NUR 242 MEDICAL-SURGICAL NURSING EXAM 4 2026/2027 |
Questions and Verified Answers | 100% Correct Grade A |
Galen College | Pass Guaranteed
Part 1: Neurological Disorders – The Brain, Spine, and Everything
Between
This section covers stroke, seizures, traumatic injuries, and neurodegenerative conditions.
Remember: neuro changes can be subtle but devastating—assessment is everything.
Q1: A 68-year-old patient presents with sudden onset left-sided facial droop, arm
weakness, and slurred speech. The symptoms started 45 minutes ago. What is the
nurse's priority action?
A. Obtain a CT scan to rule out hemorrhage before administering any anticoagulants
B. Immediately prepare the patient for possible tPA administration within the 3-4.5 hour
window [CORRECT]
C. Start aspirin 325 mg orally to prevent clot extension
D. Position the patient flat to increase cerebral perfusion
Correct Answer: B
Rationale: Ischemic stroke management is time-critical. tPA (alteplase) must be
administered within 3-4.5 hours of symptom onset for eligible patients. The nurse
should immediately activate the stroke protocol, ensure IV access, and prepare for rapid
,assessment. CT is needed to rule out hemorrhage before tPA, but the priority is
recognizing the time window. Aspirin is given after hemorrhage is ruled out, not
immediately. Flat positioning increases ICP risk.
Q2: Using the FAST acronym for stroke recognition, which finding corresponds to the
"T"?
A. Time to call emergency services if any signs are present [CORRECT]
B. Temperature elevation indicating infection
C. Tremor assessment for Parkinson's disease
D. Tongue deviation testing for cranial nerve XII
Correct Answer: A
Rationale: FAST stands for Facial droop, Arm weakness, Speech difficulty, and Time to
call 911. Time is critical because tPA has a narrow therapeutic window. The other
options are distractors that sound medical but don't belong in the FAST stroke screening
tool.
Q3: A patient with a traumatic brain injury develops Cushing's triad. Which findings
constitute this classic sign of increased intracranial pressure?
A. Hypotension, tachycardia, and rapid breathing
B. Hypertension, bradycardia, and irregular respirations [CORRECT]
C. Fever, nuchal rigidity, and altered mental status
D. Widened pulse pressure, tachypnea, and diaphoresis
,Correct Answer: B
Rationale: Cushing's triad—hypertension (widening pulse pressure), bradycardia, and
irregular respirations (Cheyne-Stokes or other patterns)—indicates severely increased
ICP and impending herniation. It's a late sign requiring immediate intervention. The
other combinations describe different pathological states.
Q4: A patient with a C6 spinal cord injury develops a severe pounding headache,
hypertension (BP 190/110), bradycardia (HR 48), and diaphoresis above the level of
injury. What condition is occurring?
A. Neurogenic shock from loss of sympathetic tone
B. Autonomic dysreflexia triggered by a noxious stimulus below the injury level
[CORRECT]
C. Meningitis from postoperative infection
D. Normal adjustment to spinal cord injury
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in patients with T6 or
higher injuries. A noxious stimulus below the injury (often bladder distention or bowel
impaction) triggers unopposed sympathetic response, causing severe hypertension,
headache, bradycardia, and sweating above the lesion. Treatment: sit patient upright,
remove the stimulus, and administer antihypertensives if needed. Neurogenic shock
causes hypotension and warm, dry skin.
Q5: A patient with epilepsy has a generalized tonic-clonic seizure lasting 4 minutes,
followed by another without full recovery of consciousness. What is this called?
, A. Complex partial seizure with secondary generalization
B. Status epilepticus requiring emergency intervention [CORRECT]
C. Absence seizure with prolonged post-ictal state
D. Pseudoseizure requiring psychological evaluation
Correct Answer: B
Rationale: Status epilepticus is defined as a seizure lasting >5 minutes or recurrent
seizures without return to baseline between them. This is a medical emergency
requiring immediate benzodiazepines (lorazepam, diazepam), airway protection, and IV
antiepileptics. Mortality increases with duration, making rapid treatment essential.
Q6: A patient with multiple sclerosis reports increased fatigue and weakness on hot
days. Which explanation should the nurse provide?
A. Heat exposure causes temporary conduction block in demyelinated nerves
[CORRECT]
B. Heat triggers an autoimmune attack against myelin
C. The patient is dehydrated and needs increased fluid intake
D. Heat causes permanent worsening of the disease course
Correct Answer: A
Rationale: Uhthoff's phenomenon describes temporary worsening of MS symptoms with
heat exposure (hot weather, fever, hot baths). Heat slows nerve conduction in
demyelinated axons, causing reversible symptoms. Cooling techniques help. The effect
Questions and Verified Answers | 100% Correct Grade A |
Galen College | Pass Guaranteed
Part 1: Neurological Disorders – The Brain, Spine, and Everything
Between
This section covers stroke, seizures, traumatic injuries, and neurodegenerative conditions.
