Title WORKBOOK - NEURO (KEY) ✅

COMPREHENSIVE PHASE WORKBOOK NEUROLOGY NOVEMBER 2024 Philippine Nurse Licensure Examination Review SITUATION: A 32 year old bus driver was rushed to the ER after sustaining severe head injury following a head-on collision with a ten wheeler truck. Nurse Lea is utilizing the Glasgow Coma Scale in assessing the neurologic status of the driver. 1. Nurse Lea is assessing the motor function of the driver. She would plan to use which of the following to test the driver’s peripheral response to pain? A. Sternal rub B. Pressure on the orbital rim C. Nail bed pressure D. Squeezing the sternocleidomastoid muscle 2. In assessing eye opening, the nurse observed that the driver opens his eyes only when peripheral pain is inflicted. What score will the nurse give? A. 1 B. 2 C. 3 D. 4 3. What GCS Score would the nurse give if Juan’s eyes open in response to pain, has no verbal response, and has decerebrate posturing? A. 4 B. 5 C. 6 D. 7 4. Nurse Lea has poor understanding about the Glasgow Coma Scale scoring when she states which of the following, EXCEPT? I. GCS is not a tool for assessing a client’s response to stimuli II. GCS scores range from 3 (normal) to 15 (deep coma) III. The smaller the GCS score, the deeper the coma IV. GCS assesses 3 areas (eye opening, motor response, verbal response) A. I and II B. II and III C. II, III and IV D. III and IV Situation 2 – A 14 year old teenager was admitted due to photophobia, throbbing headache and nuchal rigidity. A history of pneumonia was elicited. Diagnosis: Bacterial Meningitis. 5. To help support the diagnosis of bacterial meningitis, the nurse looks for Brudzinski’s sign. She knows that it is present if she sees: A. Hyperextension of the neck with passive shoulder flexion B. Flexion of the legs with rebound tenderness C. Flexion of the hip and knees with passive flexion of the neck D. Hyperflexion of the neck with rebound flexion of the legs 6. 8 hours after admission, the teenager suddenly had a tonic-clonic seizure and was unconscious after. What should the nurse do FIRST? A. Check the pulse B. Administer Valium C. Place the client in a side-lying position D. Place a tongue blade in the mouth 7. A 16 year old high school student was rushed to the ER due to a head injury following a car accident. The nurse notes a clear drainage from the left ear. The nurse would suspect: A. Concussion B. Subdural hematoma C. Basilar skull fracture D. Epidural hematoma SITUATION: A farmer is being assessed in the emergency room after sustaining a fall from a coconut tree. Admission assessment reveals that he hit his head on the grounD. 8. While assessing the farmer, which of the following neurological signs is of most concern? A. Reduced sensory responses B. Flaccid paralysis C. Pupils fixed and dilated D. Diminished spinal reflexes 9. We would be able to determine that the intracranial pressure (ICP) is rising if which of the following pulse rate result in the VITAL SIGNS is noted during the course of the work shift? I. Increased temperature II. Decreased pulse III. Increased respirations IV. Decreased BP V. Decreased temperature VI. Increased pulse VII. Decreased respirations VIII. Increased BP A. 2, 4 and 6 B. 2 C. 1, 2, 7 and 8 D. 3, 4, 5 and 6 10. The farmer is drowsy and complains of chest pain. Which of the following doctor’s orders shouldn’t the nurse question? I. Elevate the head 30° II. Nitroglycerin III. Apply antibiotics ointment to abrasions IV. Codeine for pain A. 1, 2 and 3 B. 2 and 4 only C. 3 and 4 only D. 4 only 11. On the 6th hospital day, the client developed cerebral edema and is given mannitol intravenously. The nurse knows that the drug is effective with which renal result: I. Urinary output increases II. Respirations drop to 12 and become regular III. Client’s level of consciousness improves IV. Client has no seizures A. 1 and 3 B. 1 only C. 1, 2 and 3 D. All are correct 12. The physician orders hyperventilation of the mechanical ventilator in a patient with head injury suffering from increased intracranial pressure. The nurse recognizes that hyperventilation is used to: TOP RANK REVIEW ACADEMY, INC. Page 1 | 7
A. Promote cerebral vasodilation for more blood flow to the brain B. Promote respiratory alkalosis C. To control the temperature of the client and decrease metabolic demand D. To allow more oxygen delivery to the brain SITUATION: Marian R. consulted to the doctor due to muscle weakness and ptosis. She was diagnosed with myasthenia gravis. 