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NCLEX RN NEUROLOGICAL EXAM QUESTIONS AND ANSWERS
WITH DETAILED RATIONALES UPDTE 2025/
NB: ANSWERS & RATIONALES PROVIDED BEFORE EACH QUESTION
b. "It helps us to monitor and adjust the dose to work better."
The nurse has clearly stated the prupose of the frequent venipunctures in a simple and non-technical manner that answers the client's questions. "a" is not correct because it does not address the inquiry about every 6 hour bloodwork, plus the phrasing of the statement could easily frighten the client. "c" is incorrect. This standard response does not answer the client's question about blood work nor does it provide further information about the treatment.
"d" is incorrect because it is vague and does not address the client's question about frequent blood work.
A client hospitalized with a deep vein thrombosis (DVT is on a heparin infusion. The client asks the nurse why it is necessary to have blood drawn every six hours. What is the best explanation for the nurse to provide?
a. "The medicine might make your blood much too thin."
b. "It helps us to monitor and adjust the dose to work better."
c. "it is required for anyone getting heparin intravenously."
d. "The test results tell us whether the treatment is working."
c. Gather and apply dressings to open wounds.
An LPN/VN's scope of practice includes tasks such as wound care. Covering open wounds will help decrease bacterial exposure until the registered nurse or primary healthcare provider can assess and treat each wound. If the LPN notes any serious bleeding situations, it would need to be reported immediately to the RN. "a" is incorrect. Although it will be crucial to identify each incoming client, the LPN/VN's scope of practive does not include assessment. THat task would require an RN or primary healthcare provider. "b" is incorrect. In a mass casualty situation, triage allows the nurse or primary healthcare provider to quickly determine which clients are critical versus those stable enough to wait. Because this involves assessment, an LPN/VN would not be assigned this task. "d" is incorrect. Initiating intravenous lines is not within the scope of practice of the LPN/VN. Ad
An LPN/VN has been floated to the emergency room following a chemical plant explosion. What task would be best to assign to the LPN/VN?
a. Identify and assess each incoming client.
b. Triage and assign color-coded tags to each client.
c. Gather and apply dressings to open wounds.
d. Initiate oxygen and IV lines as needed.
c. Adolescent obesity is usually an inability to recognize signals of hunger or satiety.
While all the options could be true in some cases, the mose accurate and comprehensive basis for obesity is an individual's failure to recognize, or achkowledge, signals of hunger or satiety. Neural circuitry, along with specific body hormones, drives sensations of hunger and feeling satisfied. Adolescents experience fluctuating hormones, physical changes and emotional adjustments which can disrupt body functions, including recognitions of brain signals. "a" is incorrect. Though self-esteem or concern about physical appearance is common with adolescents, it is not necessarily a cause for obesity. "b" is incorrect. Weight issues are often related to an imbalance between caloric intake and energy expenditure. While adolescents frequently snack on high-calorie junk foods in response to stress or boredom, there are more significant
The nurse is discussing information on adolescent obesity with parents of highschool students. What statement by the nurse is most comprehensive regarding obesity among teens?
a. Obesity among teens is often accompanied by psychologic issues like poor self-esteem.
b. Weight issues among teens are often due to excess eating out of boredom or stress.
c. Adolescent obesity is usually an inability to recognize signals of hunger or satiety.
d. Undiagnosed problems of the thyroid or pituitary contribute to teen obesity.
a. Plate guards
b. Transfer belt
c. Raised toilet seat
d. Long handles shoe horn
e. Wide grip utensils
The goal is to promote self-care by the client as much as possible. The case manager should evaluate the need for assistive devices to help with eating, bathing, dressing, and ambulating. The plate guard will prevent food from being pushed off of the plate. The transfer belt will provide safety for the client and family member who is assisting the client to get up into a chair or back in bed. A raised toilet seat makes it easier for the client to sit on the toilet without falling. The long handled shoe horn allows the client to put on shoes without assitance. Wide grip utensils accommodate a weak grip. "f" is incorrect. It is hard for someone with hemiplegia to use buttons. Velcro fasteners are best.
