NSG 4100 Adult Health III
Exam 4 — Comprehensive Review
Questions & Verified Solutions | Grade A | 2026/2027 Update
Galen College of Nursing
RN Licensure & BSN Academic Course Focus
Academic Year 2026–2027
, NSG 4100 Exam 4 Review
Abstract
This comprehensive examination review document for the Galen College of Nursing NSG 4100
Adult Health III Exam 4 (Final Exam) encompasses 60 evidence-based questions with verified
correct answers and detailed clinical rationales across five advanced critical care domains: (I)
Advanced Neurological Critical Care, addressing ischemic and hemorrhagic stroke management,
severe traumatic brain injury, status epilepticus, spinal cord injury, Guillain-Barré syndrome, and
myasthenia gravis crisis; (II) Advanced Cardiovascular Critical Care, covering acute coronary
syndromes, cardiogenic shock, acute decompensated heart failure, valvular heart disease, cardiac
tamponade, and aortic dissection; (III) Advanced Respiratory Critical Care, including ARDS, massive
pulmonary embolism, severe COPD exacerbation, mechanical ventilation modes and weaning, and
VAP prevention; (IV) Advanced Renal Critical Care, featuring CRRT modalities, intermittent
hemodialysis, and AKI staging and prevention; and (V) Multisystem Organ Failure and End-of-Life
Critical Care, encompassing MODS, withdrawal of life-sustaining therapy, organ donation protocols,
brain death determination, and ethical principles in critical care. All content is aligned with current
evidence-based critical care guidelines from the AHA/ASA, Brain Trauma Foundation, American
Epilepsy Society, SCCM/ESICM, ATS, KDIGO, and professional nursing standards of critical care
practice.
Keywords: critical care nursing, NSG 4100, Adult Health III, ischemic stroke, hemorrhagic
stroke, traumatic brain injury, status epilepticus, spinal cord injury, ARDS, cardiogenic shock,
CRRT, organ donation, brain death, end-of-life care, evidence-based practice
Table of Contents
Abstract ........................................................................................................................ I
Table of Contents.......................................................................................................... I
Introduction ................................................................................................................. 1
Domain I: Advanced Neurological Critical Care ........................................................... 1
Domain II: Advanced Cardiovascular Critical Care ..................................................... 6
Domain III: Advanced Respiratory Critical Care ......................................................... 9
Domain IV: Advanced Renal Critical Care .................................................................. 12
Domain V: Multisystem Organ Failure and End-of-Life Critical Care ........................ 14
References .................................................................................................................. 18
I
, NSG 4100 Exam 4 Review | Galen College of Nursing
Introduction
The NSG 4100 Adult Health III course at Galen College of Nursing represents the capstone
critical care nursing experience in the BSN curriculum, preparing registered nurses for advanced
clinical judgment in the management of critically ill adult patients. This comprehensive Exam 4
review document addresses five core domains of advanced critical care practice, each requiring
integration of pathophysiological understanding, pharmacological knowledge, hemodynamic
monitoring interpretation, and evidence-based clinical decision-making. The questions presented
herein are designed to assess the student’s ability to prioritize nursing interventions, interpret
complex clinical scenarios, and apply current evidence-based guidelines from authoritative bodies
including the American Heart Association/American Stroke Association (AHA/ASA), the Society of
Critical Care Medicine (SCCM), the Brain Trauma Foundation, the American Epilepsy Society, the
American Thoracic Society (ATS), and the Kidney Disease: Improving Global Outcomes (KDIGO)
organization. Each question is accompanied by a detailed rationale that not only identifies the correct
answer but also explains why alternative options are incorrect, thereby reinforcing the clinical
reasoning process essential for safe and effective critical care nursing practice.
The examination format includes 60 questions comprising multiple-choice and alternate-
format items (select-all-that-apply, ordered response). Answers are presented in bold green text with
rationales citing current evidence-based critical care guidelines. This review is specifically aligned
with the 2026/2027 academic cycle and reflects the most current guideline updates in critical care
medicine and nursing practice.
