NCLEX-RN Study Guide

NCLEX Neurology Questions: Stroke and ICP (2026)

November 2, 2026 · 5 min read

Short answer. Neurology NCLEX questions reward serial assessment. A single normal pupil means little; a pupil that changed since the last check is an emergency. Time is brain, so the first question is always when the symptoms started.

What the 2026 NCLEX tests in this area

Physiological Adaptation: stroke, traumatic brain injury, seizures, spinal cord injury
Reduction of Risk Potential: neurological monitoring, diagnostic testing, positioning

Key facts to know

Glasgow Coma Scale range	3 to 15, with 8 or below indicating a need to protect the airway
Normal intracranial pressure	Below 15 mmHg
Thrombolytic window for ischemic stroke	Up to 4.5 hours from symptom onset in eligible clients
First action for suspected stroke	Establish the time of onset and activate the stroke pathway
Signs of rising intracranial pressure	Decreasing level of consciousness, unequal pupils, vomiting, change in respirations
Seizure precautions	Padded rails, bed low, suction and oxygen at the bedside, no restraints during the seizure

Practice question from this chapter

A client with increased intracranial pressure is receiving mannitol. The urine output is 300 mL in the past hour, serum sodium is 148 mEq/L, serum osmolality is 310 mOsm/kg, and the neurologic status is improving. Which finding indicates the therapy is effective?

Serum osmolality 310 mOsm/kg with improving neurologic status
Urine output 40 mL over the past hour
Serum sodium 130 mEq/L
Worsening pupil response

Show answer and rationale

Correct answer: C. Serum sodium 130 mEq/L

Mannitol is effective when the serum osmolality rises into the target range and the neurologic status improves. Low urine output, a low sodium, and worsening pupils indicate the therapy is not working or the condition is deteriorating.

Second practice question

A client after a traumatic brain injury has a Glasgow Coma Scale score of 9, down from 13, blood pressure 160/90 mmHg, heart rate 52 beats/min, respiratory rate 8 breaths/min, and sluggish pupils. Which action should the nurse implement first?

Suction the nares to clear the airway
Notify the provider of increased intracranial pressure signs
Place the client in Trendelenburg position
Encourage coughing

Show answer and rationale

Correct answer: B. Notify the provider of increased intracranial pressure signs

A falling Glasgow Coma Scale score with bradycardia, hypertension, and irregular respirations is Cushing triad, indicating rising intracranial pressure, so the provider must be notified immediately. Nasal suctioning and coughing increase intracranial pressure. Trendelenburg position worsens it.

The assessment that catches deterioration

Level of consciousness is the earliest and most sensitive sign of neurological decline. It changes before pupils do and long before vital signs reflect herniation. Trend it, document it, and escalate a change even when the numbers look acceptable.

For suspected stroke, everything depends on the clock. Note the exact time the client was last known well, not the time they were found. That single detail decides eligibility for reperfusion therapy.

Cranial nerves without the memorisation

Practise the ones that appear in items: facial droop for facial nerve, swallow and gag for glossopharyngeal and vagus, tongue deviation for hypoglossal. After a stroke, aspiration risk follows a weak gag reflex, so a swallow screen comes before the first meal.

Assess in a fixed order

Level of consciousness, then pupils, then motor function, then vital signs. Consciousness changes first and vital signs change last, so an item that gives you a sleepy client with normal vitals is showing you early deterioration, not stability.

Use a consistent scale and document the trend. A Glasgow Coma Scale of 14 that was 15 an hour ago is more alarming than a stable 13, because the direction of travel is the finding.

Time and positioning

For a stroke, establish the time the client was last known well. That single fact decides reperfusion eligibility and it is the answer to many items. For raised intracranial pressure, keep the head at about thirty degrees with neutral alignment, avoid hip flexion, and prevent coughing, straining and suctioning beyond what is needed.

Seizure care is the other reliable pattern: protect the head, do not restrain, do not put anything in the mouth, turn to the side, and note the duration and the characteristics because the provider needs them.

Frequently asked questions

What is the earliest sign of increased intracranial pressure?

A change in level of consciousness. Pupil changes and vital sign shifts follow later.

What position is used for a client with high intracranial pressure?

Head of bed elevated about 30 degrees with the head in neutral alignment to promote venous drainage.

Should I restrain a client during a seizure?

No. Protect the head, clear the area and turn the client to the side. Never force anything into the mouth.

How soon must a stroke be treated?

Reperfusion therapy can be considered up to 4.5 hours from onset in eligible clients, so the onset time is the critical data point.

What are the earliest signs of rising intracranial pressure?

A decreasing level of consciousness with headache, vomiting without nausea, and a change in pupil size or reactivity. Vital sign changes such as rising blood pressure with a slowing pulse appear later.

How soon must a stroke client be assessed?

Immediately, using a validated stroke scale. Reperfusion decisions depend on symptom onset, so keep the timeline precise rather than approximate.

Practise this chapter with rationales

NCLEXDeck gives you practice questions for every body system, with a rationale for the correct answer and for each distractor. Start on the free tier, no card required.

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