13. Respiratory complications are common for individuals with myasthenia gravis because of: A. narrowed airways B. impaired immunity C. ineffective coughing D. viscosity of secretions 14. During her diagnostic workup, she was administered with Edrophonium HCL (Tensilon). If she really has myasthenia gravis, which of the following outcomes is expected? A. increase in symptoms B. drying of the mouth and throat C. increase in blood pressure D. increase in muscle strength 15. Marian R suddenly developed cholinergic crisis. The nurse administered an antidote. Which of the following s/sx would you expect? I. Increase urine output II. Constipation III. Increase secretions IV. Pupil dilation V. Decrease urine output VI. Salivation A. 1, 3 and 6 B. except 2 and 5 C. 2, 4 and 5 D. 1, 4 and 6 16. Marian R. had not been taking her medications regularly. She was rushed to the ER due to difficulty of breathing. If the client would undergo an arterial blood gas analysis, which of the following would be seen? A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis 17. When caring for a client with myasthenia gravis, an important nursing consideration would be to A. Prevent accidents from falls as a result of vertigo B. Maintain fluid and electrolyte balance C. Control situations that could increase intracranial pressure and cerebral edema D. Assess muscle groups toward the end of the day SITUATION: Lyndon J. sought consult as his son noticed pill rolling tremors. He was diagnosed with Parkinson’s Disease. 18. In order to decrease the frequency of tremors, which of the following actions should the nurse advise the family? A. Take a warm bath B. Hold an object in that hand C. Take diazepam (Valium) as needed D. Try to rest the hand and limit holding objects 19. Lyndon J’s son asks you about how he can help his father stand from a chair. Which of the following should you advise? A. Choose clothing with several snaps and buttons to increase the benefits of physical therapy B. Use a rocking motion to get up out of chairs C. Sit in a soft reclining chair to support joints while watching television D. None of the above 20. As Lyndon J. is discharged from the hospital, the home care nurse is doing her assessment on the client’s neurological status; the nurse would find the client’s gait to be: A. Staggering and unsteady B. Moonwalking but broad-based C. Walking on tips of toes D. Shuffling and propulsive SITUATION: Anthony C. is a school principal. During the flag raising ceremony, he suddenly experienced tonic clonic seizures. He was admitted in the ward for diagnostic workup. 21. A nurse was about to measure the intake and output of the patient when Anthony C. who was sitting on a chair begins seizing. Which of the following must the nurse do first? A. Insert a rubber slippers inside his mouth B. Ease the patient to the floor C. Lift the patient and put him on bed D. Ensure patient will not fall from the chair 22. Anthony C is scheduled for CT SCAN for the next day, noon time. Which of the following is the correct preparation as instructed by the nurse? A. Shampoo hair with Head and ShouldersTM thoroughly to remove oil and dirt and dandruff B. Shave scalp and securely attach electrodes to it C. Both A and B D. All are incorrect 23. Anthony C is placed on seizure precaution. All but one is not incorrect: A. Allow him to wear his own clothing B. Obtain his oral temperature C. Encourage to perform his own personal hygiene D. Encourage him to be out of bed 24. After his episode of seizure, which of the following patient status would you expect? A. Sleeps for a period of time B. Most comfortable walking and moving about C. Becomes restless and agitated D. Saying he is thirsty and hungry 25. Before, during and after seizure, the nurse knows that the patient is placed in what position? A. Low fowler’s B. Lateral C. Modified Trendelenburg D. Supine SITUATION: Mikee is an equestrian. During one of her races, she accidentally fell sustaining a spinal cord injury. 26. Her spinal cord injury led to paraplegia. Formation of urinary calculi is a complication that may be encountered by the client with paraplegia. A factor that contributes to this condition is: A. High fluid intake B. Increased intake of calcium C. Inadequate kidney function D. Increased loss of calcium from the bones 27. Another patient with a spinal cord injury at level C3 – C4 is being cared for by the nurse. What is the priority management? A. Determine the level at which the patient has intact sensation. B. Ineffective airway clearance C. Monitor respiratory effort and oxygen saturation level. D. Assess the level at which the patient has retained mobility. 28. A 16-year old with T8 spinal cord injury is seen also by the nurse. Given the patient’s deficits, which of the following is an unrealistic statement concerning her expected outcome? A. "I know this means being on a ventilator the rest of my life." B. "I know this means using a catheter for a while." C. "I know this means my legs won't work like before." D. None of the above TOP RANK REVIEW ACADEMY, INC. Page 2 | 7
