NSG 4100 EXAM 2
Neurological, Renal, and Endocrine Disorders — 100-Question
Practice Exam with Answer Key & Rationales
Section A: Neurological Disorders
Question 1: A client presents with sudden facial droop, arm weakness, and slurred speech. What
is the nurse's priority action?
● A. Wait to see if symptoms resolve on their own
● B. Activate the stroke protocol and note the time symptoms began
● C. Administer aspirin immediately
● D. Encourage the client to walk to test balance
Rationale: Rapid recognition and time of symptom onset are critical in stroke care since
treatment eligibility, such as thrombolytics, is time-dependent.
Question 2: A client is diagnosed with an ischemic stroke and is a candidate for tPA. Within
what time frame must it typically be administered from symptom onset?
● A. 24 hours
● B. 3 to 4.5 hours
● C. 72 hours
● D. 1 week
Rationale: Alteplase (tPA) is generally given within 3 to 4.5 hours of symptom onset in eligible
ischemic stroke clients to minimize the risk of hemorrhagic conversion.
Question 3: Before administering tPA to a client with acute stroke, which finding would be a
contraindication?
● A. Blood pressure of 130/80 mm Hg
● B. Evidence of hemorrhage on CT scan
● C. Blood glucose of 110 mg/dL
● D. Symptom onset 2 hours ago
Rationale: tPA is contraindicated in hemorrhagic stroke because it would worsen bleeding; a
CT scan must rule out hemorrhage before administration.
Question 4: A nurse is caring for a client with increased intracranial pressure (ICP). Which
position is appropriate?
● A. Head of bed flat
● B. Head of bed elevated 30 degrees with neutral neck alignment
● C. Trendelenburg position
● D. Prone position
,Rationale: Elevating the head of bed 30 degrees promotes venous drainage and helps reduce
intracranial pressure while maintaining cerebral perfusion.
Question 5: A client with a traumatic brain injury develops Cushing's triad. Which findings
comprise this triad?
● A. Hypotension, tachycardia, tachypnea
● B. Hypertension, bradycardia, irregular respirations
● C. Hypotension, bradycardia, bradypnea
● D. Hypertension, tachycardia, tachypnea
Rationale: Cushing's triad (widened pulse pressure/hypertension, bradycardia, and irregular
respirations) is a late and ominous sign of increased ICP indicating impending herniation.
Question 6: A nurse assesses a client's pupils and finds one pupil dilated and nonreactive to
light. What does this finding suggest?
● A. Normal variant
● B. Increased intracranial pressure with possible herniation
● C. Resolving concussion
● D. Medication side effect only
Rationale: A unilateral fixed, dilated pupil suggests compression of the oculomotor nerve from
increased ICP or herniation and is a neurological emergency.
Question 7: A client with a spinal cord injury at T4 develops a pounding headache, flushing
above the injury, and severe hypertension. What is the priority action?
● A. Lay the client flat immediately
● B. Sit the client upright and assess for a distended bladder or fecal impaction
● C. Administer IV fluids rapidly
● D. Apply a warm blanket
Rationale: These are signs of autonomic dysreflexia, often triggered by bladder distention or
constipation; the nurse should sit the client up and remove the triggering stimulus to prevent
stroke or seizure from severe hypertension.
Question 8: A nurse is caring for a client with a seizure disorder. What is the priority action
during a generalized tonic-clonic seizure?
● A. Restrain the client's limbs to prevent injury
● B. Insert a padded tongue depressor into the mouth
● C. Protect the client from injury and turn them to the side if possible
● D. Administer oral medication immediately
Rationale: During a seizure, the priority is protecting the client from injury and positioning
them to prevent aspiration; nothing should be forced into the mouth and limbs should not be
restrained.
, Question 9: A client is in status epilepticus. Which medication does the nurse anticipate
administering first?
● A. Phenytoin
● B. IV lorazepam or diazepam
● C. Oral levetiracetam
● D. Acetaminophen
Rationale: Benzodiazepines such as IV lorazepam are first-line for terminating status epilepticus
due to their rapid onset of action.
Question 10: A nurse is teaching a client newly diagnosed with epilepsy about seizure
precautions. Which statement indicates understanding?
● A. "I can stop my medication once I feel better."
● B. "I should keep a log of when seizures occur and their characteristics."
● C. "I do not need to inform my employer."
● D. "I can drive immediately after being seizure-free for one day."
Rationale: Keeping a seizure log helps track patterns and treatment effectiveness; antiepileptic
medications should not be stopped abruptly, and driving restrictions vary by state law and
seizure-free duration.
Question 11: A client with a subarachnoid hemorrhage is at risk for cerebral vasospasm. Which
medication is given prophylactically?
● A. Nimodipine
● B. Warfarin
● C. Furosemide
● D. Metoprolol
Rationale: Nimodipine, a calcium channel blocker, is used specifically to reduce the risk and
severity of cerebral vasospasm following subarachnoid hemorrhage.
Question 12: A client recovering from a stroke has difficulty swallowing. Which nursing action
is the priority?
● A. Offer thin liquids first
● B. Consult speech therapy and maintain NPO status until swallow evaluation
● C. Encourage a regular diet immediately
● D. Have the client eat lying flat
Rationale: Clients with suspected dysphagia should remain NPO until a formal swallow
evaluation is completed to prevent aspiration.
Question 13: A client with a spinal cord injury at C4 is at greatest risk for which complication?
