NEURO EXAM PRACTICE QUESTIONS WITH 100% CORRECT ANSWERS 2024

A client presents with a headache and complaining of vision difficulties. Which cranial nerve might be defective in this client? A) VIII (Vestibulocochlear) B) VII (Facial) C) XI (Accessory) D) III (Oculomotor) Answer: D A client presents to the ED with loss of consciousness. The RN evaluates the client using the Glasgow Coma Scale. The results are as follows: Eyes open to speech Abnormal flexion of extremities Use of inappropriate words What would the RN estimate this client's GCS score to be? A) 13 B) 9 C) 7 D) 4 Answer: B Eyes open to speech = 3 Abnormal flexion = 3 Inappropriate words = 3 The RN is receiving report from the night-shift nurse about a patient on the neuro unit. The night-shift nurse states that the client has had decreased proprioception throughout the night. The RN knows tthis means that A) The client has difficulty sensing their position and posture. B) The client's pupils are different sizes. C) The client' has the inability to perform purposeful movements. D) The client is exhibiting symptoms on the opposite side of the body from the brain injury. Answer: A The RN is caring for a client on a neuro unit who has sustained a head injury. The RN knows that if the pressure of either the brain, CSF, or blood goes up, the other two intracranial components must go down to compensate. This is known as the A) Orem's Self-Care Deficit theory B) Monroe-Kellie hypothesis C) Kolcaba's hypothesis D) Peplau's Neurological Compensation theory Answer: B Which of the following can lead to cytotoxic edema? (SELECT ALL THAT APPLY) A) Ischemia B) Hyperglycemia C) Hyponatremia D) SIADH E) Cardiac arrest F) Cushing's triad Answer: A, C, D, E *Anything involving decreased oxygenation can lead to cytotoxic edema. The RN is taking care of a patient on the neuro unit. The night-shift nurse indicates in the morning report that the client has sustained a right midline shift during the night. The RN interprets this to mean that the client A) Has fluid accumulating on the right side of the brain. B) Has had a brain herniation through the foramen magnum. C) Has experienced right-sided vasogenic cerebral edema. D) Has fluid accumulating on the left side of the brain. Answer: D *A "midline shift" simply means that fluid is putting pressure on one side of the brain, pushing it in the opposite direction toward the "midline". EX: A patient with a right-sided subdural hematoma will have a left midline shift. Which of the following is an early indication of a central herniation? A) Coma B) Decreased level of consciousness C) Temperature 100.4 degrees Fahrenheit D) Decorticate posturing Answer: B A nurse is caring for a patient on the neuro unit with an uncal herniation. The nurse understands that which of the following manifestations are indications of an uncal herniation? (SELECT ALL THAT APPLY) A) Positive Kellog's sign B) Ipsilateral pupil dilation C) Decerebrate posturing D) Positive Babinski reflex E) Same side motor defects F) Cheyne-Stokes respirations Answer: B, C, D, E, F A patient is being seen on the neuro unit who requires close ICP monitoring. The doctor orders a ventriculostomy. The nurse understands that a ventriculostomy A) does not drain CSF, and can produce a dampened waveform related to occlusion of clots or tissue. B) requires tubing to be flushed with sterile normal saline without preservatives. C) allows concurrent monitoring of ICP as well as a CSF drainage system. D) is the least invasive device for indirectly monitoring ICP that puts the Answer: C A patient presents to the ED with symptoms of brain herniation. The nurse knows to assess for Cushing's response, which includes A) Widening pulse pressure, decreasing systolic BP, and bradycardia. B) Widening pulse pressure, increased systolic BP, and tachycardia. C) Bradycardia, hypertension, and abnormal respirations. D) Bradycardia, widening pulse pressure, and rising systolic BP Answer: D The patient with brain herniation has been assessed, and he is progressing from Cushing's response to Cushing's triad. The nurse understands that she needs to monitor for which of the following for progression to Cushing's triad? A) Widening pulse pressure, decreasing systolic BP, and bradycardia. B) Widening pulse pressure, increased systolic BP, and tachycardia. C) Bradycardia, hypertension, and abnormal respirations. D) Bradycardia, widening pulse pressure, and rising systolic BP Answer: C After stabilizing the patient with brain herniation in the ED, he is sent to the neuro ICU for continued monitoring with an epidural transducer. The nurse understands that an epidural transducer A) is the least invasive device for indirectly monitoring ICP that puts the patient at lowest risk for infection or hemorrhage. B) allows concurrent monitoring of ICP as well as a CSF drainage system. C) does not drain CSF, and can produce a dampened waveform related to occlusion by clots or tis Answer: A An ABG has been ordered for a patient receiving continuous ICP monitoring. Which of the following results requires immediate attention by the nurse? A) pH 7.40, PaO2 75, PaCO2 45 B) pH 7.30, PaO2 80, PaCO2 34 C) pH 7.50, PaO2 70, PaCO2 50 D) pH7.48, PaO2 90, PaCO2 30 Answer: C *Increased ICP will cause a rise in pH (7.45), decrease in PaO2 (80), and a rise in PaCO2 (45). A nurse is planning care for a 45-year-old male client with increased ICP on the neuro unit with a Glasgow Coma Scale score of 12. Which of the following should the nurse include in this patient's plan of care? A) Cluster ADLs. B) Provide time for adequate rest periods throughout the day. C) Call the physician and request