Answer key practice neuro exams

Answers and Rationale

1. Answer: A. Body temperature control.

The body’s thermostat is located in the hypothalamus; therefore, injury to that

area can cause problems of body temperature control.

 Option B: Balance and equilibrium problems are related to cerebellar

damage.
 Option C: Visual acuity problems would occur following occipital
or optic nerveinjury.
 Option D: Thinking and reasoning problems are the result of injury to
the cerebrum.

2. Answer: C. Lidocaine (Xylocaine)

Administering lidocaine via an endotracheal tube may minimize elevations in

ICP caused by suctioning.

 Option A: Phenytoin doesn’t reduce ICP directly but may be used to

abolish seizures, which can increase ICP. However, phenytoin isn’t
administered endotracheally.
 Option B and D: Although mannitol and furosemide may be given to
reduce ICP, they’re administered parenterally, not endotracheally.

3. Answer: C. Perform a lumbar puncture.

The client’s history and assessment suggest that he may have increased
intracranial pressure (ICP). If this is the case, lumbar puncture shouldn’t be
done because it can quickly decompress the central nervous system and,
thereby, cause additional damage.

 Option A: After a head injury, barbiturates may be given to prevent

seizures.
 Option B: Mechanical ventilation may be required if breathing
deteriorates.
 Option D: Elevating the head of the bed may be used to reduce ICP.

4. Answer: A. Light flashes and floaters in front of the eye.

The sudden appearance of light flashes and floaters in front of the affected eye
is characteristic of retinal detachment.

 Option B: Difficulty seeing cars in another driving lane suggests a

gradual loss of peripheral vision, which may indicate glaucoma.
 Option C: Headache, nausea, and redness of the eyes are signs of
acute (angle-closure) glaucoma.
 Option D: Double vision is common in clients with cataracts.

5. Answer: B. Ineffective airway clearance

In Parkinson’s crisis, dopamine-related symptoms are severely exacerbated,

virtually immobilizing the client. A client confined to bed during such a crisis is
at risk for aspiration and pneumonia. Also, excessive drooling increases the risk
of airway obstruction. Because of these concerns, the nursing diagnosis of
Ineffective airway clearance takes highest priority. Although the other options
also are appropriate, they aren’t immediately life-threatening.

6. Answer: A. Stay with the client and encourage him to eat.

Staying with the client and encouraging him to feed himself will ensure
adequate food intake. A client with Alzheimer’s disease can forget how to eat.
  Options B, C, and D: Allowing privacy during meals, filling out the
menu, or helping the client to complete the menu doesn’t ensure
adequate nutritional intake.

7. Answer: C. Cerebral function

The mental status examination assesses functions governed by the cerebrum.

Some of these are orientation, attention span, judgment, and abstract
reasoning.

 Option A: Cerebellar function testing assesses coordination,

equilibrium, and fine motor movement.
 Option B: Intellectual functioning isn’t the only cerebral activity.
 Option D: Sensory function testing involves assessment of pain, light-
touchsensation, and temperature discrimination.

8. Answer: B. In 10 to 15 minutes

When used to treat status epilepticus, diazepam may be given every 10 to 15

minutes, as needed, to a maximum dose of 30 mg. The nurse can repeat the
regimen in 2 to 4 hours, if necessary, but the total dose shouldn’t exceed 100
mg in 24 hours.

 Option A: The nurse must not administer I.V. diazepam faster than 5
mg/minute. Therefore, the dose can’t be repeated in 30 to 45 seconds
because the first dose wouldn’t have been administered completely by
that time.
 Option C: Waiting longer than 15 minutes to repeat the dose would
increase the client’s risk of complications associated with status
epilepticus.

9. Answer: D. Cholinergic blocker

Atropine sulfate is a cholinergic blocker. It isn’t a parasympathomimetic agent,
a sympatholytic agent, or an adrenergic blocker.

10. Answer: A. Assessing the left leg

In the scenario, airway and breathing are established so the nurse’s next
priority should be circulation. With a compound fracture of the femur, there is a
high risk of profuse bleeding; therefore, the nurse should assess the site.

 Option B and D: Neurologic assessment is a secondary concern to

airway, breathing, and circulation.
 Option C: The nurse doesn’t have enough data to warrant putting the
client in Trendelenburg’s position.

11. Answer: B. Decreasing leukocyte infiltration at the site of ocular

inflammation.

Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration

at the site of ocular inflammation. This reduces the exudative reaction of
diseased tissue, lessening edema, redness, and scarring.

