NCLEX-PN
NCLEX Neurological Disorders Questions
Extract:
Question 1 of 5
On the basis of the factors that cause the client to experience paroxysmal pain, which intervention is most appropriate to include in this client's care plan?
Correct Answer: B
Rationale: Avoiding facial touch minimizes triggering paroxysmal pain in trigeminal neuralgia, which is sensitive to tactile stimuli.
Question 2 of 5
An unconscious client has left-sided paralysis. Which intervention should the nurse implement to best prevent foot drop?
Correct Answer: D
Rationale: Pressure exerted on the soles of the feet when placed firmly against the footboard can impair circulation and lead to skin breakdown. Pillows provide inadequate support to prevent plantar flexion (foot drop). Performing ROM daily helps to maintain muscle tone, but it is inadequate to prevent plantar flexion when the client is in bed. Applying a foot boot brace provides good support to prevent foot drop. Removing and reapplying it every two hours allows for pressure reduction and promotes circulation.
Question 3 of 5
The male client is admitted to the emergency department following a motorcycle accident. The client was not wearing a helmet and struck his head on the pavement. The nurse identifies the concept as impaired intracranial regulation. Which interventions should the emergency department nurse implement in the first five (5) minutes? Select all that apply.
Correct Answer: A,D,E
Rationale: Stabilizing the cervical spine (
A) prevents spinal injury, Glasgow Coma Scale (
D) assesses neurological status, and IV access (E) prepares for interventions. Organ procurement (
B) is premature, high HOB (
C) risks perfusion, and checking for blood acceptance (F) is secondary.
Question 4 of 5
When planning care for a client with a stroke, which goal is most appropriate for addressing dysphagia?
Correct Answer: A
Rationale: Swallowing soft foods without choking is a realistic and safe goal for managing dysphagia in stroke clients.
Question 5 of 5
The nurse is caring for the client who, 6 weeks after an MVA, was diagnosed with a mild TBI. Which information in the client’s history of the injury should the nurse associate with the TBI? Select all that apply.
Correct Answer: C,D,E
Rationale: The client with mild TBI usually experiences symptoms commonly associated with mild concussion, such as vomiting. The client with mild TBI usually experiences amnesia and is unable to recall events regarding the accident. Recurrent problems with headache and dizziness are the most prominent symptoms of mild TBI. Cognitive difficulties, including inability to concentrate and forgetfulness, occur with mild TBI. At the time of the accident, the person with mild TBI may experience a loss of consciousness for a few seconds or minutes.