Neurologic NCLEX Practice Test Part 1

 

Neurologic NCLEX NCLE X Practi Practice ce T Test est Part 1 May 18, 2010 By admin admin  1 Comment Comment   1. If a male male client experienced a cerebrovascular accident accident (CVA) that damaged damaged the hypothalamus, the nurse would anticipate that t hat the client has problems with: a. body temperature control.   b. balance and equilibrium. c. visual acuity. d. thinking and reasoning. 2. A female female client admitted admitted to an acute care facility after a car accident develops develops signs and and symptoms of increased intracranial pressure (ICP). The client is intubated and placed p laced on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally endot racheally before suctioning? a. phenytoin (Dilantin)   b. mannitol (Osmitrol) c. lidocaine lidocaine (Xylocaine) d. furosemide (Lasix) 3. After striking striking his head on a tree while falling falling from a ladder, a young man age 18 is admitted to the emergency department. depart ment. He¶s unconscious and his pupils are nonreact nonreactive. ive. 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 history from a male client client with with retinal detachment, the nurse nurse expects the client to report: a. light light flashes flashes and and float floaters ers in front of the eye. eye.   b. a recent driving accident while changing lanes. c. headaches, nausea, and redness of the eyes. d. frequent episodes of double vision. 5. a.   b. c. d.

Which nursing diagnosis takes highest highest priority priority for a client client with Parkinson¶s crisis? Imbalanced nutrition: Less than body requirements Ineffective airway clearance Impaired urinary elimination Risk for injury

6. To encourage adequate nutritional nutritional intake for 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.

 

c. d.

give the client privacy during meals. fill out the menu for the client.

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

Cerebral function Sensory function

8. Shortly after admission admission to an acute care facility, facility, a male male client with a seizure disorder  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? a. In 30 to 45 seconds   b. In 10 to 15 minutes c. In 30 to 45 minutes d. In 1 to 2 hours 9. A female female client complains complains of periorbital periorbital aching, tearing, blurred blurred vision, vision, and photophobia in her right eye. Ophthalmologic examination reveals revea ls a small, irregular, nonreactive pupil ² a condition resulting from acute iris inflammation (iri (iritis). tis). As part of the client¶s c lient¶s therapeutic regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% soluti so lution on in the right eye twice daily. Atropine sulfate belongs to which drug classification? a. Parasympathomimetic agent   b. Sympatholytic agent c. Adrenergic blocker  d. Cholinergic blocker  10. Emergency medical technicians transport transport a 27-year-old iron worker to the emergency emergency department. They tell the nurse, ³He fell from a two-story building. He has a large contusion on on his left chest and a hematoma hemato ma 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 saturat ion of 92% by pulse oximeter with a manual-resuscitation manual-resuscitation bag.´ bag. ´ Which intervention by the nurse has the highest priority? a. Assessing the left leg   b. Assessing Assessing the pupils c. Placing the client in Trendelenburg¶s position d. Assessing Assessing level of consciousness 11. An auto mechanic accidentally has battery acid acid splashed in in his his eyes. His coworkers coworkers irrigate 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 dro ps of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes e yes every hour; and polymyxin B sulfate (Neo (Neosporin sporin Ophthalmic), 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. Dexamethasone exerts its therapeutic effect by:

 

