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Neurological NCLEX practice questions

Five NCLEX-style questions on stroke, meningitis, spinal cord injury, increased intracranial pressure, seizures, multiple sclerosis and Parkinson’s disease. Pick your answer, then open it to see the right choice and why. New questions every week.

1. Question 1

   A nurse is assessing a client's cranial nerves as part of a neurological examination. Which of the following actions should the nurse take to assess cranial nerve III?

   • A.Checking the pupillary response to light
   • B.Eliciting the gag reflex
   • C.Testing visual acuity
   • D.Observing for facial symmetry
   Show answer and rationale ▾Answer and rationale ▴

   Answer: A. Checking the pupillary response to light

   Cranial nerve III, also known as the oculomotor nerve, controls the muscles that move the eye and regulates the size of the pupil. Assessing the pupillary response to light helps evaluate the function of this nerve. Eliciting the gag reflex is associated with cranial nerves IX (glossopharyngeal) and X (vagus), not cranial nerve III. Testing visual acuity is primarily associated with cranial nerve II (optic nerve), not cranial nerve III. Observing facial symmetry is important for assessing cranial nerve VII (facial nerve), not cranial nerve III.

2. Question 2

   George Torres is admitted with a head injury. He is comatose and is breathing rapidly. His blood gases show a pH of 7.47, PaCO2 of 32 mm Hg, and HCO3- of 26 mEq/L. Compare these gases to normal values. What type of imbalance does this patient have, and is it being compensated or uncompensated?

   • A.Metabolic alkalosis, uncompensated
   • B.Respiratory acidosis, uncompensated
   • C.Respiratory alkalosis, uncompensated
   • D.Metabolic acidosis, uncompensated
   Show answer and rationale ▾Answer and rationale ▴

   Answer: C. Respiratory alkalosis, uncompensated

   Metabolic alkalosis is a condition where the pH and the HCO3- are both elevated, indicating a loss of acids or a gain of bases in the body. This is not the case for this patient, as his HCO3- is within the normal range of 22 to 26 mEq/L. Respiratory acidosis is a condition where the pH and the PaCO2 are both low, indicating a retention of carbon dioxide in the lungs due to hypoventilation. This is not the case for this patient, as his pH is high and his PaCO2 is low. Respiratory alkalosis is a condition where the pH and the PaCO2 are both high, indicating a loss of carbon dioxide in the lungs due to hyperventilation. This is the case for this patient, as his pH is above the normal range of 7.35 to 7.45 and his PaCO2 is below the normal range of 35 to 45 mm Hg. This condition is uncompensated, as his HCO3- is within the normal range and has not changed to counteract the pH imbalance. Metabolic acidosis is a condition where the pH and the HCO3- are both low, indicating a gain of acids or a loss of bases in the body. This is not the case for this patient, as his pH is high and his HCO3- is within the normal range.

3. Question 3

   A group of nurses is researching how care providers of Stage l/m Alzheimer's clients use prior coping skills in dealing with their current situation. Which qualitative research tradition are these nurses using?

   • A.Grounded theory
   • B.Ethnography
   • C.Substantive dimension
   • D.Phenomenology
   Show answer and rationale ▾Answer and rationale ▴

   Answer: D. Phenomenology

   The group of nurses is using the phenomenology qualitative research tradition. Phenomenology is a qualitative research approach that focuses on understanding the essence of an experience from the perspective of those who have lived it ¹. In this case, the nurses are researching how care providers of Stage l/m Alzheimer's clients use prior coping skills in dealing with their current situation. This approach allows for a deeper understanding of the experiences and perspectives of the care providers.

4. Question 4

   A nurse is assessing a client who has left-sided weakness following a stroke. Which of the following findings is the nurse's priority?

   • A.The client's blood pressure is 142/94 mm Hg.
   • B.The client coughs frequently while eating.
   • C.The client leans to the left side while sitting.
   • D.The client is consuming 25% of their meals.
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. The client coughs frequently while eating.

   While elevated blood pressure may be a concern, frequent coughing while eating indicates a risk of aspiration, which is a more immediate priority. Frequent coughing while eating suggests a risk of aspiration, which can lead to serious respiratory complications such as pneumonia. Leaning to the left side while sitting may indicate weakness or postural instability but is not as immediately concerning as a risk of aspiration. Low food intake is a concern but does not present an immediate risk to the client's safety compared to the risk of aspiration.

5. Question 5

   A nurse enters the room of a client who has a seizure disorder. The client is sitting in a chair and begins to experience a seizure. Which of the following actions should the nurse take first?

   • A.Move items in the room away from the client.
   • B.Help the client lie on the floor.
   • C.Turn the client onto their side.
   • D.Loosen the client's clothing
   Show answer and rationale ▾Answer and rationale ▴

   Answer: B. Help the client lie on the floor.

   Moving items away from the client can prevent injury during the seizure, but it is not the first action to take. If a client begins to experience a seizure, the first action the nurse should take is to help them lie on the floor safely to prevent injury from falling. Turning the client onto their side helps maintain a clear airway and prevents aspiration during the seizure but should only be done after helping the client to lie in the floor. Loosening the client's clothing is important for ensuring adequate ventilation but is not the first priority during a seizure.