SITUATION: George T. is a 74 year old construction worker. He was lifting hollow blocks when he suddenly felt an intense headache, vomiting, and photophobia. He was rushed to the ER and assessment reveals hemiplegia of the right side of his body. 29. In observing George T, the nurse should check for signs of increased intracranial pressure. Of the following combinations of symptoms the most indicative of increased intracranial pressure is: A. Slow bounding pulse, rising blood pressure, elevated temperature, stupor B. Rapid weak pulse, fall in blood pressure, low temperature, restlessness C. Weak rapid pulse, normal blood pressure, intermittent fever, lethargy D. Slow bounding pulse, fall in blood pressure, temperature below 36 C (97F), stupor 30. Since Mr. Buenaflor is unconscious, the nurse should expect him to be: I. Unable to react to painful stimuli II. Incontinent of urine and feces III. Incapable of spontaneous motion IV. Incapable of hearing A. 1 and 2 B. 2, 3 and 4 C. Except 1, 3 and 4 D. Except 1 and 2 31. George T soon regained consciousness. However, when asked about what his name was, he answered “And the lights all went out in Massachusetts.” This finding is consistent with damage to a part of: A. Cerebellum B. Cerebral Cortex C. Brainstem D. Frontal lobe 32. George T suffered from a hemorrhage stroke. His wife has been reading a lot about strokes and asks why her husband did not receive Alteplase. What is the nurse’s best response? A. “Why ask me? You’d better ask his doctor.” B. “This drug is used primarily for patients who experience an acute heart attack.” C. “Alteplase dissolves clots and may cause more bleeding into your husband’s brain.” D. “Alteplase should be given on the first three hours of stroke attack.” 33. Melissa was diagnosed with Bell’s palsy. The nurse assessing the client expects to note which of the following? I. Difficulty closing the eyelid on the affected side II. A symmetrical smile III. Paroxysms of excruciating pain in the lips and cheeks on the affected side IV. Speech difficulty A. 1, 2 and 4 B. 3 only C. 1 and 4 D. Except 1 and 4 34. What is the primary action of Decadron? A. Reduces cerebral edema B. Improves the CSF outflow C. Reduces CSF production D. Increases GFR 35. Which event may trigger pain in the patient with trigeminal neuralgia? A. Walking in the mall B. Sitting in the sun C. Eating lunch D. Sleeping 36. Guillain Barre is an autoimmune attack of the peripheral nerve myelin. The major precipitating factor or predisposing event that may lead to this syndrome is: A. Change in weather B. Exposure to allergens C. Infection D. Poor nutrition 37. Phenytoin (Dilantin) has been prescribed for a client. Based on an understanding of this medication, the nurse caring for the client should exclude: I. Administer good oral hygiene II. Dilute IV Dilantin with 5% dextrose III. Give Dilantin intravenously with PNSS IV. Maintain a Dilantin level of 30-50 ug/ml A. 1 and 2 B. 2 and 4 C. 1 only D. 3 only 38. Harry D was diagnosed with amyotrophic lateral sclerosis. An early symptom associated with this is: A. Fatigue while talking B. Change in mental status C. Numbness of the hands and feet D. Spontaneous fractures 39. Helena is a world-renowned figure skater. However, during one of her exhibition spins, she slipped on a patch of ice and hit her head. A CT scan of the head shows a collection of blood between the skull and dura mater. Which type of head injury does this finding suggest? A. Subdural hematoma B. Subarachnoid hemorrhage C. Epidural hematoma D. Contusion 40. A 50 year old female was rushed to the ER due to a head injury and an emergency surgery was indicated. A procedure wherein a portion of the cranium is removed to relieve pressure on the brain structures by providing space for expansion is: A. Lobectomy B. Decortication C. Craniotomy D. Craniectomy 41. Mariana O is a patient diagnosed with Alzheimer’s Disease. You are her home care nurse. Her family complains about inadequate nutritional intake. You should: A. Stay with the client and encourage him to eat. B. Help the client fill out his menu. C. Give the client privacy during meals. D. Fill out the menu for the client. 42. Mary H sustained head injuries which were later found out to have caused a subdural hematomA. You are performing a mental status examination. This gives you an idea about the status of: A. Cerebellar function B. Intellectual function C. Cerebral function D. Sensory function 43. Kiera H came to the ER due to pain on A periorbital area, tearing, blurred vision, and photophobia in her right eye. A small, irregular, nonreactive pupil was seen. Atropine sulfate was prescribed. Atropine sulfate belongs to which drug classification A. Parasympathomimetic agent B. Sympatholytic agent C. Adrenergic blocker D. Cholinergic blocker 44. Nurse Yannie is caring for a client who underwent a lumbar laminectomy two (2) days ago. Which of the following findings should the nurse consider abnormal? A. More back pain than the first postoperative day. B. Paresthesia in the dermatomes near the wounds. C. Urine retention or incontinence. D. Temperature of 99.2¬∞ F (37.3¬∞ C). TOP RANK REVIEW ACADEMY, INC. Page 3 | 7