A case manager is evaluating a client diagnosed with hemiplegia due to cerebral vascular accident for assistive devices that will be needed upon discharge. Which resources should the case manager include for this client?
d. Client with an open chest wound that is beginning to show signs of tacheal deviations.
b. Client with blunt trauma to the spine that is unable to move extremities.
c. Client with a 4 inch (10.16 cm) laceration to the lower leg with moderate bleeding.
a. Client with traumatic amputations with agonal respirations.
d. The client with a open chest wound should be seen first. This client is one whose life could potentially be spared if lifesaving measures are taken. This client may be developing a pneumothorax and may need an immediate needle decompression. The client would also need a dressing that is taped down on 3 sides applied over the chest wound.
b. The second client to be seen is the one with blunt trauma to the spine. Although this client needs emergency treatment ASAP due to having probable spinal infury with paralysis, this client's condition is not likely to deteriorate as fast as the client with the open
A mass casualty disaster has occurred and clients are being received at the emergency department. In what order should the nurse assess these clients? Sort from highest priority to lowest priority.
a. Client with traumatic amputations with agonal respirations.
b. Client with blunt trauma to the spine that is unable to move extremities.
c. Client with a 4 inch (10.16 cm) laceration to the lower leg with moderate bleeding.
d. Client with an open chest wound that is beginning to show signs of tacheal deviations.
a. Celecoxib
b. Ibuprofen
c. Naproxen
e. Indomethacin
a, b, c, and e are correct. NSAIDs, such as celecoxib, ibuprofen, naproxen, and indomethacin preven platelet aggregation. This can result in a tendency for bleeding after a laminectomy with spinal fusion surgery.
"d" is incorrect. Acetaminophen is a peripheral-acting analgesic and not an NSAID.
A client has bee instructed not to take non-steroidal anti-inflammatory drugs (NSAIDs) post lumbar laminectomy with spinal fusion. The nurse knows that education was successful when the client identifies which medications should be avoided?
a. Celecoxib
b. Ibuprofen
c. Naproxen
d. Acetaminophen
e. Indomethacin
b. Semi-Fowler
If a client has increasing abdominal girth, they have more pressure on their abdomen and need to sit up. The head of the bed may be elevated 30 degrees or higher if the client needs help breathing.
"a" and "c" are incorrect. They would make it more difficult to breath. "d" would not benefit the client.
The nurse is assessing a client with advanced cirrhosis and notes an abdominal girth increase of 5 inches (12.7 cm) since yesterday. What is the best position for the nurse to place this client?
a. Supine
b. Semi-Fowler
c. Trendelenburg
d. Lateral, left side
c. A client with breast cancer who is experiencing severe nausea and vomiting after chemotherapy.
e. A client who takes phenytoin for partial seizures.
c and e are correct. A client with severe N?V after chemo is at an increased risk for ineffective oral hygiene due to vomiting, decreased oral intake, and the effects of the chemo on the oral mucosa. Phenytoin causes gingival overgrowth, swelling, and bleeding of the gums. This can make oral hygiene more difficult.
"a" is incorrect. The client can perform oral hygiene with minimal assistance. Knee surgery and opioid pain medication do not interfere with oral hygiene.
"b" is incorrect. Movement for one side of the body is controlled by the opposite side of the brain. This client's right hand would not be impacted by a right-sided stroke.
"d" is incorrect. This client can perform oral hygiene with minimal assistance. Ther is no information in this option that would put
The nurse is assignent five clients on a medical flood. When planning care, the nurse recognizes which clients to be at greatest risk for ineffective oral hygiene?
Select all that apply.
a. A client who has just had knee surgery taking opioids for pain.
b. A right handing client who had a stroke affecting the right hemisphere of the brain.
An experienced RN snf zlpn are working with an RN who has just recently passed the NCLEX. THe team is assigned to care for 12 clients on the medical-surgical unit. Which factor is most important to consider when delegating?
a. Lack of experience of the new graduate RN.
b. The preferences of the LPN who has experience.
c. The RN's desire to avoid confrontation.
d. The assignment of equal number of clients to the RN, the LPN, and the new nurse.
d. Notify the HCP
Notify the HCP if diarrhea occurs. It can promote the development of C. diff. infection. Cephalosporin difficile is a toxin producing bacteria that causes antibiotics-associated colitis, and can occur with ABX therapy. Cephalosporin is one of the most common antibiotics that cause C. diff.
"a" is incorrect. Taking a probiotic, stopping the ABX, or switching to another ABX are standard treatments for ABX induced diarrhea. Administering an anti-diarrheal is not recommended for ABX induced diarrhea.
"b" is incorrect. Increasing fluid intake will healp with the associated dehydration seen with diarrhea, but will not correct the problem or decrease the risk of C. diff.
"c" is incorrect. If the client has GI upset, then cephalosporin may be given with food. However, the most important thing to worry about is the development of C. diff. infection. Notifying the HCP is the most important action.
What action is most important for the nurse to take when a client receiving a cephalosporin develops abdominal cramping and diarrhea?
a. Administer antidiarrheal medication
b. Increase fluid intake
c. Provide food with the medication
d. Notify the HCP
c. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation."
Buspirone does not depress the central nervous system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitters.
"a" is incorrect. Buspirone takes 1-2 weeks to take effect and can take up to 4 - 6 weeks to achieve full clinical benefits. Lorazepam is a benzodiazepine and begins to work within a few hours to 1-2 days.
"b" is incorrect. The client should not stop taking any antianxiety medication abruptly. Serious withdrawal symptoms can occur: depression, insomnia, anxiety, vomiting, sweating, convulsions, delirium.
"d" is incorrect. The nurse should be able to discuss medication administration with the primary HCP.
A client with the diagnosis of mild anxiety asks the nurse why the primary HCP switched medications from lorazepam to busipirone. What should the nurse tell the client?
a. "Lorazepam takes longer to start working than buspirone, so the primary HCP decided to switch medications."
b. "Buspirone can be stopped quickly if necessary."
c. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation."
d. "You need to ask your primary HCP why the medication was changed from lorazepam to buspirone."
b. Nitroglycerin ointment 2% 0.5 inch to chest.
c. Ceftriaxone 250 mg intramuscularly
e. Humalog 8 units subcutaneously
b, c, and e are correct. You do not want to get nitroglycerin on your hands. The medication would be absorbed into your skin. When giving a medication IM or SQ, there is a chance of being exposed to blood and you should wear gloves.
"a" is incorrect. Gloves are not needed when administering oral medications unless contact with the client's mucous membranes is anticipated or the medication is hazardous.
"d" is incorrect. Gloves are not needed when preparing ABX such as ceftriaxone by IV piggyback.
The nurse should wear gloves when administering which medication(s)?
Select all that apply.
a. Lorazepam 1 mg orally.
b. Nitroglycerin ointment 2% 0.5 inch to chest.
5 mcg x 80 kg = 400 mcg/minute is required.
Step 2: Determine the mL/min.
D/H x Q = 400 mcg/min./1600 mcg x 1 mL = 0.25 mL/min.
Step 3: Determine the flow rate (mL/H)
0.25 x 60 = 15 mL/H
The nurse is preparing to initiate a dopamine infusion per protocol. The primary HCP prescription is Dopamine 5 mcg/kg/min. IV per infusion pump. At what rate should the nurse set the pump? Use numbers only.
a. Fever
d. Dry cough
e. Dyspnea
a, d, and e are correct. Pneumocystis carinii pneumonia (PCP), now known as pneumocystis jirovecii, is caused by a fungus and occurs in clients with weakened immune systems. Expected assessment findings include fever, dry non- productive cough and dyspnea. Any additional symptoms are related to other co-morbidities and not the pneumonia itself.
"b" is incorrect. Night sweats are an early symptom of active TB and are often the difinitive symptom, along with a productive cough, that indicates the need for immediate testing and isolation.
"c" is incorrect. Hemoptysis is among the late signs of lung cancer, in addition to weight loss. Lung cancer is asymptomatic in its early stages.
A client has been admitted with a diagnosis of pneumocystis carinii pneumonia (PCP). What initial assessment findings would the nurse expect?
Select all that apply.
a. Fever
b. Night sweats
c. Hemoptysis
d. Dry cough
e. Dyspnea
a. Liver
c. Ibuprofen
d. Sardines
e. Ascorbic acid
a, c, d, and e are correct. The following foods can cause a false positive reading: red meats, liver, turnips, broccoli, cauliflower, melons, salmon, sardines, and horseradish. Medications altering the test include aspirin, ibuprofen, ascorbic acid, indomethacin, colchines, corticosteroids, cancer chemotherapeutic agents, and anticoagulants. Ingestion of vitamin rich foods can cause a false negative result.