a. increasing the exudative reaction of ocular tissue.  b. decreasing leukocyte infiltration infiltration at the site site of ocular inflammation. inflammation. c. inhibi inhibiting ting the action of carbonic anhydrase. d. producing a miot miotic ic reaction by stimulating and and contracting the sphincter muscles of the iris. iris. 12. Nurse April April is is caring for for a client client who underwent a lumbar laminectomy laminectomy 2 days ago. Which Which of the following findings should the nurse consider co nsider abnormal? a. More back pain than the first first postoperative day   b. Paresthesia in the dermatomes near the wounds c. Urine retention or incontinence d. Temperature of 99.2° F (37.3° C) 13. After an eye examination, examination, a male male client client is diagnosed with with open-angle glaucoma. The  physician prescribes pilocarpine ophthalmic solution (Pilocar), 0.25% gtt i, OU q.i.d. q .i.d. Based on this prescription, the nurse should teach the client c lient or a family member to ad adminis minister ter the t he drug by: a. instill instilling ing one drop of pilocarpine 0.25% into into both eyes daily.  b. instilling instilling one drop of pilocarpine 0.25% into into both eyes four times daily. c. instill instilling ing one drop of pilocarpine 0.25% into the right eye eye daily. daily. d. instilling instilling one drop of pilocarpine 0.25% into the left left eye four four times daily. 14. A female female client who¶s who¶s paralyzed paralyzed on the left side has has been receiving physical therapy and attending teaching sessions about safety. Which behavior be havior indicates that the cclient lient accurately understands safety measures related to paralysis? a. The client leaves the side rails down.  b. The client uses a mirror mirror to inspect inspect the skin. skin. c. The client client repositions repositions only after being being reminded reminded to do so. d. The client client hangs hangs the left arm over the side side of the wheelchair. 15. A male male client in in the emergency department has has a suspected neurologic neurologic disorder. To assess assess gait, the nurse asks the client to take t ake a few steps; with each step, the client¶s feet make a half  circle. To document the t he client¶s gait, the nurse should use which tterm? erm? a. Ataxic   b. Dystrophic c. Helicopod d. Steppage 16. A client, client, age 22, is admitted with with bacterial meningitis. Which hospital hospital room would be the  best choice for this client? a. A private room down the hall from the nurses¶ nurses¶ station station  b. An isolation isolation room three doors from the nurses¶ nurses¶ station station c. A semiprivate room with with a 32-year-old client who who has viral meningitis d. A two-bed room room with with a client who who previously previously had bacterial meningitis 17. A physician diagnoses a client client with with myasthenia myasthenia gravis, gravis, prescribing prescribing pyridostigmine pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. ho urs. Before administering this anticholinesterase agent, the nurse reviews the client¶s history. Which preexisting condition would wou ld contraindicate the use of 

 

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

 

23. A male male client has has a history of painful, painful, continuous muscle muscle spasms. spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam d iazepam (Valium), 2 mg P.O. twice t wice daily. In addition to being used to relieve painful muscle spasms, diazepam also is recommended for: a. long-term treatment of epilepsy.   b. postoperative pain management of laminectomy clients. c. postoperative pain management of diskectomy clients d. treatment of spasticity associated with with spinal cord lesions. lesions. 24. A female female client who was was ffound ound unconscious at home home is is brought to the hospital by a rescue squad. In the intensive care unit, un it, the nurse checks the cclient¶s lient¶s oculocephalic (doll¶s eye) response  by: a. introducing ice water into into the external auditory canal.  b. touching the cornea with a wisp of cotton. c. turning the client¶s client¶s head head suddenly suddenly while holding the eyelids eyelids open. d. shining a bright light into the pupil. 25. While reviewing a client¶s chart, the nurse nurse notices notices that the female female client has has myasthenia myasthenia gravis. Which of the following statements about neuromuscular bl blocking ocking agents age nts is true for a client with this condition? a. The client client may be less sensitive to the effects of a neuromuscular blocking agent.  b. Succinylcholine shouldn¶t shouldn¶t be used; pancuronium may be used used in a lower lower dosage. c. Pancuronium shouldn¶t be used; succinylcholine may may be used in a lower lower dosage. d. Pancuronium and succinylcholine both require cautious administration. administration. 26. A male male client is color blind. The nurse understands that this client has a problem with: with: a. rods.   b. cones. c. lens. d. aqueous humor. 27.

A female female client who was was trapped inside a car for for hours after after a head-on collisi collision on is rushed to

the emergency department with w ith 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? a. Diencephalon   b. Medulla c. Midbrain d. Cortex 28. The nurse nurse is assessing a 37-year-old client diagnosed with multiple multiple sclerosis. sclerosis. Which of the following symptoms would the nurse expect to find? a. Visi Vision on changes   b. Absent deep tendon reflexes c. Tremors at rest d.

