Neurological disorders NCLEX-RN Practice Questions focus on clinical decision-making that protects brain function, maintains perfusion, and prevents secondary injury. This topic-wise set emphasizes rapid assessment, early warning signs, and evidence-based interventions for conditions such as stroke, traumatic brain injury, seizures, meningitis, myasthenia gravis, Guillain-Barré syndrome, Parkinson’s disease, and multiple sclerosis. You will apply principles of intracranial dynamics, airway and hemodynamic management, neurodiagnostics, and medication safety. Designed for M. Pharma students preparing for the NCLEX-RN, these questions challenge you to prioritize care, interpret critical data, and anticipate complications. Use them to strengthen recognition of subtle neuro changes, master emergency responses, and refine pharmacologic strategies in complex neurological care.
Q1. A 68-year-old with sudden right-sided weakness arrives 2.5 hours after onset. CT shows no bleed. Vitals: BP 188/108 mm Hg, glucose 60 mg/dL, INR 1.0. What is the nurse’s priority action before thrombolysis?
- Administer labetalol to reduce BP below 185/110 mm Hg
- Obtain informed consent for alteplase administration
- Administer IV dextrose to correct hypoglycemia
- Insert a large-bore IV for alteplase infusion
Correct Answer: Administer IV dextrose to correct hypoglycemia
Q2. Following a concussion, which finding is the earliest and most sensitive indicator of increased intracranial pressure (ICP)?
- Projectile vomiting
- Cushing’s triad (hypertension, bradycardia, irregular respirations)
- Pupillary dilation and nonreactivity
- Subtle change in level of consciousness
Correct Answer: Subtle change in level of consciousness
Q3. A client with a T6 spinal cord injury has severe headache, BP 220/120 mm Hg, and bradycardia. What is the priority intervention?
- Place client in high Fowler’s and assess for bladder distention
- Administer IV fluid bolus rapidly
- Place client supine and assess blood glucose
- Apply warm blankets and turn the client
Correct Answer: Place client in high Fowler’s and assess for bladder distention
Q4. During a generalized tonic–clonic seizure, which immediate nursing action is most appropriate?
- Insert a padded tongue blade to prevent biting
- Restrain the client’s arms to prevent injury
- Turn the client onto the side and protect the head
- Attempt to open the jaw for oral suctioning
Correct Answer: Turn the client onto the side and protect the head
Q5. A client with aneurysmal subarachnoid hemorrhage is prescribed nimodipine. What is the primary purpose of this medication?
- Prevent seizure recurrence after the bleed
- Reduce cerebral vasospasm and delayed cerebral ischemia
- Lower systemic blood pressure to reduce rebleeding
- Enhance platelet aggregation to prevent ischemia
Correct Answer: Reduce cerebral vasospasm and delayed cerebral ischemia
Q6. Teaching for a client with myasthenia gravis on pyridostigmine should include which instruction regarding meals?
- Take the medication 30–45 minutes before meals to improve swallowing
- Skip the dose if experiencing dysphagia
- Take the medication at bedtime to consolidate dosing
- Take with high-protein meals to enhance absorption
Correct Answer: Take the medication 30–45 minutes before meals to improve swallowing
Q7. A client with Parkinson’s disease is prescribed carbidopa/levodopa. Which dietary teaching is most appropriate?
- Take with a high-protein meal to minimize nausea
- Avoid all vitamin B6-containing foods
- Distribute protein evenly throughout the day and avoid high-protein meals at dosing
- Take only on an empty stomach with water
Correct Answer: Distribute protein evenly throughout the day and avoid high-protein meals at dosing
Q8. A client with suspected bacterial meningitis is admitted. Which infection control measure is appropriate?
- Airborne isolation until afebrile for 24 hours
- Droplet precautions until 24 hours after effective antibiotics
- Contact precautions only for 72 hours
- Standard precautions are sufficient
Correct Answer: Droplet precautions until 24 hours after effective antibiotics
Q9. A client’s Glasgow Coma Scale: opens eyes to pain, makes incomprehensible sounds, and withdraws from pain. What is the GCS score?
- 6
- 8
- 9
- 10
Correct Answer: 8
Q10. After traumatic brain injury, a client has urine output 150 mL/8 hr, serum sodium 122 mEq/L, serum osmolality low, urine specific gravity 1.030. What action should the nurse anticipate?
- Restrict free water and administer hypertonic saline as prescribed
- Increase oral free water intake to correct hypernatremia
- Administer desmopressin to increase urine output
- Start hypotonic IV fluids to correct dehydration
Correct Answer: Restrict free water and administer hypertonic saline as prescribed
Q11. The provider orders a lumbar puncture for a client with severe headache, papilledema, and unilateral weakness. What is the nurse’s best action?
- Assist with immediate lumbar puncture to confirm diagnosis
- Premedicate with opioids and proceed to bedside LP
- Question the order and anticipate a head CT before LP
- Place the client in Trendelenburg to reduce herniation risk
Correct Answer: Question the order and anticipate a head CT before LP
Q12. A client in status epilepticus arrives via EMS. Which medication is the priority initial therapy?
- Oral phenytoin
- IV lorazepam
- IV magnesium sulfate
- Subcutaneous sumatriptan
Correct Answer: IV lorazepam
Q13. Which teaching is appropriate for a client with multiple sclerosis to minimize exacerbations?
- Take daily hot baths to relax spastic muscles
- Avoid infection, use cooling strategies, and pace activities
- Increase strenuous exercise during flares
- Eliminate all dietary fats to reduce inflammation
Correct Answer: Avoid infection, use cooling strategies, and pace activities
Q14. A client with intracerebral hemorrhage has the following new orders. Which one should the nurse question?
- Keep head of bed at 30 degrees
- Administer stool softeners
- Initiate IV heparin infusion
- Maintain systolic BP per protocol
Correct Answer: Initiate IV heparin infusion
Q15. A ventilated client with severe TBI requires ICP control. Which arterial blood gas target best optimizes cerebral blood flow while limiting ICP?
- PaCO2 20–25 mm Hg to induce vasoconstriction
- PaCO2 35–40 mm Hg to avoid cerebral vasodilation
- PaCO2 50–55 mm Hg to improve cerebral oxygen delivery
- PaCO2 45–50 mm Hg to reduce barotrauma
Correct Answer: PaCO2 35–40 mm Hg to avoid cerebral vasodilation
Q16. A client with a suspected basilar skull fracture has clear nasal drainage positive for glucose. Which action is contraindicated?
- Place a loose sterile gauze under the nose
- Insert a nasogastric tube for decompression
- Keep head of bed elevated
- Notify the provider of possible CSF leak
Correct Answer: Insert a nasogastric tube for decompression
Q17. A client with right hemispheric stroke is admitted. Which assessment finding is most consistent with this lesion?
- Expressive aphasia and cautious behavior
- Impulsive behavior and left-sided neglect
- Right facial droop and word-finding difficulty
- Bilateral intention tremor and cogwheel rigidity
Correct Answer: Impulsive behavior and left-sided neglect
Q18. Which lab value represents a contraindication to IV alteplase for acute ischemic stroke?
- Platelet count 85,000/mm³
- INR 1.1
- Blood glucose 160 mg/dL
- BP 170/95 mm Hg
Correct Answer: Platelet count 85,000/mm³
Q19. A client with a frontal lobe tumor is prescribed dexamethasone. What is the expected therapeutic effect?
- Reduction of vasogenic cerebral edema to improve neurologic function
- Prevention of seizures by stabilizing neuronal membranes
- Decrease CSF production to lower ICP
- Enhance cerebral perfusion by vasodilation
Correct Answer: Reduction of vasogenic cerebral edema to improve neurologic function
Q20. During an edrophonium (Tensilon) test to differentiate myasthenic vs cholinergic crisis, which nursing action is a priority?
- Have atropine available at the bedside
- Place the client in Trendelenburg
- Administer a long-acting anticholinesterase before the test
- Restrict oxygen to prevent hypoventilation
Correct Answer: Have atropine available at the bedside
Q21. A client with Guillain–Barré syndrome reports increasing dyspnea and weak cough. Vital capacity is falling. What is the priority?
- Provide an incentive spirometer every hour
- Prepare for elective intubation and mechanical ventilation
- Administer high-dose corticosteroids
- Encourage ambulation to improve respiratory function
Correct Answer: Prepare for elective intubation and mechanical ventilation
Q22. Teaching for trigeminal neuralgia includes which appropriate statement?
- I will massage my face daily to decrease pain sensitivity
- I will take carbamazepine and avoid triggers like cold drafts; I’ll report fever or sore throat
- I will chew on the affected side to desensitize nerves
- I will use very hot beverages to relax the nerve
Correct Answer: I will take carbamazepine and avoid triggers like cold drafts; I’ll report fever or sore throat
Q23. Post–carotid endarterectomy, which assessment requires the most immediate action?
- Mild incisional pain
- Blood pressure 150/88 mm Hg
- Hoarseness and increasing neck swelling
- Headache rated 2/10
Correct Answer: Hoarseness and increasing neck swelling
Q24. A comatose client exhibits extension of arms and legs with pronation and plantar flexion to painful stimuli. This finding indicates:
- Decorticate posturing consistent with hemispheric dysfunction
- Decerebrate posturing consistent with brainstem dysfunction
- Normal flexor response indicating intact pathways
- Psychogenic non-epileptic response
Correct Answer: Decerebrate posturing consistent with brainstem dysfunction
Q25. A client with suspected meningococcal meningitis arrives with fever, nuchal rigidity, and photophobia. What is the priority action?
- Obtain lumbar puncture before any other interventions
- Administer empiric IV antibiotics after drawing blood cultures
- Start corticosteroids 24 hours after antibiotics
- Delay therapy until CSF culture results are available
Correct Answer: Administer empiric IV antibiotics after drawing blood cultures
Q26. A client with high cervical spinal cord injury is hypotensive, bradycardic, and warm with dry skin. What initial management is appropriate?
- Initiate aggressive cooling
- Administer IV fluids and vasopressors to maintain MAP 85–90 mm Hg
- Give beta-blockers for heart rate control
- Administer diuretics to reduce preload
Correct Answer: Administer IV fluids and vasopressors to maintain MAP 85–90 mm Hg
Q27. Caring for a client with an external ventricular drain (EVD), which action is correct?
- Clamp the EVD continuously to prevent overdrainage
- Level the transducer at the tragus every time the head of bed is repositioned
- Lower the drainage chamber below bed level to increase CSF drainage
- Irrigate the catheter every shift to maintain patency
Correct Answer: Level the transducer at the tragus every time the head of bed is repositioned
Q28. A client on oral phenytoin via feeding tube has subtherapeutic levels. Which instruction is most appropriate?
- Increase tube feed rate during phenytoin dosing
- Hold tube feeds 1–2 hours before and after phenytoin administration
- Crush and mix phenytoin with tube feed to enhance absorption
- Switch to extended-release and give with feeds
Correct Answer: Hold tube feeds 1–2 hours before and after phenytoin administration
Q29. Which is the most effective immediate therapy for an acute cluster headache attack?
- Acetaminophen 1,000 mg PO
- 100% oxygen via non-rebreather mask at high flow
- Oral triptan at bedtime
- Propranolol daily
Correct Answer: 100% oxygen via non-rebreather mask at high flow
Q30. A client with ICP of 20 mm Hg has BP 110/70 mm Hg. What is the cerebral perfusion pressure (CPP)?
- 53 mm Hg
- 63 mm Hg
- 70 mm Hg
- 90 mm Hg
Correct Answer: 63 mm Hg
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