"b" is incorrect/false. A tomato is not on the food list for false positive reading and does not have to be avoided.
A client who needs to have a stool speciman for an occult blood test is instructed by the nurse to avoid which substances two hours prior to testing?
Select all that apply.
a. Liver
b. Tomato
c. Ibuprofen
d. Sardines
e. Ascorbic acid
d. Communicating the client's impending death to the family while they are together.
Communicating news of the client's impending death to the family while they are together is the nurse's most important role. It is compassionate communication. The family needs to be informed about the situation so that they are prepared for the client's death and can provide support to one another.
"a" is incorrect. Providing respite time when death is imminent is not a priority. Family should be allowed to spend time with the client. They will, more than likely, want to be with the client in the last hours.
"b" is incorrect. When death is imminent, education of what to expect is appropriate, but it does not take priority over compassionate communication.
"c" is incorrect. Silence and listening sends a message of acceptance and comfort. Although important, allowing for expression of feelings is not more important than preparing the
The hospice nurse has beed assigned a new client who is being cared for at home by family members. Based upon the client's physical assessment, the nurse is aware that the client's death is imminent. What is the nurse's most important role in the care of the family at this time?
Hepatitis B virus (HBV) and HIV can be transmitted in similar ways, but HBV is more infectious. Studies show HBV is more readily transmitted via needle sticks than HIV. More than 1 million people currently have HIV in the United States. HBV is 50-100 times more infectious than HIV.
"a" is incorrect. Neither virus can be transmitted via toilet seats. Both are spread by contact with infected body fluids such as blood, semen, vaginal fluid, or from a mother to her baby during pregnancy or delivery.
"b" and "d" are incorrect. Both can be transmitted though body fluids during sexual contact, so condoms should be worn to reduce the chances of spreading the viruses. standard precautions should be implemented for both. The CDC recommends HBV vaccination for people who are at risk for or living with HIV, including men who have sex with men (MSM); people w
What information should be included when a nurse is teaching a group of college students about the transmission of hepatitis B and human immunodeficiency virus (HIV)?
a. HIV is transmitted via toilet seats whereas hepatitis B is not.
b. HIV is transmitted by sexual contact whereas hepatitis B is not.
c. Hepatitis B is more readily transmitted via needle sticks than HIV.
d. Neither virus is transmitted via blody fluids.
d. Elevate the extremities in bed for 30 minutes before application.
The client should have extremities elevated to encourage venous return and reduce the risk of swelling before the stockings are applied. These stockings must be the right size and fit for maximum benefit.
"a" is incorrect. Placing the stockins on immediately will cause further venous stasis and swelling.
"b" is incorrect. The extremities should be elevated before stocking application.
"c" is incorrect. This instruction alone does not give the client adequate information about the need to keep the lower extremities elevated before applying the stockings. This also delays care.
The client needs assistance to apply anti-embolism stockins each day in the long-term care facility. Today, as the nurse enters the room to apply the stockings, she finds that the client has been walking about the unit for 30 minutes. What should the nurse do first to lesson the risk of swelling of the lower extremities?
a. Ask the client to lie down and place the stockings on the legs.
b. Ask the client to sit on the bedside and place the stockings on the legs.
c. Tell the client that the nurse will return later to assist with the application.
d. Elevate the extremities in bed for 30 minutes before application.
b. Trousseau's sign noted when taking blood pressure.
When a client begins to lose large amounts of stool, important electrolytes, such as magnesium, are also lost. The presences of Trousseau's sign indicates the client has developed hypomagnesemia or hypocalcemia, and is at risk for more serious problems. The nurse should notify the primary HCP immediately.
"a" is incorrect. Many health issues can contribute to fatigue, including hospitalization, illness, and tube feedings. Dehydration secondary to the feedings could increase fatigue and the nurse will need to investigate further. However, another symptom is more concerning.
"c" is incorrect. Resisting care could be related to the discomfort of frequent turning and cleaning of the skin breakdown. It is important for hospitalized patients to remain mobile if possible. They should also be encouraged to participate in their care.
