Questions and Answers with Certified

Neurological disorders NCLEX Questions and Answers with Certified Solutions

1) A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?

• Vomiting continues
• Intracranial pressure (ICP) is increased
• The client needs mechanical ventilation
• Blood is anticipated in the cerebralspinal fluid (CSF) ✔✔2

Sudden removal of CSF results in pressures lower in the lumbar area than the brain and favors herniation of the brain; therefore, LP is contraindicated with increased ICP. Vomiting may be caused by reasons other than increased ICP; therefore, LP isn't strictly contraindicated. An LP may be preformed on clients needing mechanical ventilation. Blood in the CSF is diagnostic for subarachnoid hemorrhage and was obtained before signs and symptoms of ICP.

2) A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons?

• To reduce intraocular pressure
• To prevent acute tubular necrosis

• To promote osmotic diuresis to decrease ICP
• To draw water into the vascular system to increase blood pressure ✔✔3

Mannitol promotes osmotic diuresis by increasing the pressure gradient, drawing fluid from intracellular to intravascular spaces. Although mannitol is used for all the reasons described, the reduction of ICP in this client is a concern.

3) A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP).Which of the following results would best show the mannitol was effective?

• Urine output increases
• Pupils are 8 mm and nonreactive
• Systolic blood pressure remains at 150 mm Hg
• BUN and creatinine levels return to normal ✔✔1

Mannitol promotes osmotic diuresis by increasing the pressure gradient in the renal tubes. Fixed and dilated pupils are symptoms of increased ICP or cranial nerve damage. No information is given about abnormal BUN and creatinine levels or that mannitol is being given for renal dysfunction or blood pressure maintenance.

4) Which of the following values is considered normal for ICP?

• 0 to 15 mm Hg

• 25 mm Hg
• 35 to 45 mm Hg
• 120/80 mm Hg ✔✔1

Normal ICP is 0-15 mm Hg.

5) Which of the following symptoms may occur with a phenytoin level of 32 mg/dl?

• Ataxia and confusion
• Sodium depletion
• Tonic-clonic seizure
• Urinary incontinence ✔✔1. A therapeutic phenytoin level is 10 to 20 mg/dl. A level of 32

mg/dl indicates toxicity. Symptoms of toxicity include confusion and ataxia. Phenytoin doesn't cause hyponatremia, seizure, or urinary incontinence. Incontinence may occur during or after a seizure.

6) Which of the following signs and symptoms of increased ICP after head trauma would appear first?

• Bradycardia
• Large amounts of very dilute urine
• Restlessness and confusion

• Widened pulse pressure ✔✔3

The earliest symptom of elevated ICP is a change in mental status. Bradycardia, widened pulse pressure, and bradypnea occur later. The client may void large amounts of very dilute urine if there's damage to the posterior pituitary.

7) Problems with memory and learning would relate to which of the following lobes?

• Frontal
• Occipital
• Parietal
• Temporal ✔✔4

The temporal lobe functions to regulate memory and learning problems because of the integration of the hippocampus. The frontal lobe primarily functions to regulate thinking, planning, and judgment. The occipital lobe functions regulate vision. The parietal lobe primarily functions with sensory function.

8) While cooking, your client couldn't feel the temperature of a hot oven. Which lobe could be dysfunctional?

• Frontal
• Occipital