2026 Neurological Medical Surgical Nursing
Study Guide Practice Questions Stroke Seizures
Head Injury Parkinson Disease Neurological
Assessment Nursing Care
SECTION 1: NEUROLOGICAL ASSESSMENT (Questions 1–25)
1. A nurse is assessing a patient's level of consciousness. Which finding
indicates the earliest sign of neurological deterioration?
A) Decreased pupillary response
B) Change in level of consciousness
C) Decreased grip strength
D) Positive Babinski sign
Answer: B) Change in level of consciousness
Rationale: A change in level of consciousness is the earliest and most sensitive
indicator of neurological deterioration. Pupillary changes, motor weakness, and
Babinski signs occur later.
2. A patient has a Glasgow Coma Scale score of 8. What does this indicate?
A) Mild brain injury
B) Moderate brain injury
C) Severe brain injury
D) Normal consciousness
Answer: C) Severe brain injury
Rationale: GCS 3–8 indicates severe brain injury. GCS 9–12 indicates moderate
injury. GCS 13–15 indicates mild injury.
3. A nurse is assessing a patient's pupillary response. Which finding is
abnormal?
A) Pupils equal and reactive to light
B) Pupils 3 mm and reactive
C) Fixed, dilated pupil on one side
D) Pupils constrict with light
Answer: C) Fixed, dilated pupil on one side
,Rationale: A fixed, dilated pupil indicates increased intracranial pressure and
possible herniation, requiring immediate intervention.
4. A patient has a positive Babinski sign. Which response is expected?
A) Toes curl downward
B) Toes fan upward
C) No response
D) Foot dorsiflexes
Answer: B) Toes fan upward
Rationale: A positive Babinski sign is the fanning of toes when the sole is stroked.
It is abnormal in adults and indicates upper motor neuron dysfunction.
5. A nurse is assessing a patient's motor strength. Which grade indicates
normal strength?
A) 0
B) 2
C) 3
D) 5
Answer: D) 5
Rationale: Muscle strength is graded 0–5. Grade 5 indicates normal strength
against full resistance.
6. A patient has decerebrate posturing. Which finding is expected?
A) Arms flexed, legs extended
B) Arms extended, legs extended
C) Arms flexed, legs flexed
D) No response to pain
Answer: B) Arms extended, legs extended
Rationale: Decerebrate posturing involves extension of arms and legs and
indicates brainstem damage. Decorticate posturing involves arm flexion.
7. A nurse is assessing a patient's cranial nerve function. Which cranial nerve
is responsible for facial sensation?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Answer: A) CN V (Trigeminal)
Rationale: CN V (trigeminal) is responsible for facial sensation and mastication.
CN VII controls facial movement.
,8. A patient has difficulty swallowing. Which cranial nerve is most likely
affected?
A) CN V
B) CN VII
C) CN IX
D) CN XII
Answer: C) CN IX
Rationale: CN IX (glossopharyngeal) and CN X (vagus) are responsible for
swallowing. CN XII controls tongue movement.
9. A nurse is assessing a patient's deep tendon reflexes. Which grade indicates
a normal response?
A) 0
B) 1+
C) 2+
D) 4+
Answer: C) 2+
Rationale: Deep tendon reflexes are graded 0–4+. Grade 2+ is normal. Grade 0 is
absent, 1+ is diminished, 3+ is increased, and 4+ is hyperactive.
10. A patient has nuchal rigidity. Which condition is most likely?
A) Stroke
B) Meningitis
C) Parkinson's disease
D) Multiple sclerosis
Answer: B) Meningitis
Rationale: Nuchal rigidity (stiff neck) is a classic sign of meningeal irritation,
commonly seen in meningitis.
11. A nurse is assessing a patient's cerebellar function. Which test is
appropriate?
A) Romberg test
B) Pupillary response
C) Babinski sign
D) Gag reflex
Answer: A) Romberg test
Rationale: The Romberg test assesses balance and proprioception, which are
cerebellar functions.
12. A patient has anosmia. Which cranial nerve is affected?
A) CN I (Olfactory)
, B) CN II (Optic)
C) CN III (Oculomotor)
D) CN IV (Trochlear)
Answer: A) CN I (Olfactory)
Rationale: Anosmia is the loss of smell, which is controlled by CN I (olfactory).
13. A nurse is assessing a patient's visual acuity. Which test is used?
A) Snellen chart
B) Ishihara test
C) Confrontation test
D) Visual field test
Answer: A) Snellen chart
Rationale: The Snellen chart assesses visual acuity. Ishihara tests color vision.
Confrontation and visual field tests assess peripheral vision.
14. A patient has ptosis. Which cranial nerve is affected?
A) CN II
B) CN III
C) CN IV
D) CN VI
Answer: B) CN III
Rationale: CN III (oculomotor) controls eyelid elevation. Ptosis (drooping eyelid)
indicates CN III dysfunction.
15. A nurse is assessing a patient's gait. Which finding is abnormal?
A) Steady gait
B) Wide-based gait
C) Arm swing present
D) Heel-to-toe walking
Answer: B) Wide-based gait
Rationale: A wide-based gait indicates cerebellar dysfunction or proprioceptive
deficits.
16. A patient has aphasia. Which area of the brain is affected?
A) Frontal lobe
B) Parietal lobe
C) Temporal lobe
D) Occipital lobe
Answer: A) Frontal lobe
Rationale: Broca's area (expressive speech) is in the frontal lobe. Wernicke's area
(receptive speech) is in the temporal lobe.
