Neurologic NCLEX Practice Questions

NCLEX tests the FAST acronym (Face drooping, Arm weakness, Speech difficulty, Time to call), distinguishing ischemic from hemorrhagic stroke, tPA eligibility and time window (within 3-4.5 hours for ischemic), and priority nursing actions including keeping the client NPO, positioning, monitoring for worsening neuro status, and emergency notification.

Classic signs include Cushing triad (hypertension with widening pulse pressure, bradycardia, irregular respirations), altered level of consciousness (earliest sign), pupil changes, and worsening headache. Priority nursing actions include elevating HOB 30 degrees, reducing stimulation, maintaining adequate oxygenation, and reporting changes immediately.

Before a seizure: pad side rails, keep suction and oxygen at bedside, place bed in lowest position. During a seizure: do NOT restrain or insert anything into the mouth, turn the client to the side to protect the airway, time the seizure, and stay with the client. After (postictal): maintain side-lying position, assess airway and breathing, perform neuro checks, and document seizure characteristics. Status epilepticus (seizure lasting >5 minutes): medical emergency requiring IV benzodiazepines (lorazepam).

C3-C5 injury: affects diaphragm function (phrenic nerve), client may require mechanical ventilation. C6-C7: quadriplegia but some arm and wrist function preserved. T1-T12: paraplegia with intact upper extremity function. Key complication: autonomic dysreflexia (injuries above T6) triggered by bladder distension, fecal impaction, or tight clothing. Symptoms: severe hypertension, pounding headache, bradycardia, flushing above the level of injury. Priority action: sit the client up and remove the stimulus immediately.

GCS assesses eye opening (1-4), verbal response (1-5), and motor response (1-6). Total range: 3-15. A score of 15 is fully alert and oriented. Score of 8 or below indicates severe injury and typically requires intubation for airway protection. A declining GCS score (even by 1-2 points) is clinically significant and must be reported immediately. The motor component is the most reliable predictor of outcome.

CN II (optic): visual acuity and visual fields. CN III, IV, VI (oculomotor, trochlear, abducens): pupil response and extraocular movements (PERRLA). CN VII (facial): facial symmetry, ability to smile and frown. CN IX, X (glossopharyngeal, vagus): gag reflex and swallowing ability, critical to assess before oral intake after stroke or anesthesia. CN XII (hypoglossal): tongue movement and deviation. Changes in cranial nerve function can indicate increasing intracranial pressure or brainstem involvement.