NUR 265 Exam 2 Practice Advanced Concepts In
Medical-Surgical Nursing 2026/2027 Questions
And Answers Latest Updates
1. A client with a suspected ischemic stroke arrives in the ED 45 minutes after
symptom onset. Which intervention is the HIGHEST priority before administering
tissue plasminogen activator (tPA)?
A) Obtaining informed consent from the family for thrombolytic therapy
B) Performing a non-contrast CT scan of the brain to rule out hemorrhage
C) Administering aspirin 325 mg orally to prevent further clot formation
D) Starting an IV infusion of heparin at 1000 units/hr
Correct Answer: B) Performing a non-contrast CT scan of the brain to rule out
hemorrhage
Expert Rationale: tPA is contraindicated in hemorrhagic stroke. A non-contrast CT
scan MUST be performed before tPA administration to exclude intracranial
hemorrhage. The door-to-needle time for tPA is ≤60 minutes (ideally ≤45 minutes).
Aspirin is delayed until 24 hours after tPA. Heparin is not given with tPA due to
increased bleeding risk. Informed consent is important but should not delay time-
critical treatment.
2. The nurse is caring for a client 24 hours post-ischemic stroke with left-sided
hemiparesis. Which nursing intervention is MOST important to prevent
complications?
A) Positioning the client in high-Fowler's at all times to reduce cerebral edema
B) Performing range-of-motion exercises and repositioning every 2 hours
C) Restricting fluid intake to 1000 mL/day to prevent fluid overload
D) Keeping the client flat in bed with the head slightly turned to the affected side
Correct Answer: B) Performing range-of-motion exercises and repositioning every
2 hours
, Expert Rationale: Post-stroke clients are at high risk for contractures, pressure
injuries, and deep vein thrombosis due to immobility. Range-of-motion exercises and
repositioning every 2 hours prevent these complications. High-Fowler's is not
required 24 hours post-stroke unless there are respiratory concerns. Fluid restriction
is inappropriate and could worsen cerebral perfusion. Flat positioning is not
recommended; head of bed at 30 degrees promotes venous drainage and reduces
aspiration risk.
3. A client with a brain tumor exhibits decreasing level of consciousness, a dilated
and fixed right pupil, and bradycardia with a widening pulse pressure. Which
condition should the nurse suspect?
A) Meningitis with septic shock
B) Increased intracranial pressure (ICP) with uncal herniation
C) Cerebrovascular accident in the brainstem
D) Subarachnoid hemorrhage with vasospasm
Correct Answer: B) Increased intracranial pressure (ICP) with uncal herniation
Expert Rationale: The classic Cushing's triad (bradycardia, widening pulse
pressure/hypertension, and irregular respirations) combined with a unilateral dilated
fixed pupil indicates critically elevated ICP with uncal (transtentorial) herniation.
The oculomotor nerve (CN III) is compressed, causing ipsilateral pupillary dilation.
This is a neurosurgical emergency requiring immediate mannitol, hyperventilation,
and possible decompression.
4. A client with a seizure disorder is prescribed phenytoin (Dilantin) 300 mg daily.
Which instruction should the nurse include to ensure therapeutic effectiveness?
A) Take the medication with food to enhance absorption
B) Brush and floss daily and maintain good oral hygiene
C) Take the medication with antacids to reduce GI upset
D) Avoid all dairy products while taking this medication
Correct Answer: B) Brush and floss daily and maintain good oral hygiene
, Expert Rationale: Phenytoin causes gingival hyperplasia (overgrowth of gum
tissue) as a common adverse effect. The client must practice meticulous oral
hygiene, including brushing, flossing, and regular dental visits. Phenytoin should
NOT be taken with food (reduces absorption) or antacids (decreases absorption).
Dairy products do not interact with phenytoin. The nurse should also teach about
therapeutic drug monitoring (10-20 mcg/mL) and signs of toxicity (nystagmus,
ataxia, slurred speech).
5. The nurse is caring for a client in the post-ictal phase after a generalized tonic-
clonic seizure. Which assessment finding is EXPECTED?
A) Alert and oriented with intact memory of the seizure event
B) Confusion, drowsiness, muscle soreness, and possible tongue laceration
C) Pupillary dilation, tachycardia, and hypertension
D) Paralysis of the contralateral side and aphasia
Correct Answer: B) Confusion, drowsiness, muscle soreness, and possible tongue
laceration
Expert Rationale: The post-ictal phase follows a generalized tonic-clonic seizure
and is characterized by confusion, drowsiness, fatigue, muscle soreness (from violent
contractions), headache, and possible tongue biting/laceration. Memory of the
seizure is typically absent. Pupillary changes, paralysis, and aphasia are stroke
findings, not expected post-ictal findings. The nurse should maintain a patent airway,
provide a safe environment, and allow the client to rest.