Remember: neuro changes can be subtle but devastating—assessment is everything.
Q1: A 68-year-old patient presents with sudden onset left-sided facial droop, arm
weakness, and slurred speech. The symptoms started 45 minutes ago. What is the
nurse's priority action?
A. Obtain a CT scan to rule out hemorrhage before administering any anticoagulants
B. Immediately prepare the patient for possible tPA administration within the 3-4.5 hour
window [CORRECT]
C. Start aspirin 325 mg orally to prevent clot extension
D. Position the patient flat to increase cerebral perfusion
Correct Answer: B
Rationale: Ischemic stroke management is time-critical. tPA (alteplase) must be
administered within 3-4.5 hours of symptom onset for eligible patients. The nurse
should immediately activate the stroke protocol, ensure IV access, and prepare for rapid
,assessment. CT is needed to rule out hemorrhage before tPA, but the priority is
recognizing the time window. Aspirin is given after hemorrhage is ruled out, not
immediately. Flat positioning increases ICP risk.
Q2: Using the FAST acronym for stroke recognition, which finding corresponds to the
"T"?
A. Time to call emergency services if any signs are present [CORRECT]
B. Temperature elevation indicating infection
C. Tremor assessment for Parkinson's disease
D. Tongue deviation testing for cranial nerve XII
Correct Answer: A
Rationale: FAST stands for Facial droop, Arm weakness, Speech difficulty, and Time to
call 911. Time is critical because tPA has a narrow therapeutic window. The other
options are distractors that sound medical but don't belong in the FAST stroke screening
tool.
Q3: A patient with a traumatic brain injury develops Cushing's triad. Which findings
constitute this classic sign of increased intracranial pressure?
A. Hypotension, tachycardia, and rapid breathing
B. Hypertension, bradycardia, and irregular respirations [CORRECT]
C. Fever, nuchal rigidity, and altered mental status
D. Widened pulse pressure, tachypnea, and diaphoresis
,Correct Answer: B
Rationale: Cushing's triad—hypertension (widening pulse pressure), bradycardia, and
irregular respirations (Cheyne-Stokes or other patterns)—indicates severely increased
ICP and impending herniation. It's a late sign requiring immediate intervention. The
other combinations describe different pathological states.
Q4: A patient with a C6 spinal cord injury develops a severe pounding headache,
hypertension (BP 190/110), bradycardia (HR 48), and diaphoresis above the level of
injury. What condition is occurring?
A. Neurogenic shock from loss of sympathetic tone
B. Autonomic dysreflexia triggered by a noxious stimulus below the injury level
[CORRECT]
C. Meningitis from postoperative infection
D. Normal adjustment to spinal cord injury
Correct Answer: B
Rationale: Autonomic dysreflexia is a life-threatening emergency in patients with T6 or
higher injuries. A noxious stimulus below the injury (often bladder distention or bowel
impaction) triggers unopposed sympathetic response, causing severe hypertension,
headache, bradycardia, and sweating above the lesion. Treatment: sit patient upright,
remove the stimulus, and administer antihypertensives if needed. Neurogenic shock
causes hypotension and warm, dry skin.
Q5: A patient with epilepsy has a generalized tonic-clonic seizure lasting 4 minutes,
followed by another without full recovery of consciousness. What is this called?
, A. Complex partial seizure with secondary generalization
B. Status epilepticus requiring emergency intervention [CORRECT]
C. Absence seizure with prolonged post-ictal state
D. Pseudoseizure requiring psychological evaluation
Correct Answer: B
Rationale: Status epilepticus is defined as a seizure lasting >5 minutes or recurrent
seizures without return to baseline between them. This is a medical emergency
requiring immediate benzodiazepines (lorazepam, diazepam), airway protection, and IV
antiepileptics. Mortality increases with duration, making rapid treatment essential.
Q6: A patient with multiple sclerosis reports increased fatigue and weakness on hot
days. Which explanation should the nurse provide?
A. Heat exposure causes temporary conduction block in demyelinated nerves
[CORRECT]
B. Heat triggers an autoimmune attack against myelin
C. The patient is dehydrated and needs increased fluid intake
D. Heat causes permanent worsening of the disease course
Correct Answer: A
Rationale: Uhthoff's phenomenon describes temporary worsening of MS symptoms with
heat exposure (hot weather, fever, hot baths). Heat slows nerve conduction in
demyelinated axons, causing reversible symptoms. Cooling techniques help. The effect
