ATI MedSurg 2 NUR 265 Exam 4 Actual
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
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Q1: A nurse is caring for a patient with a traumatic brain injury whose intracranial pressure (ICP)
monitor reads 22 mmHg. The patient's blood pressure is 128/82 mmHg. What is the patient's
cerebral perfusion pressure (CPP)?
A. 68 mmHg
B. 72 mmHg
C. 74 mmHg [CORRECT]
D. 82 mmHg
Correct Answer: C
Rationale: Correct because CPP = MAP - ICP; MAP = 128 + (2 × 82) ÷ 3 = 97.3 mmHg; CPP = 97.3
- 22 = 75.3, rounded to approximately 74 mmHg. This matches the standard calculation method
used in neurological monitoring.
,Q2: A patient with a C5 spinal cord injury on day 3 post-injury presents with blood pressure
185/110 mmHg, heart rate 52 beats/minute, severe headache, and complaints of abdominal
fullness. What is the priority nursing action?
A. Administer antihypertensive medication IV push immediately
B. Place the patient in Trendelenburg position
C. Elevate the head of bed to 45-90 degrees immediately [CORRECT]
D. Insert a urinary catheter stat
Correct Answer: C
Rationale: Correct because this presentation indicates autonomic dysreflexia; elevating the HOB
45-90 degrees is the first emergency action to lower blood pressure by causing cerebral venous
drainage before identifying and removing the noxious stimulus.
Q3: A patient arrives in the emergency department 2 hours after onset of left-sided weakness and
facial droop. The last known well time was confirmed. Blood pressure is 195/110 mmHg, glucose
210 mg/dL, NIHSS score 16, and the patient takes apixaban for atrial fibrillation with the last dose
12 hours ago. What is the nurse's priority action?
A. Prepare to administer alteplase 0.9 mg/kg IV immediately
B. Obtain an INR level and proceed with tPA if <1.7
C. Notify the stroke team and prepare for mechanical thrombectomy evaluation [CORRECT]
,D. Administer labetalol IV to lower blood pressure below 185/110
Correct Answer: C
Rationale: Correct because the patient is on apixaban (a direct oral anticoagulant), which is an
absolute contraindication for tPA regardless of INR; mechanical thrombectomy is the appropriate
intervention for large vessel occlusion with last known well <6 hours.
Q4: During a generalized tonic-clonic seizure in the emergency department, which action by the
nursing student requires immediate correction by the preceptor?
A. Timing the seizure from onset
B. Moving furniture away from the patient
C. Inserting a padded tongue depressor between the patient's teeth [CORRECT]
D. Turning the patient to the lateral recumbent position
Correct Answer: C
Rationale: Correct because placing anything in the mouth during a seizure, including bite blocks or
tongue depressors, is contraindicated and can cause dental injury, aspiration, or airway
obstruction; suction should be available but not forced into the mouth.
Q5: A patient with Alzheimer's disease is prescribed donepezil. The nurse should explain to the
family that this medication works by which mechanism?
, A. Blocking NMDA receptors to prevent glutamate excitotoxicity
B. Increasing dopamine levels in the basal ganglia
C. Inhibiting acetylcholinesterase to increase acetylcholine availability [CORRECT]
D. Modulating serotonin reuptake in the hippocampus
Correct Answer: C
Rationale: Correct because donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine levels at synapses, addressing the cholinergic deficit characteristic of Alzheimer's
disease and improving cognitive symptoms temporarily.
Q6: A nurse is monitoring a patient with an external ventricular drain (EVD) for increased ICP.
Which finding requires immediate intervention?
A. Cerebrospinal fluid draining at 15 mL per hour
B. Patient's head of bed elevated at 30 degrees
C. EVD system positioned at the level of the foramen of Monro with the patient sitting upright
[CORRECT]
D. CSF appearing slightly blood-tinged
Correct Answer: C
Exam 2026/2027 with Detailed Rationales
| Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
Q1: A nurse is caring for a patient with a traumatic brain injury whose intracranial pressure (ICP)
monitor reads 22 mmHg. The patient's blood pressure is 128/82 mmHg. What is the patient's
cerebral perfusion pressure (CPP)?
