NCLEX-PN
NCLEX Neurological Disorders Questions
Extract:
Question 1 of 5
The wife of the client diagnosed with septic meningitis asks the nurse, 'I am so scared. What is meningitis?' Which statement would be the most appropriate response by the nurse?
Correct Answer: C
Rationale: Septic meningitis is a bacterial infection of the meninges (
C). Bleeding (
A) describes subarachnoid hemorrhage, viral meningitis (
B) is aseptic, and mosquito-related inflammation (
D) refers to encephalitis.
Question 2 of 5
The nurse stops at the scene of a motor-vehicle accident and provides emergency first aid at the scene. Which law protects the nurse as a first responder?
Correct Answer: C
Rationale: The Good Samaritan Act (
C) protects nurses providing emergency care from liability. First Aid Law (
A) and First Responder Law (
D) are not standard, and Ombudsman Act (
B) is unrelated.
Question 3 of 5
Spinal precautions are ordered for the client who sustained a neck injury during an MVA. The client has yet to be cleared that there is no cervical fracture. Which action is the nurse’s priority when receiving the client in the ED?
Correct Answer: C
Rationale: The nurse should determine the neurological status using the GCS, but this is not the priority. The nurse should assess sensation status at intervals to determine neurological injury progression, but this is not the priority. Maintaining the correct placement of the cervical collar will keep the client’s head and neck in a neutral position and prevent further injury if a spinal fracture or SCI is present. Because ensuring that the cervical collar is correctly placed will prevent further injury, it is priority. Applying antiembolism hose is an intervention to prevent thromboembolic complications, but this is not the priority.
Question 4 of 5
The client, who has a deteriorating status after having a stroke, has a rectal temperature of 102.3°F (39.1°C). Which should be the nurse’s rationale for initiating interventions to bring the temperature to a normal level?
Correct Answer: D
Rationale: A normal temperature does not strengthen the immune system. Although hypothermia may increase the client’s chance for survival, the question is asking for the rationale for bringing the temperature to a normal level. Hyperthermia, not a normal temperature, is associated with lower scores on the Glasgow Coma Scale. The nurse should initiate temperature reduction measures because a temperature elevation in the client poststroke can cause an increase in the infarct size. This may be due to the increased oxygen demand with hyperthermia and peripheral vasodilation that decreases cerebral perfusion.
Question 5 of 5
Which nursing action is priority for a client with a stroke experiencing unilateral neglect?
Correct Answer: D
Rationale: Teaching the client to scan the environment compensates for unilateral neglect, promoting safety and awareness.