"d" is incorrect. There is no data on
Staff notifies the nurse that the client receiving tube feedins has increased liquid stool with new rectal excoriation. Following an assessment, the nurse is most concerned about what additional symptom?
a. Reports feeling increasingly tired.
b. Trousseau's sign noted when taking blood pressure.
c. Increased resistance to care activities.
d. Reports of abdominal cramping.
c. Beta blockers
Beta blockers help anxiety and tremors. They reduce the effects of adrenaline in the body. In times of stress and emergency, the adrenal gland produces adrenaline which acts on various organs to enable us to deal with the situation. For example, the heart beats faster due to adrenaline. The beta receptors on various organs allow them to accept adrenaline. Blocking them prevents them from accepting adrenaline reducing anxiety and feeling jittery.
"a" is incorrect. Steroids influence the body system in several ways, but they are used mostly for their strong anti- inflammatory effects and in conditions related to immune function (e.g., arthritis, colitis [ulcerative colitis and
c. Vitiligo
d. Hyperkalemia
a., c., & d. Correct: Clients with Addison's disease may present with nonspecific symptoms of confusion. As the continual reduced functioning of the adrenal medulla and adrenal cortex occurs, the client will present with cognitive impairment, delusions, and hallucinations. The reduced blood cortisol increases the adrenocorticotropic hormones (ACTH) and the melanocyte-stimulating activity. The feedback mechanism results in the hyperpigmentation of skin. A deficiency of mineralocorticoids will result in the decreased excretion of potassium which results in hyperkalemia.
b. Incorrect: The client diagnosed with Addison's disease will present with hypotension. The decrease in the production of the adrenal cortex steroids results in the increased excretion of sodium. The sodium loss can cause severe dehydration, decreased circulation, and hypotension.
e. Incorrect: The increased
Which clinical manifestation does the nurse expect to see in a client diagnosed with Addison's disease?
Select all that apply.
a. Confusion
b. Hypertension
c. Vitiligo
d. Hyperkalemia
e. Hypernatremia
f. Weight gain
c. Pregnancy test
c. Correct: RAI crosses the placenta and will affect the development of the fetus. If RAI is administered to a client who is pregnant, the fetus can experience mental retardation, hypothyroidism, and develop increased cancer risk. It is imperative that a pregnancy test should be prescribed prior to administering RAI. RAI should not be administered to a client who has a positive pregnancy test.
a. Incorrect: A thyroid scan is prescribed to evaluate the function and size and shape of the thyroid gland. This scan can identify the amount of thyroid hormone the thyroid is producing (hyperthyroidism) Also the thyroid scan will evaluated for the presence of thyroid nodules. Prior to the administration of RAI, the female client should have a pregnancy test prescribed. This test will not identify if the client is pregnant.
b. Incorrect: A calcium test is prescribed to analyze the calcium level in conditio
Which laboratory test should be assessed by the nurse prior to administering radioactive iodine (RAI) to a female client?
Choose one.
a. Thyroid Scan
b. Serum calcium
c. Pregnancy test
d. Metanephrine test
c. States hands are tingling.
c. Correct. Hypocalcemia is a severe complication of a thyroidectomy due to damage to the parathyroid. The negative feedback of a low parathyroid hormone (PTH) results in a decrease in serum calcium. PTH regulates the amount of calcium levels in the blood. Symptoms of hypocalcemia include numbness, and tingling on the extremities and face. As the calcium levels decrease the client may present with tetany and spasm of the larynx.
a. Incorrect: The postoperative diet for a client post thyroidectomy begins with ice chips and progresses to a liquid diet for approximately 2 days, and then a soft diet. The last dietary step is diet as tolerated. As the diets progress, the nurse should assess the ability of the client to swallow and changes in the voice such as hoarseness may indicate swelling.
b. Incorrect: On the 3rd postoperative day the client's bed can be positioned at 15 degrees. The n
A nurse on a surgical unit is assigned a client who had a total thyroidectomy 3 days ago. As the nurse enters the room which nursing assessment is the priority for this client?