 Options C and D: Dexamethasone and other anti-inflammatory agents

don’t inhibit the action of carbonic anhydrase or produce any type of
miotic reaction.

12. Answer: C. Urine retention or incontinence

Urine retention or incontinence may indicate cauda equina syndrome, which

requires immediate surgery.

 Option A: An increase in pain on the second postoperative day is

common because the long-acting local anesthetic, which may have
been injected during surgery, will wear off.
  Option B: While paresthesia is common after surgery, progressive
weakness or paralysis may indicate spinal nerve compression.
 Option D: A mild fever is also common after surgery but is considered
significant only if it reaches 101° F (38.3° C).

13. Answer: B. Instilling one drop of pilocarpine 0.25% into both eyes
four times daily.

The abbreviation “gtt” stands for drop, “i” is the apothecary symbol for the
number 1, OU signifies both eyes, and “q.i.d.” means four times a day.
Therefore, one drop of pilocarpine 0.25% should be instilled into both eyes four
times daily.

14. Answer: B. The client uses a mirror to inspect the skin.

Using a mirror enables the client to inspect all areas of the skin for signs of
breakdown without the help of staff or family members.

 Option A: The client should keep the side rails up to help with
repositioning and to prevent falls.
 Option C: The paralyzed client should take responsibility for
repositioning or for reminding the staff to assist with it if needed.
 Option D: A client with left-side paralysis may not realize that the left
arm is hanging over the side of the wheelchair. However, the nurse
should call this to the client’s attention because the arm can get caught
in the wheel spokes or develop impaired circulation from being in a
dependent position for too long.

15. Answer: C. Helicopod

A helicopod gait is an abnormal gait in which the client’s feet make a half circle
with each step.
  Option A: An ataxic gait is staggering and unsteady.
 Option B: In a dystrophic gait, the client waddles with the legs far
apart.
 Option D: In a steppage gait, the feet, and toes raise high off the floor
and the heel comes down heavily with each step.

16. Answer: B. An isolation room three doors from the nurses’ station

A client with bacterial meningitis should be kept in isolation for at least 24 hours
after admission.

 Option A: During the initial acute phase, should be as close to the

nurses’ station as possible to allow maximal observation.
 Option C: Placing the client in a room with a client who has viral
meningitis may cause harm to both clients because the organisms
causing viral and bacterial meningitis differ; either client may contract
the other’s disease.
 Option D: Immunity to Bacterial meningitis can’t be acquired;
therefore, a client who previously had bacterial meningitis shouldn’t be
put at risk by rooming with a client who has just been diagnosed with
this disease.

17. Answer: C. Intestinal obstruction

Anticholinesterase agents such as pyridostigmine are contraindicated in a client

with a mechanical obstruction of the intestines or urinary tract, peritonitis, or
hypersensitivity to anticholinesterase agents.

 Options A, B, and D: Ulcerative colitis, blood dyscrasia, and spinal cord

injury don’t contraindicate use of the drug.

18. Answer: A. Vertigo, tinnitus, and hearing loss.

Ménière’s disease, an inner ear disease, is characterized by the symptom triad
of vertigo, tinnitus, and hearing loss. The combination of vertigo, vomiting, and
nystagmus suggests labyrinthitis. Ménière’s disease rarely causes pain, blurred
vision, or fever.

19. Answer: D. “Don’t fly in an airplane, climb to high altitudes, make

sudden movements, or expose yourself to loud sounds for 30 days.”

For 30 days after a stapedectomy, the client should avoid air travel, sudden
movements that may cause trauma, and exposure to loud sounds and pressure
changes (such as from high altitudes).

 Option A: Immediately after surgery, the client should lie flat with the
surgical ear facing upward; nose blowing is permitted but should be
done gently and on one side at a time.
 Option B: The client’s first attempt at postoperative ambulation should
be supervised to prevent falls caused by vertigo and light-headedness.
 Option C: The client must avoid shampooing and swimming to keep the
dressing and the ear dry.

20. Answer: C. Muscle weakness

The most common adverse reaction to dantrolene is muscle weakness. The drug
also may depress liver function or cause idiosyncratic hepatitis.

 Options A and B: Although excessive tearing and urine retention are

adverse reactions associated with dantrolene use; they aren’t as
common as muscle weakness.
 Option D: Muscle weakness is rarely severe enough to cause slurring of
speech, drooling, and enuresis.

