ATI LPN
Neurological Questions Questions
Question 1 of 5
A client with a medical diagnosis of a ruptured cerebral aneurysm exhibits these symptoms no eye opening, no sound vocalized, and flexion to pain (decorticate posturing). When calculating the Glasgow Coma Scale score, Which value should the nurse document for this client?
Correct Answer: D
Rationale: GCS: Eye (1, no opening), Verbal (1, no sound), Motor (3, flexion to pain) = 5. [Level: Application]
Question 2 of 5
A young adult is burned when wearing a shirt that was splashed with lighter fluid and caught. The shirt immediately without unbuttoning. What should the nurse implement first?
Correct Answer: C
Rationale: Burns require immediate neurovascular assessment (sensation) to detect nerve damage or compartment issues. B follows, A is later. [Level: Analysis]
Question 3 of 5
A female client with metastatic breast cancer is admitted with shortness of breath and pleural effusion. The client has a living will and the family is requesting hospice information. Which information should the nurse provide regarding hospice?
Correct Answer: C
Rationale: Hospice can start in-hospital and transition home, offering A/B. D is false—living wills remain valid. [Level: Application]
Question 4 of 5
A patient will attempt oral feedings for the first time after having a stroke. After assessing the gag reflex, what action should the nurse take?
Correct Answer: C
Rationale: Upright position (chair) reduces aspiration risk post-stroke if gag reflex is intact. D follows, A/B are secondary. [Level: Application]
Question 5 of 5
Which nursing intervention would be included in the plan of care for a patient who is admitted with stroke and is complaining about having liquid stools?
Correct Answer: C
Rationale: Liquid stools post-stroke may mask impaction (neurogenic bowel); checking ensures safety. A/B worsen, D is unrelated. [Level: Analysis]