,NSG4100/NSG 4100 Exam 4 | Nursing Practice – Adult
Health III | Galen College | Q & A | 2026/2027 Edition
(PDF)
1. A patient is admitted with a suspected epidural hematoma after a fall. Which finding is most
characteristic of this type of brain injury?
A) A lucid interval followed by rapid neurological deterioration
B) Gradual onset of symptoms over several days
C) Bilateral pupil dilation
D) Immediate loss of consciousness without recovery
Correct Answer: A lucid interval followed by rapid neurological deterioration
Rationale: An epidural hematoma is a medical emergency often caused by a tear in the middle
meningeal artery. The classic presentation is a brief loss of consciousness followed by a lucid interval,
then rapid deterioration as the arterial bleed expands, compressing the brain and leading to herniation.
2. A patient who is 12 hours post-craniotomy reports feeling "a lot of drainage at the back of the throat."
The nurse should recognize this as a sign of:
A) A normal postoperative reaction
B) A cerebrospinal fluid (CSF) leak
C) An allergic reaction to anesthesia
D) A developing respiratory infection
Correct Answer: A cerebrospinal fluid (CSF) leak
Rationale: Drainage at the back of the throat after a craniotomy can indicate a CSF leak, which may
result from a dural tear. This is a serious complication that should be reported immediately to prevent
infection and further complications.
,3. A patient with increased intracranial pressure (ICP) has a Glasgow Coma Scale (GCS) score that has
dropped from 13 to 9 over the past hour. Which nursing action is the priority?
A) Reassess the patient in 15 minutes
B) Notify the healthcare provider immediately
C) Elevate the head of the bed to 90 degrees
D) Administer a bolus of IV fluids
Correct Answer: Notify the healthcare provider immediately
Rationale: A drop in GCS of 4 points is a significant neurological change that indicates worsening ICP and
possible herniation. The nurse must notify the provider immediately for urgent intervention. A GCS of 9
indicates a moderate-to-severe brain injury.
4. The nurse is caring for a patient with a severe traumatic brain injury. Which position is most
appropriate to help reduce ICP?
A) Supine with the head flat
B) Semi-Fowler's position with the head elevated 30 degrees
C) Trendelenburg position
D) Left lateral position
Correct Answer: Semi-Fowler's position with the head elevated 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from the head, which
helps reduce intracranial pressure. The head should be kept in a midline, neutral position to avoid
jugular venous compression.
5. A patient with a subdural hematoma is being monitored for signs of worsening ICP. Which assessment
finding is most concerning?
A) The patient's pupil size changes from 3 mm to 6 mm bilaterally
B) The patient's pupil size changes from 3 mm to 5 mm on one side
C) The patient reports a headache rated 4 on a 0–10 scale
, D) The patient is drowsy but easily aroused
Correct Answer: The patient's pupil size changes from 3 mm to 5 mm on one side
Rationale: A unilaterally dilated and nonreactive pupil (blown pupil) is a sign of uncal herniation and
increasing ICP. This is an emergency that requires immediate intervention. Bilateral dilation can occur
later and is also serious, but unilateral dilation is an earlier, more specific sign of herniation.
6. A patient is prescribed pyridostigmine for myasthenia gravis. Which instruction should the nurse
include in the discharge teaching?
A) "Take the medication on an empty stomach for best absorption."
B) "Take the medication at the same time each day to maintain consistent levels."
C) "You can stop the medication if you feel better."
D) "Take the medication only when you experience muscle weakness."
Correct Answer: "Take the medication at the same time each day to maintain consistent levels."
Rationale: Pyridostigmine, a cholinesterase inhibitor, should be taken at the same time each day to
maintain consistent therapeutic drug levels. Abruptly stopping the medication can precipitate a
myasthenic crisis, which can lead to respiratory failure.
