NUR 242 EXAM 4
Medical-Surgical Nursing Concepts
Galen College of Nursing
High-Yield Qs to mirror the Exam
Verified Answers with Rationales
This Exam Features:
NUR 242 Exam 4 Mental Health Nursing (Galen
College) including 50 high-yield questions
written to mirror actual course exams. Covers
core Medical-Surgical Nursing Concepts with clear,
accurate, and student-friendly explanations. Perfect for mastering
high-priority topics and boosting exam confidence.
,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
• Correct Answer: C
• Expert rationale: Restlessness, headache, anisocoria (unequal pupils), and
widened pulse pressure indicate rising intracranial pressure (ICP). Elevating
the head of the bed about 30° promotes venous drainage from the brain
and helps decrease ICP. The provider must be notified immediately. Opioids
can mask neurologic changes, and other options do not address the life-
threatening ICP.
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
• Correct Answer: B
• Expert rationale: High PEEP increases intrathoracic pressure, which can
reduce venous return from the brain and worsen ICP. Mild hyperventilation
(lower PaCO₂) causes cerebral vasoconstriction and can help lower ICP short
term, and normal tidal volume and FiO₂ are not problematic.
,3.
The nurse is caring for a client with a history of generalized tonic–clonic seizures.
Which intervention has the highest priority when a seizure begins?
A. Insert a padded tongue blade
B. Restrain the client’s arms and legs
C. Turn the client to the side and protect the head
D. Check the client’s temperature
• Correct Answer: C
• Expert rationale: During an active seizure, airway and safety are priorities.
Turning the client to the side helps prevent aspiration, and protecting the
head prevents trauma. Never put anything in the client’s mouth or restrain
limbs.
4.
A client with a spinal cord injury at T4 suddenly develops a severe headache,
flushed face, and a blood pressure of 220/110 mm Hg. What is the nurse’s
priority action?
A. Lower the head of the bed
B. Check the bladder and catheter for kinks
C. Apply a warming blanket
D. Administer PRN IV hydralazine
• Correct Answer: B
• Expert rationale: These symptoms suggest autonomic dysreflexia, usually
triggered by noxious stimuli below the level of injury—most commonly a
distended bladder. The nurse should first identify and remove the cause
(e.g., kinked catheter). Antihypertensives may be required but only after
addressing the trigger. The HOB should be raised, not lowered.
,5.
The nurse is teaching a client 1 day post–total hip replacement (posterior
approach). Which statement indicates a need for further teaching?
A. “I will avoid crossing my legs while sitting.”
B. “I will use a pillow between my legs when I turn.”
C. “I can bend at my hip to tie my shoes as long as I move slowly.”
D. “I will use the raised toilet seat at home.”
• Correct Answer: C
• Expert rationale: After a posterior-approach hip replacement, the client
must avoid hip flexion greater than 90°, adduction, and internal rotation to
prevent dislocation. Bending to tie shoes violates that precaution. The other
statements reflect correct precautions.
6.
A client with a long leg cast reports severe pain unrelieved by opioids, and the
nurse notes pallor and paresthesia of the toes. What is the most appropriate
action?
A. Elevate the leg above heart level
B. Apply ice packs to the cast
C. Notify the provider immediately
D. Reassure the client this is expected
• Correct Answer: C
• Expert rationale: Severe pain out of proportion, paresthesia, and pallor
suggest acute compartment syndrome, a limb-threatening emergency. The
provider must be called immediately for possible cast bivalving or
fasciotomy. Elevating above heart level can further impair perfusion.
7.
, The nurse is reinforcing discharge teaching for a client with a new fiberglass arm
cast. Which instruction is most important to include?
A. “Use a coat hanger to scratch if your arm itches.”
B. “Keep the cast dry and avoid getting it wet.”
C. “You may bear full weight on the cast in 24 hours.”
D. “Blow hot air from a hair dryer directly into the cast if it feels damp.”
• Correct Answer: B
• Expert rationale: Moisture under the cast can cause skin breakdown and
infection. The client should keep the cast dry. Never insert objects to
scratch inside the cast and avoid high heat which can burn skin or damage
the cast.
8.
A postmenopausal client with osteoporosis is learning ways to prevent fractures.
Which statement shows correct understanding?
A. “I will increase my intake of caffeine to stay more alert.”
B. “I will start a high-impact jogging program.”
C. “I will remove throw rugs and install grab bars in my bathroom.”
D. “I should avoid all weight-bearing exercise.”
• Correct Answer: C
• Expert rationale: For osteoporosis, fall prevention is crucial—removing
tripping hazards and adding grab bars lowers fracture risk. High-impact
exercise and excess caffeine can be harmful. Moderate weight-bearing
exercise is actually beneficial.
9.
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which
provider prescription should the nurse implement first?
