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NUR 254 Exam 4|Questions and Answers 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS EXAM
QUESTIONS WILL COME FROM HERE (100% CORRECT
ANSWERS A+ GRADED
1. A nurse is assessing a patient’s level of consciousness using the
Glasgow Coma Scale (GCS). The patient opens their eyes to verbal
command, is confused in conversation, and localizes pain. What is this
patient’s total GCS score?
A. 8
B. 10
C. 12
D. 15
Answer: C. 12
Explanation: Eye opening to verbal command scores 3, confused
conversation scores 4, and localizing pain scores 5. The sum is 3 + 4 + 5
= 12.
2. During a cranial nerve assessment, the nurse asks the patient to
smile, frown, and puff out their cheeks. Which cranial nerve is being
evaluated?
A. Trigeminal (V)
B. Facial (VII)
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C. Glossopharyngeal (IX)
D. Vagus (X)
Answer: B. Facial (VII)
Explanation: The facial nerve controls the muscles of facial expression,
including smiling, frowning, and cheek puffing.
3. A patient with increased intracranial pressure is exhibiting Cushing’s
triad. Which set of vital signs would the nurse expect to find?
A. Hypotension, bradycardia, irregular respirations
B. Hypertension, bradycardia, irregular respirations
C. Hypotension, tachycardia, bradypnea
D. Hypertension, tachycardia, tachypnea
Answer: B. Hypertension, bradycardia, irregular respirations
Explanation: Cushing’s triad, a late sign of increased intracranial
pressure, consists of widening pulse pressure (hypertension),
bradycardia, and irregular or cheyne-stokes respirations.
4. A patient post-craniotomy develops clear drainage from the nose
that tests positive for glucose. What is the priority nursing action?
A. Insert a nasal tampon to stop the leak
B. Position the patient in a high-Fowler’s position
C. Notify the health care provider immediately
D. Instruct the patient to blow their nose gently
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Answer: C. Notify the health care provider immediately
Explanation: Clear, glucose-positive nasal drainage is cerebrospinal
fluid, indicating a basilar skull fracture or dural leak, creating a pathway
for meningitis. The provider must be notified immediately. Nasal
packing or blowing the nose is contraindicated.
5. A nurse is teaching a patient with myasthenia gravis about
medication management. Which statement by the patient indicates
understanding?
A. "I should take my pyridostigmine right before a meal to improve
chewing and swallowing."
B. "If I miss a dose, I should double the next dose to catch up."
C. "I can expect my muscles to become progressively weaker over time
despite treatment."
D. "I should take my medication only when I feel short of breath."
Answer: A. "I should take my pyridostigmine right before a meal to
improve chewing and swallowing."
Explanation: Pyridostigmine is an anticholinesterase that improves
muscle strength. Timing it before meals aids in chewing and
swallowing.
6. A patient in the emergency department has flaccid paralysis of the
legs that has ascended to the trunk over the past 12 hours. The nurse
recognizes this pattern as characteristic of which condition?
A. Multiple sclerosis
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B. Myasthenia gravis
C. Guillain-Barré syndrome
D. Amyotrophic lateral sclerosis
Answer: C. Guillain-Barré syndrome
Explanation: Guillain-Barré syndrome is characterized by symmetric,
ascending paralysis that typically begins in the legs and moves upward,
often following a viral infection.
7. Which assessment finding in a patient with bacterial meningitis
indicates increased intracranial pressure and requires immediate
intervention?
A. Nuchal rigidity
B. Positive Kernig’s sign
C. Photophobia
D. Widening pulse pressure
Answer: D. Widening pulse pressure
Explanation: While nuchal rigidity, Kernig's sign, and photophobia are
expected findings in meningitis, a widening pulse pressure is a late sign
of increasing intracranial pressure and herniation, requiring immediate
intervention.
8. A patient is 4 hours post-op from a transsphenoidal
hypophysectomy. Which finding requires the most immediate action?