Study Guide Practice Questions Stroke Seizures
Head Injury Parkinson Disease Neurological
Assessment Nursing Care
SECTION 1: NEUROLOGICAL ASSESSMENT (Questions 1–25)
1. A nurse is assessing a patient's level of consciousness. Which finding
indicates the earliest sign of neurological deterioration?
A) Decreased pupillary response
B) Change in level of consciousness
C) Decreased grip strength
D) Positive Babinski sign
Answer: B) Change in level of consciousness
Rationale: A change in level of consciousness is the earliest and most sensitive
indicator of neurological deterioration. Pupillary changes, motor weakness, and
Babinski signs occur later.
2. A patient has a Glasgow Coma Scale score of 8. What does this indicate?
A) Mild brain injury
B) Moderate brain injury
C) Severe brain injury
D) Normal consciousness
Answer: C) Severe brain injury
Rationale: GCS 3–8 indicates severe brain injury. GCS 9–12 indicates moderate
injury. GCS 13–15 indicates mild injury.
3. A nurse is assessing a patient's pupillary response. Which finding is
abnormal?
A) Pupils equal and reactive to light
B) Pupils 3 mm and reactive
C) Fixed, dilated pupil on one side
D) Pupils constrict with light
Answer: C) Fixed, dilated pupil on one side
,Rationale: A fixed, dilated pupil indicates increased intracranial pressure and
possible herniation, requiring immediate intervention.
4. A patient has a positive Babinski sign. Which response is expected?
A) Toes curl downward
B) Toes fan upward
C) No response
D) Foot dorsiflexes
Answer: B) Toes fan upward
Rationale: A positive Babinski sign is the fanning of toes when the sole is stroked.
It is abnormal in adults and indicates upper motor neuron dysfunction.
5. A nurse is assessing a patient's motor strength. Which grade indicates
normal strength?
A) 0
B) 2
C) 3
D) 5
Answer: D) 5
Rationale: Muscle strength is graded 0–5. Grade 5 indicates normal strength
against full resistance.
6. A patient has decerebrate posturing. Which finding is expected?
A) Arms flexed, legs extended
B) Arms extended, legs extended
C) Arms flexed, legs flexed
D) No response to pain
Answer: B) Arms extended, legs extended
Rationale: Decerebrate posturing involves extension of arms and legs and
indicates brainstem damage. Decorticate posturing involves arm flexion.
7. A nurse is assessing a patient's cranial nerve function. Which cranial nerve
is responsible for facial sensation?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN X (Vagus)
Answer: A) CN V (Trigeminal)
Rationale: CN V (trigeminal) is responsible for facial sensation and mastication.
CN VII controls facial movement.
,8. A patient has difficulty swallowing. Which cranial nerve is most likely
affected?
A) CN V
B) CN VII
C) CN IX
D) CN XII
Answer: C) CN IX
Rationale: CN IX (glossopharyngeal) and CN X (vagus) are responsible for
swallowing. CN XII controls tongue movement.
9. A nurse is assessing a patient's deep tendon reflexes. Which grade indicates
a normal response?
A) 0
B) 1+
C) 2+
D) 4+
Answer: C) 2+
Rationale: Deep tendon reflexes are graded 0–4+. Grade 2+ is normal. Grade 0 is
absent, 1+ is diminished, 3+ is increased, and 4+ is hyperactive.
10. A patient has nuchal rigidity. Which condition is most likely?
A) Stroke
B) Meningitis
C) Parkinson's disease
D) Multiple sclerosis
Answer: B) Meningitis
Rationale: Nuchal rigidity (stiff neck) is a classic sign of meningeal irritation,
commonly seen in meningitis.
11. A nurse is assessing a patient's cerebellar function. Which test is
appropriate?
A) Romberg test
B) Pupillary response
C) Babinski sign
D) Gag reflex
Answer: A) Romberg test
Rationale: The Romberg test assesses balance and proprioception, which are
cerebellar functions.
12. A patient has anosmia. Which cranial nerve is affected?
A) CN I (Olfactory)
, B) CN II (Optic)
C) CN III (Oculomotor)
D) CN IV (Trochlear)
Answer: A) CN I (Olfactory)
Rationale: Anosmia is the loss of smell, which is controlled by CN I (olfactory).
13. A nurse is assessing a patient's visual acuity. Which test is used?
A) Snellen chart
B) Ishihara test
C) Confrontation test
D) Visual field test
Answer: A) Snellen chart
Rationale: The Snellen chart assesses visual acuity. Ishihara tests color vision.
Confrontation and visual field tests assess peripheral vision.
14. A patient has ptosis. Which cranial nerve is affected?
A) CN II
B) CN III
C) CN IV
D) CN VI
Answer: B) CN III
Rationale: CN III (oculomotor) controls eyelid elevation. Ptosis (drooping eyelid)
indicates CN III dysfunction.
15. A nurse is assessing a patient's gait. Which finding is abnormal?
A) Steady gait
B) Wide-based gait
C) Arm swing present
D) Heel-to-toe walking
Answer: B) Wide-based gait
Rationale: A wide-based gait indicates cerebellar dysfunction or proprioceptive
deficits.
16. A patient has aphasia. Which area of the brain is affected?
A) Frontal lobe
B) Parietal lobe
C) Temporal lobe
D) Occipital lobe
Answer: A) Frontal lobe
Rationale: Broca's area (expressive speech) is in the frontal lobe. Wernicke's area
(receptive speech) is in the temporal lobe.
