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Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX-RN® Examination

Linda A. LaCharity, Candice K. Kumagai, Shirley M. Hosler

Chapter 9

Neurologic Problems - all with Video Answers

Educators

Chapter Questions

Problem 1

The nurse in the ER assesses a 21-year-old new admission who was in a motor vehicle crash. On assessment, the nurse discovers the patient has the pictured
manifestation. Which injury does this finding indicate to the nurse?
1. Frontal skull fracture
2. Basilar skull fracture
3. Orbital fracture
4. Temporal fracture

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Problem 2

The nurse is assessing a patient with a neurologic
health problem and discovers a change in level of consciousness from alert to lethargic. What is the nurse’s
best action?
1. Perform a complete neurologic assessment.
2. Assess the cranial nerve functions.
3. Contact the rapid response team.
4. Reassess the patient in 30 minutes

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Problem 3

The nurse on the neurologic acute care unit is assessing the orientation of a patient with severe headaches.
Which questions would the nurse use to determine
orientation? Select all that apply.
1. When did you first experience the headache
symptoms?
2. Did the mayor of Cleveland run as a Democrat or
Republican?
3. What is your health care provider’s name?
4. What year and month is it?
5. What is the color of your parents’ house?
6. What is the name of this health care facility?

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Problem 4

What is the priority nursing concern for a patient experiencing a migraine headache?
1. Pain
2. Anxiety
3. Hopelessness
4. Risk for brain injury

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Problem 5

The nurse is creating a teaching plan for a patient with
newly diagnosed migraine headaches. Which key
items will be included in the teaching plan? Select all
that apply.
1. Foods that contain tyramine, such as alcohol and
aged cheese, should be avoided.
2. Drugs such as nitroglycerin and nifedipine should
be avoided.
3. Abortive therapy is aimed at eliminating the pain
during the aura.
4. A potential side effect of medications is rebound
headache.
5. Complementary therapies such as biofeedback and
relaxation may be helpful.
6. Estrogen therapy should be continued as prescribed
by the patient’s health care provider.

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Problem 6

After a patient has a seizure, which action can the
nurse delegate to the assistive personnel (AP)?
1. Documenting the seizure
2. Performing neurologic checks
3. Checking the patient’s vital signs
4. Restraining the patient for protection

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Problem 7

. The nurse is preparing to admit a patient with a seizure disorder. Which action can be assigned to an
LPN/LVN?
1. Completing the admission assessment
2. Setting up oxygen and suction equipment
3. Placing a padded tongue blade at the bedside
4. Padding the side rails before the patient arrives

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Problem 8

A nursing student is teaching a patient and family about epilepsy before the patient’s discharge. For
which statement should the nurse intervene?
1. “You should avoid consumption of all forms of
alcohol.”
2. “Wear your medical alert bracelet at all times.”
3. “Protect your loved one’s airway during a seizure.”
4. “It’s OK to take over-the-counter medications.”

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Problem 9

A patient with Parkinson disease has a problem with
decreased mobility related to neuromuscular impairment. The nurse observes the assistive personnel (AP)
performing all of these actions. For which action must
the nurse intervene?
1. Helping the patient ambulate to the bathroom and
back to bed
2. Reminding the patient not to look at his feet when
he is walking
3. Performing the patient’s complete bathing and oral
care
4. Setting up the patient’s tray and encouraging the
patient to feed himself

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Problem 10

The nurse is preparing to discharge a patient with
chronic low back pain. Which statement by the patient indicates the need for additional teaching?
1. “I will avoid exercise because the pain gets worse.”
2. “I will use heat or ice to help control the pain.”
3. “I will not wear high-heeled shoes at home or
work.”
4. “I will purchase a firm mattress to replace my old one.”

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Problem 11

A patient with a spinal cord injury reports a sudden
severe throbbing headache that started a short time
ago. Assessment of the patient reveals increased blood
pressure (168/94 mm Hg) and decreased heart rate
(48 beats/min), diaphoresis, and flushing of the face
and neck. What action should the nurse take first?
1. Administer the ordered acetaminophen.
2. Check the indwelling catheter tubing for kinks or
obstruction.
3. Adjust the temperature in the patient’s room.
4. Notify the health care provider (HCP) about the
change in status.

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Problem 12

Which patient should the charge nurse assign to a
newly graduated RN who is orientating to the neurologic care unit?
1. A 28-year-old newly admitted patient with a spinal
cord injury
2. A 67-year-old patient who had a stroke 3 days ago
and has left-sided weakness
3. An 85-year-old patient with dementia who is to be
transferred to long-term care today
4. A 54-year-old patient with Parkinson disease who
needs assistance with bathing

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Problem 13

A patient with a spinal cord injury at level C3 to C4 is
being cared for by the nurse in the emergency department. What is the priority nursing assessment?
1. Determine the level at which the patient has intact
sensation.
2. Assess the level at which the patient has retained
mobility.
3. Check blood pressure and pulse for signs of spinal
shock.
4. Monitor respiratory effort and oxygen saturation
level.

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Problem 14

The nurse is floated from the emergency department
to the neurologic floor. Which action should the nurse
delegate to the assistive personnel (AP) when providing nursing care for a patient with a spinal cord injury?
1. Assessing the patient’s respiratory status every 4
hours
2. Checking and recording the patient’s vital signs every 4 hours
3. Monitoring the patient’s nutritional status, including calorie counts
4. Instructing the patient how to turn, cough, and
breathe deeply every 2 hours

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Problem 15

. The nurse is helping a patient with a spinal cord injury (SCI) to establish a bladder retraining program.
Which strategies may stimulate the patient to void?
Select all that apply.
1. Stroking the patient’s inner thigh
2. Pulling on the patient’s pubic hair
3. Initiating intermittent straight catheterization
4. Pouring warm water over the patient’s perineum
5. Tapping the bladder to stimulate the detrusor muscle
6. Reminding the patient to void in a urinal every
hour while awake

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Problem 16

A patient with a cervical spinal cord injury has been
placed in fixed skeletal traction with a halo fixation
device. When caring for this patient, the nurse may
assign which actions to the LPN/LVN? Select all
that apply.
1. Checking the patient’s skin for pressure from the
device
2. Assessing the patient’s neurologic status for
changes
3. Observing the halo insertion sites for signs of
infection
4. Cleaning the halo insertion sites with hydrogen
peroxide
5. Developing the nursing plan of care for the patient
6. Administering oral medications as prescribed

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Problem 17

The nurse is preparing a nursing care plan for a patient
with a spinal cord injury (SCI) for whom problems
of decreased mobility and inability to perform activities of daily living (ADLs) have been identified. The
patient tells the nurse, “I don’t know why we’re doing
all this. My life’s over.” Based on this statement, which
additional nursing concern takes priority?
1. Risk for injury
2. Decreased nutrition
3. Difficulty with coping
4. Impairment of body image

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Problem 18

Which patient should the charge nurse assign to the
traveling nurse, new to neurologic nursing care, who
has been on the neurologic unit for 1 week?
1. A 34-year-old patient with newly diagnosed multiple sclerosis (MS)
2. A 68-year-old patient with chronic amyotrophic
lateral sclerosis (ALS)
3. A 56-year-old patient with Guillain-Barré syndrome (GBS) in respiratory distress
4. A 25-year-old patient admitted with a C4-level
spinal cord injury (SCI)

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Problem 19

The critical care nurse is assessing a patient whose
baseline Glasgow Coma Scale (GCS) score in the
emergency department was 5. The current GCS score
is 3. What is the nurse’s best interpretation of this
finding?
1. The patient’s condition is improving.
2. The patient’s condition is deteriorating.
3. The patient will need intubation and mechanical
ventilation.
4. The patient’s medication regime will need adjustments.

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Problem 20

A patient with multiple sclerosis tells the assistive personnel after physical therapy that she is too tired to
take a bath. What is the priority nursing concern at
this time?
1. Fatigue
2. Impaired safety
3. Decreased mobility
4. Muscular weakness

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Problem 21

An LPN/LVN, under the RN’s supervision, is assigned
to provide nursing care for a patient with GuillainBarré syndrome (GBS). What observation should the
LPN/LVN be instructed to report immediately?
1. Reports of numbness and tingling
2. Facial weakness and difficulty speaking
3. Rapid heart rate of 102 beats/min
4. Shallow respirations and decreased breath sounds

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Problem 22

The RN notes that a patient with myasthenia gravis
has an elevated temperature (102.2°F [39°C]), an increased heart rate (120 beats/min), and a rise in blood
pressure (158/94 mm Hg) and is incontinent of urine
and stool. What is the nurse’s best action at this time?
1. Administer an acetaminophen suppository.
2. Notify the health care provider (HCP) immediately.
3. Recheck vital signs in 1 hour.
4. Reschedule the patient’s physical therapy

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Problem 23

The nurse is providing care for a patient with an acute
hemorrhagic stroke. The patient’s spouse tells the
nurse that he has been reading a lot about strokes and
asks why his wife has not received alteplase. What is
the nurse’s best response?
1. “Your wife was not admitted within the time frame
that alteplase is usually given.”
2. “This drug is used primarily for patients who experience an acute heart attack.”
3. “Alteplase dissolves clots and may cause more
bleeding into your wife’s brain.”
4. “Your wife just had gallbladder surgery 6 months
ago, so we can’t use alteplase.”

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Problem 24

. The RN is supervising a senior nursing student who
is caring for a patient with a right hemisphere stroke.
Which action by the student nurse requires that the
RN intervene?
1. Instructing the patient to sit up straight and the
patient responds with a puzzled expression
2. Moving the patient’s food tray to the right side of
his over-bed table
3. Assisting the patient with passive range-of-motion
exercises
4. Combing the hair on the left side of the patient’s
head when the patient always combs his hair on the
right side

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Problem 25

Which actions should the nurse delegate to an experienced assistive personnel (AP) when caring for
a patient with a thrombotic stroke who has residual
left-sided weakness? Select all that apply.
1. Assisting the patient to reposition every 2 hours
2. Reapplying pneumatic compression boots
3. Reminding the patient to perform active range-ofmotion exercises
4. Assessing the extremities for redness and edema
5. Setting up meal trays and assisting with feeding
6. Using a lift to assist the patient up to a bedside
chair

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Problem 26

A patient who had a stroke needs to be fed. What
instruction should the nurse give to the assistive personnel (AP) who will feed the patient?
1. Position the patient sitting up in bed before he or
she is fed.
2. Check the patient’s gag and swallowing reflexes.
3. Feed the patient quickly because there are three
more patients to feed.
4. Suction the patient’s secretions between bites of
food.

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Problem 27

The nurse has just admitted a patient with bacterial
meningitis who reports a severe headache with photophobia (sensitivity to light) and has a temperature of
102.6°F (39.2°C) orally. Which prescribed intervention should be implemented first?
1. Administer codeine 15 mg orally for the patient’s
headache.
2. Infuse ceftriaxone 2000 mg IV to treat the infection.
3. Give acetaminophen 650 mg orally to reduce the
fever.
4. Give furosemide 40 mg IV to decrease intracranial
pressure.

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Problem 28

The nurse is mentoring a student nurse in the intensive
care unit while caring for a patient with meningococcal meningitis. Which action by the student requires
that the nurse intervene most rapidly?
1. Entering the room without putting on a protective
mask and gown
2. Instructing the family that visits are restricted to 10
minutes
3. Giving the patient a warm blanket when he says he
feels cold
4. Checking the patient’s pupil response to light every
30 minutes

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Problem 29

A 23-year-old patient with a recent history of encephalitis is admitted to the medical unit with new-onset
generalized tonic-clonic seizures. Which nursing activities included in the patient’s care would be best to
assign to an LPN/LVN under the nurse’s supervision?
Select all that apply.
1. Observing and documenting the onset and duration of any seizure activity
2. Administering phenytoin 200 mg PO three times a
day
3. Teaching the patient about the need for frequent
tooth brushing and flossing
4. Developing a discharge plan that includes referral
to the Epilepsy Foundation
5. Assessing for adverse effects caused by new antiseizure medications
6. Turning the patient to his or her side to avoid
aspiration

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Problem 30

Which nursing action will be implemented first if a
patient has a generalized tonic-clonic seizure?
1. Turn the patient to one side.
2. Give lorazepam 2 mg IV.
3. Administer oxygen via a nonrebreather mask.
4. Assess the patient’s level of consciousness.

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Problem 31

A patient who recently started taking phenytoin to
control simple partial seizures is seen in the outpatient clinic. Which information obtained during the
nurse’s chart review and assessment will be of greatest
concern?
1. The gums appear enlarged and inflamed.
2. The white blood cell count is 2300/mm3 (2.3 x
109/L).
3. The patient sometimes forgets to take the phenytoin until the afternoon.
4. The patient wants to renew her driver’s license in
the next month.

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Problem 32

After the nurse receives the change-of-shift report at
7:00 AM, which patient must the nurse assess first?
1. A 23-year-old patient with a migraine headache
who reports severe nausea associated with retching
2. A 45-year-old patient who is scheduled for a craniotomy in 30 minutes and needs preoperative
teaching
3. A 59-year-old patient with Parkinson disease who
will need a swallowing assessment before breakfast
4. A 63-year-old patient with multiple sclerosis (MS)
who has an oral temperature of 101.8°F (38.8°C)
and flank pain

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Problem 33

All of the following nursing care activities are included in the care plan for a 78-year-old man with
Parkinson disease who has been referred to the home
health agency. Which activities will the nurse delegate
to the assistive personnel (AP)? Select all that apply.
1. Checking for orthostatic changes in pulse and
blood pressure
2. Assessing for improvement in tremor after levodopa is given
3. Reminding the patient to allow adequate time for
meals
4. Monitoring for signs of toxic reactions to antiParkinson medications
5. Assisting the patient with prescribed strengthening
exercises
6. Adapting the patient’s preferred activities to his
level of function

