The nurse is caring for a patient who suttered massive
head trauma, and suspected increased intracranial pres-
sure (ICP) from an automobile accident. Which cranial
nerves are most appropriate to check at this time?
B. CN II and CN III
A. CN I and CN II
B. CN II and CN III
C. CN III and CN IV
D .CN IV and CN V
When increased ICP is suspected, the nurse performs a
complete neurologic assessment. What does the pupillary
response indicate?
A. High pressure can cause blurred vision. D. Pupil changes can be caused by pressure on the ocular
B. Hemorrhage can cause visual impairment. nerve.
C. Pupil dilation is the first sign of increased ICP.
D. Pupil changes can be caused by pressure on the ocular
nerve.
When rating a patient using the Glasgow Coma Scale,
what would be appropriate for the LPN/LVN to ask the pa-
tient to do in order to test the patient's motor response?
A. Roll his eyes in a circle. D. Touch his nose with his left index finger.
B. Take a deep breath and exhale.
C. Describe the view from his window.
D. Touch his nose with his left index finger.
The nurse is assessing a patient who has a brain tumor.
What assessment finding is most indicative of increased
ICP in this patient?
A. Decreasing level of consciousness (LOC) A. Decreasing level of consciousness (LOC)
B. Elevated temperature
C. Agitation and hostility
D. Increasing blood pressure (BP)
,Neurological NCLEX Questions and Answers Graded A+
The nurse is assessing the patient's patellar reflex. The
patient asks what the purpose of this exam is. Which
response by the nurse is correct?
A. "I am checking the conscious nerve response in your
leg."
C. "Checking this reflex assesses involuntary muscular
B. "This assessment determines your hand-eye coordina-
contractions."
tion."
C. "Checking this reflex assesses involuntary muscular
contractions."
D. "The patellar reflex demonstrates large voluntary mus-
cle coordination."
The nurse is performing a "neuro check" on a patient who
has demonstrated a decreased LOC. What is the best way
to assess the patient's neuromuscular status?
A. Measure the patient's vital signs.
D. Determine whether the patient is able to move his legs
B. Test the reaction of the patient's pupils to light.
and arms
C. Check the patient's response to the stimulus of pinch-
ing.
D. Determine whether the patient is able to move his legs
and arms
A patient who is to have computed tomography (CT scan)
of the brain voices concern about the procedure. The
LPN/LVN can best allay the patient's fears by making which
statement?
A. "CT scans use only a small amount of radioactive ma-
B. "The procedure is safe and painless; you will hear a
terial injected into your brain."
clicking noise as the CT machine rotates."
B. "The procedure is safe and painless; you will hear a
clicking noise as the CT machine rotates."
C. "You will probably be given something to make you
drowsy and deaden the pain during the CT scan."
C. "CT scanning is a new procedure, and since it involves
,Neurological NCLEX Questions and Answers Graded A+
the brain, I think the doctor can answer your questions
better than I can."
The nurse is caring for a patient who has undergone a
lumbar puncture in order to run tests on the cerebrospinal
fluid (CSF). The nurse knows which laboratory value is
abnormal?
C. White blood cells (WBCs) 100/mm3
A. Glucose 60 mg/100 mL
B. Clear, colorless appearance
C. White blood cells (WBCs) 100/mm3
D. Total protein 40 mg/100 mL
The nurse is measuring the pressure of the CSF. Which
statement accurately describes CSF? (Select all that ap-
ply.)
A. CSF circulates within the subarachnoid space.
A. CSF circulates within the subarachnoid space.
B. CSF cushions and protects the brain and spinal cord.
B. CSF cushions and protects the brain and spinal cord.
D. CSF is reabsorbed by the arachnoid villi at the same
C. CSF normal pressure is 90 to 150 cm water pressure
rate at which it is formed.
(cm H2O).
E. CSF is formed continuously within the ventricles of the
D. CSF is reabsorbed by the arachnoid villi at the same
brain as a filtrate from the blood.
rate at which it is formed.
E. CSF is formed continuously within the ventricles of the
brain as a filtrate from the blood.
The LPN/LVN discusses ways to prevent a stroke with a
patient. Which measures should the nurse include in her
teaching? (Select all that apply.) A. Proper treatment for hypertension
A. Proper treatment for hypertension B. Adequate treatment of atherosclerosis
B. Adequate treatment of atherosclerosis C. Avoiding the use of recreational drugs
C. Avoiding the use of recreational drugs E. Keeping serum cholesterol levels under control
D. Encouraging the use of seat belts in vehicles
E. Keeping serum cholesterol levels under control