a spinal tap to test for suspected CSF leakage. D) Allow multiple visitors throughout the day. Answer: B *Plan of care should include: -Seizure precautions -Monitoring and treating trends, such as BP and LOC. -Space activities throughout the day to provide adequate rest (ADLs should be done in under 5 minutes). -Provide calm, quiet environment. -Limit emotional upset. -Avoid coughing, sneezing, straining with bowel movement, pushing against bedrails, and isometric exercises. Which of the following are diagnostic tests used to detect the presence of increased ICP? (SELECT ALL THAT APPLY) A) Coagulation profile. B) Chorionic villus sampling. C) Computed tomography. D) Cerebral blood flow with transcranial Doppler. E) EEG. F) Amniocentesis. G) Angiography. Answer: C, D, E, G The nurse is performing a neurologic assessment on a client. The nurse asks the patient to stick out her tongue and move it to one side, then the other. Which cranial nerve is the nurse assessing? A) Olfactory (I) B) Trigeminal (V) C) Facial (VI) D) Hypoglossal (XII) Answer: D A patient with increasing ICP is in being taken care of by a nurse in the neuro ICU. Lab data shows the following: pH = 7.38 PaO2 = 88 PaCO2 = 45 Serum osmolality = 330 What should the nurse's priority action be based upon these lab values? A) Continue to monitor the patient. B) Contact the health care provider and request an order for mannitol. C) Assess drainage from the parenchymal fiber-optic catheter. D) Administer furosemide (Lasix) as ordered. Answer: A *All values are within normal limits. Normal Levels: pH = 7.35-7.45 PaO2 = 80-100 PaCO2 = 35-45 Serum osmolality = 280-300, but maintained above 325 to maintain cerebral perfusion in patients with IICP. The nurse is caring for a patient on the neuro unit with a brain hemorrhage, which has been causing a left midline shift. The nurse anticipates the doctor ordering which of the following tests to show the progression of the hemorrhage? A) CT scan B) MRI C) Cerebral flow w/transcranial Doppler D) EEG Answer: A The nurse on a neuro unit is assessing her patient at the beginning of the night shift. After the assessment, the nurse notices the following: Eyes open to speech Obeys commands Pleasantly confused Based on the GCS score for this patient, what can the nurse conclude? A) The client has a mild brain injury. B) The client has a moderate brain injury. C) The client has a severe brain injury. D) The client is in a coma. Answer: A The nurse is caring for a patient with increased ICP who is showing signs of Cushing's triad. Which of the following nursing interventions will the nurse provide for this patient? (SELECT ALL THAT APPLY) A) Keep CPP /= 70 mmHg B) Place client in Trendelenburg position C) Assess LOC D) Elevate HOB no more than 30 degrees E) Encourage vigilant coughing to expel secretions F) Maintain neutral head position. G) Monitor ICP every 15 min-1 hr. H) Maintain MAP 70 mmHg Answer: A, C, D, F, G *CPP should be kept at or above 70 mmHg. *Client's should be placed supine with HOB at no more than 30 degrees. *Frequent neurologic exams, including assessing LOC, are needed. *Avoid coughing, sneezing, or straining. *Maintain a neutral head position with careful side-to- side rotation, when necessary. *IICP needs to be monitored q15m-1h. *MAP must be maintained between 70-95 mmHg. The nurse has taken report from the night shift nurse for a patient who has had an ICP of 25 for the past 15 minutes. The nurse checks the doctor's orders for anticipatory administration of which of the following medications? A) furosemide (Lasix) B) rifadin (Rifampin) C) Mannitol D) labetalol (Trandate) Answer: C *Osmotic diuretics, such as Mannitol, are used for patients who have a sustained ICP greater than 15-20 for 10 minutes or longer. A patient with IICP has been ordered IVFs to help maintain serum osmolality. The nurse knows that which of the following IVFs would cause the nurse to question the order? A) 0.9% normal saline B) 5% dextrose in water (D5W) C) 0.45% normal saline D) 1/2 normal saline Answer: B *Patients with IICP are given IVFs to maintain moderate dehydration, which helps to maintain serum osmolality. D5W must always be avoided in these cases due to its hypo-osmolar effects once inside the body. Which of the following medications would the nurse question if ordered for a patient with IICP? A) Acetaminophen 325 mg PO BID B) Ranitidine 150 mg PO q12h C) Dilantin 100 mg PO BID D) Fibrinogen 150 mg/dL Answer: D *Factor I (Fibrinogen) is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots. This medication will increase ICP. A patient on the neuro unit is scheduled for an angiography at 2:00pm. What should the nurse teach the patient prior to the test? (SELECT ALL THAT APPLY) A) Check for allergies to iodine or seafood. B) NPO 8 hours prior to test. C) Increase fluid intake to 2,000 mL before the test. D) It is not necessary to remove jewelry or dentures prior to this test. E) Possible burning sensation at injection site. F) Possible nausea and salty taste may occur after injection. Answer: A, B, E, F *Allergies to iodine, seafood, or previous reactions to dye need to be assessed. *Patient must be NPO 8-10 hours prior to test. *All jewelry, dentures, and hair pins must be removed. *Bladder must be emptied prior to test. *There may be a burning sensation at the injection site, as well as nausea and/or a salty taste in the mouth. The doctor has prescribed mannitol for a patient with IICP. The nurse must teach the patient that possible side effects of this medication may include A) Hypertension B) Vasodilation C) Rebound cerebral edema D) Decreased gastric motility Answer: C