NEUROLOGICAL DISORDERS NCLEX
EXAMINATION TEST QUESTIONS AND
DETAILED SOLUTIONS
1) A client admitted to the hospital with a subarachnoid hemorrhage
has complaints of severe headache, nuchal rigidity, and projectile
vomiting. The nurse knows lumbar puncture (LP) would be
contraindicated in this client in which of the following circumstances?
1. Vomiting continues
2. Intracranial pressure (ICP) is increased
3. The client needs mechanical ventilation
4. Blood is anticipated in the cerebralspinal fluid (CSF). Answer: 2
Sudden removal of CSF results in pressures lower in the lumbar area
than the brain and favors herniation of the brain; therefore, LP is
contraindicated with increased ICP. Vomiting may be caused by
reasons other than increased ICP; therefore, LP isn't strictly
contraindicated. An LP may be preformed on clients needing
mechanical ventilation. Blood in the CSF is diagnostic for
subarachnoid hemorrhage and was obtained before signs and
symptoms of ICP.
2) A client with a subdural hematoma becomes restless and confused,
with dilation of the ipsilateral pupil. The physician orders mannitol
for which of the following reasons?
1. To reduce intraocular pressure
, 2. To prevent acute tubular necrosis
3. To promote osmotic diuresis to decrease ICP
4. To draw water into the vascular system to increase blood pressure.
Answer: 3
Mannitol promotes osmotic diuresis by increasing the pressure
gradient, drawing fluid from intracellular to intravascular spaces.
Although mannitol is used for all the reasons described, the reduction
of ICP in this client is a concern.
3) A client with subdural hematoma was given mannitol to decrease
intracranial pressure (ICP). Which of the following results would best
show the mannitol was effective?
1. Urine output increases
2. Pupils are 8 mm and nonreactive
3. Systolic blood pressure remains at 150 mm Hg
4. BUN and creatinine levels return to normal. Answer: 1
Mannitol promotes osmotic diuresis by increasing the pressure
gradient in the renal tubes. Fixed and dilated pupils are symptoms of
increased ICP or cranial nerve damage. No information is given about
abnormal BUN and creatinine levels or that mannitol is being given
for renal dysfunction or blood pressure maintenance.
4) Which of the following values is considered normal for ICP?
1. 0 to 15 mm Hg
2. 25 mm Hg
3. 35 to 45 mm Hg
EXAMINATION TEST QUESTIONS AND
DETAILED SOLUTIONS
1) A client admitted to the hospital with a subarachnoid hemorrhage
has complaints of severe headache, nuchal rigidity, and projectile
vomiting. The nurse knows lumbar puncture (LP) would be
contraindicated in this client in which of the following circumstances?
1. Vomiting continues
2. Intracranial pressure (ICP) is increased
3. The client needs mechanical ventilation
4. Blood is anticipated in the cerebralspinal fluid (CSF). Answer: 2
Sudden removal of CSF results in pressures lower in the lumbar area
than the brain and favors herniation of the brain; therefore, LP is
contraindicated with increased ICP. Vomiting may be caused by
reasons other than increased ICP; therefore, LP isn't strictly
contraindicated. An LP may be preformed on clients needing
mechanical ventilation. Blood in the CSF is diagnostic for
subarachnoid hemorrhage and was obtained before signs and
symptoms of ICP.
2) A client with a subdural hematoma becomes restless and confused,
with dilation of the ipsilateral pupil. The physician orders mannitol
for which of the following reasons?
1. To reduce intraocular pressure
, 2. To prevent acute tubular necrosis
3. To promote osmotic diuresis to decrease ICP
4. To draw water into the vascular system to increase blood pressure.
Answer: 3
Mannitol promotes osmotic diuresis by increasing the pressure
gradient, drawing fluid from intracellular to intravascular spaces.
Although mannitol is used for all the reasons described, the reduction
of ICP in this client is a concern.
3) A client with subdural hematoma was given mannitol to decrease
intracranial pressure (ICP). Which of the following results would best
show the mannitol was effective?
1. Urine output increases
2. Pupils are 8 mm and nonreactive
3. Systolic blood pressure remains at 150 mm Hg
4. BUN and creatinine levels return to normal. Answer: 1
Mannitol promotes osmotic diuresis by increasing the pressure
gradient in the renal tubes. Fixed and dilated pupils are symptoms of
increased ICP or cranial nerve damage. No information is given about
abnormal BUN and creatinine levels or that mannitol is being given
for renal dysfunction or blood pressure maintenance.
4) Which of the following values is considered normal for ICP?
1. 0 to 15 mm Hg
2. 25 mm Hg
3. 35 to 45 mm Hg