Medical-Surgical Nursing Concepts
Galen College of Nursing
High-Yield Qs to mirror the Exam
Verified Answers with Rationales
This Exam Features:
NUR 242 Exam 4 Mental Health Nursing (Galen
College) including 50 high-yield questions
written to mirror actual course exams. Covers
core Medical-Surgical Nursing Concepts with clear,
accurate, and student-friendly explanations. Perfect for mastering
high-priority topics and boosting exam confidence.
,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
• Correct Answer: C
• Expert rationale: Restlessness, headache, anisocoria (unequal pupils), and
widened pulse pressure indicate rising intracranial pressure (ICP). Elevating
the head of the bed about 30° promotes venous drainage from the brain
and helps decrease ICP. The provider must be notified immediately. Opioids
can mask neurologic changes, and other options do not address the life-
threatening ICP.
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
• Correct Answer: B
• Expert rationale: High PEEP increases intrathoracic pressure, which can
reduce venous return from the brain and worsen ICP. Mild hyperventilation
(lower PaCO₂) causes cerebral vasoconstriction and can help lower ICP short
term, and normal tidal volume and FiO₂ are not problematic.
,3.
The nurse is caring for a client with a history of generalized tonic–clonic seizures.
Which intervention has the highest priority when a seizure begins?
A. Insert a padded tongue blade
B. Restrain the client’s arms and legs
C. Turn the client to the side and protect the head
D. Check the client’s temperature
• Correct Answer: C
• Expert rationale: During an active seizure, airway and safety are priorities.
Turning the client to the side helps prevent aspiration, and protecting the
head prevents trauma. Never put anything in the client’s mouth or restrain
limbs.
4.
A client with a spinal cord injury at T4 suddenly develops a severe headache,
flushed face, and a blood pressure of 220/110 mm Hg. What is the nurse’s
priority action?
A. Lower the head of the bed
B. Check the bladder and catheter for kinks
C. Apply a warming blanket
D. Administer PRN IV hydralazine
• Correct Answer: B
• Expert rationale: These symptoms suggest autonomic dysreflexia, usually
triggered by noxious stimuli below the level of injury—most commonly a
distended bladder. The nurse should first identify and remove the cause
(e.g., kinked catheter). Antihypertensives may be required but only after
addressing the trigger. The HOB should be raised, not lowered.
,5.
The nurse is teaching a client 1 day post–total hip replacement (posterior
approach). Which statement indicates a need for further teaching?
A. “I will avoid crossing my legs while sitting.”
B. “I will use a pillow between my legs when I turn.”
C. “I can bend at my hip to tie my shoes as long as I move slowly.”
D. “I will use the raised toilet seat at home.”
• Correct Answer: C
• Expert rationale: After a posterior-approach hip replacement, the client
must avoid hip flexion greater than 90°, adduction, and internal rotation to
prevent dislocation. Bending to tie shoes violates that precaution. The other
statements reflect correct precautions.
6.
A client with a long leg cast reports severe pain unrelieved by opioids, and the
nurse notes pallor and paresthesia of the toes. What is the most appropriate
action?
A. Elevate the leg above heart level
B. Apply ice packs to the cast
C. Notify the provider immediately
D. Reassure the client this is expected
• Correct Answer: C
• Expert rationale: Severe pain out of proportion, paresthesia, and pallor
suggest acute compartment syndrome, a limb-threatening emergency. The
provider must be called immediately for possible cast bivalving or
fasciotomy. Elevating above heart level can further impair perfusion.
7.
, The nurse is reinforcing discharge teaching for a client with a new fiberglass arm
cast. Which instruction is most important to include?
A. “Use a coat hanger to scratch if your arm itches.”
B. “Keep the cast dry and avoid getting it wet.”
C. “You may bear full weight on the cast in 24 hours.”
D. “Blow hot air from a hair dryer directly into the cast if it feels damp.”
• Correct Answer: B
• Expert rationale: Moisture under the cast can cause skin breakdown and
infection. The client should keep the cast dry. Never insert objects to
scratch inside the cast and avoid high heat which can burn skin or damage
the cast.
8.
A postmenopausal client with osteoporosis is learning ways to prevent fractures.
Which statement shows correct understanding?
A. “I will increase my intake of caffeine to stay more alert.”
B. “I will start a high-impact jogging program.”
C. “I will remove throw rugs and install grab bars in my bathroom.”
D. “I should avoid all weight-bearing exercise.”
• Correct Answer: C
• Expert rationale: For osteoporosis, fall prevention is crucial—removing
tripping hazards and adding grab bars lowers fracture risk. High-impact
exercise and excess caffeine can be harmful. Moderate weight-bearing
exercise is actually beneficial.
9.
A client with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). Which
provider prescription should the nurse implement first?
