NCLEX Practice Exam for Neurologic System 1

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1. If a male client experienced a cerebrovascular accident (CVA) that damaged the hypothalamus, the nurse would anticipate that the client has problems with:

  1. body temperature control.
  2. balance and equilibrium.
  3. visual acuity.
  4. thinking and reasoning.

2. 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?

  1. phenytoin (Dilantin)
  2. mannitol (Osmitrol)
  3. lidocaine (Xylocaine)
  4. furosemide (Lasix)

3. 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?

  1. Give him a barbiturate.
  2. Place him on mechanical ventilation.
  3. Perform a lumbar puncture.
  4. Elevate the head of his bed.

4. When obtaining the health history from a male client with retinal detachment, the nurse expects the client to report:

  1. light flashes and floaters in front of the eye.
  2. a recent driving accident while changing lanes.
  3. headaches, nausea, and redness of the eyes.
  4. frequent episodes of double vision.

5. Which nursing diagnosis takes highest priority for a client with Parkinson’s crisis?

  1. Imbalanced nutrition: Less than body requirements
  2. Ineffective airway clearance
  3. Impaired urinary elimination
  4. Risk for injury

6. To encourage adequate nutritional intake for a female client with Alzheimer’s disease, the nurse should:

  1. stay with the client and encourage him to eat.
  2. help the client fill out his menu.
  3. give the client privacy during meals.
  4. fill out the menu for the client.

7. The nurse is performing a mental status examination on a male client diagnosed with subdural hematoma. This test assesses which of the following?

  1. Cerebellar function
  2. Intellectual function
  3. Cerebral function
  4. Sensory function

8. 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 a second dose of diazepam, if needed and prescribed?

  1. In 30 to 45 seconds
  2. In 10 to 15 minutes
  3. In 30 to 45 minutes
  4. In 1 to 2 hours

9. 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?

  1. Parasympathomimetic agent
  2. Sympatholytic agent
  3. Adrenergic blocker
  4. Cholinergic blocker

10. Emergency medical technicians transport a 27-year-old iron worker 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?

  1. Assessing the left leg
  2. Assessing the pupils
  3. Placing the client in Trendelenburg’s position
  4. Assessing level of consciousness

11. 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 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:

  1. increasing the exudative reaction of ocular tissue.
  2. decreasing leukocyte infiltration at the site of ocular inflammation.
  3. inhibiting the action of carbonic anhydrase.
  4. producing a miotic reaction by stimulating and contracting the sphincter muscles of the iris.

12. Nurse April is caring for a client who underwent a lumbar laminectomy 2 days ago. Which of the following findings should the nurse consider abnormal?

  1. More back pain than the first postoperative day
  2. Paresthesia in the dermatomes near the wounds
  3. Urine retention or incontinence
  4. Temperature of 99.2° F (37.3° C)

13. 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:

  1. instilling one drop of pilocarpine 0.25% into both eyes daily.
  2. instilling one drop of pilocarpine 0.25% into both eyes four times daily.
  3. instilling one drop of pilocarpine 0.25% into the right eye daily.
  4. instilling one drop of pilocarpine 0.25% into the left eye four times daily.

14. 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?

  1. The client leaves the side rails down.
  2. The client uses a mirror to inspect the skin.
  3. The client repositions only after being reminded to do so.
  4. The client hangs the left arm over the side of the wheelchair.

15. 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?

  1. Ataxic
  2. Dystrophic
  3. Helicopod
  4. Steppage

16. A client, age 22, is admitted with bacterial meningitis. Which hospital room would be the best choice for this client?

  1. A private room down the hall from the nurses’ station
  2. An isolation room three doors from the nurses’ station
  3. A semiprivate room with a 32-year-old client who has viral meningitis
  4. A two-bed room with a client who previously had bacterial meningitis

17. 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?

