A patient with a growing brain hematoma has a rising intracranial pressure. Which principle explains why the pressure climbs unless the volume of cerebrospinal fluid or blood inside the skull falls to make room?
Monro-Kellie doctrine
✓
Frank-Starling law
Poiseuille's law
Fick principle
Correct Answer
Monro-Kellie doctrine
The Monro-Kellie doctrine states that the skull is a rigid, closed space holding brain tissue, blood and cerebrospinal fluid, so an increase in one must be offset by a decrease in another or pressure rises. The Frank-Starling law describes how stretch of the heart muscle affects the force of contraction. Poiseuille's law relates blood flow to vessel radius and resistance. The Fick principle is used to calculate cardiac output from oxygen uptake.
Category: Intracranial Pressure
Question 2
Why does the nurse give a prescribed stool softener to a patient with increased intracranial pressure?
To draw fluid out of swollen brain tissue
To prevent straining that raises intracranial pressure
✓
To replace potassium lost through the bowel
To speed absorption of seizure medication
Correct Answer
To prevent straining that raises intracranial pressure
Straining at stool is a Valsalva maneuver, which raises pressure in the chest and abdomen and impedes venous drainage from the head, so it can push intracranial pressure higher. To draw fluid out of swollen brain tissue describes an osmotic diuretic, not a stool softener. To replace potassium lost through the bowel is not the purpose, because stool softeners do not supply electrolytes. To speed absorption of seizure medication is wrong because stool softeners do not change how anticonvulsants are absorbed.
Category: Intracranial Pressure
Question 3
A patient with a severe head injury holds both arms rigidly flexed against the chest with the legs extended. How does the nurse document this finding?
Decerebrate posturing
Flaccid paralysis
Decorticate posturing
✓
Opisthotonos
Correct Answer
Decorticate posturing
Decorticate posturing is rigid flexion of the arms toward the chest, a sign of serious brain injury and worsening intracranial pressure that must be reported. Decerebrate posturing is rigid extension of the arms and legs and indicates deeper brainstem involvement. Flaccid paralysis is a complete loss of muscle tone with limp limbs. Opisthotonos is severe arching of the back and neck, not flexion of the arms.
Category: Intracranial Pressure
Question 4
The family of a patient with a newly found brain tumor says he has become careless, lost interest in his hobbies and acts unlike himself. Which area of the brain is the tumor most likely affecting?
Occipital lobe
Temporal lobe
Cerebellum
Frontal lobe
✓
Correct Answer
Frontal lobe
The frontal lobe governs personality, judgment and motivation, so a tumor there often shows up first as behavior and personality change. The occipital lobe processes vision, so a tumor there causes visual problems. The temporal lobe is linked to memory and to sensory disturbances such as smelling or tasting things that are not there. The cerebellum coordinates movement and balance rather than personality.
Category: Tumors and Infections
Question 5
A college student admitted with sudden fever, severe headache and a stiff neck develops small purple spots on the legs that do not fade with pressure. What does this rash suggest?
Meningococcal infection
✓
Viral meningitis
An allergic reaction to acetaminophen
Contact dermatitis from the bed linens
Correct Answer
Meningococcal infection
A petechial or purpuric rash with signs of meningitis points to Neisseria meningitidis, a rapidly progressive and contagious bacterial infection that requires immediate treatment and isolation. Viral meningitis is generally milder and does not typically cause this rash. An allergic reaction to acetaminophen usually produces raised, itchy hives that blanch rather than bleeding into the skin. Contact dermatitis from the bed linens causes red, itchy irritation where the skin touched the irritant, not purple spots with fever and neck stiffness.
Category: Tumors and Infections
Question 6
A patient with Guillain-Barre syndrome has weakness spreading into the face and throat. Which action does the nurse take when the meal tray arrives?
Lay the patient flat to rest the neck muscles
Sit the patient upright and watch for coughing or choking
✓
Offer a large meal quickly before fatigue sets in
Encourage thin liquids through a straw to ease swallowing
Correct Answer
Sit the patient upright and watch for coughing or choking
As the disease ascends it can weaken the muscles used for swallowing, so an upright position and close observation for coughing, choking or a wet voice reduce the risk of aspiration. Lay the patient flat to rest the neck muscles makes aspiration more likely. Offer a large meal quickly before fatigue sets in increases the chance of choking. Encourage thin liquids through a straw to ease swallowing is unsafe because thin liquids are the hardest to control when swallowing is weak.
Category: Autoimmune Disorders
Question 7
A patient with myasthenia gravis has a weak cough, cannot clear saliva and is anxious and increasingly short of breath. What should the nurse do first?
