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Neurological Disorders

POP QUIZ NCLEX Question

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Question A nurse is caring for a patient who has been diagnosed with a brain tumor. The patient reports a headache that is worse in the morning and improves as the day progresses. Which of the following is the most likely reason for the pattern of headache the patient is experiencing?
A. Increased intracranial pressure (ICP) due to tumor growth

B. Dehydration overnight

C. Caffeine withdrawal

D. Positional vertigo

E. Sinus congestion
Rationale: The presence of a brain tumor can lead to an increase in intracranial pressure, particularly as the tumor grows. This pressure can be more pronounced in the morning after lying flat for an extended period, which can impede the drainage of cerebrospinal fluid. As the patient becomes more upright throughout the day, gravity assists in improving the drainage, thereby reducing the pressure and the severity of the headache. Understanding this pattern is crucial for diagnosing and managing conditions related to increased intracranial pressure. Correct Answer: A. Increased intracranial pressure (ICP) due to tumor growth

Question A nurse is assessing a patient with a suspected stroke. Which of the following symptoms would indicate the patient is experiencing a left-sided stroke?
A. Impaired speech and right-sided weakness

B. Left-sided weakness and spatial disorientation

C. Difficulty swallowing and left-sided facial droop

D. Right-sided facial droop and impaired judgment

E. Loss of consciousness and bilateral weakness
Rationale: A left-sided stroke typically affects the right side of the body due to the brain’s cross-wiring, where the left hemisphere controls the right side and vice versa. Impaired speech (aphasia) and right-sided weakness are classic signs of a left-sided stroke because the left hemisphere is responsible for language and motor control of the right side. Recognizing these symptoms promptly is vital for timely intervention and reducing long-term disability. This question assesses the nurse’s ability to identify stroke symptoms and understand the brain’s hemispheric functions. Correct Answer: A. Impaired speech and right-sided weakness

Question A nurse is providing care for a patient with multiple sclerosis (MS). Which of the following interventions is most important for managing this patient’s condition?
A. Frequent repositioning to prevent pressure ulcers

B. Administration of immunosuppressive medication as prescribed

C. High-protein diet

D. Application of cold compresses to reduce inflammation

E. Vigorous physical therapy to improve muscle strength
Rationale: Multiple sclerosis is an autoimmune disease that damages the protective covering of nerves, leading to a wide range of symptoms including muscle weakness, coordination problems, and fatigue. The administration of immunosuppressive medication is crucial in managing MS because these drugs help reduce the immune system’s attack on the nervous system, potentially slowing the progression of the disease. This intervention targets the underlying pathology of MS, making it a key aspect of care. Understanding the role of immunosuppressive therapy in MS management is essential for nurses in providing comprehensive care to these patients. Correct Answer: B. Administration of immunosuppressive medication as prescribed

Question A patient with Parkinson’s disease is experiencing severe tremors. Which of the following medications is most likely to provide symptomatic relief?
A. Gabapentin

B. Levodopa/Carbidopa

C. Amitriptyline

D. Baclofen

E. Acetaminophen
Rationale: Parkinson’s disease is characterized by a deficiency of dopamine in the brain, leading to symptoms such as tremors, rigidity, and bradykinesia. Levodopa/Carbidopa is a medication that increases dopamine levels, thereby providing symptomatic relief from tremors and other motor symptoms of Parkinson’s disease. This combination is considered the gold standard for treating Parkinson’s disease symptoms. Understanding the pharmacological management of Parkinson’s disease is crucial for nurses to help optimize patient outcomes and improve quality of life. Correct Answer: B. Levodopa/Carbidopa

Question A nurse is planning care for a patient with Guillain-Barré syndrome (GBS). Which of the following should be the priority nursing intervention?
A. Encouraging daily exercise to prevent muscle atrophy

B. Monitoring for signs of respiratory failure

C. Providing high-calorie meals

D. Administering pain medication as needed

Rationale: Guillain-Barré syndrome is an autoimmune disorder that causes demyelination of peripheral nerves, leading to muscle weakness and paralysis that can ascend and affect the respiratory muscles. Monitoring for signs of respiratory failure is a critical intervention, as respiratory compromise is a major concern and can be life-threatening. Early detection and intervention can significantly improve outcomes. This priority reflects the nurse’s role in monitoring and responding to acute changes in a patient’s condition, particularly in neurological disorders like GBS. Correct Answer: B. Monitoring for signs of respiratory failure

Question A patient with amyotrophic lateral sclerosis (ALS) is experiencing difficulty speaking and swallowing. Which of the following interventions would be most appropriate for the nurse to implement?
A. Providing a straw for drinking liquids

