Neurological Disorders NCLEX Questions

Extract:

Question 1 of 5

The nurse is caring for a client diagnosed with an epidural hematoma. Which nursing interventions should the nurse implement? Select all that apply.

Correct Answer: B,C

Rationale: Stool softeners (
B) prevent straining, which could increase ICP. Maintaining pulse oximetry >93% (
C) ensures adequate oxygenation. High HOB elevation (
A) may reduce cerebral perfusion, deep suction (
D) risks increasing ICP, and sedatives (E) may mask neurological changes.

Question 2 of 5

A client diagnosed with a subarachnoid hemorrhage has undergone a craniotomy for repair of a ruptured aneurysm. Which intervention will the intensive care nurse implement?

A. Administer a stool softener bid. B. Encourage the client to cough hourly. C. Monitor neurological status every shift. D. Maintain the dopamine drip to keep BP at 160/90.

Correct Answer: A

Rationale: Post-craniotomy for subarachnoid hemorrhage, preventing increased intracranial pressure is critical. A stool softener (
A) prevents straining, which could raise ICP. Coughing (
B) increases ICP, neurological checks (
C) should be more frequent (e.g., hourly), and dopamine to maintain high BP (
D) risks re-bleeding.

Question 3 of 5

The client diagnosed with ALS asks the nurse, 'I know this disease is going to kill me. What will happen to me in the end?' Which statement by the nurse would be most appropriate?

A. You are afraid of how you will die?' B. Most people with ALS die of respiratory failure.' C. Don’t talk like that. You have to stay positive.' D. ALS is not a killer. You can live a long life.'

Correct Answer: B

Rationale: Providing factual information about respiratory failure (
B) addresses the client’s question honestly while respecting their need for clarity. Reflecting fear (
A) is vague, dismissing concerns (
C) is untherapeutic, and denying prognosis (
D) is inaccurate.

Question 4 of 5

Which assessment finding in a client with myasthenia gravis indicates a need for immediate intervention?

A. Mild diplopia B. Difficulty chewing C. Weak hand grip D. Respiratory rate of 10 breaths per minute

Correct Answer: D

Rationale: A low respiratory rate indicates potential respiratory failure in myasthenia gravis, requiring immediate intervention.

Question 5 of 5

The client diagnosed with a right-sided cerebrovascular accident is admitted to the rehabilitation unit. Which interventions should be included in the nursing care plan? Select all that apply.

A. Position the client to prevent shoulder adduction. B. Turn and reposition the client every shift. C. Encourage the client to move the affected side. D. Perform quadriceps exercises three (3) times a day. E. Instruct the client to hold the fingers in a fist.

Correct Answer: A,C,D

Rationale: For a right-sided CVA, the left side is affected. Positioning to prevent shoulder adduction (
A) supports the weak left arm to prevent contractures. Encouraging movement of the affected side (
C) promotes neuroplasticity and recovery. Quadriceps exercises (
D) strengthen the affected leg. Turning every shift (
B) is too infrequent; every 2 hours is standard to prevent pressure ulcers. Instructing to hold fingers in a fist (E) risks contractures and is not therapeutic.

Neurological Disorders NCLEX Questions | Nurselytic

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