A. 68 mmHg
B. 72 mmHg
C. 74 mmHg [CORRECT]
D. 82 mmHg
Correct Answer: C
Rationale: Correct because CPP = MAP - ICP; MAP = 128 + (2 × 82) ÷ 3 = 97.3 mmHg; CPP = 97.3
- 22 = 75.3, rounded to approximately 74 mmHg. This matches the standard calculation method
used in neurological monitoring.
,Q2: A patient with a C5 spinal cord injury on day 3 post-injury presents with blood pressure
185/110 mmHg, heart rate 52 beats/minute, severe headache, and complaints of abdominal
fullness. What is the priority nursing action?
A. Administer antihypertensive medication IV push immediately
B. Place the patient in Trendelenburg position
C. Elevate the head of bed to 45-90 degrees immediately [CORRECT]
D. Insert a urinary catheter stat
Correct Answer: C
Rationale: Correct because this presentation indicates autonomic dysreflexia; elevating the HOB
45-90 degrees is the first emergency action to lower blood pressure by causing cerebral venous
drainage before identifying and removing the noxious stimulus.
Q3: A patient arrives in the emergency department 2 hours after onset of left-sided weakness and
facial droop. The last known well time was confirmed. Blood pressure is 195/110 mmHg, glucose
210 mg/dL, NIHSS score 16, and the patient takes apixaban for atrial fibrillation with the last dose
12 hours ago. What is the nurse's priority action?
A. Prepare to administer alteplase 0.9 mg/kg IV immediately
B. Obtain an INR level and proceed with tPA if <1.7
C. Notify the stroke team and prepare for mechanical thrombectomy evaluation [CORRECT]
,D. Administer labetalol IV to lower blood pressure below 185/110
Correct Answer: C
Rationale: Correct because the patient is on apixaban (a direct oral anticoagulant), which is an
absolute contraindication for tPA regardless of INR; mechanical thrombectomy is the appropriate
intervention for large vessel occlusion with last known well <6 hours.
Q4: During a generalized tonic-clonic seizure in the emergency department, which action by the
nursing student requires immediate correction by the preceptor?
A. Timing the seizure from onset
B. Moving furniture away from the patient
C. Inserting a padded tongue depressor between the patient's teeth [CORRECT]
D. Turning the patient to the lateral recumbent position
Correct Answer: C
Rationale: Correct because placing anything in the mouth during a seizure, including bite blocks or
tongue depressors, is contraindicated and can cause dental injury, aspiration, or airway
obstruction; suction should be available but not forced into the mouth.
Q5: A patient with Alzheimer's disease is prescribed donepezil. The nurse should explain to the
family that this medication works by which mechanism?
, A. Blocking NMDA receptors to prevent glutamate excitotoxicity
B. Increasing dopamine levels in the basal ganglia
C. Inhibiting acetylcholinesterase to increase acetylcholine availability [CORRECT]
D. Modulating serotonin reuptake in the hippocampus
Correct Answer: C
Rationale: Correct because donepezil is an acetylcholinesterase inhibitor that increases
acetylcholine levels at synapses, addressing the cholinergic deficit characteristic of Alzheimer's
disease and improving cognitive symptoms temporarily.
Q6: A nurse is monitoring a patient with an external ventricular drain (EVD) for increased ICP.
Which finding requires immediate intervention?
A. Cerebrospinal fluid draining at 15 mL per hour
B. Patient's head of bed elevated at 30 degrees
C. EVD system positioned at the level of the foramen of Monro with the patient sitting upright
[CORRECT]
D. CSF appearing slightly blood-tinged
Correct Answer: C
