MDC 4 ACTUAL 2026 EXAM QUESTIONS AND SOLUTIONS
RATED A+
✔✔20. The nurse is evaluating a client with a head injury and finds drainage from the
client's nose and ears. Which of the following is the priority teaching for this client?
a. Cleanse the ear and nose with a soft cotton tipped swab and hydrogen peroxide
b. Gently suction the nasal cavity to reduce the amount of secretions
c. Wipe the nose or ears, but do not blow the nose or place anything in the ear
d. Place a pressure dressing over the affected areas to reduce leakage. - ✔✔c. Wipe
the nose or ears, but do not blow the nose or place anything in the ear
✔✔21. The nurse is assisting with the sponge and instrument count in the operating
room. Which operative phase does this occur in?
a. Perioperative phase
b. Preoperative phase
c. Intraoperative phase
d. Postoperative phase - ✔✔c. Intraoperative phase
✔✔22. A client has been diagnosed with an ischemic stroke. The nurse realizes this
client cannot have fibrinolytic therapy until which vital sign is addressed and treated?
a. Blood pressure of 220/120 mm HG
b. Oxygen saturation of 92%
c. A heart rate of 86 bpm
d. RR of 24 bpm - ✔✔a. Blood pressure of 220/120 mm HG
✔✔23. During a nutritional therapy class, the nurse educates a group of migraine
sufferers on foods that may worsen headaches. The clients are advised to avoid which
of the following food
choices? (SATA)
a. Yogurt
b. Caffeine
c. Beef
d. Pears
e. Marinated food
f. milk - ✔✔a. Yogurt
b. Caffeine
e. Marinated food
✔✔24. The nurse is caring for a client with Parkinson's disease. Which intervention
does the nurse implement to prevent respiratory complications in the client?
a. Keep an oral airway at the bedside
b. Ensure fluid intake of at least 3L/day
c. Teach the client pursed lip breathing techniques
d. Maintain the head of bed at 30 degrees or greater - ✔✔d. Maintain the head of bed at
30 degrees or greater
, ✔✔25. A client has been injured in a motorcycle accident and is presenting with signs
and symptoms of increased intracranial pressure. What is the most significant sign or
symptom of increased intracranial pressure?
a. Pupil changes
b. Ipsilateral paralysis
c. Vomiting
d. Decrease in the level of consciousness - ✔✔d. Decrease in the level of
consciousness
✔✔26. The nurse is caring for a client diagnosed with Alzheimer's disease. Which
nursing tasks should not be delegated to the unlicensed assistive personnel (UAP)?
(SATA)
a. Check the client's skin under the restraints
b. Administer the clients antipsychotic medication
c. Perform the client's morning hygiene care
d. Ambulate the client to the bathroom
e. Obtain the clients routine vital signs - ✔✔a. Check the client's skin under the
restraints
b. Administer the clients antipsychotic medication
✔✔27. The nurse is assessing a client with Alzheimer's disease. Which finding places
the client in the moderate stage of the disease process? Select all that apply
a. Wandering
b. Anger
c. incontinence of bowel and bladder
d. Visuospatial deficit
e. violent episodes - ✔✔a. Wandering
b. Anger
c. incontinence of bowel and bladder
d. Visuospatial deficit
e. violent episodes
✔✔28. Which medication will the nurse prepare to administer to the client who is
experiencing status epilepticus?
a. phenobarbital
b. lorazepam
c. Chlordiazepoxide
d. Phenytoin - ✔✔b. lorazepam
✔✔29. A nurse is explaining safe eating practices to a wife who will be caring for her
husband, who has been diagnosed with hemiplegia following his stroke. The nurse
develops the discharge teaching and identifies which of the following actions to promote
safe feeding practices for the client? Select all that apply
a. mixing liquid and solid foods together
RATED A+
✔✔20. The nurse is evaluating a client with a head injury and finds drainage from the
client's nose and ears. Which of the following is the priority teaching for this client?
a. Cleanse the ear and nose with a soft cotton tipped swab and hydrogen peroxide
b. Gently suction the nasal cavity to reduce the amount of secretions
c. Wipe the nose or ears, but do not blow the nose or place anything in the ear
d. Place a pressure dressing over the affected areas to reduce leakage. - ✔✔c. Wipe
the nose or ears, but do not blow the nose or place anything in the ear
✔✔21. The nurse is assisting with the sponge and instrument count in the operating
room. Which operative phase does this occur in?
a. Perioperative phase
b. Preoperative phase
c. Intraoperative phase
d. Postoperative phase - ✔✔c. Intraoperative phase
✔✔22. A client has been diagnosed with an ischemic stroke. The nurse realizes this
client cannot have fibrinolytic therapy until which vital sign is addressed and treated?
a. Blood pressure of 220/120 mm HG
b. Oxygen saturation of 92%
c. A heart rate of 86 bpm
d. RR of 24 bpm - ✔✔a. Blood pressure of 220/120 mm HG
✔✔23. During a nutritional therapy class, the nurse educates a group of migraine
sufferers on foods that may worsen headaches. The clients are advised to avoid which
of the following food
choices? (SATA)
a. Yogurt
b. Caffeine
c. Beef
d. Pears
e. Marinated food
f. milk - ✔✔a. Yogurt
b. Caffeine
e. Marinated food
✔✔24. The nurse is caring for a client with Parkinson's disease. Which intervention
does the nurse implement to prevent respiratory complications in the client?
a. Keep an oral airway at the bedside
b. Ensure fluid intake of at least 3L/day
c. Teach the client pursed lip breathing techniques
d. Maintain the head of bed at 30 degrees or greater - ✔✔d. Maintain the head of bed at
30 degrees or greater
, ✔✔25. A client has been injured in a motorcycle accident and is presenting with signs
and symptoms of increased intracranial pressure. What is the most significant sign or
symptom of increased intracranial pressure?
a. Pupil changes
b. Ipsilateral paralysis
c. Vomiting
d. Decrease in the level of consciousness - ✔✔d. Decrease in the level of
consciousness
✔✔26. The nurse is caring for a client diagnosed with Alzheimer's disease. Which
nursing tasks should not be delegated to the unlicensed assistive personnel (UAP)?
(SATA)
a. Check the client's skin under the restraints
b. Administer the clients antipsychotic medication
c. Perform the client's morning hygiene care
d. Ambulate the client to the bathroom
e. Obtain the clients routine vital signs - ✔✔a. Check the client's skin under the
restraints
b. Administer the clients antipsychotic medication
✔✔27. The nurse is assessing a client with Alzheimer's disease. Which finding places
the client in the moderate stage of the disease process? Select all that apply
a. Wandering
b. Anger
c. incontinence of bowel and bladder
d. Visuospatial deficit
e. violent episodes - ✔✔a. Wandering
b. Anger
c. incontinence of bowel and bladder
d. Visuospatial deficit
e. violent episodes
✔✔28. Which medication will the nurse prepare to administer to the client who is
experiencing status epilepticus?
a. phenobarbital
b. lorazepam
c. Chlordiazepoxide
d. Phenytoin - ✔✔b. lorazepam
✔✔29. A nurse is explaining safe eating practices to a wife who will be caring for her
husband, who has been diagnosed with hemiplegia following his stroke. The nurse
develops the discharge teaching and identifies which of the following actions to promote
safe feeding practices for the client? Select all that apply
a. mixing liquid and solid foods together