  1. Ulcerative colitis
  2. Blood dyscrasia
  3. Intestinal obstruction
  4. Spinal cord injury

18. 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:

  1. vertigo, tinnitus, and hearing loss.
  2. vertigo, vomiting, and nystagmus
  3. vertigo, pain, and hearing impairment.
  4. vertigo, blurred vision, and fever.

19. 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?

  1. “Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours.”
  2. “Try to ambulate independently after about 24 hours.”
  3. “Shampoo your hair every day for 10 days to help prevent ear infection.”
  4. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.”

20. Nurse Oliver is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common?

  1. Excessive tearing
  2. Urine retention
  3. Muscle weakness
  4. Slurred speech

21. 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?

  1. Tachycardia
  2. Increased salivation
  3. Hypotension
  4. Apnea

22. A male client is admitted with a cervical spine injury sustained during a diving accident. When planning this client’s care, the nurse should assign highest priority to which nursing diagnosis?

  1. Impaired physical mobility
  2. Ineffective breathing pattern
  3. Disturbed sensory perception (tactile)
  4. Self-care deficient: Dressing/grooming

23. 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), 2 mg P.O. twice daily. In addition to being used to relieve painful muscle spasms, diazepam also is recommended for:

  1. long-term treatment of epilepsy.
  2. postoperative pain management of laminectomy clients.
  3. postoperative pain management of diskectomy clients
  4. treatment of spasticity associated with spinal cord lesions.

24. 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:

  1.  introducing ice water into the external auditory canal.
  2. touching the cornea with a wisp of cotton.
  3. turning the client’s head suddenly while holding the eyelids open.
  4. shining a bright light into the pupil.

25. 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?

  1. The client may be less sensitive to the effects of a neuromuscular blocking agent.
  2. Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage.
  3. Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage.
  4. Pancuronium and succinylcholine both require cautious administration.

26. A male client is color blind. The nurse understands that this client has a problem with:

  1. rods.
  2. cones.
  3. lens.
  4. aqueous humor.

27. 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?

  1. Diencephalon
  2. Medulla
  3. Midbrain
  4. Cortex

28. The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

  1. Vision changes
  2. Absent deep tendon reflexes
  3. Tremors at rest
  4. Flaccid muscles

29. The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

  1. Sit with the client for a few minutes.
  2. Administer an analgesic.
  3. Inform the nurse manager.
  4. Call the physician immediately.

30. 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:

  1. cranial nerves I and II.
  2. cranial nerves III and V.
  3. cranial nerves VI and VIII.
  4. cranial nerves IX and X.
Answers and Rationales
  1. Answer A. The body’s thermostat is located in the hypothalamus; therefore, injury to that area can cause problems of body temperature control. Balance and equilibrium problems are related to cerebellar damage. Visual acuity problems would occur following occipital or optic nerve injury. Thinking and reasoning problems are the result of injury to the cerebrum.
  2. Answer C. Administering lidocaine via an endotracheal tube may minimize elevations in ICP caused by suctioning. Although mannitol and furosemide may be given to reduce ICP, they’re administered parenterally, not endotracheally. Phenytoin doesn’t reduce ICP directly but may be used to abolish seizures, which can increase ICP. However, phenytoin isn’t administered endotracheally.
  3. Answer C. The client’s history and assessment suggest that he may have increased intracranial pressure (ICP). If this is the case, lumbar puncture shouldn’t be done because it can quickly decompress the central nervous system and, thereby, cause additional damage. After a head injury, barbiturates may be given to prevent seizures; mechanical ventilation may be required if breathing deteriorates; and elevating the head of the bed may be used to reduce ICP.
  4. Answer A. The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision, which may indicate glaucoma. Headache, nausea, and redness of the eyes are signs of acute (angle-closure) glaucoma. Double vision is common in clients with cataracts.
  5. Answer B. In Parkinson’s crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of Ineffective airway clearance takes highest priority. Although the other options also are appropriate, they aren’t immediately life-threatening.
  6. Answer A. Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer’s disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn’t ensure adequate nutritional intake.
  7. Answer C. The mental status examination assesses functions governed by the cerebrum. Some of these are orientation, attention span, judgment, and abstract reasoning. Intellectual functioning isn’t the only cerebral activity. Cerebellar function testing assesses coordination, equilibrium, and fine motor movement. Sensory function testing involves assessment of pain, light-touch sensation, and temperature discrimination.
  8. Answer B. When used to treat status epilepticus, diazepam may be given every 10 to 15 minutes, as needed, to a maximum dose of 30 mg. The nurse can repeat the regimen in 2 to 4 hours, if necessary, but the total dose shouldn’t exceed 100 mg in 24 hours. The nurse must not administer I.V. diazepam faster than 5 mg/minute. Therefore, the dose can’t be repeated in 30 to 45 seconds because the first dose wouldn’t have been administered completely by that time. Waiting longer than 15 minutes to repeat the dose would increase the client’s risk of complications associated with status epilepticus.
  9. Answer D. Atropine sulfate is a cholinergic blocker. It isn’t a parasympathomimetic agent, a sympatholytic agent, or an adrenergic blocker.
  10. Answer A. In the scenario, airway and breathing are established so the nurse’s next priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the site. Neurologic assessment is a secondary concern to airway, breathing, and circulation. The nurse doesn’t have enough data to warrant putting the client in Trendelenburg’s position.
  11. Answer B. Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration at the site of ocular inflammation. This reduces the exudative reaction of diseased tissue, lessening edema, redness, and scarring. Dexamethasone and other anti-inflammatory agents don’t inhibit the action of carbonic anhydrase or produce any type of miotic reaction.
  12. Answer C. Urine retention or incontinence may indicate cauda equina syndrome, which requires immediate surgery. An increase in pain on the second postoperative day is common because the long-acting local anesthetic, which may have been injected during surgery, will wear off. While paresthesia is common after surgery, progressive weakness or paralysis may indicate spinal nerve compression. A mild fever is also common after surgery but is considered significant only if it reaches 101° F (38.3° C).
  13. Answer B. The abbreviation “gtt” stands for drop, “i” is the apothecary symbol for the number 1, OU signifies both eyes, and “q.i.d.” means four times a day. Therefore, one drop of pilocarpine 0.25% should be instilled into both eyes four times daily.
  14. Answer B. Using a mirror enables the client to inspect all areas of the skin for signs of breakdown without the help of staff or family members. The client should keep the side rails up to help with repositioning and to prevent falls. The paralyzed client should take responsibility for repositioning or for reminding the staff to assist with it, if needed. A client with left-side paralysis may not realize that the left arm is hanging over the side of the wheelchair. However, the nurse should call this to the client’s attention because the arm can get caught in the wheel spokes or develop impaired circulation from being in a dependent position for too long.
  15. Answer C. A helicopod gait is an abnormal gait in which the client’s feet make a half circle with each step. An ataxic gait is staggering and unsteady. In a dystrophic gait, the client waddles with the legs far apart. In a steppage gait, the feet and toes raise high off the floor and the heel comes down heavily with each step.
  16. Answer B. A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial acute phase, should be as close to the nurses’ station as possible to allow maximal observation. Placing the client in a room with a client who has viral meningitis may cause harm to both clients because the organisms causing viral and bacterial meningitis differ; either client may contract the other’s disease. Immunity to bacterial meningitis can’t be acquired; therefore, a client who previously had bacterial meningitis shouldn’t be put at risk by rooming with a client who has just been diagnosed with this disease.
  17. Answer C. Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract, peritonitis, or hypersensitivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord injury don’t contraindicate use of the drug.
  18. Answer A. Ménière’s disease, an inner ear disease, is characterized by the symptom triad of vertigo, tinnitus, and hearing loss. The combination of vertigo, vomiting, and nystagmus suggests labyrinthitis. Ménière’s disease rarely causes pain, blurred vision, or fever.
  19. Answer D. For 30 days after a stapedectomy, the client should avoid air travel, sudden movements that may cause trauma, and exposure to loud sounds and pressure changes (such as from high altitudes). Immediately after surgery, the client should lie flat with the surgical ear facing upward; nose blowing is permitted but should be done gently and on one side at a time. The client’s first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. The client must avoid shampooing and swimming to keep the dressing and the ear dry.
  20. Answer C. The most common adverse reaction to dantrolene is muscle weakness. The drug also may depress liver function or cause idiosyncratic hepatitis. Muscle weakness is rarely severe enough to cause slurring of speech, drooling, and enuresis. Although excessive tearing and urine retention are adverse reactions associated with dantrolene use, they aren’t as common as muscle weakness
  21. Answer A. Systemic absorption of atropine sulfate can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. To minimize systemic absorption, the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops. The drug also may cause dry mouth. It isn’t known to cause hypotension or apnea.
  22. Answer B. Because a cervical spine injury can cause respiratory distress, the nurse should take immediate action to maintain a patent airway and provide adequate oxygenation. The other options may be appropriate for a client with a spinal cord injury — particularly during the course of recovery — but don’t take precedence over a diagnosis of Ineffective breathing pattern.
  23. Answer D. In addition to relieving painful muscle spasms, diazepam also is recommended for treatment of spasticity associated with spinal cord lesions. Diazepam’s use is limited by its central nervous system effects and the tolerance that develops with prolonged use. The parenteral form of diazepam can treat status epilepticus, but the drug’s sedating properties make it an unsuitable choice for long-term management of epilepsy. Diazepam isn’t an analgesic agent.
  24. Answer C. To elicit the oculocephalic response, which detects cranial nerve compression, the nurse turns the client’s head suddenly while holding the eyelids open. Normally, the eyes move from side to side when the head is turned; in an abnormal response, the eyes remain fixed. The nurse introduces ice water into the external auditory canal when testing the oculovestibular response; normally, the client’s eyes deviate to the side of ice water introduction. The nurse touches the client’s cornea with a wisp of cotton to elicit the corneal reflex response, which reveals brain stem function; blinking is the normal response. Shining a bright light into the client’s pupil helps evaluate brain stem and cranial nerve III functions; normally, the pupil responds by constricting.
  25. Answer D. The nurse must cautiously administer pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a client isn’t less sensitive to the effects of a neuromuscular blocking agent. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis.
  26. Answer B. Cones provide daylight color vision, and their stimulation is interpreted as color. If one or more types of cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can’t discriminate color. The lens is responsible for focusing images. Aqueous humor is a clear watery fluid and isn’t involved with color perception.
  27. Answer C. Decerebrate posturing, characterized by abnormal extension in response to painful stimuli, indicates damage to the midbrain. With damage to the diencephalon or cortex, abnormal flexion (decorticate posturing) occurs when a painful stimulus is applied. Damage to the medulla results in flaccidity.
  28. Answer A. Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of multiple sclerosis. Deep tendon reflexes may be increased or hyperactive — not absent. Babinski’s sign may be positive. Tremors at rest aren’t characteristic of multiple sclerosis; however, intentional tremors, or those occurring with purposeful voluntary movement, are common in clients with multiple sclerosis. Affected muscles are spastic, rather than flaccid.
  29. Answer D. The headache may be an indication that the aneurysm is leaking. The nurse should notify the physician immediately. Sitting with the client is appropriate but only after the physician has been notified of the change in the client’s condition. The physician will decide whether or not administration of an analgesic is indicated. Informing the nurse manager isn’t necessary.
  30. Answer D. Swallowing is a motor function of cranial nerves IX and X. Cranial nerves I, II, and VIII don’t possess motor functions. The motor functions of cranial nerve III include extraocular eye movement, eyelid elevation, and pupil constriction. The motor function of cranial nerve V is chewing. Cranial nerve VI controls lateral eye movement.