● A. Loss of bladder control only
● B. Respiratory failure due to diaphragm involvement
● C. Bowel incontinence only
Neurological, Renal, and Endocrine Disorders — 100-Question
Practice Exam with Answer Key & Rationales
Section A: Neurological Disorders
Question 1: A client presents with sudden facial droop, arm weakness, and slurred speech. What
is the nurse's priority action?
● A. Wait to see if symptoms resolve on their own
● B. Activate the stroke protocol and note the time symptoms began
● C. Administer aspirin immediately
● D. Encourage the client to walk to test balance
Rationale: Rapid recognition and time of symptom onset are critical in stroke care since
treatment eligibility, such as thrombolytics, is time-dependent.
Question 2: A client is diagnosed with an ischemic stroke and is a candidate for tPA. Within
what time frame must it typically be administered from symptom onset?
● A. 24 hours
● B. 3 to 4.5 hours
● C. 72 hours
● D. 1 week
Rationale: Alteplase (tPA) is generally given within 3 to 4.5 hours of symptom onset in eligible
ischemic stroke clients to minimize the risk of hemorrhagic conversion.
Question 3: Before administering tPA to a client with acute stroke, which finding would be a
contraindication?
● A. Blood pressure of 130/80 mm Hg
● B. Evidence of hemorrhage on CT scan
● C. Blood glucose of 110 mg/dL
● D. Symptom onset 2 hours ago
Rationale: tPA is contraindicated in hemorrhagic stroke because it would worsen bleeding; a
CT scan must rule out hemorrhage before administration.
Question 4: A nurse is caring for a client with increased intracranial pressure (ICP). Which
position is appropriate?
● A. Head of bed flat
● B. Head of bed elevated 30 degrees with neutral neck alignment
● C. Trendelenburg position
● D. Prone position
,Rationale: Elevating the head of bed 30 degrees promotes venous drainage and helps reduce
intracranial pressure while maintaining cerebral perfusion.
Question 5: A client with a traumatic brain injury develops Cushing's triad. Which findings
comprise this triad?
● A. Hypotension, tachycardia, tachypnea
● B. Hypertension, bradycardia, irregular respirations
● C. Hypotension, bradycardia, bradypnea
● D. Hypertension, tachycardia, tachypnea
Rationale: Cushing's triad (widened pulse pressure/hypertension, bradycardia, and irregular
respirations) is a late and ominous sign of increased ICP indicating impending herniation.
Question 6: A nurse assesses a client's pupils and finds one pupil dilated and nonreactive to
light. What does this finding suggest?
● A. Normal variant
● B. Increased intracranial pressure with possible herniation
● C. Resolving concussion
● D. Medication side effect only
Rationale: A unilateral fixed, dilated pupil suggests compression of the oculomotor nerve from
increased ICP or herniation and is a neurological emergency.
Question 7: A client with a spinal cord injury at T4 develops a pounding headache, flushing
above the injury, and severe hypertension. What is the priority action?
● A. Lay the client flat immediately
● B. Sit the client upright and assess for a distended bladder or fecal impaction
● C. Administer IV fluids rapidly
● D. Apply a warm blanket
Rationale: These are signs of autonomic dysreflexia, often triggered by bladder distention or
constipation; the nurse should sit the client up and remove the triggering stimulus to prevent
stroke or seizure from severe hypertension.
Question 8: A nurse is caring for a client with a seizure disorder. What is the priority action
during a generalized tonic-clonic seizure?
● A. Restrain the client's limbs to prevent injury
● B. Insert a padded tongue depressor into the mouth
● C. Protect the client from injury and turn them to the side if possible
● D. Administer oral medication immediately
Rationale: During a seizure, the priority is protecting the client from injury and positioning
them to prevent aspiration; nothing should be forced into the mouth and limbs should not be
restrained.
, Question 9: A client is in status epilepticus. Which medication does the nurse anticipate
administering first?
● A. Phenytoin
● B. IV lorazepam or diazepam
● C. Oral levetiracetam
● D. Acetaminophen
Rationale: Benzodiazepines such as IV lorazepam are first-line for terminating status epilepticus
due to their rapid onset of action.
Question 10: A nurse is teaching a client newly diagnosed with epilepsy about seizure
precautions. Which statement indicates understanding?
● A. "I can stop my medication once I feel better."
● B. "I should keep a log of when seizures occur and their characteristics."
● C. "I do not need to inform my employer."
● D. "I can drive immediately after being seizure-free for one day."
Rationale: Keeping a seizure log helps track patterns and treatment effectiveness; antiepileptic
medications should not be stopped abruptly, and driving restrictions vary by state law and
seizure-free duration.
Question 11: A client with a subarachnoid hemorrhage is at risk for cerebral vasospasm. Which
medication is given prophylactically?
● A. Nimodipine
● B. Warfarin
● C. Furosemide
● D. Metoprolol
Rationale: Nimodipine, a calcium channel blocker, is used specifically to reduce the risk and
severity of cerebral vasospasm following subarachnoid hemorrhage.
Question 12: A client recovering from a stroke has difficulty swallowing. Which nursing action
is the priority?
● A. Offer thin liquids first
● B. Consult speech therapy and maintain NPO status until swallow evaluation
● C. Encourage a regular diet immediately
● D. Have the client eat lying flat
Rationale: Clients with suspected dysphagia should remain NPO until a formal swallow
evaluation is completed to prevent aspiration.
Question 13: A client with a spinal cord injury at C4 is at greatest risk for which complication?
● A. Loss of bladder control only
● B. Respiratory failure due to diaphragm involvement
● C. Bowel incontinence only