6. A client with bacterial meningitis is admitted to the unit. Which nursing
intervention is the HIGHEST priority during the first 24 hours?
A) Administering prophylactic antibiotics to all visitors and staff
B) Initiating droplet precautions and administering IV antibiotics immediately
C) Placing the client in a dark, quiet room and restricting all visitors
D) Performing a lumbar puncture before starting any antibiotic therapy
Correct Answer: B) Initiating droplet precautions and administering IV antibiotics
immediately
, Expert Rationale: Bacterial meningitis is a medical emergency. The HIGHEST
priority is immediate IV antibiotic administration (ideally within 30 minutes of
arrival) to reduce mortality and neurological sequelae. Droplet precautions are
implemented for suspected/confirmed bacterial meningitis caused by Neisseria
meningitidis or Haemophilus influenzae. Lumbar puncture is important for diagnosis
but should NOT delay antibiotic therapy. A dark quiet room is helpful for comfort
but not the highest priority.
7. A client with Parkinson's disease is prescribed levodopa/carbidopa (Sinemet).
Which dietary instruction should the nurse provide?
A) Take the medication with a high-protein meal for better absorption
B) Avoid protein-rich foods around the time of medication administration
C) Increase iron-rich foods to prevent anemia
D) Take the medication with grapefruit juice to enhance bioavailability
Correct Answer: B) Avoid protein-rich foods around the time of medication
administration
Expert Rationale: Dietary protein competes with levodopa for absorption across the
blood-brain barrier via the large neutral amino acid transporter. High-protein meals
can significantly reduce levodopa effectiveness, causing 'off' periods with increased
tremors and rigidity. Clients should take Sinemet on an empty stomach or with low-
protein snacks, and distribute protein intake evenly throughout the day. Iron
supplements also interfere with levodopa absorption. Grapefruit juice does not
enhance levodopa.
8. A client with myasthenia gravis (MG) is taking pyridostigmine (Mestinon). The
client reports increased weakness, difficulty swallowing, and respiratory distress.
Which condition should the nurse suspect?
A) Myasthenic crisis due to undermedication or infection
B) Cholinergic crisis due to excessive anticholinesterase medication
C) Guillain-Barré syndrome with ascending paralysis
D) Amyotrophic lateral sclerosis with bulbar involvement
Medical-Surgical Nursing 2026/2027 Questions
And Answers Latest Updates
1. A client with a suspected ischemic stroke arrives in the ED 45 minutes after
symptom onset. Which intervention is the HIGHEST priority before administering
tissue plasminogen activator (tPA)?
A) Obtaining informed consent from the family for thrombolytic therapy
B) Performing a non-contrast CT scan of the brain to rule out hemorrhage
C) Administering aspirin 325 mg orally to prevent further clot formation
D) Starting an IV infusion of heparin at 1000 units/hr
Correct Answer: B) Performing a non-contrast CT scan of the brain to rule out
hemorrhage
Expert Rationale: tPA is contraindicated in hemorrhagic stroke. A non-contrast CT
scan MUST be performed before tPA administration to exclude intracranial
hemorrhage. The door-to-needle time for tPA is ≤60 minutes (ideally ≤45 minutes).
Aspirin is delayed until 24 hours after tPA. Heparin is not given with tPA due to
increased bleeding risk. Informed consent is important but should not delay time-
critical treatment.
2. The nurse is caring for a client 24 hours post-ischemic stroke with left-sided
hemiparesis. Which nursing intervention is MOST important to prevent
complications?
A) Positioning the client in high-Fowler's at all times to reduce cerebral edema
B) Performing range-of-motion exercises and repositioning every 2 hours
C) Restricting fluid intake to 1000 mL/day to prevent fluid overload
D) Keeping the client flat in bed with the head slightly turned to the affected side
Correct Answer: B) Performing range-of-motion exercises and repositioning every
2 hours
, Expert Rationale: Post-stroke clients are at high risk for contractures, pressure
injuries, and deep vein thrombosis due to immobility. Range-of-motion exercises and
repositioning every 2 hours prevent these complications. High-Fowler's is not
required 24 hours post-stroke unless there are respiratory concerns. Fluid restriction
is inappropriate and could worsen cerebral perfusion. Flat positioning is not
recommended; head of bed at 30 degrees promotes venous drainage and reduces
aspiration risk.
3. A client with a brain tumor exhibits decreasing level of consciousness, a dilated
and fixed right pupil, and bradycardia with a widening pulse pressure. Which
condition should the nurse suspect?
A) Meningitis with septic shock
B) Increased intracranial pressure (ICP) with uncal herniation
C) Cerebrovascular accident in the brainstem
D) Subarachnoid hemorrhage with vasospasm
Correct Answer: B) Increased intracranial pressure (ICP) with uncal herniation
Expert Rationale: The classic Cushing's triad (bradycardia, widening pulse
pressure/hypertension, and irregular respirations) combined with a unilateral dilated
fixed pupil indicates critically elevated ICP with uncal (transtentorial) herniation.
The oculomotor nerve (CN III) is compressed, causing ipsilateral pupillary dilation.
This is a neurosurgical emergency requiring immediate mannitol, hyperventilation,
and possible decompression.
4. A client with a seizure disorder is prescribed phenytoin (Dilantin) 300 mg daily.
Which instruction should the nurse include to ensure therapeutic effectiveness?
A) Take the medication with food to enhance absorption
B) Brush and floss daily and maintain good oral hygiene
C) Take the medication with antacids to reduce GI upset
D) Avoid all dairy products while taking this medication
Correct Answer: B) Brush and floss daily and maintain good oral hygiene
, Expert Rationale: Phenytoin causes gingival hyperplasia (overgrowth of gum
tissue) as a common adverse effect. The client must practice meticulous oral
hygiene, including brushing, flossing, and regular dental visits. Phenytoin should
NOT be taken with food (reduces absorption) or antacids (decreases absorption).
Dairy products do not interact with phenytoin. The nurse should also teach about
therapeutic drug monitoring (10-20 mcg/mL) and signs of toxicity (nystagmus,
ataxia, slurred speech).
5. The nurse is caring for a client in the post-ictal phase after a generalized tonic-
clonic seizure. Which assessment finding is EXPECTED?
A) Alert and oriented with intact memory of the seizure event
B) Confusion, drowsiness, muscle soreness, and possible tongue laceration
C) Pupillary dilation, tachycardia, and hypertension
D) Paralysis of the contralateral side and aphasia
Correct Answer: B) Confusion, drowsiness, muscle soreness, and possible tongue
laceration
Expert Rationale: The post-ictal phase follows a generalized tonic-clonic seizure
and is characterized by confusion, drowsiness, fatigue, muscle soreness (from violent
contractions), headache, and possible tongue biting/laceration. Memory of the
seizure is typically absent. Pupillary changes, paralysis, and aphasia are stroke
findings, not expected post-ictal findings. The nurse should maintain a patent airway,
provide a safe environment, and allow the client to rest.
6. A client with bacterial meningitis is admitted to the unit. Which nursing
intervention is the HIGHEST priority during the first 24 hours?
A) Administering prophylactic antibiotics to all visitors and staff
B) Initiating droplet precautions and administering IV antibiotics immediately
C) Placing the client in a dark, quiet room and restricting all visitors
D) Performing a lumbar puncture before starting any antibiotic therapy
Correct Answer: B) Initiating droplet precautions and administering IV antibiotics
immediately
, Expert Rationale: Bacterial meningitis is a medical emergency. The HIGHEST
priority is immediate IV antibiotic administration (ideally within 30 minutes of
arrival) to reduce mortality and neurological sequelae. Droplet precautions are
implemented for suspected/confirmed bacterial meningitis caused by Neisseria
meningitidis or Haemophilus influenzae. Lumbar puncture is important for diagnosis
but should NOT delay antibiotic therapy. A dark quiet room is helpful for comfort
but not the highest priority.
7. A client with Parkinson's disease is prescribed levodopa/carbidopa (Sinemet).
Which dietary instruction should the nurse provide?
A) Take the medication with a high-protein meal for better absorption
B) Avoid protein-rich foods around the time of medication administration
C) Increase iron-rich foods to prevent anemia
D) Take the medication with grapefruit juice to enhance bioavailability
Correct Answer: B) Avoid protein-rich foods around the time of medication
administration
Expert Rationale: Dietary protein competes with levodopa for absorption across the
blood-brain barrier via the large neutral amino acid transporter. High-protein meals
can significantly reduce levodopa effectiveness, causing 'off' periods with increased
tremors and rigidity. Clients should take Sinemet on an empty stomach or with low-
protein snacks, and distribute protein intake evenly throughout the day. Iron
supplements also interfere with levodopa absorption. Grapefruit juice does not
enhance levodopa.
8. A client with myasthenia gravis (MG) is taking pyridostigmine (Mestinon). The
client reports increased weakness, difficulty swallowing, and respiratory distress.
Which condition should the nurse suspect?
A) Myasthenic crisis due to undermedication or infection
B) Cholinergic crisis due to excessive anticholinesterase medication
C) Guillain-Barré syndrome with ascending paralysis
D) Amyotrophic lateral sclerosis with bulbar involvement