A. Urine output of 500 mL in the last hour
NUR 254 Exam 4|Questions and Answers 2026-2027 BANK
QUESTIONS WITH DETAILED VERIFIED ANSWERS EXAM
QUESTIONS WILL COME FROM HERE (100% CORRECT
ANSWERS A+ GRADED
1. A nurse is assessing a patient’s level of consciousness using the
Glasgow Coma Scale (GCS). The patient opens their eyes to verbal
command, is confused in conversation, and localizes pain. What is this
patient’s total GCS score?
A. 8
B. 10
C. 12
D. 15
Answer: C. 12
Explanation: Eye opening to verbal command scores 3, confused
conversation scores 4, and localizing pain scores 5. The sum is 3 + 4 + 5
= 12.
2. During a cranial nerve assessment, the nurse asks the patient to
smile, frown, and puff out their cheeks. Which cranial nerve is being
evaluated?
A. Trigeminal (V)
B. Facial (VII)
,2|Page
C. Glossopharyngeal (IX)
D. Vagus (X)
Answer: B. Facial (VII)
Explanation: The facial nerve controls the muscles of facial expression,
including smiling, frowning, and cheek puffing.
3. A patient with increased intracranial pressure is exhibiting Cushing’s
triad. Which set of vital signs would the nurse expect to find?
A. Hypotension, bradycardia, irregular respirations
B. Hypertension, bradycardia, irregular respirations
C. Hypotension, tachycardia, bradypnea
D. Hypertension, tachycardia, tachypnea
Answer: B. Hypertension, bradycardia, irregular respirations
Explanation: Cushing’s triad, a late sign of increased intracranial
pressure, consists of widening pulse pressure (hypertension),
bradycardia, and irregular or cheyne-stokes respirations.
4. A patient post-craniotomy develops clear drainage from the nose
that tests positive for glucose. What is the priority nursing action?
A. Insert a nasal tampon to stop the leak
B. Position the patient in a high-Fowler’s position
C. Notify the health care provider immediately
D. Instruct the patient to blow their nose gently
,3|Page
Answer: C. Notify the health care provider immediately
Explanation: Clear, glucose-positive nasal drainage is cerebrospinal
fluid, indicating a basilar skull fracture or dural leak, creating a pathway
for meningitis. The provider must be notified immediately. Nasal
packing or blowing the nose is contraindicated.
5. A nurse is teaching a patient with myasthenia gravis about
medication management. Which statement by the patient indicates
understanding?
A. "I should take my pyridostigmine right before a meal to improve
chewing and swallowing."
B. "If I miss a dose, I should double the next dose to catch up."
C. "I can expect my muscles to become progressively weaker over time
despite treatment."
D. "I should take my medication only when I feel short of breath."
Answer: A. "I should take my pyridostigmine right before a meal to
improve chewing and swallowing."
Explanation: Pyridostigmine is an anticholinesterase that improves
muscle strength. Timing it before meals aids in chewing and
swallowing.
6. A patient in the emergency department has flaccid paralysis of the
legs that has ascended to the trunk over the past 12 hours. The nurse
recognizes this pattern as characteristic of which condition?
A. Multiple sclerosis
, 4|Page
B. Myasthenia gravis
C. Guillain-Barré syndrome
D. Amyotrophic lateral sclerosis
Answer: C. Guillain-Barré syndrome
Explanation: Guillain-Barré syndrome is characterized by symmetric,
ascending paralysis that typically begins in the legs and moves upward,
often following a viral infection.
7. Which assessment finding in a patient with bacterial meningitis
indicates increased intracranial pressure and requires immediate
intervention?
A. Nuchal rigidity
B. Positive Kernig’s sign
C. Photophobia
D. Widening pulse pressure
Answer: D. Widening pulse pressure
Explanation: While nuchal rigidity, Kernig's sign, and photophobia are
expected findings in meningitis, a widening pulse pressure is a late sign
of increasing intracranial pressure and herniation, requiring immediate
intervention.
8. A patient is 4 hours post-op from a transsphenoidal
hypophysectomy. Which finding requires the most immediate action?
A. Urine output of 500 mL in the last hour
