Neurological
NCLEX® practice.

Free practice set · 5 questions

5 more free neurological NCLEX-RN® practice questions

Real questions from the same bank the app serves. Pick an answer in your head, then open the rationale to see why the correct option holds and why each other option falls short. No account needed for these.

1. Question 1 of 5 · Neurological Emergencies & Cognition

   The nurse is caring for a 22-year-old man in a long-term care facility with Duchenne muscular dystrophy, which he manages with family support at home. Five months ago, progressive weakness required him to give up his college role and move from home; he reports alternating anger, sadness, and brief periods of acceptance. He continues participating in decisions and self-care, denies suicidal thoughts, and identifies his mother, partner, chaplain, and a bereavement counselor as supports. He also anticipates further loss of independence. Which approach should the nurse use to support the client's coping with anticipated losses?

   1. ATell him not to begin goodbyes or legacy planning because the anticipated losses have not occurred yet.
   2. BValidate the changing responses, ask what support feels useful today, and offer life review or a legacy project at his pace.
   3. CArrange an urgent psychiatric consultation because his alternating anger and sadness indicate abnormal grieving.
   4. DExplain that five months is enough time to adjust and encourage him to focus on moving forward.
   Show the answer and rationale

   Correct answer: B. Validate the changing responses, ask what support feels useful today, and offer life review or a legacy project at his pace.

   The best action is to validate the client’s fluctuating responses, determine what support he wants now, and pace anticipatory-grief work with him. Grief can include anger, sadness, and acceptance in a nonlinear pattern, and it has no fixed timeline. His five-month course, preserved participation, absence of suicidal thoughts, and available supports are more consistent with an expected response than persistent grief disorder requiring urgent referral. Because further functional loss is anticipated, life review, goodbyes, and legacy work may be appropriate before the loss occurs. A timeline invalidates grief; an unnecessary psychiatric referral exceeds the need; and dismissing anticipatory work delays helpful support. Platitudes, replacement suggestions, and nurse-centered self-disclosure would likewise minimize or redirect the client’s experience.

   A. Tell him not to begin goodbyes or legacy planning because the anticipated losses have not occurred yet.

   Anticipatory grief occurs before an expected loss. The client may appropriately consider life review, goodbyes, regret or forgiveness, and legacy activities now. Telling him to wait dismisses valid preparation and removes support at the time he is beginning to face further loss.

   B. Validate the changing responses, ask what support feels useful today, and offer life review or a legacy project at his pace.

   This action normalizes a broad, changing range of grief responses without imposing a schedule. It also respects the client’s current readiness and supports anticipatory grieving through life review or legacy work when he chooses. Preserved functioning, no suicidal thoughts, and existing supports do not indicate complicated grief requiring urgent mental-health referral.

   C. Arrange an urgent psychiatric consultation because his alternating anger and sadness indicate abnormal grieving.

   Anger and sadness that fluctuate during the first months after a major loss can be normative, especially when functioning and engagement remain intact. Automatically arranging urgent psychiatric consultation confuses expected grief with persistent, impairing grief; referral becomes important when severe symptoms persist with marked impairment or safety concerns.

   D. Explain that five months is enough time to adjust and encourage him to focus on moving forward.

   Grief does not have a fixed endpoint, so telling the client that five months is sufficient imposes a schedule and may invalidate his experience. Encouraging forward movement before listening to his needs can suppress expression rather than provide therapeutic support.

2. Question 2 of 5 · Emergency Response, Triage & Disaster

   An 82-year-old female in a long-term care facility received her first dose of a newly prescribed daily antibiotic. Within minutes, she developed generalized hives and wheezing while eating lunch, then collapsed. She is unresponsive, has only agonal respirations, and no palpable pulse within 10 seconds. The airway is open without visible obstruction; oxygen saturation cannot be obtained. The monitor shows asystole. Her chart lists full code; a family member says she would not want resuscitation. The code team is present, and the AED is in another room. Which action should the nurse take first?

   1. ALeave to retrieve the AED and withhold compressions because the family reports a presumed DNR.
   2. BGive IV diphenhydramine first and continue abdominal thrusts for the suspected choking.
   3. CActivate the code response and begin chest compressions at 100–120/min and 5–6 cm depth.
   4. DDeliver a defibrillation shock for the asystole, then administer atropine 1 mg IV.
   Show the answer and rationale

   Correct answer: C. Activate the code response and begin chest compressions at 100–120/min and 5–6 cm depth.

   Begin high-quality CPR immediately because this client is unresponsive, has only agonal breathing, and has no pulse; her documented full-code status requires resuscitation despite the family’s statement. This follows the AHA adult BLS chain-of-survival first step: recognize arrest, activate the response, and provide compressions before retrieving an AED that is not within arm’s reach. Asystole is a nonshockable rhythm in the ACLS PEA/asystole algorithm; continue CPR and give epinephrine every 3–5 minutes, not a shock or atropine. Although hives and wheezing suggest medication-related anaphylaxis, cardiac arrest makes CPR the immediate priority; epinephrine for anaphylaxis precedes antihistamines when circulation is present.

   A. Leave to retrieve the AED and withhold compressions because the family reports a presumed DNR.

   Compressions must not be delayed while the nurse retrieves equipment from another room; another responder should obtain the AED. The chart documents full code, so an unverified family report cannot replace a valid DNR order or justify withholding resuscitation.

   B. Give IV diphenhydramine first and continue abdominal thrusts for the suspected choking.

   The open airway and absence of a visible obstruction do not support continuing abdominal thrusts after unresponsiveness. For an unresponsive choking client, CPR replaces thrusts, with the airway checked before breaths. In this cardiac arrest, diphenhydramine is not a substitute for CPR or the cardiac-arrest algorithm; antihistamine treatment cannot replace resuscitation for asystole. Compressions should not be slow or shallow.

   C. Activate the code response and begin chest compressions at 100–120/min and 5–6 cm depth.

   This is correct. The absent pulse, unresponsiveness, and agonal respirations indicate cardiac arrest. The AHA adult BLS algorithm calls for immediate compressions at 100–120/min, 5–6 cm deep, with full recoil and minimal interruptions while another responder obtains the AED.

   D. Deliver a defibrillation shock for the asystole, then administer atropine 1 mg IV.

   Asystole is nonshockable, so defibrillation violates the ACLS PEA/asystole algorithm. Atropine is not used for asystolic arrest; the nurse continues CPR and administers epinephrine every 3–5 minutes. Defibrillation is reserved for ventricular fibrillation or pulseless ventricular tachycardia.

3. Question 3 of 5 · Neurological Emergencies & Cognition

   A 34-year-old woman in a long-term care facility was transferred 36 hours ago with bacterial meningitis and receives IV ceftriaxone and dexamethasone. One hour ago, BP was 98/60 mm Hg, HR 118/min, RR 20/min, temperature 37.8°C, and SpO₂ 98%; now BP is 132/84, HR 78, respirations are irregular, temperature is 38.0°C, and SpO₂ is 94%. The nurse notes a sluggish 5-mm right pupil, a reactive 3-mm left pupil, vomiting, and difficulty arousing after she was alert. Which action should the nurse take first?

   1. APage the health care provider about the neurologic changes and wait for instructions before intervening.
   2. BRecheck neurologic findings and vital signs in 4 hours after allowing her to rest.
   3. CActivate rapid response, support her airway and breathing, and report the findings and trend using SBAR.
   4. DReassure her that the confusion and pupil changes are expected in an older long-term care resident.
   Show the answer and rationale

   Correct answer: C. Activate rapid response, support her airway and breathing, and report the findings and trend using SBAR.

   Activate rapid response while supporting airway and breathing, then communicate the trend with SBAR. New anisocoria, vomiting, abrupt decreased consciousness, irregular respirations, falling oxygen saturation, bradycardia, and rising blood pressure identify acute intracranial pressure elevation with impending brain herniation, not routine meningitis recovery. The change from baseline is an early warning that requires action before respiratory arrest. Reassuring her incorrectly attributes deterioration to age and delays recognition. Waiting four hours is unsafe because neurologic decline is time-critical. Calling the provider without simultaneous airway and breathing support delays ABC priorities. Pulmonary embolism, sepsis, compartment syndrome, and anaphylaxis are important alternative emergencies, but actions directed toward those conditions do not explain or appropriately address this neurologic cluster.

   A. Page the health care provider about the neurologic changes and wait for instructions before intervening.

   Notification is necessary, but waiting for a callback before supporting breathing violates ABC priorities. The nurse should initiate immediate airway and oxygen-support measures while activating emergency assistance and communicating the assessment in a structured format.

   B. Recheck neurologic findings and vital signs in 4 hours after allowing her to rest.

   A four-hour reassessment interval is dangerously delayed for abrupt altered consciousness, pupillary asymmetry, irregular breathing, and changing vital signs. Early warning trends require immediate action and escalation, not observation while the client may deteriorate.

   C. Activate rapid response, support her airway and breathing, and report the findings and trend using SBAR.

   This action recognizes the early deterioration, prioritizes airway and breathing, and obtains immediate assistance. SBAR communicates the specific neurologic findings, vital-sign changes from baseline, concern for herniation, and needed emergency response.

   D. Reassure her that the confusion and pupil changes are expected in an older long-term care resident.

   New confusion or reduced arousal and unequal pupils are never explained by age, especially in a 34-year-old. Treating these findings as expected delays recognition of hypoxia and rising intracranial pressure and could allow brain herniation to progress.

4. Question 4 of 5 · Neurological Emergencies & Cognition

   During a home-health visit, a 34-year-old man is postoperative day 2 after repair of a descending thoracic aortic aneurysm; he has hypertension and stage 3 chronic kidney disease. His BP is 154/90 mm Hg in the right arm and 98/64 mm Hg in the left, compared with 132/78 and 130/76 four hours ago; HR is 112 (88), RR 24 (18), temperature 37.8°C (37.0°C), and SpO2 91% on his prescribed 4 L/min oxygen (96%). He reports new bilateral leg heaviness, numbness, and weakness, with cool feet and 18 mL urine in 2 hours. Which action should the nurse take first?

   1. ARepeat the vital signs in 4 hours because the temperature elevation and reduced urine output may reflect postoperative variation.
   2. BAdminister the prescribed opioid and reassess the leg discomfort before contacting the health care provider.
   3. CReassure the client that anxiety can cause the tachycardia, dyspnea, and oxygen desaturation after surgery.
   4. DPosition the client supine, maintain oxygen, and immediately activate emergency services while reporting the trend and neurologic findings using SBAR.
   Show the answer and rationale

   Correct answer: D. Position the client supine, maintain oxygen, and immediately activate emergency services while reporting the trend and neurologic findings using SBAR.

   The nurse should position the client, support oxygenation, and immediately escalate using SBAR. The abrupt interarm pressure difference, rising heart rate and respiratory rate, oxygen decline despite oxygen, oliguria, cool feet, and new bilateral leg weakness and numbness identify a time-critical postoperative aortic-graft or spinal-cord perfusion complication rather than expected recovery. Acting on this early trend may prevent irreversible neurologic injury or cardiovascular collapse. Airway and breathing support precede circulation-focused emergency evaluation, and SBAR should include the baseline and current vital signs, neurologic change, perfusion findings, time of onset, and requested emergency response.

   A. Repeat the vital signs in 4 hours because the temperature elevation and reduced urine output may reflect postoperative variation.

   Waiting four hours is unsafe when multiple values have worsened and neurologic and perfusion deficits are present. Possible infection or another complication requires prompt action, not delayed reassessment, while oxygenation and emergency escalation occur now.

   B. Administer the prescribed opioid and reassess the leg discomfort before contacting the health care provider.

   Analgesia alone can mask worsening ischemic or neurologic findings and does not correct the unequal pressures, cool feet, oliguria, or bilateral weakness. The nurse must support breathing and urgently escalate suspected graft or spinal-cord perfusion failure.

   C. Reassure the client that anxiety can cause the tachycardia, dyspnea, and oxygen desaturation after surgery.

   This dismisses a dangerous cluster as anxiety. New hypoxia, tachypnea, tachycardia, and postoperative deterioration require immediate assessment and escalation; reassurance alone delays treatment of a serious cardiopulmonary or perfusion complication.

   D. Position the client supine, maintain oxygen, and immediately activate emergency services while reporting the trend and neurologic findings using SBAR.

   The combined pressure change, hypoxia, oliguria, cool extremities, and new bilateral neurologic deficits signal early serious postoperative perfusion compromise. Supine positioning and oxygen address immediate ABC needs, while SBAR-based emergency escalation communicates the trend and needed response.

5. Question 5 of 5 · Neurological Emergencies & Cognition

   A home health RN is teaching a 22-year-old man newly diagnosed with seizure disorder about his antiepileptic medication after his first tonic-clonic episode two weeks ago. He has never taken a daily medication before, reports feeling anxious and fatigued from disrupted sleep, and reads at approximately a 5th-grade level. His mother is present and offers to translate instructions into Spanish because he sometimes mixes up English medical terms. After completing teaching on medication administration and seizure warning signs, the RN wants to verify that the client actually learned the material rather than simply agreeing to end the conversation. Which nursing action best accomplishes this?

   1. AHave his mother restate the instructions in Spanish and confirm he nodded in agreement.
   2. BAsk him to explain when to take the medication and what to do if a seizure lasts over 5 minutes.
   3. CAsk him, "Do you understand how and when to take your medication?"
   4. DGive him a printed handout and document that teaching is complete without providing verbal teaching or verifying understanding through teach-back.
   Show the answer and rationale

   Correct answer: B. Ask him to explain when to take the medication and what to do if a seizure lasts over 5 minutes.

   Learning is verified through teach-back: asking the client to explain, in his own words, when to take his medication and what to do for a prolonged seizure confirms he actually processed and retained the information, not merely that he is willing to end the conversation. This satisfies the teach-back principle central to safe discharge and home teaching. Asking "Do you understand?" only invites a polite yes/no response; clients frequently agree out of politeness or fatigue without truly grasping the content, so this does not confirm learning. Handing over a printed handout and marking teaching "complete" substitutes a passive resource for active teaching and verification; handouts support but never replace verbal explanation and teach-back, especially for a client reading at a 5th-grade level who needs reinforcement, not just text. Relying on his mother to restate instructions in Spanish and accepting a nod as confirmation uses an unqualified family interpreter for medical content and again falls back on a non-verbal cue rather than an active demonstration of understanding; family members risk paraphrasing or omitting critical safety information, and a nod carries the same weakness as a yes/no answer. Only having the client independently restate the key self-care and emergency actions confirms true comprehension.

   A. Have his mother restate the instructions in Spanish and confirm he nodded in agreement.

   Using his mother as an interpreter risks inaccurate or incomplete translation of safety-critical content, and a nod of agreement does not verify he actually understood the instructions.

   B. Ask him to explain when to take the medication and what to do if a seizure lasts over 5 minutes.

   Correct: asking the client to explain medication timing and the emergency action in his own words uses teach-back. This verifies comprehension rather than passive agreement.

   C. Ask him, "Do you understand how and when to take your medication?"

   A yes/no question only checks whether the client is willing to end the conversation, not whether he actually understood; teach-back requires him to demonstrate knowledge in his own words.

   D. Give him a printed handout and document that teaching is complete without providing verbal teaching or verifying understanding through teach-back.

   A handout alone is a passive resource, not active teaching or verification; documenting completion without confirming understanding leaves knowledge gaps undetected.