Neurology Nursing Revision Notes – Complete
Exam Guide (2026)
Comprehensive Practice Examination – 125
Questions
SECTION 1: NEUROLOGICAL ASSESSMENT & CEREBROVASCULAR DISORDERS (Questions 1-35)
Question 1:
A patient is brought to the emergency department with sudden onset of right-sided weakness, facial
droop, and slurred speech. The nurse notes the onset of symptoms was 45 minutes ago. Which action
should the nurse take FIRST?
A) Prepare the patient for a CT scan of the head
B) Administer aspirin 325 mg orally
C) Begin IV recombinant tissue plasminogen activator (tPA)
D) Place the patient in Trendelenburg position
Answer: A) Prepare the patient for a CT scan of the head
Rationale: In acute stroke management, the priority is to determine if the stroke is ischemic or
hemorrhagic. A non-contrast CT scan is the first diagnostic test to rule out hemorrhage. tPA can only be
administered after hemorrhage is ruled out and within the appropriate time window (typically 3-4.5
hours). Aspirin is contraindicated until hemorrhage is ruled out. Trendelenburg position can increase
intracranial pressure.
Question 2:
The nurse is performing a neurological assessment on a patient with suspected stroke. Which finding is
MOST consistent with a left hemisphere stroke?
A) Left-sided neglect
B) Expressive aphasia
C) Inability to recognize familiar objects
D) Impaired spatial perception
Answer: B) Expressive aphasia
Rationale: The left hemisphere (dominant in most individuals) controls language function. Left
hemisphere strokes often result in aphasia (expressive, receptive, or both), right-sided weakness, and
difficulty with reading/writing. Left-sided neglect, difficulty recognizing objects (agnosia), and impaired
spatial perception are characteristic of right hemisphere strokes.
,Question 3:
A patient with a subarachnoid hemorrhage reports a sudden severe headache described as "the worst
headache of my life." What complication should the nurse monitor for?
A) Hypertensive crisis
B) Re-bleeding
C) Cerebral vasospasm
D) All of the above
Answer: D) All of the above
Rationale: Subarachnoid hemorrhage can lead to multiple complications including re-bleeding (highest
risk in first 24 hours), cerebral vasospasm (peak at 3-14 days), and hypertensive crisis. Patients require
close monitoring in a neurocritical care setting with interventions to prevent and manage these
complications.
Question 4:
Which medication is used to prevent cerebral vasospasm in patients with subarachnoid hemorrhage?
A) Nimodipine
B) Phenytoin
C) Mannitol
D) Heparin
Answer: A) Nimodipine
Rationale: Nimodipine is a calcium channel blocker that is specifically indicated to prevent and treat
cerebral vasospasm following subarachnoid hemorrhage. It improves neurological outcomes by reducing
the severity of vasospasm. It is given orally or via NG tube. Mannitol is used to reduce intracranial
pressure. Heparin is for thromboembolism prevention.
Question 5:
The nurse is assessing a patient with increased intracranial pressure (ICP). Which early sign is MOST
indicative of rising ICP?
A) Cushing's triad
B) Decorticate posturing
C) Change in level of consciousness
D) Fixed and dilated pupils
Answer: C) Change in level of consciousness
Rationale: Change in level of consciousness is the earliest and most sensitive indicator of increased ICP.
As ICP rises, cerebral perfusion decreases, affecting the reticular activating system first. Cushing's triad
(hypertension, bradycardia, irregular respirations) is a late sign. Decorticate posturing and fixed dilated
pupils indicate severe neurological deterioration.
,Question 6:
A patient with a traumatic brain injury is exhibiting decerebrate posturing. What does this indicate?
A) Damage to the cerebral cortex
B) Damage to the brainstem at the midbrain level
C) Damage to the spinal cord
D) Damage to the cerebellum
Answer: B) Damage to the brainstem at the midbrain level
Rationale: Decerebrate posturing (arms extended, internally rotated, wrists pronated, legs extended)
indicates damage to the brainstem at the midbrain or pontine level. It is a more severe finding than
decorticate posturing (arms flexed, legs extended), which indicates damage to the cerebral hemispheres.
Both indicate severe neurological injury.
Question 7:
Which finding is MOST characteristic of a transient ischemic attack (TIA)?
A) Symptoms that resolve completely within 24 hours
B) Permanent neurological deficit
C) Symptoms that worsen over 48 hours
D) Loss of consciousness
Answer: A) Symptoms that resolve completely within 24 hours
Rationale: TIA is defined as a temporary episode of neurological dysfunction caused by focal brain
ischemia without acute infarction. Symptoms typically resolve within minutes to hours, with complete
resolution within 24 hours. TIAs are warning signs of potential future stroke and require urgent
evaluation and prevention strategies.
