NCLEX Neurological Disorders

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Question 1 of 5.

After receiving report, the nurse working on the step-down neurological unit begins care for four clients. Prioritize the order in which the nurse should assess the four clients.

A. 78-year-old who underwent evacuation of a chronic subdural hematoma 24 hours earlier and is recovering
B. 30-year-old who was diagnosed with viral meningitis 2 days earlier and wants to talk with the HCP
C. 24-year-old who had been unconscious at the scene of an MVA and is being admitted from the ED for observation
D. 40-year-old with Guillain-BarrÃ© who is currently receiving a third bedside plasmapheresis treatment being administered by another nurse.

Correct arrangement

C. 24-year-old who had been unconscious at the scene of an MVA and is being admitted from the ED for observation
A. 78-year-old who underwent evacuation of a chronic subdural hematoma 24 hours earlier and is recovering
B. 30-year-old who was diagnosed with viral meningitis 2 days earlier and wants to talk with the HCP
D. 40-year-old with Guillain-BarrÃ© who is currently receiving a third bedside plasmapheresis treatment being administered by another nurse.

Explanation: The 24-year-old who had been unconscious at the scene of an MVA and is being admitted from the ED for observation. The nurse should assess the newly admitted client first to determine whether there are changes in level of consciousness and any early signs of increased ICP. The 78-year-old who underwent evacuation of a chronic subdural hematoma 24 hours earlier and is recovering. This client should be assessed next because the client is postoperative day 1, but stable. The 30-year-old who was diagnosed with viral meningitis 2 days earlier and wants to talk with the HCP. This client has a self-limiting condition and likely wants to be discharged; thus, he or she should be assessed third. The 40-year-old with Guillain-BarrÃ© who is currently receiving a third bedside plasmapheresis treatment being administered by another nurse. This client can be assessed last because another nurse is in the room with the client administering the plasmapheresis treatment.

Question 2 of 5.

A 78-year-old client is admitted to the emergency department (ED) with numbness and weakness of the left arm and slurred speech. Which nursing intervention is priority?

A. Prepare to administer recombinant tissue plasminogen activator (rt-PA).

B. Discuss the precipitating factors that caused the symptoms.

C. Schedule for a STAT computed tomography (CT) scan of the head.

D. Notify the speech pathologist for an emergency consult.

Explanation: For a suspected stroke, the priority is to confirm the diagnosis and determine the type of stroke (ischemic or hemorrhagic) before initiating treatment. A STAT CT scan of the head is critical to rule out hemorrhagic stroke, which contraindicates thrombolytic therapy like rt-PA. Administering rt-PA without imaging could be harmful, discussing precipitating factors is not urgent, and a speech pathology consult is secondary to diagnostic imaging.

Question 3 of 5.

The nurse is planning care for a client experiencing agnosia secondary to a cerebrovascular accident. Which collaborative intervention will be included in the plan of care?

A. Observe the client swallowing for possible aspiration.

B. Position the client in a semi-Fowler's position when sleeping.

C. Place a suction setup at the client's bedside during meals.

D. Refer the client to an occupational therapist for evaluation.

Explanation: Agnosia is the inability to recognize objects, people, or sounds, impacting functional abilities. Referring to an occupational therapist (D) is appropriate to assess and develop strategies for managing agnosia. Swallowing issues (A, C) are related to dysphagia, not agnosia, and semi-Fowler's position (B) is not specific to agnosia management.

Question 4 of 5.

The client is diagnosed with expressive aphasia. Which psychosocial client problem would the nurse include in the plan of care?

A. Potential for injury.

B. Powerlessness.

C. Disturbed thought processes.

D. Sexual dysfunction.

Explanation: Expressive aphasia impairs the ability to communicate, leading to frustration and feelings of powerlessness (B). Injury (A) is physical, disturbed thought processes (C) relate to cognition, and sexual dysfunction (D) is not directly linked to aphasia.

Question 5 of 5.

The client diagnosed with a mild concussion is being discharged from the emergency department. Which discharge instruction should the nurse teach the client's significant other?

A. Awaken the client every two (2) hours.

B. Monitor for increased intracranial pressure (ICP).

C. Observe frequently for hypervigilance.

D. Offer the client food every three (3) to four (4) hours.

Explanation: For a mild concussion, monitoring for worsening neurological status is key. Awakening every 2 hours (A) allows assessment for altered consciousness. Monitoring ICP (B) is complex and not feasible at home, hypervigilance (C) is not typical, and frequent feeding (D) is unnecessary.