NUR242 Medical-Surgical Nursing Exam 4 Question
Bank
150 Practice Questions with Answers and Rationales
This 150-question NUR242 Medical-Surgical Nursing Exam 4 Question Bank provides
comprehensive, NCLEX-style practice covering 15 core content areas including
neurological, cardiac, respiratory, endocrine, renal, gastrointestinal, and musculoskeletal
disorders. Each question includes a realistic clinical scenario, the correct answer, and a
detailed evidence-based rationale that explains both the correct choice and why the other
options are wrong. The bank emphasizes clinical prioritization, medication safety, lab
value interpretation, and emergency response—making it an ideal study tool for nursing
students preparing for high-stakes medical-surgical examinations.
1. A client with a traumatic brain injury becomes increasingly restless, has a headache,
and the nurse notes unequal pupils and a blood pressure of 180/60 mm Hg. What is the
priority action?
,A. Reorient the client and dim the lights
B. Administer prescribed PRN opioid analgesic
C. Elevate the head of the bed 30 degrees and notify the provider
D. Instruct the client to take slow, deep breaths
Answer: C
Rationale:
2. A client with increased intracranial pressure (ICP) is receiving mechanical ventilation.
Which ventilator setting change should the nurse question?
A. Increasing the respiratory rate to lower PaCO₂
B. Increasing positive end-expiratory pressure (PEEP)
C. Maintaining FiO₂ at 40%
D. Keeping tidal volume within normal range
Answer: B
Rationale:
3. Which are risk factors for stroke? Select all that apply.
,A. Hypertension
B. Heart failure
C. Hyperlipidemia
D. Diabetes
E. Smoking
F. Chronic atrial fibrillation
Answer: A, B, C, D, E, F
Rationale:
4. A client is diagnosed with a transient ischemic attack (TIA). Which statement best
describes this condition?
A. Permanent neurologic deficit lasting more than 24 hours
B. Temporary neurologic deficit that resolves within 1 hour
C. Progressive neurologic deterioration over several days
D. Neurologic deficit that resolves within 24-48 hours
Answer: B
Rationale:
5. A patient with an ischemic stroke is being evaluated for alteplase (tPA) administration.
What is the critical time frame for administration?
, A. Within 1 hour of symptom onset
B. Within 3 hours of symptom onset
C. Within 6 hours of symptom onset
D. Within 12 hours of symptom onset
Answer: B
Rationale:
6. A client who had a stroke is exhibiting decorticate posturing. What assessment finding
would the nurse observe?
A. Arms and legs extended
B. Arms flexed toward the core, legs extended
C. Flaccid paralysis on one side
D. Rigid extension of all extremities
Answer: B
Rationale:
7. A stroke patient has damage to the left hemisphere of the brain. Which deficit would
the nurse expect?
Bank
150 Practice Questions with Answers and Rationales
This 150-question NUR242 Medical-Surgical Nursing Exam 4 Question Bank provides
comprehensive, NCLEX-style practice covering 15 core content areas including
neurological, cardiac, respiratory, endocrine, renal, gastrointestinal, and musculoskeletal
disorders. Each question includes a realistic clinical scenario, the correct answer, and a
detailed evidence-based rationale that explains both the correct choice and why the other
options are wrong. The bank emphasizes clinical prioritization, medication safety, lab
value interpretation, and emergency response—making it an ideal study tool for nursing
students preparing for high-stakes medical-surgical examinations.
1. A client with a traumatic brain injury becomes increasingly restless, has a headache,
and the nurse notes unequal pupils and a blood pressure of 180/60 mm Hg. What is the
priority action?
,A. Reorient the client and dim the lights
B. Administer prescribed PRN opioid analgesic
C. Elevate the head of the bed 30 degrees and notify the provider
D. Instruct the client to take slow, deep breaths
Answer: C
Rationale:
2. A client with increased intracranial pressure (ICP) is receiving mechanical ventilation.
Which ventilator setting change should the nurse question?
A. Increasing the respiratory rate to lower PaCO₂
B. Increasing positive end-expiratory pressure (PEEP)
C. Maintaining FiO₂ at 40%
D. Keeping tidal volume within normal range
Answer: B
Rationale:
3. Which are risk factors for stroke? Select all that apply.
,A. Hypertension
B. Heart failure
C. Hyperlipidemia
D. Diabetes
E. Smoking
F. Chronic atrial fibrillation
Answer: A, B, C, D, E, F
Rationale:
4. A client is diagnosed with a transient ischemic attack (TIA). Which statement best
describes this condition?
A. Permanent neurologic deficit lasting more than 24 hours
B. Temporary neurologic deficit that resolves within 1 hour
C. Progressive neurologic deterioration over several days
D. Neurologic deficit that resolves within 24-48 hours
Answer: B
Rationale:
5. A patient with an ischemic stroke is being evaluated for alteplase (tPA) administration.
What is the critical time frame for administration?
, A. Within 1 hour of symptom onset
B. Within 3 hours of symptom onset
C. Within 6 hours of symptom onset
D. Within 12 hours of symptom onset
Answer: B
Rationale:
6. A client who had a stroke is exhibiting decorticate posturing. What assessment finding
would the nurse observe?
A. Arms and legs extended
B. Arms flexed toward the core, legs extended
C. Flaccid paralysis on one side
D. Rigid extension of all extremities
Answer: B
Rationale:
7. A stroke patient has damage to the left hemisphere of the brain. Which deficit would
the nurse expect?