Question 8:
The nurse is caring for a patient with an intracranial hemorrhage. Which intervention is MOST important
to prevent further injury?
A) Maintain head of bed elevated at 30 degrees
B) Keep the patient in a dark, quiet environment
C) Administer stool softeners
D) All of the above
Answer: D) All of the above
Rationale: All of these interventions are important to reduce ICP and prevent re-bleeding. Head elevation
promotes venous drainage. A quiet environment reduces stimulation and agitation. Stool softeners
prevent straining (Valsalva maneuver), which increases ICP. These are standard nursing interventions for
intracranial hemorrhage.
, Question 9:
Which cranial nerve is MOST commonly affected in a patient with a stroke?
A) CN III - Oculomotor
B) CN VII - Facial
C) CN X - Vagus
D) CN XII - Hypoglossal
Answer: B) CN VII - Facial
Rationale: The facial nerve (CN VII) is frequently affected in stroke, causing facial droop on the
contralateral side. This is one of the key findings in the FAST assessment (Face, Arm, Speech, Time). CN III
involvement suggests increased ICP or brainstem herniation. CN X and XII are less commonly affected.
Question 10:
A patient with a right hemisphere stroke is at risk for which specific complication?
A) Impaired swallowing
B) Neglect syndrome
C) Broca's aphasia
D) Right-sided weakness
Answer: B) Neglect syndrome
Rationale: Right hemisphere strokes commonly cause left-sided neglect, where the patient ignores the
left side of their body and environment. This can lead to safety issues, falls, and decreased participation
in rehabilitation. Broca's aphasia and swallowing difficulties are more common with left hemisphere
strokes. Right hemisphere stroke causes left-sided, not right-sided, weakness.
Question 11:
What is the primary purpose of the Glasgow Coma Scale (GCS)?
A) To assess cranial nerve function
B) To evaluate level of consciousness
C) To measure intracranial pressure
D) To assess motor strength
Answer: B) To evaluate level of consciousness
Rationale: The Glasgow Coma Scale is a standardized tool used to assess and quantify level of
consciousness based on three components: eye opening (1-4), verbal response (1-5), and motor response
(1-6). Scores range from 3 (deep coma) to 15 (fully awake). It does not assess cranial nerves, ICP directly,
or motor strength specifically.
Question 12:
The nurse is caring for a patient with acute ischemic stroke who received tPA. Which assessment finding
is MOST concerning?
Exam Guide (2026)
Comprehensive Practice Examination – 125
Questions
SECTION 1: NEUROLOGICAL ASSESSMENT & CEREBROVASCULAR DISORDERS (Questions 1-35)
Question 1:
A patient is brought to the emergency department with sudden onset of right-sided weakness, facial
droop, and slurred speech. The nurse notes the onset of symptoms was 45 minutes ago. Which action
should the nurse take FIRST?
A) Prepare the patient for a CT scan of the head
B) Administer aspirin 325 mg orally
C) Begin IV recombinant tissue plasminogen activator (tPA)
D) Place the patient in Trendelenburg position
Answer: A) Prepare the patient for a CT scan of the head
Rationale: In acute stroke management, the priority is to determine if the stroke is ischemic or
hemorrhagic. A non-contrast CT scan is the first diagnostic test to rule out hemorrhage. tPA can only be
administered after hemorrhage is ruled out and within the appropriate time window (typically 3-4.5
hours). Aspirin is contraindicated until hemorrhage is ruled out. Trendelenburg position can increase
intracranial pressure.
Question 2:
The nurse is performing a neurological assessment on a patient with suspected stroke. Which finding is
MOST consistent with a left hemisphere stroke?
A) Left-sided neglect
B) Expressive aphasia
C) Inability to recognize familiar objects
D) Impaired spatial perception
Answer: B) Expressive aphasia
Rationale: The left hemisphere (dominant in most individuals) controls language function. Left
hemisphere strokes often result in aphasia (expressive, receptive, or both), right-sided weakness, and
difficulty with reading/writing. Left-sided neglect, difficulty recognizing objects (agnosia), and impaired
spatial perception are characteristic of right hemisphere strokes.
,Question 3:
A patient with a subarachnoid hemorrhage reports a sudden severe headache described as "the worst
headache of my life." What complication should the nurse monitor for?
A) Hypertensive crisis
B) Re-bleeding
C) Cerebral vasospasm
D) All of the above
Answer: D) All of the above
Rationale: Subarachnoid hemorrhage can lead to multiple complications including re-bleeding (highest
risk in first 24 hours), cerebral vasospasm (peak at 3-14 days), and hypertensive crisis. Patients require
close monitoring in a neurocritical care setting with interventions to prevent and manage these
complications.
Question 4:
Which medication is used to prevent cerebral vasospasm in patients with subarachnoid hemorrhage?
