Leigh
NUR 445 Exam 3 Neuro Review – 80 NCLEX-Style Questions with Answers & Full
Rationales (Brain Tumors, Stroke, ALS, MG, GBS, ICP, TBI, Shock)
1. Which brain tumor type is the most aggressive, associated with rapid
progression and poor prognosis?
A. Meningioma
B. Acoustic neuroma
C. Glioblastoma multiforme
D. Oligodendroglioma
Answer: C
Rationale:
Glioblastoma multiforme (GBM, Grade IV glioma) is the most malignant primary
brain tumor due to its rapid growth, diffuse infiltration, high recurrence rate, and
resistance to therapy.
2. Which clinical manifestation most commonly indicates increased intracranial
pressure (ICP) in a patient with a brain tumor?
A. Bradycardia with low systolic blood pressure
B. Sudden bilateral hearing loss
C. Persistent early-morning headaches
D. Hyperactive deep-tendon reflexes
Answer: C
Rationale:
Morning headaches are classic because ICP increases overnight when CO₂ rises.
This increases cerebral vasodilation, worsening headache and nausea.
3. Vasogenic edema after brain tumor surgery occurs because:
,Leigh
A. The ventricles overproduce CSF
B. The blood-brain barrier becomes more permeable
C. The brain loses autoregulation
D. The meninges are inflamed
Answer: B
Rationale:
Vasogenic edema is caused by leakage of plasma through a disrupted BBB,
commonly seen after tumor manipulation or removal.
4. Which medication is most effective for reducing vasogenic cerebral edema
after a craniotomy?
A. Furosemide
B. Mannitol
C. Dexamethasone
D. Acetazolamide
Answer: C
Rationale:
Glucocorticoids like dexamethasone are specifically effective against vasogenic
edema associated with brain tumors by reducing capillary permeability.
5. Which post-craniotomy complication is the most life-threatening and requires
immediate assessment?
A. Mild nausea
B. Periorbital edema
C. Sudden decrease in level of consciousness
D. Incisional pain
Answer: C
,Leigh
Rationale:
Any drop in LOC suggests elevated ICP, bleeding, or brain herniation—emergent
neurosurgical complications.
6. Which symptom is most strongly associated with pituitary tumors?
A. Memory loss
B. Hormonal abnormalities
C. Loss of sensation
D. Difficulty swallowing
Answer: B
Rationale:
Pituitary adenomas disrupt hormone secretion, leading to conditions such as
acromegaly, amenorrhea, or galactorrhea.
7. The nurse suspects ALS when noting which finding?
A. Loss of sensation below the injury
B. Progressive muscle weakness with intact cognition
C. Positive Babinski reflex
D. Ascending paralysis
Answer: B
Rationale:
ALS destroys motor neurons while sparing sensory function and intellect, causing
weakness, fasciculations, and muscle wasting.
8. What is the primary cause of respiratory failure in ALS?
, Leigh
A. Impaired upper-airway reflexes
B. Weakness of the diaphragm and chest wall muscles
C. Excessive respiratory secretions
D. Collapse of alveoli
Answer: B
Rationale:
Motor neuron degeneration causes progressive weakness of respiratory muscles,
eventually requiring ventilatory support.
9. Which medication slows the progression of ALS?
A. Baclofen
B. Pyridostigmine
C. Riluzole
D. Gabapentin
Answer: C
Rationale:
Riluzole decreases glutamate toxicity, slightly prolonging survival in ALS.
Edaravone also slows functional decline.
10. A patient with ALS reports difficulty swallowing. What should the nurse do
first?
A. Offer thickened liquids
B. Place the patient NPO and notify provider
C. Perform oral suctioning
D. Give a PRN antacid
Answer: A
NUR 445 Exam 3 Neuro Review – 80 NCLEX-Style Questions with Answers & Full
Rationales (Brain Tumors, Stroke, ALS, MG, GBS, ICP, TBI, Shock)
1. Which brain tumor type is the most aggressive, associated with rapid
progression and poor prognosis?
A. Meningioma
B. Acoustic neuroma
C. Glioblastoma multiforme
D. Oligodendroglioma
Answer: C
Rationale:
Glioblastoma multiforme (GBM, Grade IV glioma) is the most malignant primary
brain tumor due to its rapid growth, diffuse infiltration, high recurrence rate, and
resistance to therapy.
2. Which clinical manifestation most commonly indicates increased intracranial
pressure (ICP) in a patient with a brain tumor?
A. Bradycardia with low systolic blood pressure
B. Sudden bilateral hearing loss
C. Persistent early-morning headaches
D. Hyperactive deep-tendon reflexes
Answer: C
Rationale:
Morning headaches are classic because ICP increases overnight when CO₂ rises.
This increases cerebral vasodilation, worsening headache and nausea.
3. Vasogenic edema after brain tumor surgery occurs because:
,Leigh
A. The ventricles overproduce CSF
B. The blood-brain barrier becomes more permeable
C. The brain loses autoregulation
D. The meninges are inflamed
Answer: B
Rationale:
Vasogenic edema is caused by leakage of plasma through a disrupted BBB,
commonly seen after tumor manipulation or removal.
4. Which medication is most effective for reducing vasogenic cerebral edema
after a craniotomy?
A. Furosemide
B. Mannitol
C. Dexamethasone
D. Acetazolamide
Answer: C
Rationale:
Glucocorticoids like dexamethasone are specifically effective against vasogenic
edema associated with brain tumors by reducing capillary permeability.
5. Which post-craniotomy complication is the most life-threatening and requires
immediate assessment?
A. Mild nausea
B. Periorbital edema
C. Sudden decrease in level of consciousness
D. Incisional pain
Answer: C
,Leigh
Rationale:
Any drop in LOC suggests elevated ICP, bleeding, or brain herniation—emergent
neurosurgical complications.
6. Which symptom is most strongly associated with pituitary tumors?
A. Memory loss
B. Hormonal abnormalities
C. Loss of sensation
D. Difficulty swallowing
Answer: B
Rationale:
Pituitary adenomas disrupt hormone secretion, leading to conditions such as
acromegaly, amenorrhea, or galactorrhea.
7. The nurse suspects ALS when noting which finding?
A. Loss of sensation below the injury
B. Progressive muscle weakness with intact cognition
C. Positive Babinski reflex
D. Ascending paralysis
Answer: B
Rationale:
ALS destroys motor neurons while sparing sensory function and intellect, causing
weakness, fasciculations, and muscle wasting.
8. What is the primary cause of respiratory failure in ALS?
, Leigh
A. Impaired upper-airway reflexes
B. Weakness of the diaphragm and chest wall muscles
C. Excessive respiratory secretions
D. Collapse of alveoli
Answer: B
Rationale:
Motor neuron degeneration causes progressive weakness of respiratory muscles,
eventually requiring ventilatory support.
9. Which medication slows the progression of ALS?
A. Baclofen
B. Pyridostigmine
C. Riluzole
D. Gabapentin
Answer: C
Rationale:
Riluzole decreases glutamate toxicity, slightly prolonging survival in ALS.
Edaravone also slows functional decline.
10. A patient with ALS reports difficulty swallowing. What should the nurse do
first?
A. Offer thickened liquids
B. Place the patient NPO and notify provider
C. Perform oral suctioning
D. Give a PRN antacid
Answer: A
