NCLEX PREP NEURO EXAM QUESTIONS AND
ANSWERS
1. A client admitted to the hospital for a subarachnoid haemorrhage reports severe
headache, nuchal rigidity, and projectile vomiting. In which of the following
situations would the nurse advise against performing a lumbar puncture (LP) on
this client?
a. Continued vomiting b. Elevated intracranial pressure.
b. The client requires mechanical ventilation.
d. Blood is expected in the cerebral spinal fluid (CSF) - ANSWER 1. B. Sudden
evacuation of CSF results in pressures lower in the lumbar area than the brain and
promotes brain herniation; thus, LP is contraindicated with elevated ICP. Vomiting
can be induced by factors other than elevated ICP, therefore LP is not necessarily
contraindicated. An LP may be performed on individuals who require mechanical
ventilation. Blood in the cerebrospinal fluid is a diagnostic test for subarachnoid
haemorrhage and was obtained before ICP symptoms.
2. A client with a subdural haematoma becomes agitated and confused, with
dilatation of the ipsilateral pupil. Which of the following reasons does the physician
order mannitol?
a. To lower intraocular pressure.
b. Prevent acute tubular necrosis.
b. Promote osmotic diuresis to reduce ICP
d. Draw water into the vascular system to raise blood pressure - ANSWER 2. C.
Mannitol induces osmotic diuresis by raising the pressure gradient, which draws
fluid from intracellular to intravascular regions. Although mannitol is utilised for
all of the reasons above, the client's ICP lowering is a cause for concern.
, 3. Mannitol was administered to a client with a subdural haematoma to reduce
intracranial pressure (ICP). Which of the following results best demonstrates that
mannitol was effective?
a. Urine output increases.
b. The pupils are 8 mm and nonreactive.
c. Systolic blood pressure stays at 150 mmHg.
d. BUN and creatinine levels return to normal - ANSWER 3. A. Mannitol induces
osmotic diuresis by raising the pressure gradient in the renal tubes. Fixed and
dilated pupils are signs of elevated ICP or cranial nerve injury. There is no mention
of abnormal BUN and creatinine levels, or that mannitol is used to treat renal
impairment or maintain blood pressure.
4. Which of the following ICP readings are considered normal?
a. 0–15 mmHg
b. 25 mmHg.
Approximately 35 to 45 mmHg
c. 120/80 mmHg - ANSWER 4. A. The normal ICP ranges from 0 to 15 mmHg.
5. Which of the following symptoms can be associated with a phenytoin level of 32
mg/dl?
a. Ataxia and confusion.
b. Sodium depletion.
c. Tonic-clonic seizures.
d. Urinary incontinence - Answer 5. A. The therapeutic phenytoin level is 10 to 20
mg/dL. A level of 32 mg/dl suggests toxicity. The symptoms of poisoning include
ANSWERS
1. A client admitted to the hospital for a subarachnoid haemorrhage reports severe
headache, nuchal rigidity, and projectile vomiting. In which of the following
situations would the nurse advise against performing a lumbar puncture (LP) on
this client?
a. Continued vomiting b. Elevated intracranial pressure.
b. The client requires mechanical ventilation.
d. Blood is expected in the cerebral spinal fluid (CSF) - ANSWER 1. B. Sudden
evacuation of CSF results in pressures lower in the lumbar area than the brain and
promotes brain herniation; thus, LP is contraindicated with elevated ICP. Vomiting
can be induced by factors other than elevated ICP, therefore LP is not necessarily
contraindicated. An LP may be performed on individuals who require mechanical
ventilation. Blood in the cerebrospinal fluid is a diagnostic test for subarachnoid
haemorrhage and was obtained before ICP symptoms.
2. A client with a subdural haematoma becomes agitated and confused, with
dilatation of the ipsilateral pupil. Which of the following reasons does the physician
order mannitol?
a. To lower intraocular pressure.
b. Prevent acute tubular necrosis.
b. Promote osmotic diuresis to reduce ICP
d. Draw water into the vascular system to raise blood pressure - ANSWER 2. C.
Mannitol induces osmotic diuresis by raising the pressure gradient, which draws
fluid from intracellular to intravascular regions. Although mannitol is utilised for
all of the reasons above, the client's ICP lowering is a cause for concern.
, 3. Mannitol was administered to a client with a subdural haematoma to reduce
intracranial pressure (ICP). Which of the following results best demonstrates that
mannitol was effective?
a. Urine output increases.
b. The pupils are 8 mm and nonreactive.
c. Systolic blood pressure stays at 150 mmHg.
d. BUN and creatinine levels return to normal - ANSWER 3. A. Mannitol induces
osmotic diuresis by raising the pressure gradient in the renal tubes. Fixed and
dilated pupils are signs of elevated ICP or cranial nerve injury. There is no mention
of abnormal BUN and creatinine levels, or that mannitol is used to treat renal
impairment or maintain blood pressure.
4. Which of the following ICP readings are considered normal?
a. 0–15 mmHg
b. 25 mmHg.
Approximately 35 to 45 mmHg
c. 120/80 mmHg - ANSWER 4. A. The normal ICP ranges from 0 to 15 mmHg.
5. Which of the following symptoms can be associated with a phenytoin level of 32
mg/dl?
a. Ataxia and confusion.
b. Sodium depletion.
c. Tonic-clonic seizures.
d. Urinary incontinence - Answer 5. A. The therapeutic phenytoin level is 10 to 20
mg/dL. A level of 32 mg/dl suggests toxicity. The symptoms of poisoning include