Flaccid muscles

 

29. The nurse nurse is caring for for a male male client diagnosed diagnosed with a cerebral aneurysm who reports reports a severe headache. Which action should the nurse perform? a. Sit with the client for a few minutes.   b. Administer Administer an analgesic. c. Inform the nurse manager. d. Call the physician immediately. 30. During recovery from from a cerebrovascular accident (CVA), a female client is is given nothing 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: a. cranial nerves I and II.   b. cranial nerves III and V. c. cranial nerves VI and VIII. d. cranial nerves IX and X. ANSWER: 1. Answer A. A. The body¶s thermostat thermostat is located in the hypothalamus; therefore, injury to that area can cause problems pro blems of body temperature control. Balance and equ equilibri ilibrium um problems are related to cerebellar damage. Visual V isual 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 Administering lidocaine lidocaine via an endotracheal endotracheal tube may minimize elevations in in ICP caused by suctioning. Although mannitol and furosemide may be given to reduce ICP, they¶re administered parenterally, not endotracheally. Phenytoin Phenyto in doesn¶t reduce ICP directly but may be used to abolish seizures, which can increase ICP. Ho However, wever, phenytoin isn¶t administered endotracheally. 3. Answer C. The client¶s client¶s history and assessment assessment suggest that he he may may have increased intracranial pressure (ICP). If this is the case, lumbar puncture shouldn¶t be done because it can quickly decompress the central centra l nervous system and, thereby, cause additional damage. After a head injury, barbiturates may be given g iven 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 sudden appearance of light light flashes flashes and floaters in front front of the affected affected eye eye is characteristic of retinal detachment. Difficulty seeing cars in another driving d riving 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 w ith cataracts. 5. Answer B. In Parkinson¶s crisis, crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confi co nfined ned 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 t he nursing diagnosis of Ineffective airway clearance takes highest  priority. Although the other options also are appropriate, they aren¶t immediately lifethreatening.

 

6. Answer A. A. Staying Staying with the client and encouraging 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 examination assesses assesses functions 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 t esting 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 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, There fore, the dose can¶t be repeated repeat ed in 30 to 45 seconds because the first dose wouldn¶t have been administered co completely mpletely by that time. Waiting longer than 15 minutes to repeat the dose would increase the client¶s c lient¶s risk of  complications associated with status epilepticus. 9. Answer D. Atropine Atropine sulfate is a cholinergic blocker. It isn¶t a parasympathomimetic parasympathomimetic agent, a sympatholytic agent, or an adrenergic blocker. 10. Answer A. A. In the scenario, scenario, airway and breathing are established established so the nurse¶s next priority priority should be circulation. With a compound fracture of the femur, there is a high rris isk k of o f profuse  bleeding; therefore, the nurse should shou ld 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 Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration infiltration at the site of ocular inflammation. This reduces the t he exudative reaction of diseased ttiss issue, ue, lessening edema, redness, and scarring. Dexamethasone and other anti-inflammatory agents don¶t inhibit the action of carbonic anhydrase an hydrase or produce any type of miotic reaction. 12. Answer C. Urine Urine retention retention or incontinence may may indicate indicate cauda equina syndrome, which 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 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° (38. 3° C). 13. Answer B. The abbreviation "gtt" stands for for drop, "i" "i" is the apothecary symbol for 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 instilled into both eyes four times daily. 14.

Answer B. Using a mirror enables enables the client client to inspect inspect all areas of the skin for for signs of 

