NCLEX : Identifying Neural Conditions

Study concepts, example questions & explanations for NCLEX

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Example Questions

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Example Question #1 : Neural And Psychological Conditions

What is the most common cranial mononeuropathy in diabetic patients?

Possible Answers:

Auditory neuropathy

Bell's palsy

Third nerve palsy

Cranial mononeuropathy VI

Correct answer:

Third nerve palsy

Explanation:

Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.

Example Question #2 : Neural And Psychological Conditions

What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?

Possible Answers:

Huntington disease

Wilson's disease

Hereditary hemochromatosis

Aceruloplasminemia

Correct answer:

Wilson's disease

Explanation:

Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.

Example Question #3 : Neural And Psychological Conditions

A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course. 

The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?

Possible Answers:

Tremors

Visual hallucinations

Hypersomnolence

Hypertension

Seizure within the first 24 hours 

Correct answer:

Hypersomnolence

Explanation:

The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).

Example Question #1 : Identifying Neural Conditions

Approximately 80% of strokes are of what type?

Possible Answers:

None of these

Hemorrhagic

Ischemic

Transient ischemic attack

Correct answer:

Ischemic

Explanation:

Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes." 

Example Question #5 : Neural And Psychological Conditions

Which artery is most commonly involved in ischemic stroke?

Possible Answers:

The middle cerebral artery

The anterior cerebral artery

The posterior cerebral artery

The posterior inferior cerebellar arteries 

Correct answer:

The middle cerebral artery

Explanation:

The most common artery occluded in ischemic stroke is the middle cerebral artery, which supplies a large percentage of the frontal lobe and the lateral surface of the temporal and parietal lobes. Occlusion of this artery affects the motor and sensory areas of the face, throat, arm, hand and the areas for speech.

Example Question #2 : Identifying Neural Conditions

Which of the following is the most common etiology of intracerebral hemorrhagic stroke?

Possible Answers:

Arteriovenous malformation (AVM)

Medications

Trauma

Hypertension

Correct answer:

Hypertension

Explanation:

Hypertension is a leading etiology in intracerebral hemorrhagic stroke. Chronic hypertension can cause damage and stress to the blood vessel wall, leading to aneurism or increased risk of spontaneous rupture.

AVM, trauma, and medications such as blood thinners are all also responsible for a significant (though lesser) number of hemorrhagic strokes, or may be co-morbidities that increase the risk of a rupture in the presence of prolonged hypertension. 

Example Question #7 : Neural And Psychological Conditions

What is the most common cause of meningitis?

Possible Answers:

Viral infection

Bacterial infection

Fungal infection

Aseptic inflammation

Correct answer:

Viral infection

Explanation:

All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis: 

  • Neisseria meningitidis (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae type b (Hib)

Example Question #3 : Identifying Neural Conditions

A client has a history of spinal injury and the nurse is evaluating the client with the onset of new symptoms. The symptoms include hypertension, a throbbing headache, a slow heart rate of 40 beats per minute, and piloerection. 

The nurse recognizes these symptoms are consistent with what disorder?

Possible Answers:

Malignant hypertension

Brown Sequard syndrome

Neurogenic shock

Spinal shock

Autonomic dysreflexia

Correct answer:

Autonomic dysreflexia

Explanation:

These symptoms are evidence of autonomic dysreflexia, which is a sequela of spinal shock. It is a medical emergency and requires immediate intervention as it may lead to stroke, cardiac arrest, coma or death if untreated. 

Example Question #9 : Neural And Psychological Conditions

A 23-year-old male college student presents to the emergency room after experiencing a high fever, nausea, vomiting, and nuchal rigidity. The nurse recognizes that this combination of symptoms are indicative of bacterial meningitis. The nurse is aware cranial nerve dysfunction is related to the condition. 

Which of the following cranial nerves (CN) is correctly matched to its dysfunction?

Possible Answers:

Irritation of CN VI may cause hearing disturbances such as tinnitus. 

Irritation of CN III may cause papilledema as seen with increased intracranial pressure.

Irritation of CN VIII may cause deficits in facial movements. 

Irritation of CN V may lead to loss of the corneal reflex.

Irritation of CN II may cause ptosis, a drooping of the ipsilateral eyelid.

Correct answer:

Irritation of CN V may lead to loss of the corneal reflex.

Explanation:

The trigeminal nerve (CN V) is responsible for both sensory and motor functions of the face, including the corneal reflex which is also mediated by the facial nerve (CN VII).

CN II, optic nerve affects vision, including causing papilledema - swelling of the optic disc. CN III, oculomotor dysfunction may cause ptosis. Cranial nerve VIII, vestibulocochlear is responsible for hearing and cranial nerve VI, abducens is responsible for horizontal eye movements. 

Example Question #10 : Neural And Psychological Conditions

A 27 year old female presents complaining of an inability to "smile normally" or close her left eye. She states that she woke up and noticed that the left side of her face was "not responding" when she tried to blink, smile, or speak. She also feels a pain in her left ear. She has never experienced this before. The nurse does a physical exam, which is notable for left sided upper eyelid retraction, general left sided facial muscle weakness, and left sided brow droop. There are no cognitive or sensory defects noted. What is the most likely cause?

Possible Answers:

Bell's palsy

Transient ischemic attack

Myasthenia gravis

Otitis interna

Correct answer:

Bell's palsy

Explanation:

The symptoms and physical exam of this patient are consistent with a diagnosis of Bell's palsy, a rapid onset cranial nerve disorder that results in unilateral facial paralysis or weakness. Symptoms usually come on within 24-72 hours and may include facial tingling, ear pain, taste disturbance, headache, issues with balance, cognitive changes, and clumsiness. 

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