Free Altered Mental Status & Neuro Practice Questions

1. A 30-year-old female had a seizure witnessed by her coworkers. Upon your arrival, she is postictal and gradually becoming more alert. She states she has epilepsy and this is her "normal" seizure. She is oriented, has stable vital signs, and wants to refuse transport. What is the MOST appropriate action?

• Perform a thorough assessment, inform her of risks of refusing transport (new seizure, aspiration, injury), and if she is competent and understands the risks, obtain a signed refusal with detailed documentation
• Since she has epilepsy and this is normal for her, simply leave the scene
• Tell her she cannot refuse transport because she had a seizure
• Transport her against her will because she had altered mental status

2. A 40-year-old female has been actively seizing for 8 minutes continuously without regaining consciousness between episodes. What is this condition called, and why is it a critical emergency?

• Status epilepticus; prolonged seizure activity causes brain hypoxia, hyperthermia, and can be fatal without intervention
• Simple partial seizure; it will resolve on its own
• Psychogenic nonepileptic seizure; it is not a true emergency
• Absence seizure; she will "snap out of it" shortly

3. A 55-year-old male suddenly develops the "worst headache of his life," vomiting, and a stiff neck. He is photophobic and rapidly becoming less responsive. What is the MOST likely diagnosis, and what is unique about this patient's stroke presentation?

• Hemorrhagic stroke (likely subarachnoid hemorrhage); these patients should NOT receive thrombolytics, making rapid transport and accurate reporting critical
• Ischemic stroke; administer aspirin and transport to a stroke center for tPA
• Migraine headache; dim the lights and transport non-emergently
• Meningitis; isolation precautions are the priority

4. You are assessing an unresponsive patient who makes no eye opening, no verbal response, and exhibits abnormal extension (decerebrate posturing) to painful stimuli. What is the GCS score, and what does the motor response pattern indicate?

• GCS 4 (E1+V1+M2); decerebrate posturing indicates severe brainstem damage with a poor prognosis
• GCS 3 (minimum score); the patient is brain dead
• GCS 6 (E1+V1+M4); the motor response is normal withdrawal
• GCS 5 (E1+V1+M3); the response indicates abnormal flexion

5. You are reassessing a trauma patient during transport. Initially, his GCS was 14 (E4, V4, M6) and both pupils were equal and reactive. Now his GCS has dropped to 9 (E2, V3, M4) and his left pupil is larger than his right. What is the MOST appropriate action?

• Increase ventilation rate slightly, notify the receiving facility of the deterioration, and expedite transport
• Stop the ambulance and perform a complete head-to-toe reassessment
• The decline is expected and requires no change in treatment
• Reduce the oxygen flow rate to prevent seizures