Domain I: Advanced Neurological Critical Care
1. A 68-year-old patient arrives in the ED 2 hours after onset of right-sided weakness and aphasia.
CT scan confirms an ischemic stroke with no hemorrhage. Blood pressure is 178/98 mmHg. Which
action should the nurse take first regarding tPA administration?
A) Administer labetalol to lower BP below 140/90 mmHg before tPA
B) Proceed with tPA administration immediately as the patient is within the 4.5-hour window
C) Obtain an MRI before administering tPA
D) Administer aspirin 325 mg orally before tPA
Correct Answer: B
Rationale: The patient is within the 4.5-hour tPA administration window (AHA/ASA 2019
Guidelines). Current blood pressure is below the threshold of 185/110 mmHg required for tPA
eligibility, so no antihypertensive intervention is needed before administration. Non-contrast
CT is sufficient to rule out hemorrhage; MRI is not required. Aspirin is contraindicated within
24 hours after tPA administration.
2. A patient received tPA for an ischemic stroke 3 hours ago. Current blood pressure is 190/105
mmHg. What is the priority nursing intervention?
A) Continue monitoring; BP elevation is expected post-thrombolytics
B) Administer labetalol 10-20 mg IV push to lower BP
C) Administer additional tPA to maintain patency
D) Prepare for mechanical thrombectomy
Correct Answer: B
Rationale: After tPA administration, strict blood pressure control is mandatory. Per
AHA/ASA guidelines, BP must be maintained below 180/105 mmHg for at least 24 hours post-
thrombolytics. A reading of 190/105 mmHg requires immediate treatment with IV labetalol or
other rapid-acting antihypertensives. Failure to control BP significantly increases the risk of
hemorrhagic conversion.
3. Which of the following is an exclusion criterion for tPA administration in acute ischemic stroke?
A) Age greater than 80 years
B) Blood glucose level of 120 mg/dL
1
Exam 4 — Comprehensive Review
Questions & Verified Solutions | Grade A | 2026/2027 Update
Galen College of Nursing
RN Licensure & BSN Academic Course Focus
Academic Year 2026–2027
, NSG 4100 Exam 4 Review
Abstract
This comprehensive examination review document for the Galen College of Nursing NSG 4100
Adult Health III Exam 4 (Final Exam) encompasses 60 evidence-based questions with verified
correct answers and detailed clinical rationales across five advanced critical care domains: (I)
Advanced Neurological Critical Care, addressing ischemic and hemorrhagic stroke management,
severe traumatic brain injury, status epilepticus, spinal cord injury, Guillain-Barré syndrome, and
myasthenia gravis crisis; (II) Advanced Cardiovascular Critical Care, covering acute coronary
syndromes, cardiogenic shock, acute decompensated heart failure, valvular heart disease, cardiac
tamponade, and aortic dissection; (III) Advanced Respiratory Critical Care, including ARDS, massive
pulmonary embolism, severe COPD exacerbation, mechanical ventilation modes and weaning, and
VAP prevention; (IV) Advanced Renal Critical Care, featuring CRRT modalities, intermittent
hemodialysis, and AKI staging and prevention; and (V) Multisystem Organ Failure and End-of-Life
Critical Care, encompassing MODS, withdrawal of life-sustaining therapy, organ donation protocols,
brain death determination, and ethical principles in critical care. All content is aligned with current
evidence-based critical care guidelines from the AHA/ASA, Brain Trauma Foundation, American
Epilepsy Society, SCCM/ESICM, ATS, KDIGO, and professional nursing standards of critical care
practice.
