Name: __________________________________________________________ Date: _____________________

Section: __________________
Answer the following questions. Write the letter only avoid erasures.

1. You are working in a neuro ward when the emergency department called for an admission of a client with a frontal head
injury. Medical diagnosis reveals a subdural hematoma. Which of the following is the priority question you are to ask the
emergency nurse.
a. “What is the LOC of the client before the injury?” b. “When did the injury occur?”
c. “What medications has the client received since the injury?” d. “Is the client male or female?”
2. Aside from assessing the client’s GCS on a client with brainstem injury, the nurse also plans to:
a. Draw blood for sample for ABG and CBC b. Assist the physician in performing lumbar puncture
c. Check cranial nerve functioning and respiratory status d. Assess the clients intracranial pressure
3. You observed that the client is in decerebrate posturing after eliciting pain. This position tells the nurse that the client has a:
a. Dysfunction in the cerebrum b. Risk for increased intracranial pressure
c. Dysfunction in the brain stem d. Dysfunction in the spinal column
4. During your admission on a client, you are to perform a deep tendon reflex, it is important for the nurse to:
a. Tap the tendon lightly and slowly b. Hold the reflex hammer tightly
c. Support the joint and tendon being tested d. Distract the client as the nurse taps the tendon
5. A client admitted with cerebral contusion is confused, disoriented and restless. Which of the following nursing diagnosis takes
priority?
a. Disturbed sensory perception b. Impaired verbal communication
c. Risk for injury d. Self care deficit
6. According to monro-kellie doctrine, which of the following causes an increase level of ICP?
a. V1 b. V2
c. V3 d. V4
7. You are performing babinski reflex during a routine neurological exam on a client. In which of the following areas are you
going to place the tongue blade to begin the procedure?
A
B
C

8. Which of the following statements is INCORRRECT?

a. Paraplegia is weakness of either side of the body b. Tetraplegia is synonymous to quadriplegia
c. Akinesia is inability to move voluntarily d. Graphestesia is ability to recognize writing on skin
9. Which of the following assessment may indicate leakage of CFS.
a. otorrhea b. specimen positive for glucose
c. halo sign on linen d. all of the above
10. In assessing for balance test, which of the following can the nurse perform?
a. finger to finger test b. tandem walking
c. finger to nose test d. rapid alternating movements
11. Your client has been experiencing problem with balance, which part of the brain is malfunctioning?

A B

C D

12. What is the score on GCS of a patient, whose eye opens when called, is confused but can localize pain?
a. 9 b. 10
c. 11 d. 12
13. Which level of consciousness is described where the patient requires strong stimulus and the patient reacts by grimace or
making incomprehensible sound?
a. alert b. lethargic
c. obtunted d. coma
14. You admitted an unconscious client in the emergency room suspected of traumatic brain injury. Which of the following will
be prioritized by the nurse?
a. safety of the client b. establishes airway
c. nutrition of the client d. proper identification of the client
15. You admitted a client in the ICU after a procedure of evacuation of subdural hematoma. Which of the following interventions
are you to perform to minimize effects of an increase in ICP.
a. encourage increase fluid intake b. suction client frequently
c. elevate head of bed to 90O d. administer stool softener as ordered