NUR 336; ICR FINAL EXAM PRACTICE
QUESTIONS AND ANSWER; LATEST UPDATED
VERSION 2026
A 5-year-old girl sustained a concussion when she fell out of a
tree. In preparation for discharge, the nurse is discussing home
care with her mother. Which statement made by the mother
indicates a correct understanding of the teaching?
a. I should expect my child to have a few episodes of vomiting.
b. If I notice sleep disturbances, I should contact the physician
immediately.
c. I should expect my child to have some behavioral changes
after the accident.
d. If I notice diplopia, I will have my child rest for 1 hour. -
correct answer- C. I should expect my child to have some
behavioral changes after the accident
A child has been seizure-free for 2 years. A father asks the nurse
how much longer the child will need to take the antiseizure
medications. The nurse includes which intervention in the
response?
a. Medications can be discontinued at this time.
b. The child will need to take the drugs for 5 years after the last
seizure.
,c. A stepwise approach will be used to reduce the dosage
gradually.
d. Seizure disorders are a lifelong problem. Medications cannot
be discontinued. - correct answer- C. A stepwise
approach will be used to reduce the dosage gradually
A child is unconscious after a motor vehicle accident. The watery
discharge from the nose tests positive for glucose. The nurse
should recognize that this suggests:
a. Diabetic coma.
c. Upper respiratory tract infection.
b. Brainstem injury.
d. Leaking of cerebrospinal fluid (CSF). - correct answer-
D. Leaking of cerebrospinal fluid (CSF)
A client experiences impaired swallowing after a stroke and has
worked with speech-language pathology on eating. What
nursing assessment best indicates that a priority goal for this
problem has been met?
a. Chooses preferred items from the menu
b. Eats 75% to 100% of all meals and snacks
c. Has clear lung sounds on auscultation
,d. Gains 2 pounds after 1 week - correct answer- C. Has
clear lung sounds on auscultation
A client had an embolectomy for an arteriovenous malformation
(AVM). The client is now reporting a severe headache and has
vomited. What action by the nurse takes priority?
a. Administer pain medication.
b. Assess the clients vital signs.
c. Notify the Rapid Response Team.
d. Raise the head of the bed. - correct answer- C. Notify
the rapid response team
A client had an embolic stroke and is having an echocardiogram.
When the client asks why the provider ordered a test on my
heart, how should the nurse respond?
a. Most of these types of blood clots come from the heart.
b. Some of the blood clots may have gone to your heart too.
c. We need to see if your heart is strong enough for therapy.
d. Your heart may have been damaged in the stroke too. -
correct answer- A. Most of these types of blood clots
come from the heart
, A client has a brain abscess and is receiving phenytoin (Dilantin).
The spouse questions the use of the drug, saying the client does
not have a seizure disorder. What response by the nurse is best?
a. Increased pressure from the abscess can cause seizures.
b. Preventing febrile seizures with an abscess is important.
c. Seizures always occur in clients with brain abscesses.
d. This drug is used to sedate the client with an abscess. -
correct answer- A. Increased pressure from the abcess
can cause seizures
A client has a small-bore feeding tube (Dobhoff tube) inserted
for continuous enteral feedings while recovering from a
traumatic brain injury. What actions should the nurse include in
the clients care? (Select all that apply.)
a. Assess tube placement per agency policy.
b. Keep the head of the bed elevated at least 30 degrees.
c. Listen to lung sounds at least every 4 hours.
d. Run continuous feedings on a feeding pump.
e. Use blue dye to determine proper placement. - correct
answer- A. Assess tube placement per agency policy
B. Keep the head of the bed elevated at least 30 degrees
C. Listen to lung sounds at least every 4 hours
QUESTIONS AND ANSWER; LATEST UPDATED
VERSION 2026
A 5-year-old girl sustained a concussion when she fell out of a
tree. In preparation for discharge, the nurse is discussing home
care with her mother. Which statement made by the mother
indicates a correct understanding of the teaching?
a. I should expect my child to have a few episodes of vomiting.
b. If I notice sleep disturbances, I should contact the physician
immediately.
c. I should expect my child to have some behavioral changes
after the accident.
d. If I notice diplopia, I will have my child rest for 1 hour. -
correct answer- C. I should expect my child to have some
behavioral changes after the accident
A child has been seizure-free for 2 years. A father asks the nurse
how much longer the child will need to take the antiseizure
medications. The nurse includes which intervention in the
response?
a. Medications can be discontinued at this time.
b. The child will need to take the drugs for 5 years after the last
seizure.
,c. A stepwise approach will be used to reduce the dosage
gradually.
d. Seizure disorders are a lifelong problem. Medications cannot
be discontinued. - correct answer- C. A stepwise
approach will be used to reduce the dosage gradually
A child is unconscious after a motor vehicle accident. The watery
discharge from the nose tests positive for glucose. The nurse
should recognize that this suggests:
a. Diabetic coma.
c. Upper respiratory tract infection.
b. Brainstem injury.
d. Leaking of cerebrospinal fluid (CSF). - correct answer-
D. Leaking of cerebrospinal fluid (CSF)
A client experiences impaired swallowing after a stroke and has
worked with speech-language pathology on eating. What
nursing assessment best indicates that a priority goal for this
problem has been met?
a. Chooses preferred items from the menu
b. Eats 75% to 100% of all meals and snacks
c. Has clear lung sounds on auscultation
,d. Gains 2 pounds after 1 week - correct answer- C. Has
clear lung sounds on auscultation
A client had an embolectomy for an arteriovenous malformation
(AVM). The client is now reporting a severe headache and has
vomited. What action by the nurse takes priority?
a. Administer pain medication.
b. Assess the clients vital signs.
c. Notify the Rapid Response Team.
d. Raise the head of the bed. - correct answer- C. Notify
the rapid response team
A client had an embolic stroke and is having an echocardiogram.
When the client asks why the provider ordered a test on my
heart, how should the nurse respond?
a. Most of these types of blood clots come from the heart.
b. Some of the blood clots may have gone to your heart too.
c. We need to see if your heart is strong enough for therapy.
d. Your heart may have been damaged in the stroke too. -
correct answer- A. Most of these types of blood clots
come from the heart
, A client has a brain abscess and is receiving phenytoin (Dilantin).
The spouse questions the use of the drug, saying the client does
not have a seizure disorder. What response by the nurse is best?
a. Increased pressure from the abscess can cause seizures.
b. Preventing febrile seizures with an abscess is important.
c. Seizures always occur in clients with brain abscesses.
d. This drug is used to sedate the client with an abscess. -
correct answer- A. Increased pressure from the abcess
can cause seizures
A client has a small-bore feeding tube (Dobhoff tube) inserted
for continuous enteral feedings while recovering from a
traumatic brain injury. What actions should the nurse include in
the clients care? (Select all that apply.)
a. Assess tube placement per agency policy.
b. Keep the head of the bed elevated at least 30 degrees.
c. Listen to lung sounds at least every 4 hours.
d. Run continuous feedings on a feeding pump.
e. Use blue dye to determine proper placement. - correct
answer- A. Assess tube placement per agency policy
B. Keep the head of the bed elevated at least 30 degrees
C. Listen to lung sounds at least every 4 hours
