Medical-Surgical Nursing: Neurological Disorders (Med-Surg Nursing) Practice Questions
Test yourself on Neurological Disorders (Med-Surg Nursing) with 13 original NCLEX-RN practice questions. Pick an answer to see instant feedback and a full explanation.
Free original practice questions for study purposes. Open Exam Prep is an independent study resource and is not affiliated with, endorsed by, or sponsored by the makers of NCLEX-RN.
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1. A nurse is caring for a client with increased intracranial pressure (ICP). Which finding represents Cushing's triad and requires immediate intervention?
Explanation. Cushing's triad is a late sign of dangerously increased ICP: bradycardia, widening pulse pressure (rising systolic with falling/stable diastolic), and irregular/abnormal respirations. It signals impending brain herniation and demands emergency action. Tachycardia and hypotension reflect shock, not increased ICP.
2. A client recovering from a stroke has right-sided hemiparesis and homonymous hemianopsia. To promote safety during meals, the nurse should:
Explanation. Homonymous hemianopsia is loss of the same visual field in both eyes (here the right side). Initially place items in the intact field (left) and teach the client to turn the head/scan toward the affected side. Feeding the client unnecessarily promotes dependence; permanent liquid diet is not indicated.
3. A nurse administers tissue plasminogen activator (tPA) to a client with acute ischemic stroke. Which assessment finding requires the nurse to notify the provider immediately?
Explanation. The most dangerous complication of tPA is intracranial hemorrhage. A sudden severe headache with a decline in level of consciousness suggests bleeding and must be reported immediately. The BP and heart rate are within acceptable ranges, and a mild positional headache is not an emergency.
4. A client with a spinal cord injury at T4 suddenly develops a pounding headache, BP 210/110, and flushing above the level of injury. The nurse's FIRST action is to:
Explanation. These are signs of autonomic dysreflexia, a medical emergency seen in injuries at T6 or above. The first action is to raise the head of the bed (lowers BP) and identify/remove the trigger—most commonly a distended bladder. Antihypertensives are used if BP remains high after the trigger is addressed; supine positioning would worsen the hypertension.
5. Which intervention is most appropriate for a client experiencing a tonic-clonic seizure?
Explanation. During a seizure, turn the client to the side to maintain a patent airway and prevent aspiration, protect the head, and do not restrain. Never place objects in the mouth—this can break teeth or block the airway. Restraining can cause musculoskeletal injury.
6. A nurse is teaching a client newly diagnosed with myasthenia gravis. Which statement indicates the client understands the disease?
Explanation. Myasthenia gravis causes weakness of voluntary muscles that worsens with activity and improves with rest, due to autoantibodies blocking acetylcholine receptors. Weakness typically worsens later in the day. Demyelination describes MS; sensory symptoms are not characteristic of MG.
7. A client with Parkinson's disease is prescribed carbidopa-levodopa. Which teaching point should the nurse emphasize?
Explanation. Carbidopa-levodopa replaces dopamine but takes weeks for full effect and is titrated gradually; it controls symptoms but does not cure the disease. High-protein meals can interfere with levodopa absorption. The drug should never be stopped abruptly because it can precipitate severe symptoms.
8. A nurse uses the Glasgow Coma Scale (GCS) to assess a client. The client opens eyes to pain (2), uses inappropriate words (3), and withdraws from pain (4). What is the total GCS score and interpretation?
Explanation. GCS = eye (2) + verbal (3) + motor (4) = 9. Scores of 9–12 indicate moderate impairment; 8 or below indicates coma/severe impairment; 13–15 is mild. The key is summing the three components correctly.
9. A client with bacterial meningitis is admitted. Which precaution should the nurse implement?
Explanation. Bacterial meningitis (e.g., Neisseria meningitidis) is transmitted via respiratory droplets, so droplet precautions are required—usually for at least 24 hours after effective antibiotics begin. Airborne precautions are for TB/measles/varicella; standard or contact alone is insufficient.
10. A nurse cares for a client in the acute phase of Guillain-Barré syndrome. Which assessment is the highest priority?
Explanation. Guillain-Barré causes ascending paralysis that can affect the diaphragm and intercostal muscles, leading to respiratory failure—the leading cause of death. Continuous monitoring of respiratory status and vital capacity is the priority (airway/breathing). The other concerns are important but secondary.
11. A nurse is positioning an unconscious client with a suspected basilar skull fracture and clear drainage from the nose. The nurse should:
Explanation. Clear nasal drainage may be cerebrospinal fluid (CSF) leak, which tests positive for glucose and may show a 'halo' sign. Do NOT pack the nose, blow the nose, or insert NG tubes nasally (risk of cranial entry). Trendelenburg increases ICP and is contraindicated.
12. A client with multiple sclerosis reports fatigue and intolerance to heat. Which instruction is most appropriate?
Explanation. Heat worsens MS symptoms (Uhthoff's phenomenon), so clients should avoid overheating and plan rest periods to manage fatigue. Hot baths and exercising in warm environments aggravate symptoms; restricting fluids increases UTI risk and is not advised.
13. A nurse evaluates a client after a transient ischemic attack (TIA). Which statement by the client indicates the need for further teaching?
Explanation. A TIA is a warning of high stroke risk; symptoms resolve typically within an hour without permanent damage, but clients still require risk-factor management and antiplatelet therapy (e.g., aspirin). Believing no medications are needed after symptoms resolve is incorrect and warrants further teaching.
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FAQ
What neuro concepts appear most often on the NCLEX-RN?
High-yield topics include increased ICP (Cushing's triad), stroke management and tPA safety, seizure precautions, spinal cord injury and autonomic dysreflexia, Glasgow Coma Scale scoring, meningitis precautions, and chronic conditions like MS, Parkinson's, myasthenia gravis, and Guillain-Barré. Focus on priority actions and safety.
How should I prioritize answers on neuro questions?
Use ABCs (airway, breathing, circulation) and Maslow's hierarchy. For neuro clients, airway/breathing often takes priority (e.g., Guillain-Barré respiratory monitoring). Recognize emergencies—autonomic dysreflexia, ICP changes, and tPA bleeding—and choose the FIRST action that protects the client.
How do I remember the difference between droplet and airborne precautions for CNS infections?
Bacterial meningitis (meningococcal) uses droplet precautions for the first 24 hours of antibiotics. Airborne precautions are reserved for tuberculosis, measles, and varicella. A simple memory aid: 'meningitis = mask for droplets,' while airborne diseases require a negative-pressure room and N95 respirator.