Choose one.
a. Eating a soft diet.
b. Positioned at 15 degrees in bed.
c. States hands are tingling.
d. Expresses frontal neck pain level of 5 out of 10.
a. Milk
d. Chicken
d. Correct: The glycosylated hemoglobin (Hb A1C) test identifies the average serum glucose attached to hemoglobin over 90 days. The 90 days is correlated with 90 day life of hemoglobin. This test is reflective of how well the client's diabetes is controlled. The client has no restrictions prior to the test.
a. Incorrect: A fasting blood level indicates only the glucose level for at least 8 hours. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time.
b. Incorrect: Urine glucose testing is not an accurate reflection of blood glucose level and does not identify the average glucose level over a prolonged time. The test will identify whether there is an elevated amount of glucose in the urine.
c. Incorrect: Glucose tolerance requires the client fast for the first serum sample and then drink a glucose d
During a clinic visit 3 months following a client's diagnosis of type 2 diabetes, the client reports following a 1200 calorie diet and did not bring their glucose-monitoring record. The nurse will anticipate the prescription of which laboratory test?
Choose one.
a. Fasting blood glucose test
b. Urine glucose test
c. Glucose tolerance test (GTT)
d. Glycosylated hemoglobin level (HbA1C)
b. Asparagus, broccoli, cabbage, and cucumbers.
b. Correct: A calorie is the unit of energy needed to raise the temperature of 1 kilogram of water 1 degree of Celsius. The recommended percentage of calories from carbohydrates is 50% of the daily diet. Nonstarchy vegetables are lower in carbohydrates, so they do not raise blood sugar very much. They are also high in vitamins, minerals, and fiber, making them an important part of a healthy diet. Filling half your plate with nonstarchy vegetables means you will get plenty of servings of these superfoods. Examples include asparagus, broccoli, cabbage, brussel sprouts, carrots, and cucumbers.
a. Incorrect: The listed foods are high in protein. The intake of proteins will reduce appetite because protein takes longer to digest in the stomach. This results in a person feeling fuller for a extended period. The recommended percentage of daily calories from proteins is 20-25%
The nurse is providing dietary instructions to a client newly diagnosed with type 2 diabetes. Which food examples should make up the highest percentage of this client's recommended diet?
Choose one.
a. Pecans, eggs, pork chop
b. Asparagus, broccoli, cabbage, and cucumbers.
c. Lean hamburger, fish, skinless chicken
d. Whole milk, cheese, dark chocolate
b. 500 ml D5W at 100 mL per hour
e. 100 mL O.45% sodium chloride (NaCL) with potassium chloride KCL 10mEq IV
b. and e. Correct: The clinical manifestation of DKA is a serum glucose level of greater than 300mg/dL. The goal of the treatment for DKA is to reduce the serum glucose level. Prescribing D5W will increase the client's serum glucose level which is already elevated. The prescription should begin with 0.9% NaCL. to compensate for the effects of polyuria, IV normal saline, an isotonic solution. An isotonic solution is composed of equal concentrations of solutes and water which will increase vascular volume. Initially the potassium is normal or high and can decrease when treatment begins. This prescription should be questioned.
a. Incorrect: The prescription for arterial blood gases is appropriate. The arterial blood gases will identify if the client is in metabolic acidosis.
c. Incorrect: The goal of the treat
The nurse is reviewing the primary healthcare provider's (PHP) initial prescriptions for a client diagnosed with diabetic ketoacidosis (DKA)? Which prescription from the PHP would the nurse question?
Select all that apply.
a. Arterial blood gases
b. 500 ml D5W at 100 mL per hour
c. Serum glucose levels every hour
d. Hourly adjustment of Regular insulin IV according to serum glucose level protocol
e. 100 mL O.45% sodium chloride (NaCL) with potassium chloride KCL 10mEq IV
b. Calcium 12 mg/dL (3 mmol/L)
d. Phosphate 2.8 mg/dL (0.9 mmol/L)
b. and d. Correct: Normal calcium range is 9.0 - 10.5 mg/dl (2.25-2.62 mmol/L). The client's calcium level is 12 mg/dL (3 mmol/L) which is above normal range. Parathyroids secrete parathormone (PTH) for remodeling of the bones. PTH stimulates transfer calcium from the bone to the blood. Parathyroidism, an excess of PTH production by the parathyroids, will result in an increase in calcium movement from the bone to the blood. The normal range