Keywords: critical care nursing, NSG 4100, Adult Health III, ischemic stroke, hemorrhagic
stroke, traumatic brain injury, status epilepticus, spinal cord injury, ARDS, cardiogenic shock,
CRRT, organ donation, brain death, end-of-life care, evidence-based practice
Table of Contents
Abstract ........................................................................................................................ I
Table of Contents.......................................................................................................... I
Introduction ................................................................................................................. 1
Domain I: Advanced Neurological Critical Care ........................................................... 1
Domain II: Advanced Cardiovascular Critical Care ..................................................... 6
Domain III: Advanced Respiratory Critical Care ......................................................... 9
Domain IV: Advanced Renal Critical Care .................................................................. 12
Domain V: Multisystem Organ Failure and End-of-Life Critical Care ........................ 14
References .................................................................................................................. 18
I
, NSG 4100 Exam 4 Review | Galen College of Nursing
Introduction
The NSG 4100 Adult Health III course at Galen College of Nursing represents the capstone
critical care nursing experience in the BSN curriculum, preparing registered nurses for advanced
clinical judgment in the management of critically ill adult patients. This comprehensive Exam 4
review document addresses five core domains of advanced critical care practice, each requiring
integration of pathophysiological understanding, pharmacological knowledge, hemodynamic
monitoring interpretation, and evidence-based clinical decision-making. The questions presented
herein are designed to assess the student’s ability to prioritize nursing interventions, interpret
complex clinical scenarios, and apply current evidence-based guidelines from authoritative bodies
including the American Heart Association/American Stroke Association (AHA/ASA), the Society of
Critical Care Medicine (SCCM), the Brain Trauma Foundation, the American Epilepsy Society, the
American Thoracic Society (ATS), and the Kidney Disease: Improving Global Outcomes (KDIGO)
organization. Each question is accompanied by a detailed rationale that not only identifies the correct
answer but also explains why alternative options are incorrect, thereby reinforcing the clinical
reasoning process essential for safe and effective critical care nursing practice.
The examination format includes 60 questions comprising multiple-choice and alternate-
format items (select-all-that-apply, ordered response). Answers are presented in bold green text with
rationales citing current evidence-based critical care guidelines. This review is specifically aligned
with the 2026/2027 academic cycle and reflects the most current guideline updates in critical care
medicine and nursing practice.
Domain I: Advanced Neurological Critical Care
1. A 68-year-old patient arrives in the ED 2 hours after onset of right-sided weakness and aphasia.
CT scan confirms an ischemic stroke with no hemorrhage. Blood pressure is 178/98 mmHg. Which
action should the nurse take first regarding tPA administration?
A) Administer labetalol to lower BP below 140/90 mmHg before tPA
B) Proceed with tPA administration immediately as the patient is within the 4.5-hour window
C) Obtain an MRI before administering tPA
D) Administer aspirin 325 mg orally before tPA
Correct Answer: B
Rationale: The patient is within the 4.5-hour tPA administration window (AHA/ASA 2019
Guidelines). Current blood pressure is below the threshold of 185/110 mmHg required for tPA
eligibility, so no antihypertensive intervention is needed before administration. Non-contrast
CT is sufficient to rule out hemorrhage; MRI is not required. Aspirin is contraindicated within
24 hours after tPA administration.
2. A patient received tPA for an ischemic stroke 3 hours ago. Current blood pressure is 190/105
mmHg. What is the priority nursing intervention?
A) Continue monitoring; BP elevation is expected post-thrombolytics
B) Administer labetalol 10-20 mg IV push to lower BP
C) Administer additional tPA to maintain patency
D) Prepare for mechanical thrombectomy
Correct Answer: B
Rationale: After tPA administration, strict blood pressure control is mandatory. Per
AHA/ASA guidelines, BP must be maintained below 180/105 mmHg for at least 24 hours post-
thrombolytics. A reading of 190/105 mmHg requires immediate treatment with IV labetalol or
other rapid-acting antihypertensives. Failure to control BP significantly increases the risk of
hemorrhagic conversion.
3. Which of the following is an exclusion criterion for tPA administration in acute ischemic stroke?
A) Age greater than 80 years
B) Blood glucose level of 120 mg/dL
1