45. Gerrie complained of partial vision loss in both eyes. He was diagnosed with closed-angle glaucoma. The physician prescribes Pilocarpine ophthalmic solution, 0.25% gtt i, OU q.i.d. Based on this prescription, the nurse should teach the client or a family member to administer the drug by: A. Instilling one drop of pilocarpine 0.25% into both eyes daily. B. Instilling one drop of pilocarpine 0.25% into both eyes four times daily. C. Instilling one drop of pilocarpine 0.25% into the right eye daily. D. Instilling one drop of pilocarpine 0.25% into the left eye four times daily. 46. Rene L has been paralyzed on both legs and has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis? A. The client leaves the side rails down. B. The client uses a mirror to inspect the skin. C. The client repositions only after being reminded to do so. D. The client hangs the left arm over the side of the wheelchair. 47. You assessed a client with a hysterical disorder disorder. During the assessment you noticed that with each step, the client’s feet make a half-circle. To document the client’s gait, the nurse should use which term? A. Ataxic B. Dystrophic C. Helicopod D. Steppage 48. Serena S is admitted with bacterial meningitis pending CSF GS/CS results. Which hospital room would be the best choice for this client? A. A private room down the hall from the nurses’ station. B. An isolation room three doors from the nurses’ station. C. A semi-private room with a 32-year-old client who has viral meningitis. D. A two-bedroom with a client who previously had bacterial meningitis. 49. Aileen was diagnosed with myasthenia gravis and was prescribed with pyridostigmine 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the client’s history. Which preexisting condition would contraindicate the use of pyridostigmine? A. Ulcerative colitis B. Blood dyscrasia C. Intestinal obstruction D. Spinal cord injury 50. Yuriko X developed a ankylosis of the stapes in the oval window and undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction? A. “Lie in bed with your head elevated, and refrain from blowing your nose for 24 hours.” B. “Try to ambulate independently after about 24 hours.” C. “Shampoo your hair every day for ten (10) days to help prevent ear infection.” D. “Don’t fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days.” 51. Dantrolene was administered to a 34 year old who experienced malignant hyperthermia. Which of the following adverse effects should you watch out for? A. Excessive tearing B. Urine retention C. Muscle weakness D. Slurred speech 52. Nurse Jella is monitoring Myra for adverse reactions to atropine sulfate) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? A. Tachycardia B. Increased salivation C. Hypotension D. Apnea 53. A 35 year old male patient is admitted with a cervical spine injury sustained during a car racing accident. When planning this client’s care, the nurse should assign the highest priority to which nursing diagnosis? A. Impaired physical mobility B. Ineffective breathing pattern C. Disturbed sensory perception (tactile) D. Self-care deficit: Dressing/grooming 54. Ben D, a 40 year old mailman has a history of painful, continuous muscle spasms. His physician prescribes diazepam. He tells you that Diazepam seems familiar. You tell him that in addition to being used to relieve painful muscle spasms, Diazepam also is recommended for: A. Long-term treatment of epilepsy. B. Postoperative pain management of laminectomy clients. C. Postoperative pain management of diskectomy clients. D. Treatment of spasticity associated with spinal cord lesions. 55. Ellen A was brought to the ER after being found lying on a pavement unconscious. In the intensive care unit, the nurse checks the client’s oculocephalic (doll’s eye) response by: A. Introducing ice water into the external auditory canal. B. Touching the cornea with a wisp of cotton. C. Turning the client’s head suddenly while holding the eyelids open. D. Shining a bright light into the pupil. 56. While reviewing a client’s chart, the nurse notices that the female client has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? A. The client may be less sensitive to the effects of a neuromuscular blocking agent. B. Succinylcholine shouldn’t be used; pancuronium may be used in a lower dosage. C. Pancuronium shouldn’t be used; succinylcholine may be used in a lower dosage. D. Pancuronium and succinylcholine both require cautious administration. 57. Brad N first found out that he was color blind during a driving test. You understand that this client has a problem with: A. Rods. B. Cones. C. Lens. D. Aqueous humor. 58. Isko K was trapped inside a collapsed building for hours after an earthquake. He was rushed to the ER unconscious. During your neuro exam, you observed that he responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain? A. Diencephalon B. Medulla C. Midbrain D. Cortex 59. Merle is 45 year old teacher who was diagnosed with multiple sclerosis. Upon review of her history, which of the following s/sx would you expect A. Vision changes B. Absent deep tendon reflexes C. Tremors at rest D. Flaccid muscles 60. The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform? TOP RANK REVIEW ACADEMY, INC. Page 4 | 7