7. A patient with myasthenia gravis is experiencing a myasthenic crisis. The nurse recognizes that this
condition is primarily characterized by:
A) Severe muscle spasms
B) Respiratory failure
C) Seizures
D) Hyperthermia
Correct Answer: Respiratory failure
Health III | Galen College | Q & A | 2026/2027 Edition
(PDF)
1. A patient is admitted with a suspected epidural hematoma after a fall. Which finding is most
characteristic of this type of brain injury?
A) A lucid interval followed by rapid neurological deterioration
B) Gradual onset of symptoms over several days
C) Bilateral pupil dilation
D) Immediate loss of consciousness without recovery
Correct Answer: A lucid interval followed by rapid neurological deterioration
Rationale: An epidural hematoma is a medical emergency often caused by a tear in the middle
meningeal artery. The classic presentation is a brief loss of consciousness followed by a lucid interval,
then rapid deterioration as the arterial bleed expands, compressing the brain and leading to herniation.
2. A patient who is 12 hours post-craniotomy reports feeling "a lot of drainage at the back of the throat."
The nurse should recognize this as a sign of:
A) A normal postoperative reaction
B) A cerebrospinal fluid (CSF) leak
C) An allergic reaction to anesthesia
D) A developing respiratory infection
Correct Answer: A cerebrospinal fluid (CSF) leak
Rationale: Drainage at the back of the throat after a craniotomy can indicate a CSF leak, which may
result from a dural tear. This is a serious complication that should be reported immediately to prevent
infection and further complications.
,3. A patient with increased intracranial pressure (ICP) has a Glasgow Coma Scale (GCS) score that has
dropped from 13 to 9 over the past hour. Which nursing action is the priority?
A) Reassess the patient in 15 minutes
B) Notify the healthcare provider immediately
C) Elevate the head of the bed to 90 degrees
D) Administer a bolus of IV fluids
Correct Answer: Notify the healthcare provider immediately
Rationale: A drop in GCS of 4 points is a significant neurological change that indicates worsening ICP and
possible herniation. The nurse must notify the provider immediately for urgent intervention. A GCS of 9
indicates a moderate-to-severe brain injury.
4. The nurse is caring for a patient with a severe traumatic brain injury. Which position is most
appropriate to help reduce ICP?
A) Supine with the head flat
B) Semi-Fowler's position with the head elevated 30 degrees
C) Trendelenburg position
D) Left lateral position
Correct Answer: Semi-Fowler's position with the head elevated 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from the head, which
helps reduce intracranial pressure. The head should be kept in a midline, neutral position to avoid
jugular venous compression.
5. A patient with a subdural hematoma is being monitored for signs of worsening ICP. Which assessment
finding is most concerning?
A) The patient's pupil size changes from 3 mm to 6 mm bilaterally
B) The patient's pupil size changes from 3 mm to 5 mm on one side
C) The patient reports a headache rated 4 on a 0–10 scale
, D) The patient is drowsy but easily aroused
Correct Answer: The patient's pupil size changes from 3 mm to 5 mm on one side
Rationale: A unilaterally dilated and nonreactive pupil (blown pupil) is a sign of uncal herniation and
increasing ICP. This is an emergency that requires immediate intervention. Bilateral dilation can occur
later and is also serious, but unilateral dilation is an earlier, more specific sign of herniation.
6. A patient is prescribed pyridostigmine for myasthenia gravis. Which instruction should the nurse
include in the discharge teaching?
A) "Take the medication on an empty stomach for best absorption."
B) "Take the medication at the same time each day to maintain consistent levels."
C) "You can stop the medication if you feel better."
D) "Take the medication only when you experience muscle weakness."
Correct Answer: "Take the medication at the same time each day to maintain consistent levels."
Rationale: Pyridostigmine, a cholinesterase inhibitor, should be taken at the same time each day to
maintain consistent therapeutic drug levels. Abruptly stopping the medication can precipitate a
myasthenic crisis, which can lead to respiratory failure.
7. A patient with myasthenia gravis is experiencing a myasthenic crisis. The nurse recognizes that this
condition is primarily characterized by:
A) Severe muscle spasms
B) Respiratory failure
C) Seizures
D) Hyperthermia
Correct Answer: Respiratory failure