21. Answer: A. Tachycardia

Systemic absorption of atropine sulfate can cause tachycardia, palpitations,
flushing, dry skin, ataxia, and confusion. To minimize systemic absorption, the
client should apply digital pressure over the punctum at the inner canthus for 2
to 3 minutes after instilling the drops.

 Options B, C, and D: The drug also may cause dry mouth. It isn’t
known to cause hypotension or apnea.

22. Answer: B. Ineffective breathing pattern

Because a cervical spine injury can cause respiratory distress, the nurse should
take immediate action to maintain a patent airway and provide adequate
oxygenation.

 Options A, C, and D: The other options may be appropriate for a client

with a spinal cord injury — particularly during the course of recovery —
but don’t take precedence over a diagnosis of Ineffective breathing
pattern.

23. Answer: D. Treatment of spasticity associated with spinal cord

lesions.

In addition to relieving painful muscle spasms, Diazepam also is recommended

for treatment of spasticity associated with spinal cord lesions. Diazepam’s use is
limited by its central nervous system effects and the tolerance that develops
with prolonged use.

 Option A: The parenteral form of diazepam can treat status epilepticus,

but the drug’s sedating properties make it an unsuitable choice for
long-term management of epilepsy.
 Options B and C: Diazepam isn’t an analgesic agent.

24. Answer: C. Turning the client’s head suddenly while holding the
eyelids open.
To elicit the oculocephalic response, which detects cranial nerve compression,
the nurse turns the client’s head suddenly while holding the eyelids open.
Normally, the eyes move from side to side when the head is turned; in an
abnormal response, the eyes remain fixed.

 Option A: The nurse introduces ice water into the external auditory
canal when testing the oculovestibular response; normally, the client’s
eyes deviate to the side of ice water introduction.
 Option B: The nurse touches the client’s cornea with a wisp of cotton to
elicit the corneal reflex response, which reveals brain stem function;
blinking is the normal response.
 Option D: Shining a bright light into the client’s pupil helps evaluate
brain stem and cranial nerve III functions; normally, the pupil
responds by constricting.

25. Answer: D. Pancuronium and succinylcholine both require cautious

administration.

The nurse must cautiously administer pancuronium, succinylcholine, and any

other neuromuscular blocking agent to a client with myasthenia gravis.

 Option A: Such a client isn’t less sensitive to the effects of a

neuromuscular blocking agent.
 Options B and C: Either succinylcholine or pancuronium can be
administered in the usual adult dosage to a client with myasthenia
gravis.

26. Answer: B. Cones.

Cones provide daylight color vision, and their stimulation is interpreted as color.
If one or more types of cones are absent or defective, color blindness occurs.
  Option A: Rods are sensitive to low levels of illumination but can’t
discriminate color.
 Option C: The lens is responsible for focusing images.
 Option D: Aqueous humor is a clear watery fluid and isn’t involved in
color perception.

27. Answer: C. Midbrain

Decerebrate posturing, characterized by abnormal extension in response to

painful stimuli, indicates damage to the midbrain.

 Options A and D: With damage to the diencephalon or cortex,

abnormal flexion(decorticate posturing) occurs when a painful stimulus
is applied.
 Option B: Damage to the medulla results in flaccidity.

28. Answer: A. Vision changes

Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms
of multiple sclerosis.

 Option B: Deep tendon reflexes may be increased or hyperactive — not

absent. Babinski’s sign may be positive.
 Option C: Tremors at rest aren’t characteristic of multiple sclerosis;
however, intentional tremors, or those occurring with purposeful
voluntary movement, are common in clients with multiple sclerosis.
 Option D: Affected muscles are spastic, rather than flaccid.

29. Answer: D. Call the physician immediately.

A headache may be an indication that an aneurysm is leaking. The nurse should

notify the physician immediately.
  Option A: Sitting with the client is appropriate but only after the
physician has been notified of the change in the client’s condition.
 Option B: The physician will decide whether or not an administration of
an analgesic is indicated.
 Option C: Informing the nurse manager isn’t necessary.

30. Answer: D. Cranial nerves IX and X.

Swallowing is a motor function of cranial nerves IX and X.

 Options A, B, and C: Cranial nerves I, II, and VIII don’t possess motor
functions. The motor functions of cranial nerve III include extraocular
eye movement, eyelid elevation, and pupil constriction. The motor
function of cranial nerve V is chewing. Cranial nerve VI controls lateral
eye movement.