NSG 223 Exam 4
Medical-Surgical Nursing II
Guide Questions and Verified Answers | Herzing University
Latest Update | Grade A | 100% Correct
Course NSG 223 Medical-Surgical Nursing II
Exam Exam 4: Neurological, Endocrine, and Musculoskeletal
Total Questions 50 (Multiple Choice, A-D Format)
Difficulty Level 25% Recall, 55% Application, 20% Analysis
Institution Herzing University
Curriculum 2026/2027 Academic Year Standards
50 Verified Questions with Comprehensive A+ Graded Rationales
,Section 1: Neurological Disorders (Q1-Q15)
Q1: A 68-year-old patient is brought to the emergency department with sudden onset of left-sided
hemiparesis, facial drooping, and slurred speech that began 45 minutes ago. The patient has a history
of hypertension and atrial fibrillation. Which type of stroke is most likely occurring, and what is the
priority nursing action?
A. Hemorrhagic stroke; immediately administer mannitol to reduce intracranial pressure
B. Ischemic stroke from an embolic source; prepare the patient for immediate CT scan to determine
tPA eligibility [CORRECT]
C. Ischemic thrombotic stroke; administer aspirin and send for carotid ultrasound
D. Transient ischemic attack (TIA); observe the patient for 24 hours before any intervention
Correct Answer: B
Rationale: This patient presents with sudden onset of focal neurological deficits (left-sided hemiparesis, facial droop,
dysarthria) and a history of atrial fibrillation, which is a major risk factor for embolic stroke. The priority is obtaining a
CT scan immediately to differentiate ischemic from hemorrhagic stroke, as thrombolytic therapy with tPA (alteplase) must
be administered within 3-4.5 hours of symptom onset for ischemic stroke. Choice A incorrectly assumes hemorrhagic
stroke; mannitol is used for increased ICP, not as first-line treatment. Choice C administers aspirin prematurely; aspirin is
contraindicated until hemorrhage is ruled out by CT. Choice D inappropriately delays intervention; TIAs require urgent
evaluation, and the current presentation suggests a completed stroke, not a TIA.
Q2: A patient arrives at the ED with a sudden, severe headache described as the worst headache of her
life, vomiting, and photophobia. Her blood pressure is 198/110 mmHg. The CT scan reveals blood in
the subarachnoid space. Which nursing intervention is the highest priority?
A. Administer aspirin 325 mg immediately to prevent further clot formation
B. Maintain the patient on strict bed rest in a quiet, dark room with the head of bed at 30 degrees and
monitor for signs of rebleeding and increased ICP [CORRECT]
C. Position the patient flat to increase cerebral perfusion pressure
D. Encourage the patient to ambulate to prevent deep vein thrombosis
Correct Answer: B
Rationale: This patient has a subarachnoid hemorrhage (SAH), indicated by the classic worst headache of her life,
vomiting, photophobia, and blood on CT scan. The highest priority is maintaining the patient on strict bed rest in a quiet,
dark environment (to reduce stimuli that could increase ICP), with HOB at 30 degrees (to promote venous drainage and
reduce ICP), and monitoring for rebleeding and vasospasm, the most common complications. Choice A is dangerous;
aspirin would worsen bleeding. Choice C increases ICP by reducing venous drainage. Choice D increases the risk of
rebleeding.
Q3: A patient with an ischemic stroke is being considered for tPA (alteplase) administration. Which of
the following is a contraindication to tPA therapy?
A. Blood pressure of 150/90 mmHg on arrival at the ED
B. Symptom onset within the last 2 hours with no evidence of hemorrhage on CT scan
C. Recent history of major surgery (appendectomy) within the past 14 days [CORRECT]
D. History of hyperlipidemia controlled with atorvastatin
Correct Answer: C
Rationale: Recent major surgery within 14 days is an absolute contraindication to tPA administration because of the
significantly increased risk of bleeding. tPA is a thrombolytic agent that dissolves clots but can cause life-threatening
hemorrhage. Absolute contraindications also include active internal bleeding, intracranial hemorrhage on CT, recent
, intracranial surgery or trauma, and uncontrolled hypertension (systolic >185 mmHg or diastolic >110 mmHg). Choice A
shows BP within acceptable parameters (<185/110). Choice B describes an ideal candidate (within the time window, no
hemorrhage). Choice D (controlled hyperlipidemia) is not a contraindication.
Q4: The nurse is performing neurologic checks on a post-stroke patient. Which assessment finding
requires immediate notification of the healthcare provider?
A. Pupils equal and reactive at 3 mm, GCS score of 14, new-onset confusion in the last hour
[CORRECT]
B. Patient reports mild headache that is relieved by repositioning
C. Blood pressure of 144/88 mmHg in a patient with a history of hypertension
D. Patient has difficulty swallowing thickened liquids but tolerates pureed foods
Correct Answer: A
Rationale: New-onset confusion (a change in level of consciousness) is a critical finding that may indicate increased
intracranial pressure, extension of the stroke, or a new neurological event such as hemorrhagic transformation or cerebral
edema. It requires immediate provider notification. While the GCS of 14 is stable, the new confusion represents a change
from baseline that warrants urgent evaluation. Choice B (mild headache relieved by repositioning) is expected post-stroke
and not an emergency. Choice C (BP 144/88) is within acceptable range; permissive hypertension is often allowed
post-ischemic stroke to maintain cerebral perfusion. Choice D describes dysphagia, which is common post-stroke and
should be managed with speech therapy referral and diet modification but is not an immediate emergency.