Encourage the patient to rest and reassess later
Offer sips of thin liquid to loosen the secretions
Notify the provider and prepare for airway support
✓
Place the patient flat to reduce the work of breathing
Correct Answer
Notify the provider and prepare for airway support
These findings signal a respiratory crisis, in which weak breathing and swallowing muscles threaten the airway, so the provider is alerted at once and equipment for ventilation support such as intubation or noninvasive ventilation is readied. Encourage the patient to rest and reassess later delays care for a life-threatening emergency. Offer sips of thin liquid to loosen the secretions adds aspiration risk when swallowing is failing. Place the patient flat to reduce the work of breathing is wrong because lying flat makes breathing harder; an upright position helps.
Category: Autoimmune Disorders
Question 8
A patient with myasthenia gravis says that household chores leave her too weak to finish the day. Which strategy should the nurse teach?
Finish all chores in one session to save time
Exercise to exhaustion daily to build strength
Stop using assistive devices to keep muscles active
Plan rest periods between activities
✓
Correct Answer
Plan rest periods between activities
Muscle strength in myasthenia gravis fades with repeated use and recovers with rest, so spacing tasks with rest periods conserves energy for the whole day. Finish all chores in one session to save time drains strength and worsens weakness. Exercise to exhaustion daily to build strength worsens fatigue rather than improving it. Stop using assistive devices to keep muscles active is wrong because tools such as a cane or electric can opener save energy.
Category: Autoimmune Disorders
Question 9
Which test measures how quickly nerve signals travel along pathways in the brain and spinal cord, a speed that is slowed in multiple sclerosis?
Evoked potential testing
✓
Electroencephalography
Lumbar puncture
Tonometry
Correct Answer
Evoked potential testing
Evoked potential tests record the brain's response to visual, auditory or sensory stimuli and show the delayed conduction caused by damaged myelin. Electroencephalography records ongoing electrical activity of the brain and is mainly used for seizures. Lumbar puncture samples cerebrospinal fluid rather than timing nerve conduction. Tonometry measures pressure inside the eye.
Category: Autoimmune Disorders
Question 10
The family of a patient with major neurocognitive disorder reports several problems at home. Which one should the nurse address first?
Misplacing keys and glasses
Leaving the house at night and getting lost
✓
Asking the same question repeatedly
Trouble finding the right word
Correct Answer
Leaving the house at night and getting lost
Wandering away and getting lost threatens the patient's physical safety, so it takes priority over problems that are frustrating but not dangerous. Misplacing keys and glasses is a common memory symptom that poses little immediate risk. Asking the same question repeatedly is upsetting for caregivers but not unsafe. Trouble finding the right word affects communication but does not endanger the patient.
Category: Neurodegenerative Disease
Question 11
A patient with advanced Parkinson disease coughs and clears the throat often during meals. Which complication do these findings place the patient at risk for?
Pressure injury
Urinary retention
Aspiration pneumonia
✓
Joint contracture
Correct Answer
Aspiration pneumonia
Parkinson disease weakens and slows the muscles of chewing and swallowing, so coughing during meals suggests food or fluid is entering the airway, which can lead to aspiration pneumonia. Pressure injury results from prolonged pressure on the skin, not from swallowing problems. Urinary retention is a bladder problem unrelated to meals. Joint contracture develops from immobility and muscle shortening, not from coughing while eating.
Category: Neurodegenerative Disease
Question 12
A patient with a seizure disorder is admitted and placed on seizure precautions. Which equipment should the nurse make sure is at the bedside?
A padded tongue blade
Wrist restraints
A cooling blanket
Suction and oxygen equipment
✓
Correct Answer
Suction and oxygen equipment
Suction and oxygen allow the nurse to clear secretions and support breathing during and after a seizure, which helps prevent aspiration and hypoxia. A padded tongue blade should never be placed in the mouth during a seizure because it can break teeth, injure the mouth or block the airway. Wrist restraints can cause injury when the body jerks against them; movement is allowed while hazards are removed. A cooling blanket is used for fever, not as standard seizure equipment.
Category: Seizures
Question 13
A patient has frequent atonic seizures, in which muscle tone is suddenly lost. Which nursing measure most directly protects against the main injury risk of this seizure type?
Fall precautions and help when walking
✓
A padded tongue blade kept at the bedside
Soft wrist restraints while out of bed
A dark, quiet room with visitors limited
Correct Answer
Fall precautions and help when walking
Atonic seizures cause a sudden loss of muscle tone, so the patient can drop to the floor without warning, and fall precautions with assistance during walking target that danger. A padded tongue blade kept at the bedside is unsafe because nothing is placed in the mouth during a seizure. Soft wrist restraints while out of bed can cause injury and do not prevent a fall. A dark, quiet room with visitors limited reduces stimulation but does nothing to prevent injury from a sudden drop.
Category: Seizures
Question 14
After teaching about migraine triggers, which statement by the patient shows understanding?
