (infratentorial) craniotomy, which of
the following is contraindicated when positioning
the client?
a) Keeping the client flat on one side or the
other.
b) Elevating the head of the bed to 30
degrees.
c) Logrolling or turning as a unit when turning.
d) Keeping the head in a neutral position.
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 cam

148. A client has been pronounced brain dead. Which

findings would the nurse assess? Select all that
apply.
a) Decerebrate posturing
b) Dilated nonreactive pupils
c) Deep tendon reflexes
d) Absent corneal reflex

149. A 23-year-old patient with a recent history of

encephalitis is admitted to the medical unit with new
onset generalized tonic-clonic seizures. Which
nursing activities included in the patient’s care will
be best to delegate to an LPN/LVN whom you are
supervising?
a) Document the onset time, nature of seizure
activity, and postictal behaviors for all
seizures.
b) Administer phenytoin (Dilantin) 200 mg
PO daily.
c) Teach the patient about the need for good
oral hygiene.
d) Develop a discharge plan, including
physician visits and referral to the Epilepsy
Foundation.

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