Neurological Nursing Examination Questions and
Verified Answers 2026-2027
Comprehensive Clinical Assessment and Board Review for Neurological and
Neurosurgical Nursing
1. A client admitted with an acute traumatic brain injury has an intracranial pressure (ICP)
monitoring catheter in place. The baseline ICP reading is 24 mmHg. Which nursing
intervention should be implemented first to promote venous drainage from the head?
A. Turn the client onto their left side with the knees flexed toward the chest.
B. Elevate the head of the bed to 30 degrees while keeping the neck in a neutral,
midline alignment.
C. Perform vigorous endotracheal suctioning to clear airway secretions.
D. Administer a flat trendelenburg position for 15 minutes every hour.
Rationale: Elevating the head of the bed to 30 degrees promotes jugular venous drainage
and reduces intracranial pressure without compromising cerebral perfusion pressure. Neck
flexion or rotation compresses the jugular veins, increasing ICP.
2. A client diagnosed with Myasthenia Gravis presents with severe generalized muscle
weakness, respiratory distress, and dysphagia. To differentiate between a myasthenic
crisis and a cholinergic crisis, the provider prepares to administer Edrophonium
(Tensilon). Which finding indicates a myasthenic crisis?
A. Immediate worsening of muscle weakness and hyper-salivation.
B. Sudden onset of severe bradycardia and abdominal cramping.
C. Rapid, temporary improvement in muscle strength and respiratory effort.
D. Severe hypotension and pupillary constriction.
Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor. Rapid improvement
in muscle strength indicates a myasthenic crisis (under-medication), whereas increased
weakness or cholinergic side effects indicate a cholinergic crisis (over-medication).
3. A client post-ischemic stroke displays expressive aphasia. Which area of the cerebral
cortex was most likely affected by the cerebrovascular occlusion?
A. Broca's area in the dominant frontal lobe
B. Wernicke's area in the temporal lobe
C. Primary occipital cortex
D. Postcentral gyrus in the parietal lobe
Rationale: Broca's area, located in the posterior inferior frontal gyrus of the dominant
hemisphere, controls motor speech production. Damage leads to expressive aphasia, where
speech output is non-fluent and laborious despite intact comprehension.
,4. A nurse performs a neurological assessment on a client with a suspected spinal cord
injury. When testing the Babinski reflex, the nurse strokes the lateral sole of the foot.
Which response constitutes a positive Babinski sign in an adult?
A. Plantar flexion of all toes.
B. Dorsiflexion of the great toe with fanning out of the remaining toes.
C. Rapid withdrawal of the entire lower limb without toe movement.
D. Inversion of the ankle with flexion of the knee.
Rationale: A positive Babinski sign (dorsiflexion of the big toe and fanning of other toes)
indicates upper motor neuron dysfunction, such as corticospinal tract damage. Plantar flexion
is the normal adult response.
5. A client who suffered an acute spinal cord injury at the T3 level 4 weeks ago reports a
severe, pounding headache and nasal congestion. The blood pressure is 210/110 mmHg,
and the skin above the lesion level is flushed and diaphoretic. What is the priority
nursing action?
A. Place the client in an upright sitting position and check the bladder for distention or
catheter obstruction.
B. Administer IV push metoprolol immediately.
C. Place the client in Trendelenburg position to improve cerebral arterial flow.
D. Perform a deep tracheal suctioning pass to stimulate coughing.
Rationale: These findings represent autonomic dysreflexia, an uninhibited sympathetic
response to a noxious stimulus (most commonly bladder distention or bowel impaction) in
injuries at or above T6. Sitting the client upright immediately lowers intracranial blood
pressure while the underlying trigger is removed.
6. A client diagnosed with Amyotrophic Lateral Sclerosis (ALS) is discussing disease
progression with the nurse. Which physiological function typically remains fully
preserved throughout the course of ALS?
A. Voluntary extremity movement
B. Diaphragmatic respiratory effort
C. Cognitive and sensory function
D. Swallowing and phonation
Rationale: ALS selectively degenerates upper and lower motor neurons leading to
progressive muscle atrophy and respiratory failure. Sensory function, cognitive capabilities,
and involuntary sphincter tone generally remain completely intact.
7. A client with a head injury exhibits a Glasgow Coma Scale (GCS) score of 6. How
should the nurse interpret this GCS score?
A. Fully alert and oriented
B. Mild cognitive impairment
C. Moderate neurological deficit
D. Severe brain injury indicating coma
Rationale: Glasgow Coma Scale scores range from 3 to 15. A total score of 8 or less
, indicates severe brain injury and coma, requiring advanced airway management and
intensive monitoring.
8. A client diagnosed with Guillain-Barré Syndrome is admitted to the progressive care
unit. Which assessment parameter is most critical for the nurse to monitor continuously?
A. Forced vital capacity and negative inspiratory force
B. Deep tendon reflexes in the lower extremities
C. Daily urine output totals
D. Bilateral pupillary light responses
Rationale: Guillain-Barré Syndrome causes ascending polyneuropathy that can progress
rapidly to involve the phrenic nerve and intercostal muscles. Serial monitoring of vital capacity
and negative inspiratory force detects impending respiratory failure requiring mechanical
ventilation.
9. A client receiving intravenous Mannitol for raised intracranial pressure requires
monitoring for which common systemic complication?
A. Acute hepatic encephalopathy
B. Severe dehydration, hypernatremia, and fluid volume deficit
C. Metabolic alkalosis with hypcarbia
D. Systemic hypertension with fluid overload
Rationale: Mannitol is an osmotic diuretic that draws fluid from brain parenchyma into the
vascular bed. High doses can cause massive diuresis, leading to severe dehydration,
hypernatremia, and electrolyte imbalances.
10. A client presents with a history of brief, single-sided, stabbing facial pain triggered by
eating or touching the cheek. Which cranial nerve is affected in Trigeminal Neuralgia?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Rationale: Trigeminal Neuralgia (tic douloureux) involves sensory branches of Cranial Nerve
V. It produces paroxysmal, excruciating facial pain along the ophthalmic, maxillary, or
mandibular distributions.
11. What classic physical clinical assessment triad indicates raised intracranial pressure
with impending brainstem herniation (Cushing's Triad)?
A. Systemic hypertension with widening pulse pressure, bradycardia, and irregular
respirations
B. Hypotension, tachycardia, and tachypnea
C. Hyperthermia, narrow pulse pressure, and hyperventilation
D. Tachycardia, unequal pupils, and hypotension
Verified Answers 2026-2027
Comprehensive Clinical Assessment and Board Review for Neurological and
Neurosurgical Nursing
1. A client admitted with an acute traumatic brain injury has an intracranial pressure (ICP)
monitoring catheter in place. The baseline ICP reading is 24 mmHg. Which nursing
intervention should be implemented first to promote venous drainage from the head?
A. Turn the client onto their left side with the knees flexed toward the chest.
B. Elevate the head of the bed to 30 degrees while keeping the neck in a neutral,
midline alignment.
C. Perform vigorous endotracheal suctioning to clear airway secretions.
D. Administer a flat trendelenburg position for 15 minutes every hour.
Rationale: Elevating the head of the bed to 30 degrees promotes jugular venous drainage
and reduces intracranial pressure without compromising cerebral perfusion pressure. Neck
flexion or rotation compresses the jugular veins, increasing ICP.
2. A client diagnosed with Myasthenia Gravis presents with severe generalized muscle
weakness, respiratory distress, and dysphagia. To differentiate between a myasthenic
crisis and a cholinergic crisis, the provider prepares to administer Edrophonium
(Tensilon). Which finding indicates a myasthenic crisis?
A. Immediate worsening of muscle weakness and hyper-salivation.
B. Sudden onset of severe bradycardia and abdominal cramping.
C. Rapid, temporary improvement in muscle strength and respiratory effort.
D. Severe hypotension and pupillary constriction.
Rationale: Edrophonium is a short-acting acetylcholinesterase inhibitor. Rapid improvement
in muscle strength indicates a myasthenic crisis (under-medication), whereas increased
weakness or cholinergic side effects indicate a cholinergic crisis (over-medication).
3. A client post-ischemic stroke displays expressive aphasia. Which area of the cerebral
cortex was most likely affected by the cerebrovascular occlusion?
A. Broca's area in the dominant frontal lobe
B. Wernicke's area in the temporal lobe
C. Primary occipital cortex
D. Postcentral gyrus in the parietal lobe
Rationale: Broca's area, located in the posterior inferior frontal gyrus of the dominant
hemisphere, controls motor speech production. Damage leads to expressive aphasia, where
speech output is non-fluent and laborious despite intact comprehension.
,4. A nurse performs a neurological assessment on a client with a suspected spinal cord
injury. When testing the Babinski reflex, the nurse strokes the lateral sole of the foot.
Which response constitutes a positive Babinski sign in an adult?
A. Plantar flexion of all toes.
B. Dorsiflexion of the great toe with fanning out of the remaining toes.
C. Rapid withdrawal of the entire lower limb without toe movement.
D. Inversion of the ankle with flexion of the knee.
Rationale: A positive Babinski sign (dorsiflexion of the big toe and fanning of other toes)
indicates upper motor neuron dysfunction, such as corticospinal tract damage. Plantar flexion
is the normal adult response.
5. A client who suffered an acute spinal cord injury at the T3 level 4 weeks ago reports a
severe, pounding headache and nasal congestion. The blood pressure is 210/110 mmHg,
and the skin above the lesion level is flushed and diaphoretic. What is the priority
nursing action?
A. Place the client in an upright sitting position and check the bladder for distention or
catheter obstruction.
B. Administer IV push metoprolol immediately.
C. Place the client in Trendelenburg position to improve cerebral arterial flow.
D. Perform a deep tracheal suctioning pass to stimulate coughing.
Rationale: These findings represent autonomic dysreflexia, an uninhibited sympathetic
response to a noxious stimulus (most commonly bladder distention or bowel impaction) in
injuries at or above T6. Sitting the client upright immediately lowers intracranial blood
pressure while the underlying trigger is removed.
6. A client diagnosed with Amyotrophic Lateral Sclerosis (ALS) is discussing disease
progression with the nurse. Which physiological function typically remains fully
preserved throughout the course of ALS?
A. Voluntary extremity movement
B. Diaphragmatic respiratory effort
C. Cognitive and sensory function
D. Swallowing and phonation
Rationale: ALS selectively degenerates upper and lower motor neurons leading to
progressive muscle atrophy and respiratory failure. Sensory function, cognitive capabilities,
and involuntary sphincter tone generally remain completely intact.
7. A client with a head injury exhibits a Glasgow Coma Scale (GCS) score of 6. How
should the nurse interpret this GCS score?
A. Fully alert and oriented
B. Mild cognitive impairment
C. Moderate neurological deficit
D. Severe brain injury indicating coma
Rationale: Glasgow Coma Scale scores range from 3 to 15. A total score of 8 or less
, indicates severe brain injury and coma, requiring advanced airway management and
intensive monitoring.
8. A client diagnosed with Guillain-Barré Syndrome is admitted to the progressive care
unit. Which assessment parameter is most critical for the nurse to monitor continuously?
A. Forced vital capacity and negative inspiratory force
B. Deep tendon reflexes in the lower extremities
C. Daily urine output totals
D. Bilateral pupillary light responses
Rationale: Guillain-Barré Syndrome causes ascending polyneuropathy that can progress
rapidly to involve the phrenic nerve and intercostal muscles. Serial monitoring of vital capacity
and negative inspiratory force detects impending respiratory failure requiring mechanical
ventilation.
9. A client receiving intravenous Mannitol for raised intracranial pressure requires
monitoring for which common systemic complication?
A. Acute hepatic encephalopathy
B. Severe dehydration, hypernatremia, and fluid volume deficit
C. Metabolic alkalosis with hypcarbia
D. Systemic hypertension with fluid overload
Rationale: Mannitol is an osmotic diuretic that draws fluid from brain parenchyma into the
vascular bed. High doses can cause massive diuresis, leading to severe dehydration,
hypernatremia, and electrolyte imbalances.
10. A client presents with a history of brief, single-sided, stabbing facial pain triggered by
eating or touching the cheek. Which cranial nerve is affected in Trigeminal Neuralgia?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Rationale: Trigeminal Neuralgia (tic douloureux) involves sensory branches of Cranial Nerve
V. It produces paroxysmal, excruciating facial pain along the ophthalmic, maxillary, or
mandibular distributions.
11. What classic physical clinical assessment triad indicates raised intracranial pressure
with impending brainstem herniation (Cushing's Triad)?
A. Systemic hypertension with widening pulse pressure, bradycardia, and irregular
respirations
B. Hypotension, tachycardia, and tachypnea
C. Hyperthermia, narrow pulse pressure, and hyperventilation
D. Tachycardia, unequal pupils, and hypotension
