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NSG 3280 Unit 5 Neurological Practice Questions
Question 1 A patient suffered severe global ischemia following a myocardial infarction (MI). The nurse understands that the resulting generalized brain edema is primarily due to which cellular mechanism? A. Increased vessel pressure causing a midline shift (vasogenic edema) B. Cellular energy failure leading to decreased ATP and subsequent Na+ accumulation inside the cell C. Excessive influx of water and Ca+ into the cells due to increased glutamate D. Compression of the cerebral vessels causing secondary interstitial edema Question 2 A patient's Intracranial Pressure (ICP) monitor reading has been consistently above 22 mmHg for the past 10 minutes. The nurse recognizes that this finding indicates: A. The patient is compensating via the Monroe-Kellie doctrine, as this slight increase is manageable. B. Brain impairment is occurring due to sustained compression. C. The patient is experiencing a temporary, slight increase in ICP typical of a sneeze or laugh. D. The CSF component is decreasing to offset the increased pressure. Question 3 A nurse is preparing a presentation on the Monroe-Kellie doctrine. The nurse should include that the three main cranial components whose volume must remain relatively constant are: A. Brain, Neurons, and Arterial Blood B. Brain tissue, Venous Sinuses, and CSF C. Brain, Cerebral Spinal Fluid (CSF), and Blood D. Dura Mater, Pia Mater, and Arachnoid Membrane
Question 4 A patient presents to the Emergency Department following a fall. Which finding would the nurse recognize as the MOST sensitive indicator of increasing intracranial pressure (ICP)? A. Worsening headache B. Increased drowsiness C. Onset of Cushing’s Triad D. Hypotension Question 5 (SATA) The nurse assesses a patient and identifies Cushing's Triad. The nurse understands this is a sympathetic nervous system reaction to increased ICP in an attempt to maintain cerebral perfusion. Which findings are components of Cushing’s Triad? A. Decreased blood pressure (BP) B. Increased respiratory rate C. Increased systolic blood pressure (BP) D. Decreased heart rate (HR) E. Respiratory changes Question 6 The nurse is performing a neurological assessment on an unresponsive patient. Upon checking the cranial nerve reflexes, the patient exhibits fixed and dilated pupils. The nurse should immediately conclude that this sign indicates: A. Early pressure on Cranial Nerve (CN) III due to midbrain displacement. B. An issue localized to the Pons. C. The presence of significant opioid drug effects. D. Poor brain perfusion.
Question 11 (SATA) A patient is diagnosed with a Subarachnoid Hemorrhage (SAH). The nurse plans for potential complications that can arise, which include: A. Vasospasm B. Hydrocephalus C. Ischemia D. Blood in the cerebrospinal fluid E. Rapid deterioration followed by lucidity Question 12 A patient arrives at the hospital exhibiting sudden left-sided hemiparesis. The nurse understands that this physical manifestation suggests that the ischemic injury likely occurred in which hemisphere of the brain? A. Left hemisphere B. Right hemisphere C. Cerebellum D. Pons Question 13 (SATA) A nurse is educating a community group about primary prevention of ischemic stroke. Which risk factors should the nurse address in the education plan? A. Diabetes B. Family history of Polycystic Kidney Disease (PKD) C. Atrial fibrillation D. Hyperlipidemia E. Advanced age Question 14 In the pathology of an ischemic stroke, the area of brain tissue surrounding the central necrosis that is still viable due to collateral circulation is known as the: A. Lacunar infarct B. Penumbra C. Circle of Willis
D. Bridging vein area Question 15 A nurse is reviewing the causes of Hemorrhagic Stroke. The nurse understands that the most common cause is: A. Chronic alcoholism B. Longstanding hypertension (HTN) C. Saccular (berry) aneurysms D. Atherosclerosis causing thrombus formation Question 16 A patient is admitted 5 days after suffering a cerebral aneurysm rupture. The nurse knows that a major complication risk at this point is vasospasm, which leads to secondary ischemia. This occurs because: A. The patient is undergoing anticoagulant therapy. B. The highest risk for rebleeding is now present. C. Blood has entered the Cerebral Spinal Fluid (CSF). D. The aneurysm was located on the Circle of Willis. Question 17 A nurse is assessing a patient who reports a sudden, excruciating "thunderclap" headache, stiff neck, photophobia, and nausea. These symptoms are characteristic of: A. A migraine preceded by an aura B. A sentinel leak preceding aneurysm rupture C. An Arteriovenous Malformation (AVM) rupture D. An acute aneurysm rupture Question 18 A patient is diagnosed with an Arteriovenous Malformation (AVM). The nurse explains that a specific concern related to this condition is Vascular Steal Syndrome. This complication is characterized by: A. The formation of Lewy Bodies, disrupting brain function. B. Abnormal connections between arteries and veins without a capillary network. C. Abnormal shunting of blood, causing ischemia in surrounding normal tissues. D. Increased incidence of migraine headaches and photophobia.
Question 23 A child is frequently experiencing brief episodes where they become motionless and stare, sometimes continuing the motor task they were performing just before the event. These episodes last approximately 5 seconds. The nurse suspects this is characteristic of which seizure type? A. Focal Impaired Awareness B. Myoclonic C. Absence D. Tonic-Clonic Question 24 A nurse is reviewing the pathophysiology of Parkinson Disease (PD). The primary cause of the motor symptoms is the degeneration of neurons responsible for producing which neurotransmitter? A. Glutamate B. Acetylcholine C. GABA D. Dopamine Question 25 (SATA) A patient is diagnosed with Parkinson Disease. Which clinical manifestations should the nurse expect to see as the disease progresses? A. Unilateral tremor B. Micrographia (small handwriting) C. Delayed swallowing and drooling D. Development of Lewy Bodies leading to dementia Question 26 A nurse is assessing a patient suspected of having Bell Palsy. Which finding is the nurse most likely to note during the physical examination? A. Sudden, excruciating pain localized to the face B. Bilateral tremors and muscle rigidity C. Unilateral facial weakness and decreased eye blink D. Fixed and dilated pupils
Question 27 The nurse is educating a patient newly diagnosed with Bell Palsy. The most critical complication to discuss regarding long-term care is: A. Vascular Steal Syndrome B. Corneal damage C. Status Epilepticus D. Sudden rapid deterioration Question 28 A patient with Trigeminal Neuralgia reports that their pain feels like a sudden, severe electrical shock to their face. The nurse understands that this pain is primarily caused by: A. Inflammation of the CN VII B. Demyelination of CN V due to chronic compression C. Increased ICP causing pressure on CN III D. Atherosclerosis obstructing the arterioles (lacunar infarct) Question 29 (SATA) A patient with Multiple Sclerosis (MS) is at increased risk for developing Trigeminal Neuralgia because: A. MS can cause congenital defects leading to saccular aneurysms. B. MS involves the demyelination of nerves. C. Trigeminal Neuralgia is caused by the demyelination of the trigeminal nerve. D. The combination of MS and chronic compression leads to exacerbated symptoms. Question 30 A patient reports experiencing a migraine that began with flashing lights and unilateral paresthesia. The nurse documents that these symptoms represent the: A. Prodrome phase B. Aura C. Postictal period D. Sentinel leak
D. Formation of bridging veins that shear easily Question 35 A patient with chronic hypertension develops symptoms of a large cerebral hemorrhage. Why does the patient often present with clinical manifestations identical to an ischemic stroke (e.g., hemiparesis, cognitive deficits)? A. The bleeding in the hemorrhage triggers secondary thrombus formation, causing ischemia. B. Longstanding HTN is exclusively the cause of hemorrhagic strokes. C. The expanding hematoma acts as a mass, causing compression, ischemia, and increased ICP. D. The high mortality rate of hemorrhagic stroke masks the specific ischemic symptoms. Question 36 A nurse is caring for a patient who suffered a massive focal injury (coup) during a motor vehicle crash. Two hours later, the patient’s ICP rapidly increases due to the development of cerebral edema and CSF blockage. The cerebral edema and CSF blockage are classified as which type of injury? A. Primary injury B. Diffuse injury C. Polar injury D. Secondary injury
NSG 3280 Unit 5 Neurological ANSWERS
Question 1 A patient suffered severe global ischemia following a myocardial infarction (MI). The nurse understands that the resulting generalized brain edema is primarily due to which cellular mechanism? A. Increased vessel pressure causing a midline shift (vasogenic edema) B. Cellular energy failure leading to decreased ATP and subsequent Na+ accumulation inside the cell C. Excessive influx of water and Ca+ into the cells due to increased glutamate D. Compression of the cerebral vessels causing secondary interstitial edema Answer: B Rationale: Intracellular edema (cytotoxic edema), often associated with global ischemia (like an MI), occurs when cellular energy fails, decreasing ATP production. This leads to Na+ accumulation within the cell, which attracts water, causing generalized brain edema and increased ICP. Option A describes interstitial (vasogenic) edema. Options C describes cell damage
related to glutamate following ischemia. Option D is a potential complication
of severe cytotoxic edema, not the primary mechanism. Question 2 A patient's Intracranial Pressure (ICP) monitor reading has been consistently above 22 mmHg for the past 10 minutes. The nurse recognizes that this finding indicates: A. The patient is compensating via the Monroe-Kellie doctrine, as this slight increase is manageable. B. Brain impairment is occurring due to sustained compression. C. The patient is experiencing a temporary, slight increase in ICP typical of a sneeze or laugh. D. The CSF component is decreasing to offset the increased pressure. Answer: B Rationale: Brain impairment occurs when ICP is sustained above 22 mmHg for more than 5 minutes due to compression. While the Monroe-Kellie doctrine explains how the brain, CSF, and blood compensate, that compliance is limited. An ICP > 22 mmHg sustained for > 5 minutes is defined as causing impairment.