B. Implementing a soft or pureed diet

C. Encouraging the patient to eat large meals

D. Administering anticholinergic medications

E. Encouraging vigorous neck exercises
Rationale: ALS is a progressive neurodegenerative disease that affects motor neurons, leading to muscle weakness and atrophy. Difficulty speaking and swallowing (dysarthria and dysphagia) are common as the disease progresses. Implementing a soft or pureed diet can help prevent choking and aspiration, making it easier for the patient to eat and maintain nutrition. This intervention addresses the patient’s immediate safety and quality of life, highlighting the nurse’s role in adapting care to meet the evolving needs of patients with neurodegenerative disorders. Correct Answer: B. Implementing a soft or pureed diet

Question A nurse is assessing a patient with a history of seizures. Which of the following findings would suggest the patient is experiencing an aura before a seizure?
A. Sudden increase in blood pressure

B. Visual disturbances

C. Involuntary muscle spasms

D. Immediate loss of consciousness

E. High fever
Rationale: An aura is a perceptual disturbance experienced by some people with epilepsy before a seizure. It can manifest as visual disturbances, such as flashes of light or changes in vision, and serves as a warning sign that a seizure may be imminent. Recognizing an aura allows patients and caregivers to take precautions to prevent injury during a seizure. This question tests the nurse’s understanding of seizure manifestations and the importance of patient education in managing epilepsy. Correct Answer: B. Visual disturbances

Question A nurse is caring for a patient who recently underwent a lumbar puncture. Which of the following actions is most important to prevent complications after the procedure?
A. Encouraging the patient to ambulate frequently

B. Instructing the patient to remain flat for several hours

C. Applying a hot pack to the puncture site

D. Administering antibiotics prophylactically

E. Encouraging caffeine intake
Rationale: After a lumbar puncture, it is important to instruct the patient to remain flat for several hours to reduce the risk of a post-lumbar puncture headache. This position helps to prevent cerebrospinal fluid leakage from the puncture site, which can lead to decreased cerebrospinal fluid pressure and headaches. This preventive measure is a key aspect of post-procedure care and reflects the nurse’s role in minimizing complications and promoting patient comfort. Understanding the rationale for post-procedure care is essential for effective nursing practice. Correct Answer: B. Instructing the patient to remain flat for several hours

Question Which of the following symptoms would most likely indicate a patient is experiencing a hemorrhagic stroke?
A. Sudden, severe headache

B. Gradual onset of weakness over several days

C. Isolated difficulty with swallowing

D. Numbness in the feet and hands

E. Slow, progressive memory loss
Rationale: A hemorrhagic stroke occurs when a blood vessel in the brain bursts, leading to bleeding within the brain. This type of stroke is often characterized by a sudden, severe headache, described as the worst headache of the patient’s life. This symptom, along with other signs such as altered consciousness and focal neurological deficits, helps differentiate hemorrhagic stroke from other types of stroke or neurological conditions. Prompt recognition of these symptoms is crucial for early intervention and potentially life-saving treatment. Correct Answer: A. Sudden, severe headache

Question A nurse is evaluating a patient with a suspected meningitis. Which of the following clinical findings would support this diagnosis?
A. Positive Brudzinski’s sign

B. Hypotension

C. Bradycardia

D. Decreased respiratory rate

E. Hyperthermia
Rationale: Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. A positive Brudzinski’s sign, where involuntary lifting of the legs occurs when the patient’s neck is flexed, is a classic sign of meningitis. This finding, along with other symptoms such as fever, headache, and neck stiffness, can help support the diagnosis of meningitis. Recognizing these signs and symptoms is essential for nurses to initiate prompt diagnostic testing and treatment to prevent serious complications. Correct Answer: A. Positive Brudzinski’s sign

Evaluation of Neurological Disorders

The computed tomography (CT) scan of the head may be done with or without contrast. Excellent images can be obtained without contrast, and the issue of dye or contrast allergies doesn’t come into question. Routinely, if you have, for example, a patient who is undergoing a CT scan for trauma, it’s not done with contrast. You often want to know very quickly if the patient has suffered some intracranial trauma or bleeding. This can be done in under 10 minutes.

CT for head injury

If spinal trauma must be ruled out, consider obtaining a CT scan of the spine. This helps rule out spine fractures. The goal is to remove the patient’s spine collar if the collar is not needed. “Clearing” the spine allows the health care provider to get the patient out of the uncomfortable C-collar. In a patient who has suffered a traumatic event, the patient will remain in the C-collar until the patient’s spine is cleared.