 breakdown without the help of o f 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 responsibility for  repositioning or for reminding the staff to assist with it, if needed. A client c lient with left-side  paralysis may not realize that the left left arm is hanging over the side of the wheelchair. whee lchair. 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 helicopod gait is an abnormal gait in which the client¶s client¶s feet make make a half circle with each step. An ataxic gait ga it is staggering and unsteady. In a dystrophic gait, the client waddles with the legs far apart. In a steppage gait, the feet and to toes es raise high off the floor and the heel comes down heavily with each step. 16. Answer B. A client with with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial initial acute phase, should be as close to the t he nurses¶ station as possible to allow maximal observation. Placing P lacing the client in a room with a cclient lient who has viral meningitis may cause harm to both bot h clients because the organisms causing viral and bacter bacterial ial 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 shou shouldn¶t ldn¶t be put at risk by rooming with a client c lient who has just been diagnosed with this d disease. isease. 17. Answer C. Anticholinesterase Anticholinesterase agents such as pyridostigmine pyridostigmine are contraindicated in in a cli client ent with a mechanical obstruction of the intestines or urinary tract, peritonitis peritonitis,, or hypersensi hypersensitivity tivity to anticholinesterase agents. Ulcerative colitis, blood dyscrasia, and spinal cord co rd injury don¶t contraindicate use of the drug. 18. Answer A. A. Ménière¶s disease, an inner ear disease, is characterized by the symptom triad of  vertigo, tinnitus, and hearing loss. The combination co mbination of vertigo, vomiting, and nystagmus suggests labyrinthitis. Ménière¶s disease rarely causes pain, blurred vision, or fever. 19. Answer D. For 30 days after after a stapedectomy, stapedectomy, the client should should avoid air travel, 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 w ith the surgical ear  facing upward; nose blowing is permitted per mitted but should be done gent gently ly 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 t he ear dry. 20. Answer C. The most most common common adverse reaction reaction to dantrolene 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 tear ing and urine retention are adverse reactions associated with dantrolene dant rolene use, they aren¶t as common as muscle weakness 21. Answer A. Systemic Systemic absorption of atropine sulfate can cause tachycardia, palpitations, flushing, dry skin, ataxia, and confusion. co nfusion. To minimize systemic absorption, the client should apply digital pressure over the punctum punctu m at the inner canthus for 2 to 3 minutes after instilling 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 injury can cause respiratory respiratory distress, 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 ² particularly during the course of recovery ² 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 is recommended 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 o f epilepsy. Diazepam isn¶t an analgesic agent. 24. Answer C. To elicit elicit the oculocephalic response, which which detects cranial nerve compression, compression, the nurse turns the client¶s head suddenly sudden ly while holding the eyelids open. No Normally rmally,, the eyes e yes move from side to side when the t he head is turned; in an aabnormal bnormal response, the eyes remain fixed. The nurse introduces ice water into the external auditory canal when ttesting esting 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 w isp of cotton to elicit the corneal reflex response, which reveals brain stem function; blinking is the normal response. Shining S hining a bright light into the client¶s pupil helps evaluate brain stem and cranial cra nial nerve III functions; normally, the pupil responds by constricting. 25. Answer D. The nurse must must cautiously administer pancuronium, pancuronium, succinylcholine, and any other neuromuscular blocking agent to a client with myasthenia gravis. Such a cclient lient isn¶t less sensitive to the effects of a neuromuscular neuro muscular blocking agent. Either succinylcholine or   pancuronium can be administered ad ministered in the usual adult dosage to a client with myasthenia gravis. 26. Answer B. Cones provide daylight daylight color vision, vision, and their stimulation stimulation is interpreted as color. If one or more types of o f cones are absent or defective, color blindness occurs. Rods are sensitive to low levels of illumination but can¶t discriminate discr iminate color. The lens is responsible for  focusing images. Aqueous humor is a clear c lear watery fluid and isn¶t involved with color perception. 27.

Answer C. Decerebrate posturing, characterized by abnormal extension in in response to

 painful stimuli, indicates damage to the midbrain. With damage to the diencephalon o orr cortex, abnormal flexion (decorticate posturing) occurs when a painful pa inful stimulus is applied. Damage to the medulla results in flaccidity. 28. Answer A. Vision Vision changes, such as diplopia, diplopia, nystagmus, and blurred blurred vision, vision, are symptoms symptoms of multiple sclerosis. Deep tendon reflexes may be increased or hyperactive ² not absent. Babinski¶s sign may be positive. Tremors at rest aren¶t characteristic of mul multiple tiple 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 indication that the aneurysm is leaking. leaking. The nurse nurse should notify the physician immediately. Sitting S itting with 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 ana lgesic is indicated. Informing the nurse manager isn¶t necessary. 30. Answer D. Swallowing is is a motor motor function of cranial nerves IX and X. Cranial 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.