Questions
Question 1

The physician has ordered a rectal
diazepam (Valium) for a 2 year old boy with
status epilepticus. Which of the following
instructions is essential for the nurse to
teach the parents?
Monitor the level of sedation and the
respiratory rate.
b. Watch for a temperature elevation, indicating
infection.
c. Gradually reduce the dose of medication.
d. Monitor for an allergic reaction to the
medication.
a.
Question 2

As a result of seizure activity, a CT scan
was performed and showed that an 18
month old child has an intracranial
arteriovenous malformation. The nurse
would focus measures on prevention of
which of the following?
a.
b.
c.
d.
Drug interaction
Developmental disabilities
Hemorrhagic stroke
Respiratory paralysis
Question 3

A 4 year old boy has a febrile seizure
during a well-child visit. Which of the
following is the priority nursing
intervention?
Placing the child on his side, hyperextending
his head, during the seizure.
b. Positioning the child on his back while holding
him still until the seizure ends.
c. Loosening the child’s clothing to ensure a
patent airway.
d. Protecting the child from harm during the
seizure.
a.
Question 4

The nurse is caring for a 8 year old boy
who has a diagnosis of epilepsy with no
sign of the seizure activity diminishing.
Which of the following would be a priority
for this child?
Multiple corrective surgeries to slowly remove
diseased parts of his brain.
b. Physical, occupational, and speech therapy to
maximize his potential.
c. Support for maintaining self-esteem because of
his altered lifestyle.
d. Hyperventilation therapy to counteract the
periods of decreased oxygenation.
a.
Question 5

A child with increased intracranial
pressure is being treated with
hyperventilation. The nurse
understands that which of the following
is the rationale for this treatment?
a. PaC02 levels decrease, causing
vasoconstriction.
b. Drainage of cerebrospinal fluid occurs.
c. Activity is controlled via a stimulator.
d. Hyperexcitability of the nerves is reduced.
Question 6

Which of the following would lead the
nurse to suspect that a child is
beginning to develop ICP?
a. Bradycardia
b. Cheyne-Stokes respiration
c. Fixed-dilated pupils
d. Projectile vomiting
Question 7

A patient is being admitted to the Neuro
ICU following an acute head injury. The
patient has cerebral edema. The nurse
would expect to administer what priority
medication to reduce the swelling?
a. HydroDiuril
b. Lasix
c. Mannitol
d. Aldactone
Question 8

You have admitted a patient to the Neuro ICU with a
brainstem herniation. The patient is now exhibiting an
altered LOC. The nurse has determined that the patient’s
MAP is 60 with an ICP reading of 5 mm/Hg. The nurse
would be correct in determining the cerebral perfusion
pressure (CPP) as which of the following values?
a.
b.
c.
d.
Normal
High
Low
Compensating
Question 9

The nurse is caring for a postop craniotomy
patient. When writing the plan of care, the
patient has deficient fluid volume related to
fluid restriction related to Mannitol use.
What would be an appropriate intervention
for this deficiency?
Change the patient’s position as indicated
b. Monitor serum electrolytes
c. Maintain NPO status
d. Monitor ABG’s
a.
Question 10

The nurse is caring for a patient on the
neuro unit who is in status epilepticus.
What medication does the nurse know
may be given to halt the seizure
immediately?
a. IV Phenobarbitol
b. IV Valium
c. Oral Ativan
d. Oral Dilantin
Question 11

What should the nurse suspect when
hourly assessments of urine ouput on a
postcraniotomy patient exhibits a urine
output from a catheter of 1500 ml for 2
consecutive hours?
a. Cushing’s syndrome
b. Syndrome of inappropriate antidiuretic
hormone
c. Adrenal crisis
d. Diabetes insipidus
Question 12

During the examination of an
unconscious patient, the nurse notices
that the patient’s pupils are fixed and
dilated. What is the clinical significance
of the nurse's findings?
a. It suggests onset of metabolic problems
b. It indicates paralysis on the right side of
the body
c. It indicates paralysis of cranial nerve X
d. It indicates an injury at the midbrain level
Question 13

When caring for a patient with a
neurologic impairment and his or her
family, what are the mutual goals?
a. Achieve as high a level of function as
possible
b. Enhance the quantity of life
c. Teach the family proper care of the patient
d. Provide community assistance
Question 14

You have a patient with an altered level
of consciousness. What would be your
first action when assessing this patient?
a. Assessing the verbal response
b. Assessing if the patient follows commands
c. Assessing whether the patient will open
their eyes
d. Assessing response to pain
Question 15

A patient is considered terminal after being
involved in a MVA/MVC in which they received
massive trauma to the head. As the patient’s
ICP increases and condition worsens, the
family asks you what indication of approaching
or impending death will there be. What would
be your best response?
a.
b.
c.
d.
“there is change in the pattern of their respirations”
“projectile vomiting and hemiplegia usually occur
just before death”
“posturing may develop as pressure on the
brainstem increases”
“loss of brainstem reflexes is a sign of approaching
death”
Question 16

