Neurological Exam Questions

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Sample questions from Neurological Exam Questions

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 67-year-old client arrives 35 minutes after sudden onset of right-sided weakness and difficulty speaking. BP is 186/104 mm Hg, HR 96/min, and blood glucose is 112 mg/dL. Which action should the nurse take first?

   • A.Administer an oral antihypertensive medication to lower the blood pressure.
   • B.Activate the facility's stroke response and communicate the time the client was last known well.
   • C.Obtain a detailed family history before notifying the stroke team.
   • D.Give the client water to determine whether swallowing is impaired.

   Rationale: Activating the stroke response and reporting the last-known-well time supports rapid evaluation for time-sensitive treatment. Oral fluids are unsafe until swallowing is assessed, and an oral antihypertensive could delay care and may not be appropriate before imaging and treatment decisions. A detailed family history can be gathered after the urgent stroke evaluation is underway.

2. 2.In the pediatric intensive care unit, a 9-year-old client being monitored after a head injury becomes harder to arouse over 2 hours. Refer to the client's chart. Which actions should the nurse take now? Select all that apply.

   • A.Dim the lights and defer reassessment for 1 hour to promote uninterrupted sleep.
   • B.Reassess and document level of consciousness, pupil response, and motor response.
   • C.Immediately notify the provider or activate the rapid response process for the acute neurologic change.
   • D.Administer a sedative to prevent agitation from increasing intracranial pressure.
   • E.Keep the client NPO until the change is evaluated and swallowing safety is known.

   Rationale: The decline from responding promptly at 0800 to requiring repeated stimulation at 1000 is an acute neurologic change that requires prompt escalation and a focused reassessment. Keeping the client NPO avoids aspiration if consciousness or swallowing is impaired. Deferring reassessment delays recognition of deterioration, and a sedative could mask further changes in the neurologic examination.

3. 3.At change of shift on a medical unit, a 74-year-old client with a new seizure diagnosis is prescribed oral levetiracetam. The client is drowsy after a seizure, has a weak cough, and has not yet had a swallowing assessment. Which task is appropriate for the nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assess the client's swallowing ability before the medication is given.
   • B.Determine whether the client is experiencing medication-related sedation.
   • C.Administer the scheduled levetiracetam with a small amount of water.
   • D.Keep the client on seizure precautions and report any observed seizure activity immediately.

   Rationale: A UAP may maintain an established safety environment and report observable seizure activity promptly. Medication administration, swallowing assessment, and evaluation of sedation require nursing judgment and must remain with the licensed nurse. The nurse should clarify safe medication administration after assessing the client's current level of consciousness and swallowing status.

4. 4.During a home visit, a 52-year-old client with multiple sclerosis reports worsening leg weakness and blurred vision for 2 days. The client has a temperature of 38.3 C, HR 104/min, and reports burning with urination. Which action should the home health nurse take?

   • A.Contact the provider promptly to report the neurologic symptoms and possible urinary infection.
   • B.Advise the client to increase exercise to reverse the weakness.
   • C.Reassure the client that these symptoms are an expected permanent progression of multiple sclerosis.
   • D.Recommend stopping all prescribed multiple sclerosis medications until the symptoms resolve.

   Answer and rationale are in the full material.

5. 5.On a postpartum unit, a 29-year-old client reports a sudden severe headache and has a BP of 168/110 mm Hg, blurred vision, and brisk reflexes 6 hours after birth. Which action should the nurse take first?

   • A.Place the client in a quiet, dim room and reassess the blood pressure in 1 hour.
   • B.Encourage oral fluids and ambulation to reduce the headache.
   • C.Notify the obstetric provider immediately and initiate the prescribed severe-hypertension or seizure response.
   • D.Administer an opioid analgesic and reassess the headache before reporting the findings.

   Answer and rationale are in the full material.