Q5: A patient with a history of seizures is admitted to the hospital. The nurse witnesses the patient
having a tonic-clonic seizure. Which nursing intervention is most important during the active seizure
phase?
A. Restrain the patient's limbs to prevent injury from violent movements
B. Insert a padded tongue blade between the teeth to prevent tongue biting
C. Clear the area of hazards, position the patient on their side (recovery position) if possible, protect
the head, and time the seizure duration [CORRECT]
D. Immediately administer oral antiepileptic medication to stop the seizure
Correct Answer: C
Rationale: During the active phase of a tonic-clonic seizure, the nurse should clear the area of dangerous objects, position
the patient on their side (recovery position) to prevent aspiration and maintain an airway, protect the head from injury,
and time the seizure duration (seizures >5 minutes constitute status epilepticus, a medical emergency). Choice A is incorrect
and dangerous; restraining limbs can cause fractures. Choice B is outdated and dangerous; nothing should be inserted into
the mouth during a seizure (risk of airway obstruction, dental damage, and bitten fingers). Choice D is incorrect; oral
medications cannot be safely administered during an active seizure; IV or rectal benzodiazepines (lorazepam, diazepam)
are used for prolonged seizures.
Q6: A patient with a seizure disorder is prescribed phenytoin (Dilantin). Which statement by the
patient indicates a need for further teaching regarding this medication?
A. I should take my medication at the same time every day and never suddenly stop taking it without my
doctor's guidance
B. I should maintain good oral hygiene and schedule regular dental checkups while taking this medication
C. It is fine to double my dose if I miss a dose to catch up quickly [CORRECT]
D. I should avoid alcohol while taking this medication because it may increase seizure risk
Correct Answer: C
Rationale: The patient should never double a dose of phenytoin to catch up after a missed dose. Phenytoin has a narrow
therapeutic index, and doubling the dose can lead to toxic levels, causing nystagmus, ataxia, gingival hyperplasia, and
confusion. The patient should be instructed to take the missed dose as soon as remembered (unless it is close to the next
Medical-Surgical Nursing II
Guide Questions and Verified Answers | Herzing University
Latest Update | Grade A | 100% Correct
Course NSG 223 Medical-Surgical Nursing II
Exam Exam 4: Neurological, Endocrine, and Musculoskeletal
Total Questions 50 (Multiple Choice, A-D Format)
Difficulty Level 25% Recall, 55% Application, 20% Analysis
Institution Herzing University
Curriculum 2026/2027 Academic Year Standards
50 Verified Questions with Comprehensive A+ Graded Rationales
,Section 1: Neurological Disorders (Q1-Q15)
Q1: A 68-year-old patient is brought to the emergency department with sudden onset of left-sided
hemiparesis, facial drooping, and slurred speech that began 45 minutes ago. The patient has a history
of hypertension and atrial fibrillation. Which type of stroke is most likely occurring, and what is the
priority nursing action?
A. Hemorrhagic stroke; immediately administer mannitol to reduce intracranial pressure
B. Ischemic stroke from an embolic source; prepare the patient for immediate CT scan to determine
tPA eligibility [CORRECT]
C. Ischemic thrombotic stroke; administer aspirin and send for carotid ultrasound
D. Transient ischemic attack (TIA); observe the patient for 24 hours before any intervention
Correct Answer: B
Rationale: This patient presents with sudden onset of focal neurological deficits (left-sided hemiparesis, facial droop,
dysarthria) and a history of atrial fibrillation, which is a major risk factor for embolic stroke. The priority is obtaining a
CT scan immediately to differentiate ischemic from hemorrhagic stroke, as thrombolytic therapy with tPA (alteplase) must
be administered within 3-4.5 hours of symptom onset for ischemic stroke. Choice A incorrectly assumes hemorrhagic
stroke; mannitol is used for increased ICP, not as first-line treatment. Choice C administers aspirin prematurely; aspirin is
contraindicated until hemorrhage is ruled out by CT. Choice D inappropriately delays intervention; TIAs require urgent
evaluation, and the current presentation suggests a completed stroke, not a TIA.
Q2: A patient arrives at the ED with a sudden, severe headache described as the worst headache of her
life, vomiting, and photophobia. Her blood pressure is 198/110 mmHg. The CT scan reveals blood in
the subarachnoid space. Which nursing intervention is the highest priority?
A. Administer aspirin 325 mg immediately to prevent further clot formation
B. Maintain the patient on strict bed rest in a quiet, dark room with the head of bed at 30 degrees and
monitor for signs of rebleeding and increased ICP [CORRECT]
C. Position the patient flat to increase cerebral perfusion pressure
D. Encourage the patient to ambulate to prevent deep vein thrombosis
Correct Answer: B
Rationale: This patient has a subarachnoid hemorrhage (SAH), indicated by the classic worst headache of her life,
vomiting, photophobia, and blood on CT scan. The highest priority is maintaining the patient on strict bed rest in a quiet,
dark environment (to reduce stimuli that could increase ICP), with HOB at 30 degrees (to promote venous drainage and
reduce ICP), and monitoring for rebleeding and vasospasm, the most common complications. Choice A is dangerous;
aspirin would worsen bleeding. Choice C increases ICP by reducing venous drainage. Choice D increases the risk of
rebleeding.
Q3: A patient with an ischemic stroke is being considered for tPA (alteplase) administration. Which of
the following is a contraindication to tPA therapy?
A. Blood pressure of 150/90 mmHg on arrival at the ED
B. Symptom onset within the last 2 hours with no evidence of hemorrhage on CT scan
C. Recent history of major surgery (appendectomy) within the past 14 days [CORRECT]
D. History of hyperlipidemia controlled with atorvastatin
Correct Answer: C
Rationale: Recent major surgery within 14 days is an absolute contraindication to tPA administration because of the
significantly increased risk of bleeding. tPA is a thrombolytic agent that dissolves clots but can cause life-threatening
hemorrhage. Absolute contraindications also include active internal bleeding, intracranial hemorrhage on CT, recent
, intracranial surgery or trauma, and uncontrolled hypertension (systolic >185 mmHg or diastolic >110 mmHg). Choice A
shows BP within acceptable parameters (<185/110). Choice B describes an ideal candidate (within the time window, no
hemorrhage). Choice D (controlled hyperlipidemia) is not a contraindication.
Q4: The nurse is performing neurologic checks on a post-stroke patient. Which assessment finding
requires immediate notification of the healthcare provider?
A. Pupils equal and reactive at 3 mm, GCS score of 14, new-onset confusion in the last hour
[CORRECT]
B. Patient reports mild headache that is relieved by repositioning
C. Blood pressure of 144/88 mmHg in a patient with a history of hypertension
D. Patient has difficulty swallowing thickened liquids but tolerates pureed foods
Correct Answer: A
Rationale: New-onset confusion (a change in level of consciousness) is a critical finding that may indicate increased
intracranial pressure, extension of the stroke, or a new neurological event such as hemorrhagic transformation or cerebral
edema. It requires immediate provider notification. While the GCS of 14 is stable, the new confusion represents a change
from baseline that warrants urgent evaluation. Choice B (mild headache relieved by repositioning) is expected post-stroke
and not an emergency. Choice C (BP 144/88) is within acceptable range; permissive hypertension is often allowed
post-ischemic stroke to maintain cerebral perfusion. Choice D describes dysphagia, which is common post-stroke and
should be managed with speech therapy referral and diet modification but is not an immediate emergency.
Q5: A patient with a history of seizures is admitted to the hospital. The nurse witnesses the patient
having a tonic-clonic seizure. Which nursing intervention is most important during the active seizure
phase?
A. Restrain the patient's limbs to prevent injury from violent movements
B. Insert a padded tongue blade between the teeth to prevent tongue biting
C. Clear the area of hazards, position the patient on their side (recovery position) if possible, protect
the head, and time the seizure duration [CORRECT]
D. Immediately administer oral antiepileptic medication to stop the seizure
Correct Answer: C
Rationale: During the active phase of a tonic-clonic seizure, the nurse should clear the area of dangerous objects, position
the patient on their side (recovery position) to prevent aspiration and maintain an airway, protect the head from injury,
and time the seizure duration (seizures >5 minutes constitute status epilepticus, a medical emergency). Choice A is incorrect
and dangerous; restraining limbs can cause fractures. Choice B is outdated and dangerous; nothing should be inserted into
the mouth during a seizure (risk of airway obstruction, dental damage, and bitten fingers). Choice D is incorrect; oral
medications cannot be safely administered during an active seizure; IV or rectal benzodiazepines (lorazepam, diazepam)
are used for prolonged seizures.
Q6: A patient with a seizure disorder is prescribed phenytoin (Dilantin). Which statement by the
patient indicates a need for further teaching regarding this medication?
A. I should take my medication at the same time every day and never suddenly stop taking it without my
doctor's guidance
B. I should maintain good oral hygiene and schedule regular dental checkups while taking this medication
C. It is fine to double my dose if I miss a dose to catch up quickly [CORRECT]
D. I should avoid alcohol while taking this medication because it may increase seizure risk
Correct Answer: C
Rationale: The patient should never double a dose of phenytoin to catch up after a missed dose. Phenytoin has a narrow
therapeutic index, and doubling the dose can lead to toxic levels, causing nystagmus, ataxia, gingival hyperplasia, and
confusion. The patient should be instructed to take the missed dose as soon as remembered (unless it is close to the next
