Neurologic NCLEX Practice Test Part 1

May 18, 2010 By admin 1 Comment 1. 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. 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? a. phenytoin (Dilantin) b. mannitol (Osmitrol) c. lidocaine (Xylocaine) d. 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? a. Give him a barbiturate. b. Place him on mechanical ventilation. c. Perform a lumbar puncture. d. 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: 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. 5. 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 6. 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.

In 1 to 2 hours 9. Sensory function 8. Atropine sulfate belongs to which drug classification? a. two drops of 0. Emergency medical technicians transport a 27-year-old iron worker to the emergency department. a male client with a seizure disorder develops status epilepticus.´ Which intervention by the nurse has the highest priority? a. How soon can the nurse administer a second dose of diazepam. Cerebral function d. He has a large contusion on his left chest and a hematoma in the left parietal area. and photophobia in her right eye. Dexamethasone exerts its therapeutic effect by: . Assessing the left leg b. Adrenergic blocker d. The physician orders diazepam (Valium) 10 mg I. the physician prescribes atropine sulfate (Atropisol). He has a compound fracture of his left femur and he¶s comatose. fill out the menu for the client. if needed and prescribed? a. They tell the nurse. blurred vision. where he receives emergency care for corneal injury. In 30 to 45 minutes d.V. stat. Sympatholytic agent c. 7. In 30 to 45 seconds b.c. Cholinergic blocker 10. d. A female client complains of periorbital aching. As part of the client¶s therapeutic regimen. Intellectual function c. irregular. His coworkers irrigate his eyes with water for 20 minutes. The physician prescribes dexamethasone (Maxidex Ophthalmic Suspension). tearing. Placing the client in Trendelenburg¶s position d. 0. Shortly after admission to an acute care facility. We intubated him and he¶s maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Assessing level of consciousness 11. An auto mechanic accidentally has battery acid splashed in his eyes. ³He fell from a two-story building. In 10 to 15 minutes c. Cerebellar function b. Parasympathomimetic agent b. The nurse is performing a mental status examination on a male client diagnosed with subdural hematoma.5% solution in the right eye twice daily.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. This test assesses which of the following? a. Ophthalmologic examination reveals a small. give the client privacy during meals. and then take him to the emergency department of a nearby hospital. and polymyxin B sulfate (Neosporin Ophthalmic). two drops of 0. Assessing the pupils c. nonreactive pupil ² a condition resulting from acute iris inflammation (iritis).1% solution to be instilled initially into the conjunctival sacs of both eyes every hour.

A physician diagnoses a client with myasthenia gravis.O. The client uses a mirror to inspect the skin. A private room down the hall from the nurses¶ station b. 12. Ataxic b. producing a miotic reaction by stimulating and contracting the sphincter muscles of the iris. More back pain than the first postoperative day b. the nurse asks the client to take a few steps. the nurse reviews the client¶s history. c. A client. To assess gait. The client hangs the left arm over the side of the wheelchair. prescribing pyridostigmine (Mestinon). Temperature of 99. 0. increasing the exudative reaction of ocular tissue. 14. The client leaves the side rails down. every 3 hours.2° F (37. Which hospital room would be the best choice for this client? a. is admitted with bacterial meningitis. with each step. 60 mg P. Urine retention or incontinence d. b. age 22. 15. d. Which of the following findings should the nurse consider abnormal? a.25% into the left eye four times daily. The physician prescribes pilocarpine ophthalmic solution (Pilocar). d. A semiprivate room with a 32-year-old client who has viral meningitis d. c. instilling one drop of pilocarpine 0.d. the nurse should use which term? a. After an eye examination. Steppage 16. An isolation room three doors from the nurses¶ station c. b. inhibiting the action of carbonic anhydrase. A male client in the emergency department has a suspected neurologic disorder. instilling one drop of pilocarpine 0. instilling one drop of pilocarpine 0.a. c. OU q. b.3° C) 13. Dystrophic c.25% into both eyes four times daily. The client repositions only after being reminded to do so. Paresthesia in the dermatomes near the wounds c. decreasing leukocyte infiltration at the site of ocular inflammation. Before administering this anticholinesterase agent. A two-bed room with a client who previously had bacterial meningitis 17. Which preexisting condition would contraindicate the use of . the client¶s feet make a half circle.25% gtt i. the nurse should teach the client or a family member to administer the drug by: a. Nurse April is caring for a client who underwent a lumbar laminectomy 2 days ago. To document the client¶s gait. Based on this prescription. instilling one drop of pilocarpine 0.i. A female client who¶s paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety.25% into both eyes daily.25% into the right eye daily. a male client is diagnosed with open-angle glaucoma. Which behavior indicates that the client accurately understands safety measures related to paralysis? a. d. Helicopod d.

