1
NCLEX RN Exam Bank: Neurologic Crisis, Stroke,
Increased ICP & TBI Management
Table of Contents
Subtopic 1: Acute Ischemic Stroke, Assessment, Diagnosis & Initial Interventions (Q1–Q20)
.................................................................................................................................... 2
Subtopic 2: Hemorrhagic Stroke—Recognition, Surgical & Medical Management (Q21–Q40)
.................................................................................................................................. 10
Subtopic 3: Increased Intracranial Pressure (ICP)—Monitoring, Management &
Complications (Q41–Q60) ........................................................................................... 19
Subtopic 4: Traumatic Brain Injury (TBI)—Types, Phases & Emergency Response (Q61–Q80)
.................................................................................................................................. 27
Subtopic 5: Post-Stroke and TBI Rehabilitation, Safety & Patient Education (Q81–Q100)... 35
Subtopic 6: Pediatric and Geriatric Considerations in Neurologic Crises ......................... 43
Subtopic 7: Neurosurgical Interventions and Post-Op Nursing Care ................................ 52
Subtopic 8: Pediatric and Geriatric Considerations in Neurologic Crises ......................... 60
Subtopic 9: Brain Herniation Syndromes, Monitoring & Emergency Interventions ............. 69
Subtopic 10: Emergency Response, Crisis Prioritization & Neuroprognostication ............. 77
, 2
Subtopic 1: Acute Ischemic Stroke, Assessment,
Diagnosis & Initial Interventions (Q1–Q20)
Question 1
A client presents with sudden right-sided weakness and slurred speech. What is the
nurse’s priority action?
A. Administer oxygen at 2 L/min via nasal cannula
B. Check blood glucose
C. Notify the stroke team immediately
D. Reassure the patient and gather more history
Correct Answer: C. Notify the stroke team immediately
Rationale: Timely activation of the stroke team facilitates urgent diagnostic imaging (CT
scan) and intervention. "Time is brain"—delays in care can worsen neurologic outcomes.
Question 2
Which of the following diagnostic tests must be completed before administering tPA?
A. MRI of the brain
B. Non-contrast CT scan of the head
C. Carotid Doppler ultrasound
D. Lumbar puncture
Correct Answer: B. Non-contrast CT scan of the head
Rationale: A non-contrast CT is necessary to rule out hemorrhagic stroke, which is a
contraindication to tPA.
Question 3
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Which symptom is most suggestive of a left middle cerebral artery (MCA) stroke?
A. Aphasia and right-sided hemiparesis
B. Visual neglect and left-sided weakness
C. Loss of consciousness and seizure
D. Ataxia and diplopia
Correct Answer: A. Aphasia and right-sided hemiparesis
Rationale: Left MCA strokes commonly affect language centers and motor control of the
right side of the body.
Question 4
A patient is suspected of having a stroke. What is the first priority in the emergency
department?
A. Insert an indwelling catheter
B. Obtain informed consent for tPA
C. Assess airway, breathing, and circulation
D. Prepare the patient for carotid endarterectomy
Correct Answer: C. Assess airway, breathing, and circulation
Rationale: ABCs are the priority in all emergency cases. A compromised airway or
breathing must be addressed immediately.
Question 5
What is the time window for administering IV alteplase (tPA) in most ischemic strokes?
A. Within 12 hours of symptom onset
B. Within 4.5 hours of symptom onset
C. Within 2 hours of hospital arrival
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D. Within 24 hours of symptom onset
Correct Answer: B. Within 4.5 hours of symptom onset
Rationale: Current guidelines support administration within 4.5 hours, after which risks of
hemorrhage increase.
Question 6
Which of the following is a contraindication to tPA administration?
A. Age over 80
B. Facial droop and aphasia
C. Recent gastrointestinal bleeding
D. Right-sided hemiparesis
Correct Answer: C. Recent gastrointestinal bleeding
Rationale: Active or recent internal bleeding increases risk of hemorrhagic complications
with thrombolytics.
Question 7
Which NIH Stroke Scale component assesses arm drift?
A. Level of consciousness
B. Facial palsy
C. Motor arm
D. Ataxia
Correct Answer: C. Motor arm
Rationale: The NIHSS "motor arm" item evaluates limb strength and drift, a critical
indicator in stroke assessment.
