Nursing Neurological Pathophysiology 2026
Practice Test Questions Detailed Rationales CNS
Disorders Stroke Seizures Intracranial Changes
Neurological Assessment Review
1. A nurse is performing a neurological assessment on a patient who was
admitted with a suspected stroke. Which of the following assessments is the
priority for determining the patient's level of consciousness?
A. Assessing pupillary response
B. Checking deep tendon reflexes
C. Using the Glasgow Coma Scale (GCS)
D. Testing for Babinski sign
Answer: C. Using the Glasgow Coma Scale (GCS)
Rationale: The Glasgow Coma Scale is the standard tool for assessing and
quantifying a patient's level of consciousness. It evaluates three key areas: eye-
opening, verbal response, and motor response. While pupillary response is a
critical part of a neurological exam, the GCS provides a comprehensive and
standardized measure of consciousness, which is the most critical indicator of
neurological deterioration.
2. A patient presents with a sudden, severe "thunderclap" headache. The
nurse should prioritize preparing the patient for which diagnostic test?
A. Lumbar puncture
B. CT scan of the head without contrast
C. MRI of the brain with contrast
D. Electroencephalogram (EEG)
Answer: B. CT scan of the head without contrast
Rationale: A "thunderclap" headache is a classic symptom of a subarachnoid
hemorrhage (SAH), which is typically caused by a ruptured cerebral aneurysm. A
non-contrast CT scan is the initial diagnostic test of choice because it can rapidly
and reliably detect acute bleeding in the subarachnoid space. A lumbar puncture is
contraindicated if there is suspicion of increased intracranial pressure (ICP) from a
bleed, as it could lead to herniation.
,3. A nurse is caring for a patient with a traumatic brain injury (TBI). Which
of the following findings would be the earliest indicator of increasing
intracranial pressure (ICP)?
A. Decreased level of consciousness
B. A fixed and dilated pupil
C. Cushing's triad (hypertension, bradycardia, bradypnea)
D. Decerebrate posturing
Answer: A. Decreased level of consciousness
Rationale: A change in the level of consciousness is often the earliest and most
sensitive indicator of increasing ICP. As the brain tissue swells, it compromises
neuronal function, leading to subtle changes in alertness and orientation before
more dramatic signs like pupillary changes, Cushing's triad, or posturing appear.
Cushing's triad is a late sign indicating impending herniation.
4. A patient is admitted with an ischemic stroke. The nurse knows that the
priority goal of acute management is to:
A. Lower blood pressure aggressively.
B. Administer a thrombolytic agent if within the therapeutic window.
C. Provide supportive care and rehabilitation.
D. Prevent seizure activity with prophylactic anticonvulsants.
Answer: B. Administer a thrombolytic agent if within the therapeutic window.
Rationale: For an acute ischemic stroke, the priority is to restore blood flow to the
ischemic penumbra (the area of brain tissue that is ischemic but not yet infarcted)
as quickly as possible. If the patient meets the criteria and presents within the
therapeutic window (typically up to 4.5 hours from symptom onset), administering
a thrombolytic (e.g., alteplase) is the priority intervention to salvage brain tissue
and improve outcomes.
5. A nurse is assessing a patient with a suspected stroke. The patient is unable
to feel a light touch on the left side of their body. The nurse should document
this finding as:
A. Hemiparesis
B. Hemiplegia
C. Hemianesthesia
D. Hemianopsia
Answer: C. Hemianesthesia
Rationale: Hemianesthesia is the term for loss of sensation on one side of the
body. Hemiparesis refers to weakness on one side, hemiplegia is paralysis on one
,side, and hemianopsia is blindness in half of the visual field. This question tests the
precise use of neurological terminology.
6. A patient is experiencing a generalized tonic-clonic seizure. What is the
nurse's priority action during the seizure?
A. Insert a padded tongue blade into the mouth.
B. Restrain the patient's limbs to prevent injury.
C. Protect the patient's head and turn them onto their side.
D. Administer oxygen via a non-rebreather mask.
Answer: C. Protect the patient's head and turn them onto their side.
Rationale: The priority during a seizure is safety. Protecting the head from injury
and turning the patient to the side (to maintain a patent airway and prevent
aspiration) are the most critical interventions. Never insert anything into the mouth,
as this can cause injury to the patient or the nurse. Restraining limbs can cause
musculoskeletal injury.
7. A patient is prescribed phenytoin for seizure prophylaxis. Which of the
following lab values should the nurse monitor most closely?
A. Serum potassium
B. Serum sodium
C. Therapeutic drug level
D. Liver function tests (LFTs)
Answer: C. Therapeutic drug level
Rationale: Phenytoin has a narrow therapeutic index, meaning the difference
between a therapeutic dose and a toxic dose is small. Therefore, monitoring the
serum drug level is crucial to ensure efficacy and prevent toxicity. While LFTs
should also be monitored, the therapeutic drug level is the most direct measure of
safe and effective dosing for this specific medication.