The nursing instructor is teaching her
students about monitoring a patient with
increased ICP. What is a trend of ICP
measurements over time an important
indication of?
a. Patient’s level of consciousness
b. Patient’s ultimate prognosis
c. Whether or not the patient’s brainstem is
going to herniate
d. Patient’s underlying status
Question 17

A priority in postoperative management
of a patient who has had intracranial
surgery is what?
a. Reducing pain
b. Reducing periorbital edema
c. Monitoring ICP
d. Preserving seizures
Question 18

A patient with a newly diagnosed seizure
disorder is to be discharged home in the
morning. You are preparing
patient/family teaching and know that a
priority to the teach the family is what?
a. Place the patient in a side-lying position
b. Pad the bed rails
c. Keep a bite block nearby at all times
d. Withhold medication after a seizure
Question 19

When caring for a patient who had a
hemorrhagic stroke, close monitoring of
vital signs and neurologic changes are
imperative. What is the earliest sign of
deterioration in a patient with a
hemorrhagic stroke?
a.
b.
c.
d.
Headache
Alterations in level of consciousness
Tonic-clonic seizures
Shortness of breath
Question 20

A patient who just suffered a
hemorrhagic stroke is brought to the ED
by ambulance. What would the nurse’s
primary assessment focus on?
a. Cardiac and respiratory status
b. Seizure activity
c. Urinary output
d. Fluid and electrolyte balance
Question 21

The patient has been diagnosed with
aphasia after suffering a stroke. What can
the nurse do to make the patient’s
atmosphere more conducive to
communication?
Help the patient compose a list of daily tasks
b. Have the patient speak to loved ones on the
phone daily
c. Help the patient complete his or her sentences
d. Speak in a louder voice to the patient
a.
Question 22

The nurse is caring for a patient with
increased ICP caused by a traumatic brain
injury. Which of the following clinical
manifestations would indicate the patient is
experiencing increased brain compression
causing brainstem damage?
Hyperthermia
b. Tachycardia
c. Hypertension
d. bradypnea
a.
Question 23

A patient is bought to the ED by her family after
falling off the roof. A family tells the nurse that when
the patient fell she was “knocked out” but came to
and seemed ok. Now, the patient is complaining of
severe headache and not feeling well. The nurse
suspects an epidural hematoma. Based on the
knowledge of the progression of this type of
hematoma, the nurse prepares for which priority
intervention?
a.
b.
c.
d.
Insertion of ICP monitor device
Treatment with antihypertensives
Emergency craniotomy
Administration of anticoagulant therapy
Question 24

The paramedics have brought an intubated
patient to the ED following a head injury
due to acceleraton-deceleration MVA. ICP
is suspected. An appropriate nursing
intervention would include what?
Keep the HOB flat at all times
b. Teach the patient to perform the Valsalva
maneuver
c. Administer antipyretics on a prn basis
d. Perform endotracheal suctioning every hour
a.
Question 25

An elderly female is found on the floor of her
home. She had apparently fallen and hit her
head on the bathtub. She has a decreased
LOC on admission to the neuro unit. What is
the best rationale for the following physician
orders: elevate HOB, keep head in neutral
alignment with no neck flexion or head
rotation, and avoid sharp hip flexion.
a.
b.
c.
d.
To decrease cerebral arterial pressure
To avoid impending venous outlflow
To prevent flexion contractures
To prevent aspiration of stomach contents
Question 26 (bonus)

The ED is notified that a six year old is in
transit with a suspected brain injury after
being involved in a pedestrian/MVA. The
child is unresponsive at this time. Vital
signs are within normal limits. What will
the therapy used on this child be directed
towards?
a.
b.
c.
d.
Maintaining the child’s airway
Decreasing the ICP
Assessing for secondary brain injury
Preserving brain homeostasis
Question 27

An 82 year old male is admitted for
observation after a fall. What is this
patient at increased risk for?
a. Hematoma
b. Skull fracture
c. Embolus
d. Stroke
Question 28

A 77 year old patient had a
thromboembolic right stroke; his left arm is
swollen. Which of the following conditions
may cause swelling after a stroke?
Elbow contracture secondary to spasticity
Loss of muscle contraction decreasing venous
return
c. DVT due to immobility of the ipsilateral (same)
side
d. Hypoalbuminemia due to protein escape from
the inflamed glomerulus
a.
b.
Question 29

The parents of a child in a coma with a
serious head injury ask the nurse if the
child is going to be all right. Which of the
following responses by the nurse would be
the most appropriate?
“children usually don’t do very well after head
injuries like this”
b. “children usually recover rapidly from head
injuries”
c. “it’s hard to tell this early, but we’ll keep you
informed of the progress”
d. “that’s something you will have to talk to the
doctor about”
a.
Question 30

During the first 24 hours after
thrombolytic treatment for an ischemic
stroke, the primary goal is to control the
clients?
a. Pulse
b. Respirations
c. Blood Pressure
d. Temperature