1|Page
Ace Your NR 603 Midterm Exam 2025/2026: The
Ultimate Test Bank with Verified Questions, Answers,
and In-Depth Rationales.
A 75-year-old man is involved in a motor vehicle accident and strikes
his forehead on the windshield. He complains of neck pain and severe
burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does
this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - ANSWER-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more
severe in the upper extremities than in the lower extremities, and is more
severe in the hands. There is typically hyperesthesia over the shoulders
and arms. Anterior cord syndrome presents with paraplegia or
quadriplegia, loss of lateral spinothalamic function with preservation of
posterior column function. Brown-Séquard syndrome consists of
weakness and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic
function one to two levels below the lesion. Complete cord transection
would affect motor and sensory function distal to the lesion. Cauda
equina syndrome typically presents as low back pain with radiculopathy.
,2|Page
A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the alley
cement, and he lost consciousness for about 1 minute; he woke up with a
headache, but he had no other complaints. A few hours later, the patient
is brought to the emergency room by his neighbor because of an intense
headache, confusion, and left hand hemiparesis. On examination, the
patient has a bruise located over the right temporal region, mydriasis,
and right deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without contrast
reveals a lens-shaped hyper-density under the right temporal bone with
mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 - ANSWER-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from minutes
to hours followed by altered mental status and focal deficits is typical for
epidural hematoma, this clinical picture is only encountered in up to 1/3
of the patients. The collection of blood between the skull and dura mater
causes an evident mass effect with ophthalmic nerve palsy and the
contralateral hemiparesis. Surgical evacuation of the clot via burr holes
is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging
veins that connect the cerebrum to the venous sinuses within the dura.
This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks. The
CT scan will show a concave, crescent-shaped hyper-density compared
to the convex, lens-shaped hyper-density in epidural hematoma.
,3|Page
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most
common is the congenital berry aneurysm. The clinical picture is of a
sudden, severe headache with meningeal irritation. A CT scan will show
blood in the subarachnoid space, and a lumbar puncture will reveal
xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by
hypertension complicated with Charcot-Bouchard aneurysms. The blood
accumulates into the brain substance and most commonly involves the
basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of
meningeal irritation dominate the clinical picture. Lumbar puncture,
indicated if there are no focal neurological signs on clinical examination,
will be the diagnostic procedure. The CT scan of the patient presented in
this case is characteristic for epidural hematoma, and there is no
indication for a lumbar punctu
A 31-year-old woman presents with a purpural rash covering her arms,
legs, and abdomen. She also has fever, chills, nausea, abdominal
tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive for Gram-
negative diplococci in the blood, along with thrombocytopenia and an
elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital
signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient denies
any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the
hospital and placed in respiratory isolation. What major course of
therapy should this patient receive?
Answer Choices
1 Steroids
, 4|Page
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici - ANSWER-Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The
preferred drug for active infection is penicillin G. For those allergic to
penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be
initiated quickly if the patient is to survive. Intensive care placement
may be necessary if organ failure is imminent. Ventilatory support,
inotropic support, and IV fluids are necessary in some. If adrenal
insufficiency occurs, corticosteroid replacement may be considered. A
central venous line helps to provide large amounts of volume expanders
and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of
meningococcemia. However, they have been used in addition to
antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the
patient suffers from a devastating coagulopathy, blood or blood products
may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the
granules of neutrophils. It binds to endotoxin in vitro and neutralizes it.
This technique is experimental, and it is not used in everyday treatment
of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
Ace Your NR 603 Midterm Exam 2025/2026: The
Ultimate Test Bank with Verified Questions, Answers,
and In-Depth Rationales.
A 75-year-old man is involved in a motor vehicle accident and strikes
his forehead on the windshield. He complains of neck pain and severe
burning in his shoulders and arms. His physical examination reveals
weakness of his upper extremities. What type of spinal cord injury does
this patient have?
A anterior cord syndrome
B central cord syndrome
C Brown-Séquard syndrome
D complete cord transection
E cauda equina syndrome
ANS: B - ANSWER-Central Cord Syndrome
the central cord syndrome involves loss of motor function that is more
severe in the upper extremities than in the lower extremities, and is more
severe in the hands. There is typically hyperesthesia over the shoulders
and arms. Anterior cord syndrome presents with paraplegia or
quadriplegia, loss of lateral spinothalamic function with preservation of
posterior column function. Brown-Séquard syndrome consists of
weakness and loss of posterior column function on one side of the body
distal to the lesion with contralateral loss of lateral spinothalamic
function one to two levels below the lesion. Complete cord transection
would affect motor and sensory function distal to the lesion. Cauda
equina syndrome typically presents as low back pain with radiculopathy.
