RASMUSSEN UNIVERSITY
Bachelor of Science in Nursing (BSN)
MDC IV - Multidimensional Care IV
Academic Year: 2026/2027
Exam 1 Review - Neurological Nursing Question Bank
Question 1
A client with a left middle cerebral artery ischemic stroke 2 days ago is experiencing a
visual field deficit. Which nursing intervention is best to ensure client safety?
A. Place the call light on the client's right side
B. Place the call light on the client's left side
C. Keep the call light within reach on the overbed table
D. Instruct the client to call out for assistance when needed
CORRECT ANSWER B. Place the call light on the client's left side
RATIONALE
A left middle cerebral artery stroke typically causes right-sided visual field deficits (right
homonymous hemianopsia). Placing the call light on the unaffected (left) side ensures the client
can see and access it, promoting safety and independence.
, Question 2
A client with a traumatic brain injury is at risk for venous thromboembolism (VTE).
Which actions should the nurse take? (Select all that apply)
A. Administer anticoagulant therapy as prescribed
B. Reposition client in bed every 2 hours
C. Apply sequential compression devices (SCDs)
D. Encourage the client to remain in high Fowler position
CORRECT ANSWER
A, B, C. Administer anticoagulants as prescribed, reposition every 2 hours, and
apply SCDs are appropriate VTE prevention measures.
RATIONALE
VTE prevention in TBI includes pharmacologic prophylaxis (anticoagulants when not
contraindicated), mechanical prophylaxis (SCDs, compression stockings), and early
mobilization/repositioning. High Fowler position does not prevent VTE.
Question 3
A client has a comminuted fracture of T6-T7, resulting in paraplegia. The nurse educates
the client on preventing autonomic dysreflexia. Which of the following is the priority
intervention to avoid this medical emergency?
A. Preventing constipation
B. Preventing bladder distension
C. Maintaining proper body positioning
D. Avoiding tight clothing
CORRECT ANSWER B. Preventing bladder distension
RATIONALE
Autonomic dysreflexia is most commonly triggered by bladder distention or bowel impaction in
patients with spinal cord injury above T6. Bladder distention is the most frequent cause and
should be prevented through scheduled voiding, catheter management, and monitoring for signs
of urinary retention.
Bachelor of Science in Nursing (BSN)
MDC IV - Multidimensional Care IV
Academic Year: 2026/2027
Exam 1 Review - Neurological Nursing Question Bank
Question 1
A client with a left middle cerebral artery ischemic stroke 2 days ago is experiencing a
visual field deficit. Which nursing intervention is best to ensure client safety?
A. Place the call light on the client's right side
B. Place the call light on the client's left side
C. Keep the call light within reach on the overbed table
D. Instruct the client to call out for assistance when needed
CORRECT ANSWER B. Place the call light on the client's left side
RATIONALE
A left middle cerebral artery stroke typically causes right-sided visual field deficits (right
homonymous hemianopsia). Placing the call light on the unaffected (left) side ensures the client
can see and access it, promoting safety and independence.
, Question 2
A client with a traumatic brain injury is at risk for venous thromboembolism (VTE).
Which actions should the nurse take? (Select all that apply)
A. Administer anticoagulant therapy as prescribed
B. Reposition client in bed every 2 hours
C. Apply sequential compression devices (SCDs)
D. Encourage the client to remain in high Fowler position
CORRECT ANSWER
A, B, C. Administer anticoagulants as prescribed, reposition every 2 hours, and
apply SCDs are appropriate VTE prevention measures.
RATIONALE
VTE prevention in TBI includes pharmacologic prophylaxis (anticoagulants when not
contraindicated), mechanical prophylaxis (SCDs, compression stockings), and early
mobilization/repositioning. High Fowler position does not prevent VTE.
Question 3
A client has a comminuted fracture of T6-T7, resulting in paraplegia. The nurse educates
the client on preventing autonomic dysreflexia. Which of the following is the priority
intervention to avoid this medical emergency?
A. Preventing constipation
B. Preventing bladder distension
C. Maintaining proper body positioning
D. Avoiding tight clothing
CORRECT ANSWER B. Preventing bladder distension
RATIONALE
Autonomic dysreflexia is most commonly triggered by bladder distention or bowel impaction in
patients with spinal cord injury above T6. Bladder distention is the most frequent cause and
should be prevented through scheduled voiding, catheter management, and monitoring for signs
of urinary retention.
