NUR 242 MEDICAL-SURGICAL NURSING EXAM 4 2026/2027 |
Questions and Verified Answers | 100% Correct Grade A | Galen
College | Pass Guaranteed
Neurological Disorders: Stroke, Seizures, Head/Spine Injury, and
Neurodegenerative Conditions
(20 questions)
Q1: A 68-year-old patient is brought to the ED by family after they noticed sudden onset
of left-sided facial droop, left arm weakness, and slurred speech that began 45 minutes
ago. Vital signs are stable except BP 188/96 mmHg. Which intervention is the priority
for this patient?
A. Immediate administration of IV labetalol to reduce blood pressure below 140/90
B. Rapid neuro assessment and preparation for possible tPA administration [CORRECT]
C. Insertion of nasogastric tube for enteral feeding
D. Administration of enteric-coated aspirin 325 mg
Correct Answer: B
Rationale: This patient presents with classic FAST symptoms (Face, Arm, Speech, Time)
of acute ischemic stroke. The priority is rapid assessment to determine eligibility for
thrombolytic therapy (tPA window 3-4.5 hours). BP management (A) is
cautious—excessive lowering reduces perfusion. NG tube (C) requires swallow
screening first. Aspirin (D) is appropriate but not before ruling out hemorrhagic stroke
with CT.
,Q2: Which of the following risk factors is most strongly associated with cardioembolic
ischemic stroke?
A. Hyperlipidemia and cigarette smoking
B. Atrial fibrillation and valvular heart disease [CORRECT]
C. Diabetes mellitus and obesity
D. Family history and advanced age
Correct Answer: B
Rationale: Atrial fibrillation causes stasis and thrombus formation in the atria, leading to
cardioembolic stroke—approximately 15-20% of all ischemic strokes. Valvular disease
(rheumatic, prosthetic) also creates thromboembolic risk. While A, C, and D are risk
factors, they are more associated with atherosclerotic stroke mechanisms rather than
cardioembolic.
Q3: A patient with a history of epilepsy suddenly begins having a generalized
tonic-clonic seizure in the hospital room. The seizure lasts 3 minutes. Which nursing
intervention is the priority during the active seizure phase?
A. Insert a padded tongue blade to prevent airway obstruction
B. Turn patient to side-lying position and protect head from injury [CORRECT]
C. Immediately start IV diazepam to stop the seizure
D. Restrain the patient's extremities to prevent injury
Correct Answer: B
,Rationale: During an active seizure, priority interventions are safety: protect from
falls/objects, turn to side to prevent aspiration, time the event, and do not force anything
into the mouth (A) or restrain (D)—these cause injury. IV benzodiazepines (C) are for
status epilepticus (>5 minutes or recurrent without consciousness return), not brief
self-limited seizures.
Q4: A 22-year-old patient sustained a T12-L1 spinal cord injury 3 days ago. While you are
turning the patient, they suddenly develop a severe pounding headache, diaphoresis
above the level of injury, and nasal congestion. Vital signs show BP 220/110 and HR 52.
Which condition is occurring, and what is the first nursing action?
A. Neurogenic shock; administer IV fluids and elevate legs
B. Autonomic dysreflexia; sit patient upright and remove noxious stimuli [CORRECT]
C. Increased intracranial pressure; administer mannitol and hyperventilate
D. Malignant hypertension; administer sublingual nifedipine immediately
Correct Answer: B
Rationale: This is classic autonomic dysreflexia: noxious stimulus below injury (often
bladder distention, bowel impaction, or tight clothing) triggers uncontrolled sympathetic
response causing severe hypertension, bradycardia (parasympathetic response), and
headache/sweating above lesion. Priority is to sit patient up (lower cerebral pressure)
and remove the stimulus. Neurogenic shock (A) presents with hypotension and
bradycardia. ICP (C) causes Cushing's triad but not typically with spinal injury.
Q5: Which assessment finding distinguishes an epidural hematoma from a subdural
hematoma in traumatic brain injury?
, A. Location between dura and arachnoid mater
B. Lucid interval followed by rapid deterioration [CORRECT]
C. Crescent-shaped lesion on CT scan crossing suture lines
D. Venous bleeding from bridging veins
Correct Answer: B
Rationale: Epidural hematomas (arterial, usually middle meningeal artery) classically
present with "talk and die" phenomenon—initial consciousness, lucid interval, then rapid
deterioration as hematoma expands. Subdural hematomas (venous, bridging veins)
typically present with gradual confusion/decline. Crescent shape crossing sutures (C)
describes subdural. Location (A) and venous source (D) describe subdural anatomy.
Q6: A patient with Parkinson's disease is scheduled for carbidopa/levodopa. Which
nursing instruction regarding medication administration is essential?
A. Take with high-protein meals to enhance absorption
B. Take on an empty stomach or with low-protein meals to prevent competition for
absorption [CORRECT]
C. Crush extended-release tablets if patient has dysphagia
D. Stop medication immediately if dyskinesias occur
Correct Answer: B
Rationale: Large neutral amino acids in dietary protein compete with levodopa for
transport across the blood-brain barrier and gut absorption. Taking on empty stomach
or with low-protein meals maximizes medication effectiveness. High-protein meals (A)
Questions and Verified Answers | 100% Correct Grade A | Galen
College | Pass Guaranteed
Neurological Disorders: Stroke, Seizures, Head/Spine Injury, and
Neurodegenerative Conditions
(20 questions)
Q1: A 68-year-old patient is brought to the ED by family after they noticed sudden onset
of left-sided facial droop, left arm weakness, and slurred speech that began 45 minutes
ago. Vital signs are stable except BP 188/96 mmHg. Which intervention is the priority
for this patient?
A. Immediate administration of IV labetalol to reduce blood pressure below 140/90
B. Rapid neuro assessment and preparation for possible tPA administration [CORRECT]
C. Insertion of nasogastric tube for enteral feeding
D. Administration of enteric-coated aspirin 325 mg
Correct Answer: B
Rationale: This patient presents with classic FAST symptoms (Face, Arm, Speech, Time)
of acute ischemic stroke. The priority is rapid assessment to determine eligibility for
thrombolytic therapy (tPA window 3-4.5 hours). BP management (A) is
cautious—excessive lowering reduces perfusion. NG tube (C) requires swallow
screening first. Aspirin (D) is appropriate but not before ruling out hemorrhagic stroke
with CT.
,Q2: Which of the following risk factors is most strongly associated with cardioembolic
ischemic stroke?
A. Hyperlipidemia and cigarette smoking
B. Atrial fibrillation and valvular heart disease [CORRECT]
C. Diabetes mellitus and obesity
D. Family history and advanced age
Correct Answer: B
Rationale: Atrial fibrillation causes stasis and thrombus formation in the atria, leading to
cardioembolic stroke—approximately 15-20% of all ischemic strokes. Valvular disease
(rheumatic, prosthetic) also creates thromboembolic risk. While A, C, and D are risk
factors, they are more associated with atherosclerotic stroke mechanisms rather than
cardioembolic.
Q3: A patient with a history of epilepsy suddenly begins having a generalized
tonic-clonic seizure in the hospital room. The seizure lasts 3 minutes. Which nursing
intervention is the priority during the active seizure phase?
A. Insert a padded tongue blade to prevent airway obstruction
B. Turn patient to side-lying position and protect head from injury [CORRECT]
C. Immediately start IV diazepam to stop the seizure
D. Restrain the patient's extremities to prevent injury
Correct Answer: B
,Rationale: During an active seizure, priority interventions are safety: protect from
falls/objects, turn to side to prevent aspiration, time the event, and do not force anything
into the mouth (A) or restrain (D)—these cause injury. IV benzodiazepines (C) are for
status epilepticus (>5 minutes or recurrent without consciousness return), not brief
self-limited seizures.
Q4: A 22-year-old patient sustained a T12-L1 spinal cord injury 3 days ago. While you are
turning the patient, they suddenly develop a severe pounding headache, diaphoresis
above the level of injury, and nasal congestion. Vital signs show BP 220/110 and HR 52.
Which condition is occurring, and what is the first nursing action?
A. Neurogenic shock; administer IV fluids and elevate legs
B. Autonomic dysreflexia; sit patient upright and remove noxious stimuli [CORRECT]
C. Increased intracranial pressure; administer mannitol and hyperventilate
D. Malignant hypertension; administer sublingual nifedipine immediately
Correct Answer: B
Rationale: This is classic autonomic dysreflexia: noxious stimulus below injury (often
bladder distention, bowel impaction, or tight clothing) triggers uncontrolled sympathetic
response causing severe hypertension, bradycardia (parasympathetic response), and
headache/sweating above lesion. Priority is to sit patient up (lower cerebral pressure)
and remove the stimulus. Neurogenic shock (A) presents with hypotension and
bradycardia. ICP (C) causes Cushing's triad but not typically with spinal injury.
Q5: Which assessment finding distinguishes an epidural hematoma from a subdural
hematoma in traumatic brain injury?
, A. Location between dura and arachnoid mater
B. Lucid interval followed by rapid deterioration [CORRECT]
C. Crescent-shaped lesion on CT scan crossing suture lines
D. Venous bleeding from bridging veins
Correct Answer: B
Rationale: Epidural hematomas (arterial, usually middle meningeal artery) classically
present with "talk and die" phenomenon—initial consciousness, lucid interval, then rapid
deterioration as hematoma expands. Subdural hematomas (venous, bridging veins)
typically present with gradual confusion/decline. Crescent shape crossing sutures (C)
describes subdural. Location (A) and venous source (D) describe subdural anatomy.
Q6: A patient with Parkinson's disease is scheduled for carbidopa/levodopa. Which
nursing instruction regarding medication administration is essential?
A. Take with high-protein meals to enhance absorption
B. Take on an empty stomach or with low-protein meals to prevent competition for
absorption [CORRECT]
C. Crush extended-release tablets if patient has dysphagia
D. Stop medication immediately if dyskinesias occur
Correct Answer: B
Rationale: Large neutral amino acids in dietary protein compete with levodopa for
transport across the blood-brain barrier and gut absorption. Taking on empty stomach
or with low-protein meals maximizes medication effectiveness. High-protein meals (A)
