Neurological Nursing for the NCLEX-RN Exam

Common failure modes

These are the patterns that cause most candidates to lose marks on this topic. Recognising them in advance is half the work.

• !Giving tPA outside the 4.5-hour window or without verifying contraindications (recent surgery, active bleeding, anticoagulation)
• !Missing Cushing triad (hypertension + bradycardia + irregular respirations) as a sign of imminent herniation
• !Positioning a stroke patient flat when HOB should be 30° to optimize CPP
• !Restraining a patient during a seizure — only protect from injury and move objects away

Study tips

• 1Memorize the FAST stroke screen: Face, Arms, Speech, Time. Combined with last-known-well time, this drives all stroke decision-making.
• 2Know the tPA inclusion/exclusion criteria — every NCLEX has a tPA contraindication question.
• 3Drill increased ICP priorities: HOB 30°, head midline, avoid hip flexion, avoid Valsalva, prevent hyperthermia.
• 4Status epilepticus: lorazepam IV first-line; if recurrent, fosphenytoin or levetiracetam; if refractory, intubation and propofol.

Sample NCLEX-RN Neurological Nursing questions

These sample items mirror the format and difficulty of real NCLEX-RN questions. Practice with thousands more on the free Koydo question bank.

1. 1

   A client with a head injury has BP 180/95, pulse 52, and irregular respirations. The nurse recognizes this as:

   • ACushing's triad indicating increased intracranial pressureCorrect
   • BSeptic shock
   • CDiabetic ketoacidosis
   • DSpinal shock
   Why this answer?

   Cushing's triad — hypertension (with widened pulse pressure), bradycardia, and irregular respirations — is a late and ominous sign of increased intracranial pressure with brainstem compression. Immediate action is required to prevent herniation.