NCLEX : Symptoms and Tests for Neural Conditions

Study concepts, example questions & explanations for NCLEX

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Example Questions

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Example Question #1 : Symptoms And Tests For Neural Conditions

A client admitted to the neuro intensive care unit is having his level of responsiveness assessed by the nurse on duty. Her findings include eyes opening to verbal command, is disoriented but can converse, and obeys commands.

 What is this client's Glasgow Coma Scale score?

Possible Answers:


Correct answer:

Explanation:

The score of this client includes: eye open response is a , best verbal response is  and best motor response is .

Example Question #2 : Symptoms And Tests For Neural Conditions

An unconscious patient exhibits stiffly extended arms that are also adducted with the wrists hyperpronated. The nurse recognizes this presentation to be __________.

Possible Answers:

decorticate positioning

Babinski reflex

vestibulospinal reflex

crossed extensor reflex

decerebrate positioning

Correct answer:

decerebrate positioning

Explanation:

Decerebrate positioning is an involuntary response of abduction, extension, and hyperpronation of the upper extremities due to noxious stimuli. There also is hyperextension of the lower extremities and the feet are plantarflexed. Decorticate positioning involves "mummy baby" posture - elbows, wrists, and fingers flexed, and legs extended and rotated medially. The Babinski reflex involves the extension of the big toe following stimulation of the sole of the foot. The crossed extensor reflex is also known as the withdrawal reflex, which involves the differential flexion and relaxation of muscles in the withdrawal of a limb. Vestibulospinal reflexes involve the use of vestibular organs and skeletal muscle to maintain balance, posture, and coordination.

Example Question #3 : Symptoms And Tests For Neural Conditions

Swaying or inability to maintain balance while standing with the eyes closed is considered a positive finding in what test?

Possible Answers:

Rapidly alternating movement test

Gait test

Test for ataxia

Romberg's test

Correct answer:

Romberg's test

Explanation:

Romberg's test is an evaluation of both proprioception and vestibular function. The patient is asked to stand with eyes open, then to close their eyes and remain still. Any tilting or loss of balance is considered to be a sign of either proprioceptive or vestibular impairment, and should be evaluated further. 

Gait test assesses for gait abnormalities. Rapidly alternating movement test is done with the patient seated with their hands on their thighs. They are asked to rapidly turn their hands over, then return them palms down to their thighs 10 times. This test is evaluating for dysdiadochokinesis, or inability to perform rapidly alternating movements. Ataxia, or the loss of control of bodily movements, is not a specific test, but rather a clinical finding.

Example Question #4 : Symptoms And Tests For Neural Conditions

A 46-year-old patient presents with dysdiadochokinesis (an inability to perform rapidly alternating movements). What condition is the most common cause of dysdiadochokinesis in adults?

Possible Answers:

Lesion in the pons

Cerebellar lesion

Parkinson's disease

Multiple sclerosis

Correct answer:

Multiple sclerosis

Explanation:

In adults, the most common cause of dysdiadochokinesia is multiple sclerosis.

Cerebellar lesion is the most common cause of this finding in children. This symptom is not a normal finding in Parkinson's disease, or in pontine gliomas (tumors of the pons), though neurological impairment or ataxia itself may make rapidly alternating movements difficult.

Example Question #5 : Symptoms And Tests For Neural Conditions

A 26-year-old woman presents to urgent care after a bike accident in which she got "a bad bump on the head." She was not wearing a helmet. She must now be assessed for increased intracranial pressure. All of the following are signs of increased intracranial pressure except __________.

Possible Answers:

migraine aura that persists after headache has resolved

effort-related or positional headache 

one or both pupils are dilated and unresponsive to light

altered consciousness

Correct answer:

migraine aura that persists after headache has resolved

Explanation:

Increased intracranial pressure can be chronic or acute. The nurse must assess for pupilary response, level of consciousness, and quality of headache if present, in addition to motor response.

Migraine aura that persists after headache has resolved should be evaluated for stroke, transient ischemic attack, or arteriovenous malformation. 

Example Question #6 : Symptoms And Tests For Neural Conditions

Which of the following terms denotes neurological impairment of the ability to speak or understand language?

Possible Answers:

Ataxia

Dysmetria

Aphasia

Apraxia

Correct answer:

Aphasia

Explanation:

Aphasia is the term for neurological impairment of a person's ability to speak or understand language. 

The other terms listed all denote various deficiencies:

  • Ataxia is a loss or lack of coordinated motor function. 
  • Apraxia describes a lack of motor planning or inability to execute a specific intentional movement.
  • Dysmetria is an inability to judge distance when attempting movements such as grasping at a nearby object

Example Question #7 : Symptoms And Tests For Neural Conditions

The nurse cares for a patient who is prescribed phenytoin for seizures. Which of the following serum drug levels would most concern the nurse?

Possible Answers:

Correct answer:

Explanation:

The therapeutic serum phenytoin level is between .

 would be below the therapeutic level and may be due to non-compliance by the client or increased metabolism of the drug. The other options are within the listed therapeutic range.

Example Question #8 : Symptoms And Tests For Neural Conditions

Which of the following is a term for an abnormal surge or excess of electrical activity in the brain?

Possible Answers:

Twitch

Spasm

Dyskinesia

Seizure

Correct answer:

Seizure

Explanation:

A seizure is defined as an abnormal surge or excess of electrical activity in the brain. This can result in partial or total loss of consciousness, and may cause muscular spasms, twitches, or other types of dyskinesia (disorders of movement). Spasms, twitches, and dyskinesias are not always caused by seizure disorders, however - they may be caused by a wide range of neuromuscular dysfunctions. 

Example Question #9 : Symptoms And Tests For Neural Conditions

Schizophrenic individuals frequently have abnormally high levels of what signaling molecule?

Possible Answers:

Dopamine

Acetylcholine

Serotonin

Norepinephrine

Correct answer:

Dopamine

Explanation:

While many people with schizophrenia do seem to have dysfunctions in multiple signaling molecules, excess levels of dopamine have been clearly associated with this disorder. 

Example Question #10 : Symptoms And Tests For Neural Conditions

Hank is a schizophrenic 46 year old male. He experiences a persistent belief that a particular television commercial actor is addressing him directly, and that the commercial was created specifically to communicate with him. What type of delusion is Hank experiencing?

Possible Answers:

Delusion of control

Delusion of reference

Cotard delusion

Erotomania

Correct answer:

Delusion of reference

Explanation:

The belief that general or innocuous events exist specifically for or relate specifically to an individual is called a delusion of reference. Examples include belief that a billboard or television commercial is attempting to communicate directly to an individual, the ascribing of significance to random coincidences, or the observation of coded signals or signs in the general environment.

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