D. Decreased heart rate (HR) E. Respiratory changes Answer: C, D, E Rationale: Cushing’s Triad includes increased BP, decreased HR, and respiratory changes. Question 6 The nurse is performing a neurological assessment on an unresponsive patient. Upon checking the cranial nerve reflexes, the patient exhibits fixed and dilated pupils. The nurse should immediately conclude that this sign indicates: A. Early pressure on Cranial Nerve (CN) III due to midbrain displacement. B. An issue localized to the Pons. C. The presence of significant opioid drug effects. D. Poor brain perfusion. Answer: D Rationale: Fixed and dilated pupils are a clinical manifestation of poor brain perfusion. Mild dilation with a decreased or absent response suggests increased pressure on CN III. Small (pinpoint) pupils suggest a Pons issue or drug effects. Question 7 When testing the Oculovestibular Reflex using the Doll’s Eyes Test, the nurse turns the patient's head to the right. A normal response is documented if the patient's eyes: A. Deviate toward the side of the head movement (right). B. Stay midline, appearing "painted on". C. Move opposite the direction of head movement (left). D. Blinked Answer: C Rationale: A normal response to the Doll’s Eyes Test is for the eyes to move opposite the direction of head movement. This adjustment allows the object fixation on the retina even when the head is moving. An absent response is when the eyes stay midline.
Question 8 A nurse is caring for a patient admitted with a Traumatic Brain Injury (TBI). The patient's injury is described as "Coup-countercoup." The nurse understands that this injury classification is: A. Diffuse, involving widespread damage from shearing forces. B. Focal, localized strictly to the site of impact. C. Polar, involving damage at the site of impact and the opposite side of the brain. D. Secondary, resulting from vessel spasm or edema. Answer: C Rationale: Polar injuries (Coup-countercoup) involve injury at the site of impact and on the opposite side of the brain due to the forward-backward movement of the brain within the skull. Diffuse injuries cause widespread damage from rotational forces and shearing. Secondary injuries are complications that form due to the body's response to the original injury, such as cerebral edema or vessel rebleed. Question 9 A patient presents to the ED after falling off a ladder. Initially, the patient appeared stable and lucid, but they rapidly deteriorated 30 minutes later. The CT scan reveals a bleed located between the inner skull and the dura mater, originating from an artery. The nurse recognizes this presentation as consistent with which type of hematoma? A. Subdural Hematoma B. Subarachnoid Hemorrhage C. Epidural Hematoma D. Lacunar Infarct Answer: C Rationale: An Epidural Hematoma is located between the inner skull and the dura mater, and most bleeds are arterial. The patient may feel stable at first, then rapidly deteriorate. A Subdural Hematoma is usually venous, located between the dura and outer arachnoid membrane, and the bleed is slower. Question 10 An older adult patient with cerebral atrophy is at particularly high risk for which type of intracranial bleed following a fall?