NCLEX RN Exam Bank: Neurologic Crisis, Stroke,
Increased ICP & TBI Management
Table of Contents
Subtopic 1: Acute Ischemic Stroke, Assessment, Diagnosis & Initial Interventions (Q1–Q20)
.................................................................................................................................... 2
Subtopic 2: Hemorrhagic Stroke—Recognition, Surgical & Medical Management (Q21–Q40)
.................................................................................................................................. 10
Subtopic 3: Increased Intracranial Pressure (ICP)—Monitoring, Management &
Complications (Q41–Q60) ........................................................................................... 19
Subtopic 4: Traumatic Brain Injury (TBI)—Types, Phases & Emergency Response (Q61–Q80)
.................................................................................................................................. 27
Subtopic 5: Post-Stroke and TBI Rehabilitation, Safety & Patient Education (Q81–Q100)... 35
Subtopic 6: Pediatric and Geriatric Considerations in Neurologic Crises ......................... 43
Subtopic 7: Neurosurgical Interventions and Post-Op Nursing Care ................................ 52
Subtopic 8: Pediatric and Geriatric Considerations in Neurologic Crises ......................... 60
Subtopic 9: Brain Herniation Syndromes, Monitoring & Emergency Interventions ............. 69
Subtopic 10: Emergency Response, Crisis Prioritization & Neuroprognostication ............. 77
, 2
Subtopic 1: Acute Ischemic Stroke, Assessment,
Diagnosis & Initial Interventions (Q1–Q20)
Question 1
A client presents with sudden right-sided weakness and slurred speech. What is the
nurse’s priority action?
A. Administer oxygen at 2 L/min via nasal cannula
B. Check blood glucose
C. Notify the stroke team immediately
D. Reassure the patient and gather more history
Correct Answer: C. Notify the stroke team immediately
Rationale: Timely activation of the stroke team facilitates urgent diagnostic imaging (CT
scan) and intervention. "Time is brain"—delays in care can worsen neurologic outcomes.
Question 2
Which of the following diagnostic tests must be completed before administering tPA?
A. MRI of the brain
B. Non-contrast CT scan of the head
C. Carotid Doppler ultrasound
D. Lumbar puncture
Correct Answer: B. Non-contrast CT scan of the head
Rationale: A non-contrast CT is necessary to rule out hemorrhagic stroke, which is a
contraindication to tPA.
Question 3
, 3
Which symptom is most suggestive of a left middle cerebral artery (MCA) stroke?
A. Aphasia and right-sided hemiparesis
B. Visual neglect and left-sided weakness
C. Loss of consciousness and seizure
D. Ataxia and diplopia
Correct Answer: A. Aphasia and right-sided hemiparesis
Rationale: Left MCA strokes commonly affect language centers and motor control of the
right side of the body.
Question 4
A patient is suspected of having a stroke. What is the first priority in the emergency
department?
A. Insert an indwelling catheter
B. Obtain informed consent for tPA
C. Assess airway, breathing, and circulation
D. Prepare the patient for carotid endarterectomy
Correct Answer: C. Assess airway, breathing, and circulation
Rationale: ABCs are the priority in all emergency cases. A compromised airway or
breathing must be addressed immediately.
Question 5
What is the time window for administering IV alteplase (tPA) in most ischemic strokes?
A. Within 12 hours of symptom onset
B. Within 4.5 hours of symptom onset
C. Within 2 hours of hospital arrival
, 4
D. Within 24 hours of symptom onset
Correct Answer: B. Within 4.5 hours of symptom onset
Rationale: Current guidelines support administration within 4.5 hours, after which risks of
hemorrhage increase.
Question 6
Which of the following is a contraindication to tPA administration?
A. Age over 80
B. Facial droop and aphasia
C. Recent gastrointestinal bleeding
D. Right-sided hemiparesis
Correct Answer: C. Recent gastrointestinal bleeding
Rationale: Active or recent internal bleeding increases risk of hemorrhagic complications
with thrombolytics.
Question 7
Which NIH Stroke Scale component assesses arm drift?
A. Level of consciousness
B. Facial palsy
C. Motor arm
D. Ataxia
Correct Answer: C. Motor arm
Rationale: The NIHSS "motor arm" item evaluates limb strength and drift, a critical
indicator in stroke assessment.
