NCLEX : NCLEX

Study concepts, example questions & explanations for NCLEX

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Example Questions

Example Question #5 : Neural And Psychological Conditions

Which of the following is the most common etiology of intracerebral hemorrhagic stroke?

Possible Answers:

Trauma

Arteriovenous malformation (AVM)

Hypertension

Medications

Correct answer:

Hypertension

Explanation:

Hypertension is a leading etiology in intracerebral hemorrhagic stroke. Chronic hypertension can cause damage and stress to the blood vessel wall, leading to aneurism or increased risk of spontaneous rupture.

AVM, trauma, and medications such as blood thinners are all also responsible for a significant (though lesser) number of hemorrhagic strokes, or may be co-morbidities that increase the risk of a rupture in the presence of prolonged hypertension. 

Example Question #6 : Neural And Psychological Conditions

What is the most common cause of meningitis?

Possible Answers:

Fungal infection

Aseptic inflammation

Bacterial infection

Viral infection

Correct answer:

Viral infection

Explanation:

All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis: 

  • Neisseria meningitidis (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae type b (Hib)

Example Question #7 : Neural And Psychological Conditions

A client has a history of spinal injury and the nurse is evaluating the client with the onset of new symptoms. The symptoms include hypertension, a throbbing headache, a slow heart rate of 40 beats per minute, and piloerection. 

The nurse recognizes these symptoms are consistent with what disorder?

Possible Answers:

Neurogenic shock

Malignant hypertension

Autonomic dysreflexia

Spinal shock

Brown Sequard syndrome

Correct answer:

Autonomic dysreflexia

Explanation:

These symptoms are evidence of autonomic dysreflexia, which is a sequela of spinal shock. It is a medical emergency and requires immediate intervention as it may lead to stroke, cardiac arrest, coma or death if untreated. 

Example Question #8 : Neural And Psychological Conditions

A 23-year-old male college student presents to the emergency room after experiencing a high fever, nausea, vomiting, and nuchal rigidity. The nurse recognizes that this combination of symptoms are indicative of bacterial meningitis. The nurse is aware cranial nerve dysfunction is related to the condition. 

Which of the following cranial nerves (CN) is correctly matched to its dysfunction?

Possible Answers:

Irritation of CN V may lead to loss of the corneal reflex.

Irritation of CN VIII may cause deficits in facial movements. 

Irritation of CN II may cause ptosis, a drooping of the ipsilateral eyelid.

Irritation of CN III may cause papilledema as seen with increased intracranial pressure.

Irritation of CN VI may cause hearing disturbances such as tinnitus. 

Correct answer:

Irritation of CN V may lead to loss of the corneal reflex.

Explanation:

The trigeminal nerve (CN V) is responsible for both sensory and motor functions of the face, including the corneal reflex which is also mediated by the facial nerve (CN VII).

CN II, optic nerve affects vision, including causing papilledema - swelling of the optic disc. CN III, oculomotor dysfunction may cause ptosis. Cranial nerve VIII, vestibulocochlear is responsible for hearing and cranial nerve VI, abducens is responsible for horizontal eye movements. 

Example Question #9 : Neural And Psychological Conditions

A 27 year old female presents complaining of an inability to "smile normally" or close her left eye. She states that she woke up and noticed that the left side of her face was "not responding" when she tried to blink, smile, or speak. She also feels a pain in her left ear. She has never experienced this before. The nurse does a physical exam, which is notable for left sided upper eyelid retraction, general left sided facial muscle weakness, and left sided brow droop. There are no cognitive or sensory defects noted. What is the most likely cause?

Possible Answers:

Transient ischemic attack

Otitis interna

Myasthenia gravis

Bell's palsy

Correct answer:

Bell's palsy

Explanation:

The symptoms and physical exam of this patient are consistent with a diagnosis of Bell's palsy, a rapid onset cranial nerve disorder that results in unilateral facial paralysis or weakness. Symptoms usually come on within 24-72 hours and may include facial tingling, ear pain, taste disturbance, headache, issues with balance, cognitive changes, and clumsiness. 

Example Question #271 : Conditions And Treatments

A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?