A) Nimodipine
B) Phenytoin
C) Mannitol
D) Heparin
Answer: A) Nimodipine
Rationale: Nimodipine is a calcium channel blocker that is specifically indicated to prevent and treat
cerebral vasospasm following subarachnoid hemorrhage. It improves neurological outcomes by reducing
the severity of vasospasm. It is given orally or via NG tube. Mannitol is used to reduce intracranial
pressure. Heparin is for thromboembolism prevention.
Question 5:
The nurse is assessing a patient with increased intracranial pressure (ICP). Which early sign is MOST
indicative of rising ICP?
A) Cushing's triad
B) Decorticate posturing
C) Change in level of consciousness
D) Fixed and dilated pupils
Answer: C) Change in level of consciousness
Rationale: Change in level of consciousness is the earliest and most sensitive indicator of increased ICP.
As ICP rises, cerebral perfusion decreases, affecting the reticular activating system first. Cushing's triad
(hypertension, bradycardia, irregular respirations) is a late sign. Decorticate posturing and fixed dilated
pupils indicate severe neurological deterioration.
,Question 6:
A patient with a traumatic brain injury is exhibiting decerebrate posturing. What does this indicate?
A) Damage to the cerebral cortex
B) Damage to the brainstem at the midbrain level
C) Damage to the spinal cord
D) Damage to the cerebellum
Answer: B) Damage to the brainstem at the midbrain level
Rationale: Decerebrate posturing (arms extended, internally rotated, wrists pronated, legs extended)
indicates damage to the brainstem at the midbrain or pontine level. It is a more severe finding than
decorticate posturing (arms flexed, legs extended), which indicates damage to the cerebral hemispheres.
Both indicate severe neurological injury.
Question 7:
Which finding is MOST characteristic of a transient ischemic attack (TIA)?
A) Symptoms that resolve completely within 24 hours
B) Permanent neurological deficit
C) Symptoms that worsen over 48 hours
D) Loss of consciousness
Answer: A) Symptoms that resolve completely within 24 hours
Rationale: TIA is defined as a temporary episode of neurological dysfunction caused by focal brain
ischemia without acute infarction. Symptoms typically resolve within minutes to hours, with complete
resolution within 24 hours. TIAs are warning signs of potential future stroke and require urgent
evaluation and prevention strategies.
Question 8:
The nurse is caring for a patient with an intracranial hemorrhage. Which intervention is MOST important
to prevent further injury?
A) Maintain head of bed elevated at 30 degrees
B) Keep the patient in a dark, quiet environment
C) Administer stool softeners
D) All of the above
Answer: D) All of the above
Rationale: All of these interventions are important to reduce ICP and prevent re-bleeding. Head elevation
promotes venous drainage. A quiet environment reduces stimulation and agitation. Stool softeners
prevent straining (Valsalva maneuver), which increases ICP. These are standard nursing interventions for
intracranial hemorrhage.
, Question 9:
Which cranial nerve is MOST commonly affected in a patient with a stroke?
A) CN III - Oculomotor
B) CN VII - Facial
C) CN X - Vagus
D) CN XII - Hypoglossal
Answer: B) CN VII - Facial
Rationale: The facial nerve (CN VII) is frequently affected in stroke, causing facial droop on the
contralateral side. This is one of the key findings in the FAST assessment (Face, Arm, Speech, Time). CN III
involvement suggests increased ICP or brainstem herniation. CN X and XII are less commonly affected.
Question 10:
A patient with a right hemisphere stroke is at risk for which specific complication?
A) Impaired swallowing
B) Neglect syndrome
C) Broca's aphasia
D) Right-sided weakness
Answer: B) Neglect syndrome
Rationale: Right hemisphere strokes commonly cause left-sided neglect, where the patient ignores the
left side of their body and environment. This can lead to safety issues, falls, and decreased participation
in rehabilitation. Broca's aphasia and swallowing difficulties are more common with left hemisphere
strokes. Right hemisphere stroke causes left-sided, not right-sided, weakness.
Question 11:
What is the primary purpose of the Glasgow Coma Scale (GCS)?
A) To assess cranial nerve function
B) To evaluate level of consciousness
C) To measure intracranial pressure
D) To assess motor strength
Answer: B) To evaluate level of consciousness
Rationale: The Glasgow Coma Scale is a standardized tool used to assess and quantify level of
consciousness based on three components: eye opening (1-4), verbal response (1-5), and motor response
(1-6). Scores range from 3 (deep coma) to 15 (fully awake). It does not assess cranial nerves, ICP directly,
or motor strength specifically.
Question 12:
The nurse is caring for a patient with acute ischemic stroke who received tPA. Which assessment finding
is MOST concerning?