8. Which of the following is a classic sign of meningeal irritation?
A. Positive Babinski sign
B. Positive Brudzinski's sign
C. Ataxia
D. Intention tremor
Answer: B. Positive Brudzinski's sign
Rationale: Brudzinski's sign is a physical sign of meningeal irritation. It is elicited
by flexing the patient's neck, which causes involuntary flexion of the hips and
knees. This is a classic sign of meningitis. A positive Babinski sign indicates an
, upper motor neuron lesion, while ataxia and intention tremors are associated with
cerebellar dysfunction.
9. A patient with a history of myasthenia gravis is admitted with increasing
weakness and difficulty swallowing. The nurse should assess for which of the
following complications?
A. Myasthenic crisis
B. Cholinergic crisis
C. Status epilepticus
D. Autonomic dysreflexia
Answer: A. Myasthenic crisis
Rationale: Myasthenic crisis is a life-threatening exacerbation of myasthenia
gravis, characterized by severe muscle weakness, including the muscles used for
breathing and swallowing. It is often triggered by infection, stress, or medication
non-adherence. Cholinergic crisis is caused by an overdose of anticholinesterase
medications and presents with SLUDGE symptoms (salivation, lacrimation,
urination, diarrhea, GI upset, emesis).
10. A nurse is caring for a patient with a ventriculostomy for ICP monitoring.
Which of the following findings requires immediate intervention?
A. Clear fluid draining from the ventriculostomy site.
B. ICP reading of 15 mmHg.
C. Sudden, sustained increase in ICP to 30 mmHg.
D. Patient is awake and alert.
Answer: C. Sudden, sustained increase in ICP to 30 mmHg.
Rationale: A sudden, sustained increase in ICP indicates a neurological
emergency, such as a new hemorrhage or acute brain swelling. Normal ICP is
typically 0-15 mmHg. A reading of 30 mmHg requires immediate intervention and
notification of the provider to prevent herniation and brain death. The other
findings may be expected or stable.
11. A patient is diagnosed with a transient ischemic attack (TIA). The nurse's
most important teaching point is:
A. "A TIA is a minor stroke that won't cause lasting damage."
B. "You need to take a daily aspirin to prevent a stroke."
C. "A TIA is a warning sign for a future stroke and requires immediate medical
follow-up."
D. "You should avoid all physical activity for the next month."
Practice Test Questions Detailed Rationales CNS
Disorders Stroke Seizures Intracranial Changes
Neurological Assessment Review
1. A nurse is performing a neurological assessment on a patient who was
admitted with a suspected stroke. Which of the following assessments is the
priority for determining the patient's level of consciousness?
A. Assessing pupillary response
B. Checking deep tendon reflexes
C. Using the Glasgow Coma Scale (GCS)
D. Testing for Babinski sign
Answer: C. Using the Glasgow Coma Scale (GCS)
Rationale: The Glasgow Coma Scale is the standard tool for assessing and
quantifying a patient's level of consciousness. It evaluates three key areas: eye-
opening, verbal response, and motor response. While pupillary response is a
critical part of a neurological exam, the GCS provides a comprehensive and
standardized measure of consciousness, which is the most critical indicator of
neurological deterioration.
2. A patient presents with a sudden, severe "thunderclap" headache. The
nurse should prioritize preparing the patient for which diagnostic test?
A. Lumbar puncture
B. CT scan of the head without contrast
C. MRI of the brain with contrast
D. Electroencephalogram (EEG)
Answer: B. CT scan of the head without contrast
Rationale: A "thunderclap" headache is a classic symptom of a subarachnoid
hemorrhage (SAH), which is typically caused by a ruptured cerebral aneurysm. A
non-contrast CT scan is the initial diagnostic test of choice because it can rapidly
and reliably detect acute bleeding in the subarachnoid space. A lumbar puncture is
contraindicated if there is suspicion of increased intracranial pressure (ICP) from a
bleed, as it could lead to herniation.
,3. A nurse is caring for a patient with a traumatic brain injury (TBI). Which
of the following findings would be the earliest indicator of increasing
intracranial pressure (ICP)?
A. Decreased level of consciousness
B. A fixed and dilated pupil
C. Cushing's triad (hypertension, bradycardia, bradypnea)
D. Decerebrate posturing
Answer: A. Decreased level of consciousness
Rationale: A change in the level of consciousness is often the earliest and most
sensitive indicator of increasing ICP. As the brain tissue swells, it compromises
neuronal function, leading to subtle changes in alertness and orientation before
more dramatic signs like pupillary changes, Cushing's triad, or posturing appear.
Cushing's triad is a late sign indicating impending herniation.