Possible Answers:

Migraine

Sinus

Caffeine withdrawal

Tension

Correct answer:

Migraine

Explanation:

The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:

  • More than 5 episodes (lifetime)
  • Headache lasts 4-72 hours
  • During headache at least one of the following:
    • nausea / vomiting
    • photophobia or phonophobia
  • Headache has at least two of the following characteristics:
    • unilateral
    • moderate or severe pain intensity
    • pulsating
    • aggravation by normal physical activity, may cause avoidance of normal activities of life
  • Not attributed to another disorder

Example Question #272 : Conditions And Treatments

A 37 year old man comes into the clinic for chronic headaches. He describes his headaches as in his forehead and temples bilaterally, occasionally wrapping around his head toward his neck. Pain is rated as a 4 out of 10. He has these headaches around 3 times per week. No photophobia with his headaches, no nausea or vomiting. Headache feels better when he presses on his scalp. When asked to describe the sensation of the headache, he replies that it's "like a band" around his head. These headaches are not preventing him from normal activity. These are most likely what type of headache?

Possible Answers:

Classic migraine 

Tension headaches

Cluster headaches

Ocular migraine 

Correct answer:

Tension headaches

Explanation:

The symptoms described by this individual make tension headaches the most likely diagnosis. Tension headaches are defined by the following criteria:

  • Minimum of 10 episodes occurring on less than 15 days per month for at least 3 months
  • Headaches last from 30 minutes to 7 days
  • Headache has at least two of the following qualities:
    • mild or moderate intensity
    • bilateral
    • pressing or tightening (non-pulsing) quality
    • not aggravated by routine activities of daily living
  • Both of the following:
    • no nausea or vomiting
    • either photophobia or phonophobia, but not both
  • Not attributed to another disorder

Example Question #273 : Conditions And Treatments

A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He has up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types?

Possible Answers:

Migraine without aura

Cluster headache

Migraine with aura

Tension hedache

Correct answer:

Cluster headache

Explanation:

The presentation of this patient's headaches would make cluster headache the most likely diagnosis. Cluster headaches are defined by the following criteria:

  • At least 5 attacks
  • Severe unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes 
  • Headache is accompanied by at least one of the following:
    • ipsilateral conjunctival injection and/or lacrimation
    • ipsilateral nasal congestion and/or rhinorrhoea
    • ipsilateral eyelid swelling
    • ipsilateral facial sweating
    • ipsilateral miosis or ptosis
    • restlessness or agitation
  • Attack frequency ranges from every other day to 8 per day
  • Not attributed to another disorder

Example Question #13 : Neural And Psychological Conditions

Which of the following is not a common trigger for migraine headaches?

Possible Answers:

Caffeine

Lack of sleep

Medication

Food allergies

Correct answer:

Caffeine

Explanation:

While caffeine may be a migraine trigger for certain individuals, in the majority of people who experience migraine headaches, caffeine provides significant relief of pain. This may be due to it's antagonizing adenosine receptors, which has the effect of cerebral vasoconstriction. Caffeine withdrawal, however, is a common cause of headaches and may trigger migraine is susceptible individuals. Other common migraine triggers include food allergies, medications, bright lights, stress, lack of sleep, hormone fluctuations, strong odors, alcohol, and certain types of exercise. 

Example Question #14 : Neural And Psychological Conditions

Which of the following seizure types is characterized by a brief loss in muscle control, often resulting in a fall or collapse, in the absence of spasm or rigidity?

Possible Answers:

Atonic seizure

Absence seizure

Tonic-clonic seizure

Myoclonic seizure

Correct answer:

Atonic seizure

Explanation:

Atonic seizures are characterized by brief (2-15 second) loss or lapses in muscle control, resulting in sudden relaxation of the neck, legs, or whole body. This seizure type frequently causes injury due to falls or head trauma. There may be spasm or twitching at some point during an atonic seizure, but they generally present without any form of rigidity or clonus, unlike tonic-clonic and myoclonic seizures. Atonic seizures differ from absence seizures in that an individual experiencing absence seizures will generally only experience a loss of consciousness, without an accompanying loss of muscle control. 

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