Another critical study used in neurological disorders is magnetic resonance imaging or MRI. The MRI of the brain is used to image soft tissue tumors among other things. It is not that you can’t identify bleeds with MRI, but for trauma, we don’t typically use the MRI as an initial study. The MRI is the preferred study for patients with ruptured or herniated disc injuries. It is really the study of choice for evaluating the spine. It can also be done with or without dye or contrast.

what does a lumbar puncture test for?

Additionally, we have some invasive studies that neurotrauma patients or patients with head and spine trauma or even infection may undergo. The lumbar puncture involves a needle inserted in the lumbar region of the spine, to obtain cerebral spinal fluid (CSF) and send it to the lab for analysis.

More: Neuro NCLEX Questions

The CSF can give us a lot of information about infections, abnormal cells, and bleeding. It is a valuable diagnostic test. It may be used to diagnose subarachnoid hemorrhage in patients who have a negative CT scan of the head.  The test is usually avoided in patients with elevated intracranial pressure because of the risk of cerebral herniation and in patients at risk for bleeding, for example in patients with low platelet counts.

What are the signs and symptoms of increased elevated ICP? Vomiting, excess sleeping, behavioral changes, headache, papilledema, and blurred vision are all signs of elevated ICP.

Nursing considerations that are important for preparing a patient for this procedure include having the patient empty the bladder and positioning the patient. The patient may be positioned in the lateral recumbent position or sitting. There’s more than one position that you can use for the lumbar puncture. The procedure can also be done with fluoroscopic guidance and the patient may be prone in this case. Correct patient positioning is critical. The skin will be carefully cleaned, and local anesthesia is infiltrated. After the procedure is done, the patient may experience post-lumbar puncture headache, back pain, or minor neurological symptoms. Patients may be asked to remain flat for a period of time after the procedure and limit their activity level for 24 hours following the procedure.

eeg test for seizures

Another procedure that is done to evaluate neurological conditions is the electroencephalogram (EEG) this test measures the electrical activity of the brain or “brain wave activity”. There are some nursing considerations for the EEG. Remind patients not to consume stimulants, tranquilizers, tea, caffeine, and energy drinks. We also recommend that patients should not take some muscle relaxants and benzodiazepines. Usually, this is the case for 24 to 48 hours prior to this procedure. Patients should wash their hair before the procedure. This is a test that can be used to assess for seizures.

Neuro NCLEX Questions, below

management of unconscious patient in hospital

In terms of the care of the neurologic patient, the unconscious patient is one that required special nursing consideration and may be one of the most challenging patients to care for. A decrease in the level of consciousness can be due to trauma, stroke, metabolic, infectious, and toxic causes. It may be iatrogenic. We can provide sedation or other medications that will make the patients unarousable. Most patients are alert, arousable, and responsive. When a patient has an altered state of consciousness, it is important to preserve brain function.

We must be familiar with how to assess and care for these patients. Perhaps the most important thing is ensuring that the airway is protected. The way that we protect the airway in an unconscious patient is with intubation. So typically, unconscious patients (patients who cannot protect their own airway), are intubated and on a mechanical ventilator. We ensure adequate oxygenation and carbon dioxide or CO₂ exhalation.

During the nursing assessment, it’s also essential to assess and maintain their skin and prevent skin breakdown. Oral hygiene and general hygiene are essential. This maintains excellent health and prevents infection. During oral hygiene, look in the mouth, and inspect the teeth and gums. Note any signs of infection or debris. Use a soft toothbrush to clean the gums and the teeth. Pay attention to subtle changes in vital signs and laboratory results. Changes may indicate a change in condition, organ function, infection, and early signs of sepsis. During care, the airway must be maintained and the oxygen status is continuously monitored. The neurological exam is done regularly to assess for improvement and any changes.

management of Elevated ICP

And then the other thing with the unconscious neurotrauma patient is attention to intracranial pressure. An increase in intracranial pressure can result from a motor vehicle accident, a high-speed accident that results in bleeding in the skull. Monitoring these patients’ ICP will be part of their ongoing care and ensuring that we intervene in a timely way if there’s a change in intracranial pressure. Elevated intracranial pressure can be harmful and lead to permanent brain damage.

The assessment of the level of consciousness can be an indication of elevated intracranial pressure. The higher the intracranial pressure, the more likely the patient is going to have a decline in alertness, orientation, and mental function. In short, the level of consciousness is affected by intracranial pressure.

The other thing that can affect ICP or that can may indicate elevation in ICP is a patient who tells you that their headache is worsening. Vital signs may suggest an elevation in ICP. This includes the respiratory rate, blood pressure, and heart rate. The respirations may become irregular. Patients with elevated ICP may have hypertension, the heart rate often goes down and we see bradycardia. The body is trying to overcome the elevated pressure within the brain, so the blood pressure goes up. We don’t overcorrect or treat this aggressively because it’s an important physiological mechanism to allow the body to compensate for the elevated ICP.

If the patient is awake, the patient may complain of nausea or vomiting. The other thing we see in patients with elevated ICP is involuntary posturing. When the limbs are extended, they are decerebrate. When the patient’s limbs are flexed, they are decorticate posturing. Posturing is an ominous sign.

So now we know how to recognize ICP and monitor ICP. So often, these patients have ventricular drains or a ventriculostomy in the intensive care unit. This a device that can be used to measure the intracranial pressure and drain excess cerebrospinal fluid (CSF).

We also monitor the partial pressure of carbon dioxide (PaCO2). Elevated PaCO2 increases intracranial pressure. For this reason, we monitor and attempt to keep the PaCO2 low or within the normal range. In patients who have elevated ICP, avoid hypothermia. Monitoring temperature closely. Shivering increases intracranial pressure. Avoid constipation. You want to avoid straining; this increases intracranial pressure. It is critical to avoid hypoxia in patients with brain trauma. The aforementioned are some of the most important things to think about. From a nursing standpoint, these are things that are all very much within your control when you are monitoring and taking care of a patient with elevated ICP.

Open-head injuries and closed-head injuries. Open head injuries are those injuries that see with an open wound or scalp laceration. Closed head injuries, there is not an open wound but they can be just as serious. Head injury can involve fractures of the skull. They can involve contusions of the brain and intracranial bleeding.

What’s the treatment of severely elevated ICP that we cannot control with other mechanisms? There is a surgical intervention for these patients with elevated ICP. This is referred to as craniotomy. Usually, we can manage intracranial pressure with nonsurgical means. A cerebral aneurysm often referred to as the “worst headache” or the worst headache of your life is usually associated with visual changes, sometimes ringing in the ears, and sometimes seizures, these are all signs of cerebral aneurysms.

A ruptured cerebral aneurysm is devastating; it can result in a sharp increase in intracranial pressure. An aneurysm is a dilated or weakened artery in the brain or a cerebral artery that can rupture.  

management of seizure disorder

What is a seizure? A seizure is basically an excess of electrical activity in the brain and a seizure can happen once and never happen again. Or it can be chronic. It can cause a condition which is called epilepsy, which is chronic seizure activity. This is treated long-term with medication.  The factors that can cause chronic seizure disorders to include, it can be genetic factors. The cause can be unknown, or it can be due to trauma, metabolic, or drug-related, or it can be affected by electrolyte abnormalities.  

Once diagnosed, these patients are often treated with medication. There are a number of medications called anticonvulsants that are very effective. Benzodiazepines are good medications for acute control. A few examples of medications for the management of seizures are phenytoin, valproic acid, and gabapentin. Status epilepticus is a term used to describe continuous or unremitting generalized convulsive seizures of more than 5 minutes. It is a medical emergency and must be promptly treated.

What is an aura? An aura is a sudden change in visual signs, this can be halos, or bright lights,  for example. It’s a visual sensation that lets the patient know that a seizure is coming. Other prodromal signs are irritability, difficulty sleeping, confusion, headache, and anxiety. These are some signs of an impending seizure. The hallmark of the seizure, depending on the type of seizure is the involuntary shaking or excessive muscle contraction that occurs. Loss of bowel function, and sometimes loss of urinary or bladder function. This is the ictal phase.

nursing care after a seizure

The pre-ictal state may be very short and is referred to as the aura. The post-ictal phase is the period following the seizure. It is the period of recovery for the patient, when the patient is starting to wake up, they may be very sleepy or confused. Their speech and thinking may not be clear. They may have a headache and express that they are fatigued.

The safety actions that the nurse will take during a seizure, and is to protect the airway. If you are outdoors or in an office setting, ease the patient to the floor. You can allow the patient to stay on their side in case they vomit, making sure that the airway is clear. You don’t want to restrain the patient during the seizure.

More NCLEX Style Questions

Neuro NCLEX Questions, below

NCLEX QUESTION 1. The UAP ask the nurse about sciatica in a recently admitted patient. The nurse correctly answers, (select all that apply)
A. More common in pediatrics
B. Results from compression of the sciatic nerve
C. More common in males
D. Also known as lumbar radiculopathy

compartment syndrome nursing diagnosis

NCLEX QUESTION 2. The nurse is caring for a 33-year-old male with a large circumferential burn of his left lower extremity. The nurse suspects compartment syndrome at physical examination. What is the best next step?
A. Lower the extremity
B. Administer the pain medication ordered
C. Encourage ambulation
D. Call the health care provider

neurological problems after surgery

NCLEX QUESTION 3. The nurse is caring for a 53-year-old diabetic female who recently underwent an above knee amputation (AKA) of the left lower extremity. What are possible post-operative complications of an AKA? (select all that apply).
A. Atelectasis
B. Infection
C. Bleeding.
D. Phantom limb pain

Normal ICP range in adults

NCLEX QUESTION 4. What is the normal range of intracranial pressure?
A.  ≤15 millimeters of mercury
B.  ≤25 millimeters of mercury
C.  ≤35 millimeters of mercury
D.  ≤50 millimeters of mercury

early signs of increased iCP

NCLEX QUESTION 5. The UAP ask the nurse about how to recognize increased intracranial pressure (ICP) in an infant with a brain tumor. The nurse correctly answers, (select all that apply)
A. hunger and thirst
B. high-pitched cry
C. decreased head circumference
D. bulging fontanels

symptoms of brain tumor in teenager

NCLEX QUESTION 6. The UAP ask the nurse about pediatric brain tumors. The nurse correctly answers, (select all that apply)
A. Brain tumors are second in frequency to leukemias in children
B. Headaches occur at night and are improved upon waking in the morning
C. Vomiting may occur that is not related to diet
D. New onset seizures may occur

opiate withdrawal assessment

NCLEX QUESTION 7. What exam findings should the nurse recognize as signs of opiate withdrawal? (select all that apply)
A. pinpoint pupils
B. shivering
C. hunger
D. excessive yawning

major types of neurotransmitters

NCLEX QUESTION 8. What neurotransmitter is the major inhibitory transmitter in the brain?
A. Serotonin
B. GABA
C. norepinephrine
D. acetylcholine

EEG Preparation

NCLEX QUESTION 9. The nurse is providing pre-procedure education to a patient undergoing an EEG in the morning. What information should the nurse provide?
A. NPO after midnight before the EEG
B. Avoid consuming coffee before the procedure
C. Consume only liquids for breakfast in the morning
D. Hold all medications on the morning of the procedure

elevated intracranial pressure

NCLEX QUESTION 10. What are the clinical manifestations of elevated intracranial pressure after head trauma? (select all that apply)
A. vomiting.
B. hyperactivity
C. diarrhea
D. headache
E. somnolence

Answers to NCLEX-style Questions

Neuro NCLEX Questions

1. B, C and D
Sciatica occurs when pain affects the sciatic nerve. It typically occurs on one side. Patients describe the pain as radiating down the back of the extremity. It may be mild or severe. Sciatica is commonly caused by a herniated disk compressing a  lumbosacral nerve root.
2. D
Compartment syndrome of the extremities occurs when pressure increases within a compartment and compromises the circulation (blood flow) to the tissues within the space. Acute compartment syndrome is a surgical emergency. Failure to recognize the condition may result in limb loss.
3. A, B, C and D
The complications listed above: A, B, C, and D are not uncommon. Other problems associated with poor outcomes are neuroma and knee contracture. Atelectasis can be reduced by good nursing and respiratory care, and include encouraging cough, deep breathing, and incentive spirometry.
4. A
5. B and D
Elevated ICP is a risk in infants and children with a brain tumor and post craniotomy. Physical findings in infants include B and D, poor feeding, and irritability.
6. A, C and D
Headaches in children with brain tumors are typically worse in the morning upon waking. B states the opposite. Behavioral changes may occur as well as double vision.
7. B and D
Physical signs of opiate withdrawal include insomnia, agitation, muscle aches, frequent yawning and nausea. Hot and cold flashes may affect some individuals.
8. B
GABA or gamma-aminobutyric acid is an inhibitory neurotransmitter in the brain. It reduces the neurons excitability.
9. B
Drinks containing caffeine such as coffee and cola should be withheld before an EEG because of the stimulant effects. This affects the brain waves. Patients do not need to be NPO before the procedure and low blood sugar may affect the brain waves.  Patients should eat a normal meal on the morning of the EEG.
10. A. D and E
Elevated intracranial pressure (ICP) results from tumor, trauma, or stroke. If not treated elevated ICP leads to worsening symptoms including A, D and E and may progress to permanent neurological impairment or death.

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