4. A patient is admitted with an ischemic stroke. The nurse knows that the
priority goal of acute management is to:
A. Lower blood pressure aggressively.
B. Administer a thrombolytic agent if within the therapeutic window.
C. Provide supportive care and rehabilitation.
D. Prevent seizure activity with prophylactic anticonvulsants.
Answer: B. Administer a thrombolytic agent if within the therapeutic window.
Rationale: For an acute ischemic stroke, the priority is to restore blood flow to the
ischemic penumbra (the area of brain tissue that is ischemic but not yet infarcted)
as quickly as possible. If the patient meets the criteria and presents within the
therapeutic window (typically up to 4.5 hours from symptom onset), administering
a thrombolytic (e.g., alteplase) is the priority intervention to salvage brain tissue
and improve outcomes.
5. A nurse is assessing a patient with a suspected stroke. The patient is unable
to feel a light touch on the left side of their body. The nurse should document
this finding as:
A. Hemiparesis
B. Hemiplegia
C. Hemianesthesia
D. Hemianopsia
Answer: C. Hemianesthesia
Rationale: Hemianesthesia is the term for loss of sensation on one side of the
body. Hemiparesis refers to weakness on one side, hemiplegia is paralysis on one
,side, and hemianopsia is blindness in half of the visual field. This question tests the
precise use of neurological terminology.
6. A patient is experiencing a generalized tonic-clonic seizure. What is the
nurse's priority action during the seizure?
A. Insert a padded tongue blade into the mouth.
B. Restrain the patient's limbs to prevent injury.
C. Protect the patient's head and turn them onto their side.
D. Administer oxygen via a non-rebreather mask.
Answer: C. Protect the patient's head and turn them onto their side.
Rationale: The priority during a seizure is safety. Protecting the head from injury
and turning the patient to the side (to maintain a patent airway and prevent
aspiration) are the most critical interventions. Never insert anything into the mouth,
as this can cause injury to the patient or the nurse. Restraining limbs can cause
musculoskeletal injury.
7. A patient is prescribed phenytoin for seizure prophylaxis. Which of the
following lab values should the nurse monitor most closely?
A. Serum potassium
B. Serum sodium
C. Therapeutic drug level
D. Liver function tests (LFTs)
Answer: C. Therapeutic drug level
Rationale: Phenytoin has a narrow therapeutic index, meaning the difference
between a therapeutic dose and a toxic dose is small. Therefore, monitoring the
serum drug level is crucial to ensure efficacy and prevent toxicity. While LFTs
should also be monitored, the therapeutic drug level is the most direct measure of
safe and effective dosing for this specific medication.
8. Which of the following is a classic sign of meningeal irritation?
A. Positive Babinski sign
B. Positive Brudzinski's sign
C. Ataxia
D. Intention tremor
Answer: B. Positive Brudzinski's sign
Rationale: Brudzinski's sign is a physical sign of meningeal irritation. It is elicited
by flexing the patient's neck, which causes involuntary flexion of the hips and
knees. This is a classic sign of meningitis. A positive Babinski sign indicates an
, upper motor neuron lesion, while ataxia and intention tremors are associated with
cerebellar dysfunction.
9. A patient with a history of myasthenia gravis is admitted with increasing
weakness and difficulty swallowing. The nurse should assess for which of the
following complications?
A. Myasthenic crisis
B. Cholinergic crisis
C. Status epilepticus
D. Autonomic dysreflexia
Answer: A. Myasthenic crisis
Rationale: Myasthenic crisis is a life-threatening exacerbation of myasthenia
gravis, characterized by severe muscle weakness, including the muscles used for
breathing and swallowing. It is often triggered by infection, stress, or medication
non-adherence. Cholinergic crisis is caused by an overdose of anticholinesterase
medications and presents with SLUDGE symptoms (salivation, lacrimation,
urination, diarrhea, GI upset, emesis).
10. A nurse is caring for a patient with a ventriculostomy for ICP monitoring.
Which of the following findings requires immediate intervention?
A. Clear fluid draining from the ventriculostomy site.
B. ICP reading of 15 mmHg.
C. Sudden, sustained increase in ICP to 30 mmHg.
D. Patient is awake and alert.
Answer: C. Sudden, sustained increase in ICP to 30 mmHg.
Rationale: A sudden, sustained increase in ICP indicates a neurological
emergency, such as a new hemorrhage or acute brain swelling. Normal ICP is
typically 0-15 mmHg. A reading of 30 mmHg requires immediate intervention and
notification of the provider to prevent herniation and brain death. The other
findings may be expected or stable.
11. A patient is diagnosed with a transient ischemic attack (TIA). The nurse's
most important teaching point is:
A. "A TIA is a minor stroke that won't cause lasting damage."
B. "You need to take a daily aspirin to prevent a stroke."
C. "A TIA is a warning sign for a future stroke and requires immediate medical
follow-up."
D. "You should avoid all physical activity for the next month."