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Problem 34

The nurse is in charge of developing a standard plan
of care for an Alzheimer disease care facility and is
responsible for assigning and supervising resident care
given by LPNs/LVNs and delegating and supervising
care given by assistive personnel (AP). Which activity
is best to assign to the LPN/LVN team leaders?
1. Checking for improvement in resident memory after medication therapy is initiated
2. Using the Mini-Mental State Examination to assess residents every 6 months
3. Assisting residents in using the toilet every 2 hours
to decrease risk for urinary incontinence
4. Developing individualized activity plans after consulting with residents and family

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Problem 35

A patient who has Alzheimer disease is hospitalized
with new-onset angina. Her spouse tells the nurse that
he does not sleep well because he needs to be sure the
patient does not wander during the night. He insists
on checking each of the medications the nurse gives
the patient to be sure they are “the same pills she takes
at home.” Based on this information, which nursing
problem is most appropriate for this patient?
1. Acute patient confusion
2. Care provider role stress
3. Increased risk for falls
4. Noncompliance with therapeutic plan

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Problem 36

The nurse is caring for a patient with a glioblastoma
who is receiving dexamethasone 4 mg IV push every 6
hours to relieve symptoms of right arm weakness and
headache. Which assessment information concerns
the nurse the most?
1. The patient no longer recognizes family members.
2. The blood glucose level is 234 mg/dL (13 mmol/L).
3. The patient reports a continuing headache.
4. The daily weight has increased 2.2 lb (1 kg).

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Problem 37

A 70-year-old patient with alcoholism who has become lethargic, confused, and incontinent during the
last week is admitted to the emergency department.
His wife tells the nurse that he fell down the stairs
about a month ago but that “he didn’t have a scratch
afterward.” Which collaborative interventions will the
nurse implement first?
1. Place the patient on the hospital alcohol withdrawal protocol.
2. Transport the patient to the radiology department
for a computed tomography scan.
3. Make a referral to the social services department.
4. Give the patient phenytoin 100 mg PO.

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Problem 38

Which patient in the neurologic intensive care unit
should the charge nurse assign to an RN who has been
floated from the medical unit?
1. A 26-year-old patient with a basilar skull fracture
who has clear drainage coming out of the nose
2. A 42-year-old patient admitted several hours ago
with a headache and a diagnosis of a ruptured berry
aneurysm
3. A 46-year-old patient who was admitted 48 hours
ago with bacterial meningitis and has an intravenous antibiotic dose due
4. A 65-year-old patient with an astrocytoma who has
just returned to the unit after undergoing a craniotomy

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Problem 39

The nurse is providing care for a patient newly diagnosed with early Alzheimer disease (AD). On assessment, which finding would the nurse expect to
discover?
1. Short-term memory impairment
2. Rapid mood swings
3. Physical aggressiveness
4. Increased confusion at night

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Problem 40

For which patient with severe migraine headaches would
the nurse question a prescription for sumatriptan?
1. A 58-year-old patient with gastroesophageal reflux
disease
2. A 48-year-old patient with hypertension
3. A 65-year-old patient with mild emphysema
4. A 72-year-old patient with hyperthyroidism

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Problem 41

A patient with Guillain-Barré syndrome is to undergo plasmapheresis to remove circulating antibodies thought to be responsible for the disease. Which
patient care action should the nurse delegate to the
experienced assistive personnel (AP)?
1. Observe the access site for ecchymosis or bleeding.
2. Instruct the patient that there will be three or four
treatments.
3. Weigh the patient before and after the procedure.
4. Assess the access site for bruit and thrill every 2 to
4 hours.

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Problem 42

Case Study and Question
The nurse is supervising a senior nursing student
who will provide nursing care for a 63-yearold man diagnosed with amyotrophic lateral
sclerosis (ALS).
Which statements by the student indicate
accurate understanding of the disease process,
assessment findings, and nursing care needed
for this patient?
Instructions: Read the case study on the left and circle the numbers that best answer the question. Select all that apply.
1. Patients usually die within 10 to 15 years of diagnosis.
2. Early symptoms include tripping, dropping things, and fatigue of extremities
3. ALS always leads to changes in consciousness and confusion.
4. Nursing care for a patient with ALS includes decreasing risk for aspiration and falls
5. There are no drugs and there is no cure for ALS.
6. The patient is likely to exhibit signs of depression.
7. The most common cause of death is respiratory tract infection.
8. Riluzole is a drug that can slow the progression of ALS.

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