D. Pons Answer: B Rationale: Physical symptoms, such as hemiparesis or paralysis, occur on the site opposite of the injury location. Left-sided weakness suggests injury to the right hemisphere. Question 13 (SATA) A nurse is educating a community group about primary prevention of ischemic stroke. Which risk factors should the nurse address in the education plan? A. Diabetes B. Family history of Polycystic Kidney Disease (PKD) C. Atrial fibrillation D. Hyperlipidemia E. Advanced age Answer: A, C, D, E Rationale: Risk factors for ischemic stroke include Atherosclerosis, HTN, Smoking, Sedentary lifestyle, Atrial fibrillation, Obesity, Hyperlipidemia, Diabetes, Advanced age, and Alcoholism. Polycystic Kidney Disease (PKD) is a risk factor for cerebral aneurysms, not specifically ischemic stroke. Question 14 In the pathology of an ischemic stroke, the area of brain tissue surrounding the central necrosis that is still viable due to collateral circulation is known as the: A. Lacunar infarct B. Penumbra C. Circle of Willis D. Bridging vein area Answer: B Rationale: The penumbra is the area around the necrosis that remains viable due to collateral circulation. Lacunar infarcts are occlusions of arterioles. Question 15 A nurse is reviewing the causes of Hemorrhagic Stroke. The nurse understands that the most common cause is:
A. Chronic alcoholism B. Longstanding hypertension (HTN) C. Saccular (berry) aneurysms D. Atherosclerosis causing thrombus formation Answer: B Rationale: The number one cause of hemorrhagic stroke is longstanding hypertension (HTN). Aneurysms are a common cause of subarachnoid hemorrhage, but HTN is cited as the primary cause of bleeding within the brain. Question 16 A patient is admitted 5 days after suffering a cerebral aneurysm rupture. The nurse knows that a major complication risk at this point is vasospasm, which leads to secondary ischemia. This occurs because: A. The patient is undergoing anticoagulant therapy. B. The highest risk for rebleeding is now present. C. Blood has entered the Cerebral Spinal Fluid (CSF). D. The aneurysm was located on the Circle of Willis. Answer: C Rationale: Vasospasm around the area of rupture, typically occurring 4 to 14 days after the event, is due to blood in the CSF. This decreases blood flow and increases ischemia. The highest risk for rebleeding is in the first 24 hours. Question 17 A nurse is assessing a patient who reports a sudden, excruciating "thunderclap" headache, stiff neck, photophobia, and nausea. These symptoms are characteristic of: A. A migraine preceded by an aura B. A sentinel leak preceding aneurysm rupture C. An Arteriovenous Malformation (AVM) rupture D. An acute aneurysm rupture Answer: D
Question 20 The underlying mechanism that leads to neuronal hyperexcitability and the formation of an epileptogenic focus in seizures involves an imbalance between which two key neurotransmitters? A. Dopamine and Acetylcholine B. Glutamate and GABA C. Serotonin and Norepinephrine D. Nitrous Oxide and Calcium Answer: B Rationale: Normal function relies on Glutamate (excites neurons) and GABA (inhibits neurons). In a seizure, an imbalance develops between Glutamate and GABA, causing neurons to become hyperexcitable and forming the epileptogenic focus. Question 21 (SATA) The nurse is observing a patient experiencing a generalized onset tonic-clonic seizure. Which characteristics are typical of this seizure phase? A. Loss of consciousness (LOC) B. Stiffening (tonic phase) followed by jerking (clonic phase) C. Incontinence D. No change in LOC with movements limited to one body part E. Apnea during the clonic phase Answer: A, B, C, E Rationale: Tonic-clonic seizures are characterized by loss of LOC, stiffening and jerking movements, incontinence, and apnea during the clonic phase. Option D describes a Focal Onset Aware seizure. Question 22 Following a generalized tonic-clonic seizure, the patient enters the postictal period. The nurse anticipates finding which classic symptoms during this period? A. Sudden, excruciating facial pain B. Confusion, lethargy, and amnesia about the event C. Pupillary, skin, and respiratory autonomic changes while maintaining LOC
D. Motionless staring spells lasting 2 to 10 seconds Answer: B Rationale: Characteristics of the postictal period following a generalized seizure include confusion, potentially severe lethargy, and amnesia about the event. Option D describes an Absence seizure. Option C describes a Focal Onset Aware seizure. Question 23 A child is frequently experiencing brief episodes where they become motionless and stare, sometimes continuing the motor task they were performing just before the event. These episodes last approximately 5 seconds. The nurse suspects this is characteristic of which seizure type? A. Focal Impaired Awareness B. Myoclonic C. Absence D. Tonic-Clonic Answer: C Rationale: Absence seizures usually occur in children and involve staring spells that last 2 to 10 seconds. The child may be motionless or may continue the motor task they were doing when the seizure started. Question 24 A nurse is reviewing the pathophysiology of Parkinson Disease (PD). The primary cause of the motor symptoms is the degeneration of neurons responsible for producing which neurotransmitter? A. Glutamate B. Acetylcholine C. GABA D. Dopamine Answer: D Rationale: Parkinson Disease is caused by the degeneration of dopaminergic neurons (neurons that make dopamine). Dopamine is responsible for controlled muscle movement, and its impairment leads to the characteristic motor symptoms.