I will sleep in late on weekends to catch up on rest
I will keep a regular sleep schedule and not skip meals
✓
I will snack on aged cheese when I feel a headache coming
I will keep the lights bright so I can stay alert
Correct Answer
I will keep a regular sleep schedule and not skip meals
Irregular sleep and low blood sugar are common migraine triggers, so a steady sleep schedule and regular meals help prevent attacks. I will sleep in late on weekends to catch up on rest creates the irregular sleep pattern that can trigger a migraine. I will snack on aged cheese when I feel a headache coming is wrong because certain foods such as cheese can trigger attacks. I will keep the lights bright so I can stay alert is wrong because bright or flashing light can trigger migraines and worsen pain during one.
Category: Pain and Spinal Disorders
Question 15
A patient being treated for low back pain reports several new symptoms. Which one should the nurse report to the provider promptly?
Pain that worsens after sitting a long time
Stiffness after bending to lift a box
New loss of bladder control
✓
Aching that improves with rest
Correct Answer
New loss of bladder control
Low back pain with new bowel or bladder dysfunction can mean the bundle of nerve roots in the lower spinal canal (cauda equina) is being compressed, which needs urgent evaluation to prevent permanent damage. Pain that worsens after sitting a long time is a typical feature of ordinary low back pain. Stiffness after bending to lift a box reflects a common muscle strain. Aching that improves with rest is expected and not a warning sign.
Category: Pain and Spinal Disorders
Question 16
After surgery to remove a spinal tumor, the patient must keep the spine straight. How should the nurse turn the patient?
Have the patient twist at the waist to turn
Raise the head of the bed fully before turning
Pull the patient up by the arms to reposition
Log roll the patient as a unit with the spine aligned
✓
Correct Answer
Log roll the patient as a unit with the spine aligned
Log rolling moves the head, shoulders and hips together so the spine stays in line and the surgical site is protected from bending or twisting. Have the patient twist at the waist to turn rotates the spine, which is what must be avoided. Raise the head of the bed fully before turning flexes the spine. Pull the patient up by the arms to reposition strains the back and shoulders and does not keep the spine aligned.
Category: Pain and Spinal Disorders
Question 17
After a traumatic brain injury, which nursing goal is aimed at preventing secondary brain injury?
Preventing hypoxia and low blood pressure
✓
Restoring memory through cognitive drills
Healing the scalp laceration
Teaching the family about helmet use
Correct Answer
Preventing hypoxia and low blood pressure
Secondary injury develops after the initial trauma as swelling, low oxygen and poor blood flow damage more brain tissue, so keeping oxygenation and blood pressure adequate protects the brain that was not destroyed at impact. Restoring memory through cognitive drills is part of rehabilitation, not prevention of further injury. Healing the scalp laceration addresses the wound, not the brain. Teaching the family about helmet use is prevention of future injuries rather than of secondary damage now.
Category: Neurologic Injury
Question 18
Which set of responses does the nurse score when using the Glasgow Coma Scale?
Pupil size, pulse and respiratory rate
Eye opening, verbal response and motor response
✓
Orientation, memory and judgment
Reflexes, sensation and muscle tone
Correct Answer
Eye opening, verbal response and motor response
The Glasgow Coma Scale rates eye opening, the best verbal response and the best motor response to judge level of consciousness, and a falling score signals worsening brain function. Pupil size, pulse and respiratory rate are part of a full neurological check but are not scored on this scale. Orientation, memory and judgment are elements of a mental status examination. Reflexes, sensation and muscle tone are parts of a neurological examination, not the scale.
Category: Neurologic Injury
Question 19
A patient is admitted with a new spinal cord injury in the cervical region. Which assessment is the nurse's priority?
Bowel sounds
Skin over the sacrum
Respiratory rate and effort
✓
Strength of the leg muscles
Correct Answer
Respiratory rate and effort
Injury to the cervical cord can weaken or paralyze the muscles of breathing, so airway and breathing are assessed first and watched closely. Bowel sounds matter for later bowel care but are not an immediate threat to life. Skin over the sacrum is checked to prevent pressure injury, a later concern. Strength of the leg muscles helps define the injury but does not take priority over breathing.
Category: Neurologic Injury
Question 20
A patient with a cervical spinal cord injury has a sudden pounding headache, flushing above the injury and a sharply elevated blood pressure. After raising the head of the bed and loosening tight clothing, what should the nurse check next?
The pupils for reaction to light
The blood glucose level
The temperature of the feet
The urinary catheter for kinks or blockage
✓
Correct Answer
The urinary catheter for kinks or blockage
These signs describe autonomic dysreflexia, a dangerous rise in blood pressure set off by a stimulus below the level of injury, and a full bladder from a kinked or blocked catheter is the most common trigger, so finding and removing it stops the reflex. The pupils for reaction to light do not reveal the cause of the reflex. The blood glucose level is not a trigger of this response. The temperature of the feet does not identify the noxious stimulus driving the blood pressure up.
Category: Neurologic Injury