NUR 242 MEDICAL-SURGICAL NURSING EXAM 4 REVIEW
2026/2027 | Complete Guide with Questions and Verified
Answers | 100% Correct | Galen College | Pass Guaranteed -
A+ Graded
Section 1: Neurological Disorders (Stroke, Seizures, Head/Spine
Injury, Neurodegenerative)
Q1: A 72-year-old patient presents to the emergency department with sudden onset of
right-sided facial droop, inability to lift the right arm, and slurred speech that started 45
minutes ago. The nurse recognizes these as classic signs of:
A. Transient ischemic attack with temporary symptoms
B. Ischemic stroke requiring immediate tPA evaluation [CORRECT]
C. Seizure activity with post-ictal weakness
D. Migraine with aura and neurological symptoms
Correct Answer: B
Rationale: The FAST symptoms (Facial droop, Arm weakness, Speech difficulty, Time to
call 911) indicate acute stroke. The 45-minute window makes the patient a candidate
for thrombolytic therapy (tPA within 3-4.5 hours). TIA (A) symptoms resolve within 24
hours (usually <1 hour). Seizures (C) typically have altered consciousness and post-ictal
confusion, not this presentation. Migraine (D) usually has gradual onset with headache.
Q2: A patient with acute ischemic stroke is being evaluated for tPA administration.
Which finding would contraindicate tPA therapy?
A. Blood pressure of 175/95 mmHg
B. Blood pressure of 220/120 mmHg [CORRECT]
C. Blood glucose of 140 mg/dL
D. NIHSS score of 8
,Correct Answer: B
Rationale: tPA is contraindicated if blood pressure is >185/110 mmHg (or requires
aggressive treatment to lower it). BP must be controlled before and during tPA infusion
to reduce hemorrhagic transformation risk. BP 175/95 (A) requires treatment but isn't
an absolute contraindication. Glucose >400 or <50 is a contraindication, not 140 (C).
NIHSS 8 (D) indicates moderate stroke—tPA appropriate.
Q3: A patient with hemorrhagic stroke has a blood pressure of 190/100 mmHg. The
nurse understands that blood pressure management in hemorrhagic stroke aims to:
A. Maintain cerebral perfusion pressure and prevent hematoma expansion [CORRECT]
B. Lower BP as quickly as possible to normal range
C. Allow permissive hypertension up to 240/140 mmHg
D. Focus only on mean arterial pressure, not systolic pressure
Correct Answer: A
Rationale: In hemorrhagic stroke, BP management balances preventing hematoma
expansion (lower BP) with maintaining cerebral perfusion (avoiding ischemia).
Guidelines typically target SBP <160 or MAP <110, avoiding rapid drops. Extremely rapid
reduction (B) can cause ischemia. Permissive hypertension (C) is inappropriate—BP
must be controlled. Both SBP and MAP matter (D).
Q4: A patient with epilepsy suddenly loses consciousness, becomes rigid, and then has
rhythmic jerking of all extremities lasting 2 minutes. Afterward, the patient is confused
and sleepy. This describes:
A. Absence seizure with brief staring spell
B. Focal impaired awareness seizure
C. Generalized tonic-clonic seizure with post-ictal state [CORRECT]
D. Myoclonic seizure with brief jerks
Correct Answer: C
,Rationale: Generalized tonic-clonic seizures have three phases: tonic (rigidity), clonic
(rhythmic jerking), and post-ictal (confusion, fatigue, headache). The description
matches perfectly. Absence seizures (A) are brief staring spells without motor activity
or post-ictal confusion. Focal seizures (B) start in one brain area. Myoclonic seizures (D)
are brief, shock-like jerks without the tonic-clonic progression.
Q5: A patient has been seizing continuously for 8 minutes without regaining
consciousness. This is classified as:
A. Focal status epilepticus with localized activity
B. Generalized status epilepticus requiring emergency intervention [CORRECT]
C. Simple partial seizure with motor symptoms
D. Complex migraine with neurological deficits
Correct Answer: B
Rationale: Status epilepticus is defined as seizure activity lasting >5 minutes or
recurrent seizures without recovery between episodes. This is a neurological emergency
requiring immediate treatment (benzodiazepines first-line, airway protection) to prevent
neuronal damage and death. After 30 minutes, permanent brain injury risk increases
significantly.
Q6: A patient with traumatic brain injury is being monitored for increased intracranial
pressure. Which vital sign pattern indicates Cushing's triad?
A. Hypotension, tachycardia, and tachypnea
B. Hypertension, bradycardia, and irregular respirations [CORRECT]
C. Hypotension, bradycardia, and apnea
D. Hypertension, tachycardia, and hyperventilation
Correct Answer: B
Rationale: Cushing's triad (hypertension, bradycardia, irregular respirations) is a late
sign of critically elevated ICP (>40 mmHg) indicating brainstem compression. The
hypertension is a compensatory response to maintain cerebral perfusion pressure (CPP
, = MAP - ICP). It's a pre-terminal sign requiring immediate intervention. Other
combinations describe different shock states or physiological responses.
Q7: A patient with a head injury has a brief loss of consciousness, then a lucid interval
during which they appear normal, followed by rapid deterioration with headache,
vomiting, and unilateral pupillary dilation. CT shows a lens-shaped hematoma. This
indicates:
A. Subdural hematoma from venous bleeding
B. Epidural hematoma from arterial bleeding requiring emergency evacuation
[CORRECT]
C. Intracerebral hemorrhage from parenchymal injury
D. Subarachnoid hemorrhage from aneurysm rupture
Correct Answer: B
Rationale: The lucid interval followed by deterioration is classic for epidural hematoma,
typically from middle meningeal artery laceration with temporal bone fracture. The
lens-shaped (biconvex) hematoma on CT reflects dural attachment limiting spread. This
is a neurosurgical emergency. Subdural hematomas (A) are crescent-shaped and lack
lucid intervals. Intracerebral (C) and subarachnoid (D) have different presentations.
Q8: A patient with spinal cord injury at T6 develops a pounding headache, severe
hypertension (210/120 mmHg), bradycardia, and flushing above the level of injury
during bladder catheterization. The nurse recognizes this as:
A. Neurogenic shock from sympathetic disruption
B. Autonomic dysreflexia requiring immediate stimulus removal [CORRECT]
C. Spinal shock with flaccid paralysis
D. Meningitis from infection
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in T6 and above
injuries triggered by noxious stimuli below the injury level (bladder distention, bowel
impaction, tight clothing). The stimulus triggers massive sympathetic discharge
causing hypertension, headache, sweating above the injury, and bradycardia (vagal
2026/2027 | Complete Guide with Questions and Verified
Answers | 100% Correct | Galen College | Pass Guaranteed -
A+ Graded
Section 1: Neurological Disorders (Stroke, Seizures, Head/Spine
Injury, Neurodegenerative)
Q1: A 72-year-old patient presents to the emergency department with sudden onset of
right-sided facial droop, inability to lift the right arm, and slurred speech that started 45
minutes ago. The nurse recognizes these as classic signs of:
A. Transient ischemic attack with temporary symptoms
B. Ischemic stroke requiring immediate tPA evaluation [CORRECT]
C. Seizure activity with post-ictal weakness
D. Migraine with aura and neurological symptoms
Correct Answer: B
Rationale: The FAST symptoms (Facial droop, Arm weakness, Speech difficulty, Time to
call 911) indicate acute stroke. The 45-minute window makes the patient a candidate
for thrombolytic therapy (tPA within 3-4.5 hours). TIA (A) symptoms resolve within 24
hours (usually <1 hour). Seizures (C) typically have altered consciousness and post-ictal
confusion, not this presentation. Migraine (D) usually has gradual onset with headache.
Q2: A patient with acute ischemic stroke is being evaluated for tPA administration.
Which finding would contraindicate tPA therapy?
A. Blood pressure of 175/95 mmHg
B. Blood pressure of 220/120 mmHg [CORRECT]
C. Blood glucose of 140 mg/dL
D. NIHSS score of 8
,Correct Answer: B
Rationale: tPA is contraindicated if blood pressure is >185/110 mmHg (or requires
aggressive treatment to lower it). BP must be controlled before and during tPA infusion
to reduce hemorrhagic transformation risk. BP 175/95 (A) requires treatment but isn't
an absolute contraindication. Glucose >400 or <50 is a contraindication, not 140 (C).
NIHSS 8 (D) indicates moderate stroke—tPA appropriate.
Q3: A patient with hemorrhagic stroke has a blood pressure of 190/100 mmHg. The
nurse understands that blood pressure management in hemorrhagic stroke aims to:
A. Maintain cerebral perfusion pressure and prevent hematoma expansion [CORRECT]
B. Lower BP as quickly as possible to normal range
C. Allow permissive hypertension up to 240/140 mmHg
D. Focus only on mean arterial pressure, not systolic pressure
Correct Answer: A
Rationale: In hemorrhagic stroke, BP management balances preventing hematoma
expansion (lower BP) with maintaining cerebral perfusion (avoiding ischemia).
Guidelines typically target SBP <160 or MAP <110, avoiding rapid drops. Extremely rapid
reduction (B) can cause ischemia. Permissive hypertension (C) is inappropriate—BP
must be controlled. Both SBP and MAP matter (D).
Q4: A patient with epilepsy suddenly loses consciousness, becomes rigid, and then has
rhythmic jerking of all extremities lasting 2 minutes. Afterward, the patient is confused
and sleepy. This describes:
A. Absence seizure with brief staring spell
B. Focal impaired awareness seizure
C. Generalized tonic-clonic seizure with post-ictal state [CORRECT]
D. Myoclonic seizure with brief jerks
Correct Answer: C
,Rationale: Generalized tonic-clonic seizures have three phases: tonic (rigidity), clonic
(rhythmic jerking), and post-ictal (confusion, fatigue, headache). The description
matches perfectly. Absence seizures (A) are brief staring spells without motor activity
or post-ictal confusion. Focal seizures (B) start in one brain area. Myoclonic seizures (D)
are brief, shock-like jerks without the tonic-clonic progression.
Q5: A patient has been seizing continuously for 8 minutes without regaining
consciousness. This is classified as:
A. Focal status epilepticus with localized activity
B. Generalized status epilepticus requiring emergency intervention [CORRECT]
C. Simple partial seizure with motor symptoms
D. Complex migraine with neurological deficits
Correct Answer: B
Rationale: Status epilepticus is defined as seizure activity lasting >5 minutes or
recurrent seizures without recovery between episodes. This is a neurological emergency
requiring immediate treatment (benzodiazepines first-line, airway protection) to prevent
neuronal damage and death. After 30 minutes, permanent brain injury risk increases
significantly.
Q6: A patient with traumatic brain injury is being monitored for increased intracranial
pressure. Which vital sign pattern indicates Cushing's triad?
A. Hypotension, tachycardia, and tachypnea
B. Hypertension, bradycardia, and irregular respirations [CORRECT]
C. Hypotension, bradycardia, and apnea
D. Hypertension, tachycardia, and hyperventilation
Correct Answer: B
Rationale: Cushing's triad (hypertension, bradycardia, irregular respirations) is a late
sign of critically elevated ICP (>40 mmHg) indicating brainstem compression. The
hypertension is a compensatory response to maintain cerebral perfusion pressure (CPP
, = MAP - ICP). It's a pre-terminal sign requiring immediate intervention. Other
combinations describe different shock states or physiological responses.
Q7: A patient with a head injury has a brief loss of consciousness, then a lucid interval
during which they appear normal, followed by rapid deterioration with headache,
vomiting, and unilateral pupillary dilation. CT shows a lens-shaped hematoma. This
indicates:
A. Subdural hematoma from venous bleeding
B. Epidural hematoma from arterial bleeding requiring emergency evacuation
[CORRECT]
C. Intracerebral hemorrhage from parenchymal injury
D. Subarachnoid hemorrhage from aneurysm rupture
Correct Answer: B
Rationale: The lucid interval followed by deterioration is classic for epidural hematoma,
typically from middle meningeal artery laceration with temporal bone fracture. The
lens-shaped (biconvex) hematoma on CT reflects dural attachment limiting spread. This
is a neurosurgical emergency. Subdural hematomas (A) are crescent-shaped and lack
lucid intervals. Intracerebral (C) and subarachnoid (D) have different presentations.
Q8: A patient with spinal cord injury at T6 develops a pounding headache, severe
hypertension (210/120 mmHg), bradycardia, and flushing above the level of injury
during bladder catheterization. The nurse recognizes this as:
A. Neurogenic shock from sympathetic disruption
B. Autonomic dysreflexia requiring immediate stimulus removal [CORRECT]
C. Spinal shock with flaccid paralysis
D. Meningitis from infection
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in T6 and above
injuries triggered by noxious stimuli below the injury level (bladder distention, bowel
impaction, tight clothing). The stimulus triggers massive sympathetic discharge
causing hypertension, headache, sweating above the injury, and bradycardia (vagal