,2|Page
A 37-year-old man fell from a ladder as he finished hanging the
Christmas lights on his house. The right side of his head hit the alley
cement, and he lost consciousness for about 1 minute; he woke up with a
headache, but he had no other complaints. A few hours later, the patient
is brought to the emergency room by his neighbor because of an intense
headache, confusion, and left hand hemiparesis. On examination, the
patient has a bruise located over the right temporal region, mydriasis,
and right deviation of the right eye, papilledema, and left extensor
plantar response. An emergency CT scan of the head without contrast
reveals a lens-shaped hyper-density under the right temporal bone with
mass effect and edema. What is the most likely diagnosis?
Answer Choices
1 Epidural hematoma
2 Subdural hematoma
3 Subarachnoid hemorrhage
4 Intracerebral parenchymal hemorrhage
5 Acute meningitis
ANS: 1 - ANSWER-Epidural Hematoma
Epidural hematoma most often results from a traumatic tear of the
middle meningeal artery. Although a lucid interval ranging from minutes
to hours followed by altered mental status and focal deficits is typical for
epidural hematoma, this clinical picture is only encountered in up to 1/3
of the patients. The collection of blood between the skull and dura mater
causes an evident mass effect with ophthalmic nerve palsy and the
contralateral hemiparesis. Surgical evacuation of the clot via burr holes
is the treatment of choice.
Subdural hematoma results from a traumatic rupture of the bridging
veins that connect the cerebrum to the venous sinuses within the dura.
This venous hemorrhage will result in a gradual increase of the
hematoma, with a progressive clinical picture over days or weeks. The
CT scan will show a concave, crescent-shaped hyper-density compared
to the convex, lens-shaped hyper-density in epidural hematoma.
,3|Page
Subarachnoid hemorrhage is the result of an aneurysm rupture; the most
common is the congenital berry aneurysm. The clinical picture is of a
sudden, severe headache with meningeal irritation. A CT scan will show
blood in the subarachnoid space, and a lumbar puncture will reveal
xanthochromia CSF.
Intracerebral parenchymal hemorrhage is most likely caused by
hypertension complicated with Charcot-Bouchard aneurysms. The blood
accumulates into the brain substance and most commonly involves the
basal ganglia.
Acute meningitis is not associated with trauma. Fever and signs of
meningeal irritation dominate the clinical picture. Lumbar puncture,
indicated if there are no focal neurological signs on clinical examination,
will be the diagnostic procedure. The CT scan of the patient presented in
this case is characteristic for epidural hematoma, and there is no
indication for a lumbar punctu
A 31-year-old woman presents with a purpural rash covering her arms,
legs, and abdomen. She also has fever, chills, nausea, abdominal
tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive for Gram-
negative diplococci in the blood, along with thrombocytopenia and an
elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital
signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient denies
any foreign travel and does not have any sick contacts. However, she
does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the
hospital and placed in respiratory isolation. What major course of
therapy should this patient receive?
Answer Choices
1 Steroids
, 4|Page
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici - ANSWER-Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The
preferred drug for active infection is penicillin G. For those allergic to
penicillin, chloramphenicol and cephalosporins (ie, cefotaxime,
cefuroxime) may be used as alternatives.
Patients will also receive supportive care, but antibiotic therapy must be
initiated quickly if the patient is to survive. Intensive care placement
may be necessary if organ failure is imminent. Ventilatory support,
inotropic support, and IV fluids are necessary in some. If adrenal
insufficiency occurs, corticosteroid replacement may be considered. A
central venous line helps to provide large amounts of volume expanders
and inotropic medications for adequate tissue perfusion.
Steroids have not been shown to play a major role in the treatment of
meningococcemia. However, they have been used in addition to
antibiotic therapy. In the case of adrenal insufficiency, for example,
steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the
patient suffers from a devastating coagulopathy, blood or blood products
may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the
granules of neutrophils. It binds to endotoxin in vitro and neutralizes it.
This technique is experimental, and it is not used in everyday treatment
of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