or expose yourself to loud sounds for 30 days. and fever. ³Try to ambulate independently after about 24 hours. 19. vertigo. including possible Ménière¶s disease. the nurse expects to note: a. A female client is admitted to the facility for investigation of balance and coordination problems. climb to high altitudes. ³Lie in bed with your head elevated. vertigo. Tachycardia b. vomiting. blurred vision. Intestinal obstruction d. 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. Hypotension d. Urine retention c. the nurse should provide which client instruction? a. tinnitus.´ c. and refrain from blowing your nose for 24 hours. vertigo.´ d. A male client is admitted with a cervical spine injury sustained during a diving accident. make sudden movements. and nystagmus c. After the stapedectomy. Spinal cord injury 18. When assessing this client. Ineffective breathing pattern c. Ulcerative colitis b. Which adverse reaction is most common? a. pain. When planning this client¶s care.´ 20. Self-care deficient: Dressing/grooming . vertigo. the nurse should assign highest priority to which nursing diagnosis? a. The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. and hearing impairment. Impaired physical mobility b. ³Shampoo your hair every day for 10 days to help prevent ear infection. Nurse Oliver is monitoring a client for adverse reactions to dantrolene (Dantrium). Increased salivation c. Excessive tearing b. Disturbed sensory perception (tactile) d. Apnea 22. Blood dyscrasia c. ³Don¶t fly in an airplane. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? a. Slurred speech 21. and hearing loss.pyridostigmine? a. d. Muscle weakness d. b.´ b.

He has taken several skeletal muscle relaxants without experiencing relief. succinylcholine may be used in a lower dosage. Vision changes b. While reviewing a client¶s chart.O. cones. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? a. the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain? a. A male client has a history of painful. A male client is color blind. Succinylcholine shouldn¶t be used. postoperative pain management of laminectomy clients. During the neurologic examination. pancuronium may be used in a lower dosage. The client may be less sensitive to the effects of a neuromuscular blocking agent. 24. His physician prescribes diazepam (Valium). b. diazepam also is recommended for: a. turning the client¶s head suddenly while holding the eyelids open. The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Midbrain d. shining a bright light into the pupil. a. aqueous humor. lens. 27. the nurse notices that the female client has myasthenia gravis. Diencephalon b. c. b. Medulla c. A female client who was found unconscious at home is brought to the hospital by a rescue squad. b. long-term treatment of epilepsy. 26. d.23. postoperative pain management of diskectomy clients d. Pancuronium shouldn¶t be used. twice daily. 25. the nurse checks the client¶s oculocephalic (doll¶s eye) response by: a. Absent deep tendon reflexes c. 2 mg P. Which of the following symptoms would the nurse expect to find? a. continuous muscle spasms. Cortex 28. d. c. c. treatment of spasticity associated with spinal cord lesions. 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. In addition to being used to relieve painful muscle spasms. The nurse understands that this client has a problem with: rods. touching the cornea with a wisp of cotton. Pancuronium and succinylcholine both require cautious administration. Tremors at rest d. Flaccid muscles . introducing ice water into the external auditory canal. d. c. b. In the intensive care unit.

Answer B. The client¶s history and assessment suggest that he may have increased intracranial pressure (ICP). nausea. Headache. If this is the case. a female client is given nothing by mouth. b. c.29. 2. Administer an analgesic. Which action should the nurse perform? a. and redness of the eyes are signs of acute (angle-closure) glaucoma. not endotracheally. Sit with the client for a few minutes. cranial nerves I and II. 30. 3. excessive drooling increases the risk of airway obstruction. phenytoin isn¶t administered endotracheally. . d. they¶re administered parenterally. virtually immobilizing the client. Visual acuity problems would occur following occipital or optic nerve injury. Inform the nurse manager. the nurse assesses the client¶s swallowing ability once each shift. However. Answer A. therefore. which may indicate glaucoma. mechanical ventilation may be required if breathing deteriorates. Because of these concerns. cause additional damage. 4. Answer A. b. Thinking and reasoning problems are the result of injury to the cerebrum. Difficulty seeing cars in another driving lane suggests gradual loss of peripheral vision. 5. The sudden appearance of light flashes and floaters in front of the affected eye is characteristic of retinal detachment. injury to that area can cause problems of body temperature control. thereby. This assessment evaluates: a. Administering lidocaine via an endotracheal tube may minimize elevations in ICP caused by suctioning. After a head injury. d. cranial nerves III and V. In Parkinson¶s crisis. Although the other options also are appropriate. The body¶s thermostat is located in the hypothalamus. Answer C. cranial nerves IX and X. barbiturates may be given to prevent seizures. to help prevent aspiration. Answer C. Although mannitol and furosemide may be given to reduce ICP. cranial nerves VI and VIII. dopamine-related symptoms are severely exacerbated. Phenytoin doesn¶t reduce ICP directly but may be used to abolish seizures. they aren¶t immediately lifethreatening. ANSWER: 1. During recovery from a cerebrovascular accident (CVA). and elevating the head of the bed may be used to reduce ICP. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Double vision is common in clients with cataracts. Call the physician immediately. Balance and equilibrium problems are related to cerebellar damage. The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. To determine when the client is ready for a liquid diet. which can increase ICP. c. the nursing diagnosis of Ineffective airway clearance takes highest priority. lumbar puncture shouldn¶t be done because it can quickly decompress the central nervous system and. Also.

and temperature discrimination. if necessary. An increase in pain on the second postoperative day is common because the long-acting local anesthetic. Urine retention or incontinence may indicate cauda equina syndrome. Answer B. lessening edema. Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration at the site of ocular inflammation." means four times a day.i. Sensory function testing involves assessment of pain. the nurse should assess the site. While paresthesia is common after surgery. diazepam faster than 5 mg/minute.6. 12.3° C). Intellectual functioning isn¶t the only cerebral activity. equilibrium. When used to treat status epilepticus. but the total dose shouldn¶t exceed 100 mg in 24 hours. The client should keep the side rails up . Answer B. Therefore. A client with Alzheimer¶s disease can forget how to eat. attention span. therefore. "i" is the apothecary symbol for the number 1. or helping the client to complete the menu doesn¶t ensure adequate nutritional intake. Therefore. Answer B. one drop of pilocarpine 0. With a compound fracture of the femur. Cerebellar function testing assesses coordination. 7. 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. Staying with the client and encouraging him to feed himself will ensure adequate food intake. and scarring.V. Dexamethasone and other anti-inflammatory agents don¶t inhibit the action of carbonic anhydrase or produce any type of miotic reaction. light-touch sensation. It isn¶t a parasympathomimetic agent. Answer C. Neurologic assessment is a secondary concern to airway. or an adrenergic blocker. airway and breathing are established so the nurse¶s next priority should be circulation. The nurse must not administer I. 13. will wear off. which may have been injected during surgery. 14. The abbreviation "gtt" stands for drop. Answer A.25% should be instilled into both eyes four times daily. breathing. A mild fever is also common after surgery but is considered significant only if it reaches 101° F (38. and fine motor movement. filling out the menu. Answer C. progressive weakness or paralysis may indicate spinal nerve compression. and abstract reasoning. The mental status examination assesses functions governed by the cerebrum. Allowing privacy during meals. Answer A. and circulation. 8. the dose can¶t be repeated in 30 to 45 seconds because the first dose wouldn¶t have been administered completely by that time. to a maximum dose of 30 mg.d. This reduces the exudative reaction of diseased tissue. 9. which requires immediate surgery. The nurse doesn¶t have enough data to warrant putting the client in Trendelenburg¶s position. The nurse can repeat the regimen in 2 to 4 hours. as needed. Waiting longer than 15 minutes to repeat the dose would increase the client¶s risk of complications associated with status epilepticus. 10. and "q. Atropine sulfate is a cholinergic blocker. 11. Answer D. there is a high risk of profuse bleeding. diazepam may be given every 10 to 15 minutes. a sympatholytic agent. In the scenario. judgment. Some of these are orientation. Answer B. redness. OU signifies both eyes.

and spinal cord injury don¶t contraindicate use of the drug. dry skin. The paralyzed client should take responsibility for repositioning or for reminding the staff to assist with it. Immediately after surgery. either client may contract the other¶s disease. or hypersensitivity to anticholinesterase agents. A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and. Systemic absorption of atropine sulfate can cause tachycardia. The drug also may depress liver function or cause idiosyncratic hepatitis. the client waddles with the legs far apart. 16. Answer C. Answer A. It isn¶t known to cause hypotension or apnea. and hearing loss. To minimize systemic absorption. sudden movements that may cause trauma. In a steppage gait. drooling. Answer A. Immunity to bacterial meningitis can¶t be acquired. Anticholinesterase agents such as pyridostigmine are contraindicated in a client with a mechanical obstruction of the intestines or urinary tract. tinnitus. therefore. Answer B. 18. 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. or fever. and exposure to loud sounds and pressure changes (such as from high altitudes). However. An ataxic gait is staggering and unsteady. The drug also may cause dry mouth. Answer C. the client should apply digital pressure over the punctum at the inner canthus for 2 to 3 minutes after instilling the drops. Answer C. A client with left-side paralysis may not realize that the left arm is hanging over the side of the wheelchair. 19. Ulcerative colitis. and enuresis. 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. For 30 days after a stapedectomy. The client¶s first attempt at postoperative ambulation should be supervised to prevent falls caused by vertigo and light-headedness. vomiting. flushing. Ménière¶s disease. 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. they aren¶t as common as muscle weakness 21. and nystagmus suggests labyrinthitis. blurred vision. the feet and toes raise high off the floor and the heel comes down heavily with each step. 17. if needed. In a dystrophic gait. palpitations. peritonitis.to help with repositioning and to prevent falls. A helicopod gait is an abnormal gait in which the client¶s feet make a half circle with each step. and confusion. Answer D. blood dyscrasia. should be as close to the nurses¶ station as possible to allow maximal observation. 15. Ménière¶s disease rarely causes pain. . the client should lie flat with the surgical ear facing upward. Although excessive tearing and urine retention are adverse reactions associated with dantrolene use. is characterized by the symptom triad of vertigo. 20. the client should avoid air travel. The client must avoid shampooing and swimming to keep the dressing and the ear dry. Muscle weakness is rarely severe enough to cause slurring of speech. an inner ear disease. The most common adverse reaction to dantrolene is muscle weakness. ataxia. The combination of vertigo. nose blowing is permitted but should be done gently and on one side at a time. during the initial acute phase.

the eyes move from side to side when the head is turned. 23. The nurse should notify the physician immediately. intentional tremors. the eyes remain fixed. normally. To elicit the oculocephalic response. 25. Babinski¶s sign may be positive. and blurred vision.22. Shining a bright light into the client¶s pupil helps evaluate brain stem and cranial nerve III functions. 29. Rods are sensitive to low levels of illumination but can¶t discriminate color. rather than flaccid. Answer C. succinylcholine. characterized by abnormal extension in response to painful stimuli. Answer A. The physician will decide . Tremors at rest aren¶t characteristic of multiple sclerosis. 24. Such a client isn¶t less sensitive to the effects of a neuromuscular blocking agent. blinking is the normal response. the pupil responds by constricting. which detects cranial nerve compression. Normally. Deep tendon reflexes may be increased or hyperactive ² not absent. Affected muscles are spastic. diazepam also is recommended for treatment of spasticity associated with spinal cord lesions. indicates damage to the midbrain. Diazepam isn¶t an analgesic agent. The other options may be appropriate for a client with a spinal cord injury ² particularly during the course of recovery ² but don¶t take precedence over a diagnosis of Ineffective breathing pattern. In addition to relieving painful muscle spasms. Answer B. If one or more types of cones are absent or defective. The lens is responsible for focusing images. or those occurring with purposeful voluntary movement. Damage to the medulla results in flaccidity. Because a cervical spine injury can cause respiratory distress. 27. such as diplopia. the nurse should take immediate action to maintain a patent airway and provide adequate oxygenation. The nurse introduces ice water into the external auditory canal when testing the oculovestibular response. Answer D. but the drug¶s sedating properties make it an unsuitable choice for long-term management of epilepsy. Answer D. Sitting with the client is appropriate but only after the physician has been notified of the change in the client¶s condition. normally. With damage to the diencephalon or cortex. nystagmus. color blindness occurs. and any other neuromuscular blocking agent to a client with myasthenia gravis. The parenteral form of diazepam can treat status epilepticus. The headache may be an indication that the aneurysm is leaking. which reveals brain stem function. abnormal flexion (decorticate posturing) occurs when a painful stimulus is applied. the nurse turns the client¶s head suddenly while holding the eyelids open. Answer C. Decerebrate posturing. Vision changes. Aqueous humor is a clear watery fluid and isn¶t involved with color perception. are common in clients with multiple sclerosis. Answer B. The nurse must cautiously administer pancuronium. Answer D. the client¶s eyes deviate to the side of ice water introduction. Either succinylcholine or pancuronium can be administered in the usual adult dosage to a client with myasthenia gravis. however. in an abnormal response. 26. 28. and their stimulation is interpreted as color. Cones provide daylight color vision. Diazepam¶s use is limited by its central nervous system effects and the tolerance that develops with prolonged use. are symptoms of multiple sclerosis. The nurse touches the client¶s cornea with a wisp of cotton to elicit the corneal reflex response.

Cranial nerves I. . The motor functions of cranial nerve III include extraocular eye movement. The motor function of cranial nerve V is chewing.whether or not administration of an analgesic is indicated. eyelid elevation. Answer D. Informing the nurse manager isn¶t necessary. and VIII don¶t possess motor functions. Cranial nerve VI controls lateral eye movement. Swallowing is a motor function of cranial nerves IX and X. and pupil constriction. II. 30.

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