A 70-kg man with Guillain-Barre syndrome has weakness spreading to his arms. His vital capacity has fallen from 2.8 L to 1.1 L over 12 hours, and his cough is weak. The unit protocol lists a vital capacity below 20 mL/kg as a criterion for elective intubation. What should the nurse do?

Report it: VC is about 16 mL/kg, below the cut-off

Continue routine care: VC is still above 15 mL/kg

Start incentive spirometry: VC is 1.1 mL/kg

Recheck in 12 hours: VC is about 40 mL/kg

Cushing's triad, a late sign of raised intracranial pressure, consists of:

Rising systolic BP, bradycardia and irregular breathing

Falling BP, tachycardia and rapid shallow breathing

Falling BP, bradycardia and fixed dilated pupils

Rising BP, tachycardia and deep regular breathing

A patient with a T4 spinal cord injury suddenly has a pounding headache, BP 210/112 mmHg, pulse 50/min, flushing and sweating above the level of injury, and cold, pale skin below it. What should the nurse do first?

Sit the patient upright and lower the legs

Give the next oral antihypertensive dose

Lay the patient flat and raise the legs

Insert a catheter after applying lidocaine gel

A patient with raised ICP is receiving IV mannitol 20%. Which parameters should the nurse monitor most closely during therapy?

Urine output and serum osmolality

Platelet count and clotting time

Serum potassium and the ECG only

A patient with myasthenia gravis took extra pyridostigmine tablets for her weakness. She now has worse weakness, profuse salivation, sweating, abdominal cramps, small pupils, muscle twitching and a pulse of 50/min. What is the most likely cause, and which drug should be kept ready?

Cholinergic crisis; pyridostigmine

Neurological: stroke, head injury, ICP and seizures

28 AIIMS NORCET (Nursing Officer) practice questions on Neurological: stroke, head injury, ICP and seizures, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 70-kg man with Guillain-Barre syndrome has weakness spreading to his arms. His vital capacity has fallen from 2.8 L to 1.1 L over 12 hours, and his cough is weak. The unit protocol lists a vital capacity below 20 mL/kg as a criterion for elective intubation. What should the nurse do?
1. AContinue routine care: VC is still above 15 mL/kg
2. BReport it: VC is about 16 mL/kg, below the cut-off
3. CStart incentive spirometry: VC is 1.1 mL/kg
4. DRecheck in 12 hours: VC is about 40 mL/kg
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Answer: B · Report it: VC is about 16 mL/kg, below the cut-off
Vital capacity in mL/kg is 1100 / 70 = about 16 mL/kg, below the protocol's 20 mL/kg cut-off. A fall of more than half in 12 hours with a weak cough shows rapidly failing respiratory muscles. The nurse reports it at once so that intubation can be planned before the patient tires and arrests. Waiting for the blood gas to deteriorate is unsafe in GBS, because CO2 rises late.
- A: The protocol cut-off is 20 mL/kg, not 15, so the patient already meets it.
- C: Dividing litres by weight gives a wrong unit; the VC is about 16 mL/kg.
- D: Forty mL/kg comes from the earlier value of 2.8 L, not the current one.
Question 2 · Easy
Cushing's triad, a late sign of raised intracranial pressure, consists of:
1. AFalling BP, tachycardia and rapid shallow breathing
2. BFalling BP, bradycardia and fixed dilated pupils
3. CRising systolic BP, bradycardia and irregular breathing
4. DRising BP, tachycardia and deep regular breathing
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Answer: C · Rising systolic BP, bradycardia and irregular breathing
As ICP rises, the brainstem becomes ischaemic and the body raises systolic pressure to keep blood flowing to the brain, often widening the pulse pressure. The baroreceptors respond with a slow pulse, and pressure on the respiratory centre makes breathing irregular. This is a late sign that brainstem herniation is near. The nurse reports it at once and does not wait for the next routine observation.
- A: Falling BP with tachycardia is the pattern of shock, not of raised ICP.
- B: Falling BP and fixed pupils describe a terminal stage, not Cushing's triad.
- D: Raised ICP slows the pulse; tachycardia and regular deep breathing do not fit.
Question 3 · Hard
A patient with a T4 spinal cord injury suddenly has a pounding headache, BP 210/112 mmHg, pulse 50/min, flushing and sweating above the level of injury, and cold, pale skin below it. What should the nurse do first?
1. ASit the patient upright and lower the legs
2. BGive the next oral antihypertensive dose
3. CLay the patient flat and raise the legs
4. DInsert a catheter after applying lidocaine gel
Show answerHide answer
Answer: A · Sit the patient upright and lower the legs
These findings are autonomic dysreflexia, a dangerous reflex rise in BP seen in injuries at T6 or above. Sitting the patient up and lowering the legs pools blood in the legs and lowers BP at once. The nurse then looks for the trigger, most often a full bladder, a blocked catheter or constipation, and removes it. If the BP stays very high, a fast-acting antihypertensive is given as ordered.
- B: An oral antihypertensive acts too slowly and does not treat the trigger.
- C: Lying flat with the legs raised raises the BP further.
- D: Checking the bladder comes after the patient is sat up, which lowers BP at once.
Question 4 · Medium
A patient with raised ICP is receiving IV mannitol 20%. Which parameters should the nurse monitor most closely during therapy?
1. APlatelet count and clotting time
2. BBlood glucose every hour
3. CUrine output and serum osmolality
4. DSerum potassium and the ECG only
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Answer: C · Urine output and serum osmolality
Mannitol is an osmotic diuretic that draws water out of brain tissue into the blood and is then excreted by the kidneys. A large diuresis follows, so urine output is charted hourly, often with a catheter. Serum osmolality is checked because a high level (often above about 320 mOsm/kg) risks kidney injury. The solution is inspected for crystals and given through a filter.
- A: Mannitol does not affect clotting or platelets.
- B: Mannitol does not significantly affect blood glucose.
- D: Electrolytes do change, but potassium and ECG alone miss the main risks of dehydration and hyperosmolality.
Question 5 · Hard
A patient with myasthenia gravis took extra pyridostigmine tablets for her weakness. She now has worse weakness, profuse salivation, sweating, abdominal cramps, small pupils, muscle twitching and a pulse of 50/min. What is the most likely cause, and which drug should be kept ready?
1. ACholinergic crisis; atropine
2. BMyasthenic crisis; neostigmine
3. CMyasthenic crisis; edrophonium
4. DCholinergic crisis; pyridostigmine
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Answer: A · Cholinergic crisis; atropine
Weakness with salivation, sweating, cramps, small pupils, fasciculations and bradycardia shows an excess of acetylcholine, a cholinergic crisis caused by too much anticholinesterase. The pyridostigmine is stopped, the airway and breathing are supported, and atropine is given to block the muscarinic effects. A myasthenic crisis, by contrast, is weakness from too little drug and lacks these cholinergic signs. Both crises can cause respiratory failure, so vital capacity is watched closely.
- B: Neostigmine is another anticholinesterase and would make a cholinergic crisis worse.
- C: The cholinergic signs show this is not a myasthenic crisis.
- D: More pyridostigmine would deepen the cholinergic crisis.
Question 6 · Hard
A 64-year-old reaches the emergency department 2 hours after sudden left-sided weakness began. CT shows no haemorrhage, blood glucose is 132 mg/dL, and BP is 196/112 mmHg. The team plans IV alteplase. Which step must come before the infusion starts?
1. ALower the BP to below 120/80 mmHg
2. BRepeat the CT after 6 hours
3. CLower the BP to below 185/110 mmHg
4. DGive aspirin 300 mg by mouth
Answer and explanation in LearnFree account
Question 7 · Easy
Which drug is the first-line treatment for a convulsive seizure lasting more than five minutes when IV access is available?
1. ALevetiracetam
2. BPhenytoin
3. CCarbamazepine
4. DLorazepam
Answer and explanation in LearnFree account
Question 8 · Medium
After a road traffic accident, a patient opens the eyes only to a painful stimulus, uses inappropriate words, and pulls the hand away from the pain. What is the GCS?
1. A8
2. B10
3. C7
4. D9
Answer and explanation in LearnFree account
Question 9 · Easy
Intravenous alteplase for acute ischaemic stroke is given only within how many hours of symptom onset (the time last known well)?
1. A4.5 hours
2. B12 hours
3. C24 hours
4. D1.5 hours
Answer and explanation in LearnFree account
Question 10 · Hard
A 70-kg patient is to receive IV alteplase 0.9 mg/kg (maximum 90 mg), with 10% of the dose as a bolus over 1 minute and the rest infused over 60 minutes. What are the bolus and the infusion doses?
1. A7 mg bolus, then 63 mg over 60 minutes
2. B9 mg bolus, then 81 mg over 60 minutes
3. C6.3 mg bolus, then 56.7 mg over 60 minutes
4. D6.3 mg bolus, then 63 mg over 60 minutes
Answer and explanation in LearnFree account
Question 11 · Easy
Which drug is the mainstay of symptomatic treatment in myasthenia gravis?
1. ALevodopa
2. BBaclofen
3. CAtropine
4. DPyridostigmine
Answer and explanation in LearnFree account
Question 12 · Medium
During a generalised tonic-clonic seizure, which nursing action is correct?
1. ATurn the patient on the side and protect the head
2. BGive sips of water to prevent dehydration
3. CHold the limbs firmly to stop the jerking
4. DInsert a padded tongue blade between the teeth
Answer and explanation in LearnFree account
Question 13 · Medium
A patient with a basal skull fracture has clear fluid dripping from the nose. Which nursing action is most appropriate?
1. APack the nostril firmly with sterile gauze
2. BLet it drain onto a sterile pad and report it
3. CAsk the patient to blow the nose gently
4. DSuction the nose to keep the airway clear
Answer and explanation in LearnFree account
Question 14 · Easy
Parkinson disease results mainly from a loss of which neurotransmitter in the basal ganglia?
1. AAcetylcholine
2. BDopamine
3. CSerotonin
4. DGABA
Answer and explanation in LearnFree account
Question 15 · Easy
Pain and resistance when the examiner tries to straighten the knee while the hip is flexed to 90 degrees is called:
1. ABrudzinski's sign
2. BBabinski's sign
3. CKernig's sign
4. DRomberg's sign
Answer and explanation in LearnFree account
Question 16 · Medium
A right-handed patient has an occlusion of the left middle cerebral artery. Which deficit is expected?
1. ARight-sided weakness with aphasia
2. BLeft-sided weakness with aphasia
3. CLeft-sided weakness with neglect
4. DRight-sided weakness with neglect
Answer and explanation in LearnFree account
Question 17 · Easy
In Guillain-Barre syndrome, the complication that most needs close nursing monitoring is:
1. AHaemorrhagic stroke
2. BRaised intracranial pressure
3. CRespiratory muscle failure
4. DGeneralised seizures
Answer and explanation in LearnFree account
Question 18 · Easy
What is the lowest score possible on the Glasgow Coma Scale?
1. A1
2. B6
3. C3
4. D0
Answer and explanation in LearnFree account
Question 19 · Hard
A 30-year-old with a head injury had GCS 13, BP 124/80 mmHg and pulse 88/min on admission. Four hours later: GCS 8, BP 176/68 mmHg, pulse 52/min, irregular breathing with pauses, right pupil 6 mm and sluggish, left pupil 3 mm and brisk. What do these findings indicate?
1. ARising ICP with impending brain herniation
2. BA postictal state after an unwitnessed seizure
3. CHypoglycaemia after prolonged fasting
4. DNeurogenic shock from a cervical cord injury
Answer and explanation in LearnFree account
Question 20 · Medium
Intravenous phenytoin should be diluted only in 0.9% sodium chloride because, in dextrose solutions, it:
1. AIs converted to an inactive metabolite
2. BIs absorbed onto the PVC bag
3. CPrecipitates and forms crystals
4. DCauses severe hyperglycaemia
Answer and explanation in LearnFree account
Question 21 · Hard
A 25-year-old has had a generalised convulsion for 15 minutes despite two doses of IV lorazepam 4 mg given 5 minutes apart. The airway is supported, oxygen is on, and blood glucose is 98 mg/dL. Which order should the nurse expect next?
1. AOral carbamazepine by nasogastric tube
2. BA third dose of IV lorazepam 4 mg
3. CIV phenytoin loading dose of 20 mg/kg
4. DIV 25% dextrose 50 mL as a bolus
Answer and explanation in LearnFree account
Question 22 · Medium
For a patient with raised intracranial pressure, which position best helps venous drainage from the brain?
1. AFlat supine with the neck flexed on a pillow
2. BProne with the head of the bed at 60 degrees
3. CTrendelenburg with the head turned sideways
4. DHead of bed at 30 degrees, head in midline
Answer and explanation in LearnFree account
Question 23 · Medium
A patient with a severe head injury has BP 110/65 mmHg and an intracranial pressure (ICP) of 25 mmHg. What is the cerebral perfusion pressure (CPP), and what does it mean?
1. A55 mmHg, below the safe level
2. B80 mmHg, within the target range
3. C45 mmHg, which is normal for raised ICP
4. D85 mmHg, within the target range
Answer and explanation in LearnFree account
Question 24 · Medium
Levodopa is combined with carbidopa in Parkinson disease because carbidopa:
1. AImproves the absorption of levodopa from the gut
2. BBlocks the conversion of levodopa outside the brain
3. CStimulates dopamine receptors in the brain directly
4. DBlocks the breakdown of dopamine by MAO-B in the brain
Answer and explanation in LearnFree account
Question 25 · Medium
A patient admitted with suspected meningococcal meningitis needs droplet precautions until:
1. AThe full antibiotic course is finished
2. BThe CSF culture report comes back negative
3. CThe fever has settled for 48 hours
4. D24 hours of effective antibiotics are completed
Answer and explanation in LearnFree account

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Neurological: stroke, head injury, ICP and seizures

A 70-kg man with Guillain-Barre syndrome has weakness spreading to his arms. His vital capacity has fallen from 2.8 L to 1.1 L over 12 hours, and his cough is weak. The unit protocol lists a vital capacity below 20 mL/kg as a criterion for elective intubation. What should the nurse do?

Cushing's triad, a late sign of raised intracranial pressure, consists of:

A patient with a T4 spinal cord injury suddenly has a pounding headache, BP 210/112 mmHg, pulse 50/min, flushing and sweating above the level of injury, and cold, pale skin below it. What should the nurse do first?

A patient with raised ICP is receiving IV mannitol 20%. Which parameters should the nurse monitor most closely during therapy?

A patient with myasthenia gravis took extra pyridostigmine tablets for her weakness. She now has worse weakness, profuse salivation, sweating, abdominal cramps, small pupils, muscle twitching and a pulse of 50/min. What is the most likely cause, and which drug should be kept ready?

A 64-year-old reaches the emergency department 2 hours after sudden left-sided weakness began. CT shows no haemorrhage, blood glucose is 132 mg/dL, and BP is 196/112 mmHg. The team plans IV alteplase. Which step must come before the infusion starts?

Which drug is the first-line treatment for a convulsive seizure lasting more than five minutes when IV access is available?

After a road traffic accident, a patient opens the eyes only to a painful stimulus, uses inappropriate words, and pulls the hand away from the pain. What is the GCS?

Intravenous alteplase for acute ischaemic stroke is given only within how many hours of symptom onset (the time last known well)?

A 70-kg patient is to receive IV alteplase 0.9 mg/kg (maximum 90 mg), with 10% of the dose as a bolus over 1 minute and the rest infused over 60 minutes. What are the bolus and the infusion doses?

Which drug is the mainstay of symptomatic treatment in myasthenia gravis?

During a generalised tonic-clonic seizure, which nursing action is correct?

A patient with a basal skull fracture has clear fluid dripping from the nose. Which nursing action is most appropriate?

Parkinson disease results mainly from a loss of which neurotransmitter in the basal ganglia?

Pain and resistance when the examiner tries to straighten the knee while the hip is flexed to 90 degrees is called:

A right-handed patient has an occlusion of the left middle cerebral artery. Which deficit is expected?

In Guillain-Barre syndrome, the complication that most needs close nursing monitoring is:

What is the lowest score possible on the Glasgow Coma Scale?

A 30-year-old with a head injury had GCS 13, BP 124/80 mmHg and pulse 88/min on admission. Four hours later: GCS 8, BP 176/68 mmHg, pulse 52/min, irregular breathing with pauses, right pupil 6 mm and sluggish, left pupil 3 mm and brisk. What do these findings indicate?

Intravenous phenytoin should be diluted only in 0.9% sodium chloride because, in dextrose solutions, it:

A 25-year-old has had a generalised convulsion for 15 minutes despite two doses of IV lorazepam 4 mg given 5 minutes apart. The airway is supported, oxygen is on, and blood glucose is 98 mg/dL. Which order should the nurse expect next?

For a patient with raised intracranial pressure, which position best helps venous drainage from the brain?

A patient with a severe head injury has BP 110/65 mmHg and an intracranial pressure (ICP) of 25 mmHg. What is the cerebral perfusion pressure (CPP), and what does it mean?

Levodopa is combined with carbidopa in Parkinson disease because carbidopa:

A patient admitted with suspected meningococcal meningitis needs droplet precautions until: