A positive Kernig sign in a patient with suspected meningitis is shown by:

Pain and resistance on extending the knee with the hip flexed

Upward movement of the big toe when the sole is stroked

Twitching of the face when the facial nerve is tapped

Involuntary flexion of the hips and knees when the neck is flexed

A patient is confirmed to have meningococcal meningitis. Which staff member needs antibiotic chemoprophylaxis?

The nurse who suctioned his airway without a mask

The nurse who gave his oral medicines on the ward

The porter who took him to the CT scanner

The cleaner who mopped the floor of his room

Twelve hours after a severe head injury a patient passes 400 mL of urine per hour. Urine specific gravity is 1.002 and serum sodium is 153 mmol/L (135 to 145). No mannitol has been given and urine glucose is negative. Which condition is most likely?

Osmotic diuresis from hyperglycaemia

A 62-year-old man with type 2 diabetes arrives with right-sided weakness and slurred speech that began 40 minutes ago. His capillary glucose is 2.4 mmol/L (43 mg/dL). What should the nurse do first?

Give IV dextrose and reassess his neurology

Give a full glass of juice by mouth straight away

Start an insulin infusion to control his glucose

Send him for CT and prepare the alteplase infusion

A patient with Parkinson disease says his levodopa-carbidopa seems to work less well after lunch. Which advice is best?

Take the dose about 30 minutes before meals

Take the dose with milk to protect the stomach

Take the whole day's dose at bedtime

Take every dose with a large high-protein meal

Neurological and neurosurgical care

36 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Neurological and neurosurgical care, part of Adult Health 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 · Easy
A positive Kernig sign in a patient with suspected meningitis is shown by:
1. AUpward movement of the big toe when the sole is stroked
2. BPain and resistance on extending the knee with the hip flexed
3. CTwitching of the face when the facial nerve is tapped
4. DInvoluntary flexion of the hips and knees when the neck is flexed
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Answer: B · Pain and resistance on extending the knee with the hip flexed
Kernig sign is tested with the patient supine and the hip flexed to 90 degrees; pain and resistance when the knee is extended indicate meningeal irritation. Brudzinski sign is involuntary hip and knee flexion when the neck is bent forward. Both support the diagnosis but a lumbar puncture and blood cultures confirm it.
- A: This is the Babinski response of an upper motor neuron lesion.
- C: This is Chvostek sign of hypocalcaemia.
- D: This describes Brudzinski sign, the other sign of meningeal irritation.
Question 2 · Medium
A patient is confirmed to have meningococcal meningitis. Which staff member needs antibiotic chemoprophylaxis?
1. AThe nurse who suctioned his airway without a mask
2. BThe nurse who gave his oral medicines on the ward
3. CThe porter who took him to the CT scanner
4. DThe cleaner who mopped the floor of his room
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Answer: A · The nurse who suctioned his airway without a mask
Chemoprophylaxis for health workers is advised only after direct exposure to the patient's respiratory secretions without protection, such as suctioning, intubation or mouth-to-mouth resuscitation without a mask. Routine contact does not need it. Droplet precautions for the first 24 hours of effective treatment prevent most exposures.
- B: Giving oral medicines is routine contact without exposure to secretions.
- C: Transport is not close exposure to respiratory secretions.
- D: Cleaning the room is not direct contact with secretions.
Question 3 · Hard
Twelve hours after a severe head injury a patient passes 400 mL of urine per hour. Urine specific gravity is 1.002 and serum sodium is 153 mmol/L (135 to 145). No mannitol has been given and urine glucose is negative. Which condition is most likely?
1. ASyndrome of inappropriate ADH
2. BCerebral salt wasting
3. CDiabetes insipidus
4. DOsmotic diuresis from hyperglycaemia
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Answer: C · Diabetes insipidus
Head injury can damage the pituitary or hypothalamus and stop antidiuretic hormone release, so large volumes of dilute urine are lost and the serum sodium rises. A very low urine specific gravity with a high sodium and no osmotic agent is typical. The nurse reports it, keeps a strict hourly fluid balance and expects fluid replacement and desmopressin.
- A: SIADH causes low urine output, concentrated urine and a low sodium.
- B: Salt wasting causes a low serum sodium with salt loss in the urine.
- D: Urine glucose is negative, so a glucose-driven diuresis is excluded.
Question 4 · Hard
A 62-year-old man with type 2 diabetes arrives with right-sided weakness and slurred speech that began 40 minutes ago. His capillary glucose is 2.4 mmol/L (43 mg/dL). What should the nurse do first?
1. AGive IV dextrose and reassess his neurology
2. BGive a full glass of juice by mouth straight away
3. CStart an insulin infusion to control his glucose
4. DSend him for CT and prepare the alteplase infusion
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Answer: A · Give IV dextrose and reassess his neurology
Hypoglycaemia can mimic a stroke with focal weakness and speech change, so glucose is checked in every suspected stroke. A level below about 2.8 mmol/L (50 mg/dL) is treated first with IV dextrose, and the neurology is reassessed; the deficit often clears. If it persists after the glucose is normal, the stroke pathway continues.
- B: A patient with slurred speech may have impaired swallowing and could aspirate.
- C: Insulin would make the hypoglycaemia worse.
- D: Thrombolysing a hypoglycaemia mimic exposes him to bleeding risk without benefit.
Question 5 · Medium
A patient with Parkinson disease says his levodopa-carbidopa seems to work less well after lunch. Which advice is best?
1. ATake the dose about 30 minutes before meals
2. BTake the dose with milk to protect the stomach
3. CTake the whole day's dose at bedtime
4. DTake every dose with a large high-protein meal
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Answer: A · Take the dose about 30 minutes before meals
Dietary amino acids compete with levodopa for absorption from the gut and for transport into the brain, so a high-protein meal can weaken a dose. Taking it about 30 minutes before meals, and spreading protein through the day, gives a steadier effect. A small carbohydrate snack can be used if the drug causes nausea.
- B: Milk is a protein source and can weaken the dose.
- C: One bedtime dose leaves the patient unmedicated during the day.
- D: High-protein meals reduce levodopa absorption and brain uptake.
Question 6 · Hard
A patient is still having a generalised seizure ten minutes after two correctly timed doses of IV lorazepam. Which drug should the nurse prepare next?
1. AOral carbamazepine through a nasogastric tube
2. BIV magnesium sulphate over 20 minutes
3. CAn IV loading dose of levetiracetam
4. DA third dose of IV lorazepam
Answer and explanation in LearnFree account
Question 7 · Easy
In the BE-FAST stroke screening tool, the letters B and E add which two warning signs to the original FAST check?
1. ABlurred speech and sudden emotional change
2. BBradycardia and sudden forced deviation of both eyes
3. CSudden loss of balance and sudden loss of vision
4. DBack pain and sudden extremity numbness
Answer and explanation in LearnFree account
Question 8 · Medium
A patient with Parkinson disease is nil by mouth before a hip operation tomorrow. His levodopa-carbidopa is due every four hours. What should the nurse do?
1. AOmit all doses until he is eating again
2. BWait until after surgery to discuss his drugs
3. CAsk the team for a non-oral route so no doses are missed
4. DGive the doses only at night to reduce risk
Answer and explanation in LearnFree account
Question 9 · Easy
During a log roll of a patient with a suspected cervical spine injury, who gives the commands to move?
1. AThe staff member at the patient's hips
2. BThe staff member who will inspect the spine
3. CThe staff member holding the head and neck
4. DThe most senior nurse present in the room
Answer and explanation in LearnFree account
Question 10 · Hard
A 74-year-old with Parkinson disease is agitated and nauseated in the emergency department. Which prescribed drug should the nurse question?
1. AOndansetron 4 mg IV
2. BHaloperidol 5 mg IM
3. CParacetamol 1 g IV
4. DLactulose 15 mL orally
Answer and explanation in LearnFree account
Question 11 · Hard
A young man was briefly knocked out in a road crash, then woke and talked normally for two hours. He now has a severe headache, vomiting, falling GCS and a fixed dilated left pupil. Which condition is most likely?
1. AExtradural haematoma
2. BCerebral concussion
3. CChronic subdural haematoma
4. DDiffuse axonal injury
Answer and explanation in LearnFree account
Question 12 · Medium
A man with epilepsy on twice-daily antiseizure medicine plans to fast during Ramadan. Which advice is best?
1. AStop the antiseizure medicine for the month of fasting
2. BDiscuss moving his doses to suhoor and iftar with his doctor
3. CTake the whole day's medicine at iftar on his own
4. DFasting has no effect on his risk of seizures
Answer and explanation in LearnFree account
Question 13 · Medium
A patient with fever, neck stiffness and confusion is suspected of having bacterial meningitis. The lumbar puncture is delayed because a CT scan is needed first. What is the priority?
1. AGive paracetamol and reassess the fever in one hour
2. BArrange an MRI to look for a brain abscess first
3. CWait for the lumbar puncture before giving antibiotics
4. DTake blood cultures and give antibiotics now
Answer and explanation in LearnFree account
Question 14 · Medium
A man injured in a high-speed road crash is unresponsive and his airway is obstructed. A cervical spine injury is suspected. How should the nurse open the airway?
1. AUse a head tilt with chin lift
2. BTurn the head to one side to drain secretions
3. CUse a jaw thrust without tilting the head
4. DLift the neck to extend the head backwards
Answer and explanation in LearnFree account
Question 15 · Easy
The tremor typical of Parkinson disease is best described as a:
1. ACoarse tremor that worsens as the hand nears a target
2. BFlapping tremor of the hands held in dorsiflexion
3. CResting pill-rolling tremor that lessens on purposeful movement
4. DFine tremor that appears only when the arms are outstretched
Answer and explanation in LearnFree account
Question 16 · Medium
To protect the affected shoulder of a patient with left-sided hemiplegia after a stroke, the nurse should:
1. ALift the patient up the bed by holding the left arm
2. BLet the left arm hang freely to keep the joint loose
3. CKeep the left arm in a sling day and night
4. DSupport the left arm on a pillow and never pull on it
Answer and explanation in LearnFree account
Question 17 · Hard
A ventilated head-injured patient's ICP alarm shows 24 mmHg for five minutes after a turn. His BP is 110/70 mmHg (MAP 83), the head of the bed is flat and his head is turned to the right. What should the nurse do first?
1. AGive a bolus of IV mannitol from the ward stock
2. BSilence the alarm and recheck in 30 minutes
3. CRaise the bed to 30 degrees, head midline
4. DHyperventilate him with the bag to a low PaCO2
Answer and explanation in LearnFree account
Question 18 · Hard
A patient with headache, fever and neck stiffness has these CSF results: clear fluid, white cells 180 per mm3 (mostly lymphocytes), protein 0.7 g/L (0.15 to 0.45), glucose 3.6 mmol/L with blood glucose 5.8 mmol/L. Which diagnosis do these results best support?
1. ASubarachnoid haemorrhage
2. BNormal cerebrospinal fluid
3. CViral meningitis
4. DBacterial meningitis
Answer and explanation in LearnFree account
Question 19 · Hard
Which of these neurosurgical patients needs the nurse's attention first?
1. AHead injury, right pupil newly larger and slow to react
2. BParkinson disease, drooling and slow to start walking
3. CStroke on day 3, expressive aphasia unchanged since admission
4. DMeningitis on day 2 of antibiotics, headache rated 6 out of 10
Answer and explanation in LearnFree account
Question 20 · Medium
A patient's intracranial pressure is 22 mmHg. Which planned nursing care is most likely to raise it further?
1. AKeeping the room quiet with dimmed lights
2. BKeeping the head in a neutral midline position
3. CSuctioning, turning and bathing back to back
4. DRaising the head of the bed to 30 degrees
Answer and explanation in LearnFree account
Question 21 · Easy
In a patient with suspected acute stroke, a non-contrast CT scan of the head is done first mainly to:
1. ARule out intracranial bleeding before thrombolysis
2. BConfirm the diagnosis of an ischaemic stroke
3. CMeasure blood flow through the carotid arteries
4. DShow the exact size and location of the ischaemic area
Answer and explanation in LearnFree account
Question 22 · Medium
When suctioning an intubated patient with raised intracranial pressure, the nurse should:
1. AUse deep suction with several passes during one session
2. BLower the head of the bed flat before passing the catheter
3. CPre-oxygenate and limit each pass to 10 seconds
4. DSuction every hour to keep the airway completely clear
Answer and explanation in LearnFree account
Question 23 · Medium
A man admitted after a fall was calm and fully oriented at the last check. He is now restless, keeps pulling at his sheets and is unsure of the day. His vital signs are unchanged. How should the nurse interpret this?
1. AExpected fatigue after a minor head injury
2. BNormal anxiety about being in hospital
3. CAn early sign of rising ICP to report now
4. DA late sign of brainstem herniation
Answer and explanation in LearnFree account
Question 24 · Medium
A patient received IV alteplase for stroke six hours ago. An order for oral aspirin 300 mg now appears on the chart. What should the nurse do?
1. AGive the aspirin with food to protect the stomach
2. BGive half the dose and monitor for bleeding
3. CGive the aspirin rectally to avoid aspiration
4. DHold the aspirin and clarify the order
Answer and explanation in LearnFree account
Question 25 · Easy
A patient with an aneurysmal subarachnoid haemorrhage is started on oral nimodipine every 4 hours. The main purpose of this drug is to:
1. AControl the headache from meningeal irritation
2. BPrevent seizures in the first week
3. CPrevent cerebral vasospasm and delayed ischaemia
4. DLower intracranial pressure by drawing fluid out of the brain
Answer and explanation in LearnFree account

11 more Neurological and neurosurgical care questions

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Neurological and neurosurgical care

A positive Kernig sign in a patient with suspected meningitis is shown by:

A patient is confirmed to have meningococcal meningitis. Which staff member needs antibiotic chemoprophylaxis?

Twelve hours after a severe head injury a patient passes 400 mL of urine per hour. Urine specific gravity is 1.002 and serum sodium is 153 mmol/L (135 to 145). No mannitol has been given and urine glucose is negative. Which condition is most likely?

A 62-year-old man with type 2 diabetes arrives with right-sided weakness and slurred speech that began 40 minutes ago. His capillary glucose is 2.4 mmol/L (43 mg/dL). What should the nurse do first?

A patient with Parkinson disease says his levodopa-carbidopa seems to work less well after lunch. Which advice is best?

A patient is still having a generalised seizure ten minutes after two correctly timed doses of IV lorazepam. Which drug should the nurse prepare next?

In the BE-FAST stroke screening tool, the letters B and E add which two warning signs to the original FAST check?

A patient with Parkinson disease is nil by mouth before a hip operation tomorrow. His levodopa-carbidopa is due every four hours. What should the nurse do?

During a log roll of a patient with a suspected cervical spine injury, who gives the commands to move?

A 74-year-old with Parkinson disease is agitated and nauseated in the emergency department. Which prescribed drug should the nurse question?

A young man was briefly knocked out in a road crash, then woke and talked normally for two hours. He now has a severe headache, vomiting, falling GCS and a fixed dilated left pupil. Which condition is most likely?

A man with epilepsy on twice-daily antiseizure medicine plans to fast during Ramadan. Which advice is best?

A patient with fever, neck stiffness and confusion is suspected of having bacterial meningitis. The lumbar puncture is delayed because a CT scan is needed first. What is the priority?

A man injured in a high-speed road crash is unresponsive and his airway is obstructed. A cervical spine injury is suspected. How should the nurse open the airway?

The tremor typical of Parkinson disease is best described as a:

To protect the affected shoulder of a patient with left-sided hemiplegia after a stroke, the nurse should:

A ventilated head-injured patient's ICP alarm shows 24 mmHg for five minutes after a turn. His BP is 110/70 mmHg (MAP 83), the head of the bed is flat and his head is turned to the right. What should the nurse do first?

A patient with headache, fever and neck stiffness has these CSF results: clear fluid, white cells 180 per mm3 (mostly lymphocytes), protein 0.7 g/L (0.15 to 0.45), glucose 3.6 mmol/L with blood glucose 5.8 mmol/L. Which diagnosis do these results best support?

Which of these neurosurgical patients needs the nurse's attention first?

A patient's intracranial pressure is 22 mmHg. Which planned nursing care is most likely to raise it further?

In a patient with suspected acute stroke, a non-contrast CT scan of the head is done first mainly to:

When suctioning an intubated patient with raised intracranial pressure, the nurse should:

A man admitted after a fall was calm and fully oriented at the last check. He is now restless, keeps pulling at his sheets and is unsure of the day. His vital signs are unchanged. How should the nurse interpret this?

A patient received IV alteplase for stroke six hours ago. An order for oral aspirin 300 mg now appears on the chart. What should the nurse do?

A patient with an aneurysmal subarachnoid haemorrhage is started on oral nimodipine every 4 hours. The main purpose of this drug is to: