NSG 3130 Fundamental Concepts and Skills for Nursing Practice II | Exam 2 Review
NSG 3130 Fundamental Concepts and Skills for Nursing Practice II
Exam 2 Latest Practice Test with 100% Correct Verified Answers
Galen College of Nursing | 100 Questions (A-D) | With Evidence-Based Rationales
Section 1: Neurological and Sensory Disorders (Q1-Q20)
Stroke, Seizures, Alzheimer, Parkinson, Vision/Hearing, Neurological Assessments
Section 2: Musculoskeletal Disorders and Mobility (Q21-Q35)
OA, Osteoporosis, Fractures, Amputations, Joint Replacement, Mobility Aids
Section 3: GI and Nutritional Disorders (Q36-Q50)
GERD, PUD, IBD, Cirrhosis, Hepatitis, Pancreatitis, EN/PN, Bariatric Surgery
Section 4: Endocrine and Metabolic Disorders (Q51-Q65)
DM Types 1/2, DKA, HHS, Thyroid, Adrenal Disorders
Section 5: Renal and Urinary Disorders (Q66-Q78)
AKI, CKD, UTI, Incontinence, Dialysis, Fluid/Electrolytes
Section 6: Skin Integrity and Wound Care (Q79-Q88)
Pressure Injuries, Wound Healing, Assessment, Dressings, Ostomy Care
Section 7: Comprehensive Clinical Case Scenarios (Q89-Q100)
Integrated Nursing Care Across Multiple Systems
Q1: A 68-year-old arrives at the ED with sudden right hemiparesis and aphasia onset 45 minutes ago. CT shows no hemorrhage.
Which medication should the nurse prepare to administer?
A. Alteplase (tPA) IV within 3 hours of symptom onset, as the patient meets criteria for thrombolytic therapy with
CT-confirmed ischemia [CORRECT]
B. Heparin sodium IV, as anticoagulation is first-line for all acute stroke presentations
C. Aspirin 325 mg PO, because antiplatelet therapy is the priority for acute ischemic stroke
D. Mannitol 20% IV, as osmotic diuretics are primary treatment to reduce ICP
Correct Answer: A
Rationale: tPA is the gold-standard thrombolytic for acute ischemic stroke within 3 hours (up to 4.5h in select patients). This patient has confirmed
ischemia and is within the window. Heparin is not indicated acutely. Aspirin is given after tPA is ruled out or 24h post-thrombolytics. Mannitol treats
ICP but does not dissolve the clot.
Q2: The nurse assesses a patient using the Glasgow Coma Scale. Eyes open to pain only, incomprehensible sounds, withdraws from
pain with all extremities. What is the GCS score?
A. GCS of 8, indicating severe brain injury and critical need for airway protection [CORRECT]
B. GCS of 10, indicating moderate brain injury requiring close monitoring
C. GCS of 6, indicating deep coma with no brainstem function
D. GCS of 12, indicating mild brain injury with favorable prognosis
Correct Answer: A
Rationale: GCS: Eyes to pain=2, Verbal incomprehensible=2, Motor withdrawal=4, total=8. A GCS of 8 or less is severe brain injury, the critical
threshold for airway protection, typically requiring intubation. Scores 9-12 moderate, 13-15 mild.
Q3: A patient with epilepsy has a generalized tonic-clonic seizure lasting 35 minutes despite lorazepam 4 mg IV. What condition and
priority intervention?
Page 1
, NSG 3130 Fundamental Concepts and Skills for Nursing Practice II | Exam 2 Review
A. Status epilepticus; administer second-line antiepileptic (fosphenytoin) while preparing for intubation and continuous EEG
[CORRECT]
B. Cluster seizure; reposition patient and document activity
C. Status epilepticus; apply physical restraints to prevent injury
D. Psychogenic nonepileptic seizure; provide emotional support
Correct Answer: A
Rationale: Status epilepticus is seizure activity >5 minutes or recurrent seizures without recovery. After benzodiazepines fail, second-line agents
(fosphenytoin, valproic acid) are needed. Airway management and EEG monitoring essential. Restraints contraindicated during seizures.
Q4: A 74-year-old with moderate Alzheimer disease is started on donepezil (Aricept). How does this medication work?
A. Cholinesterase inhibitor preventing acetylcholine breakdown, temporarily improving cognition and function [CORRECT]
B. Cures Alzheimer disease by regenerating damaged neurons
C. Dopamine replacement that reduces tremors and improves mobility
D. Reduces amyloid plaques, stopping disease progression
Correct Answer: A
Rationale: Donepezil inhibits acetylcholinesterase, increasing acetylcholine at synapses. It provides modest temporary cognitive improvement but does
not cure disease, replace dopamine, or remove amyloid plaques.
Q5: A Parkinson patient on levodopa/carbidopa shows worsening tremor and rigidity 30 minutes before the next dose. What is this
phenomenon?
A. On-off phenomenon; document and reassure patient
B. Wearing-off effect; consult provider about adjusting dosing, adding COMT inhibitor, or using extended-release
[CORRECT]
C. Dyskinesia; hold next dose and notify provider
D. Medication toxicity; prepare antidote and discontinue drug
Correct Answer: B
Rationale: Wearing-off occurs when levodopa effect diminishes before the next dose. Report to provider who may adjust frequency, add entacapone
(COMT inhibitor), or switch to extended-release. Dyskinesia occurs at peak dose, not before next dose.
Q6: A head injury patient has right pupil 7mm round non-reactive; left pupil 3mm reactive. What does this indicate?
A. CN III compression on right, classic sign of uncal herniation requiring immediate intervention [CORRECT]
B. Normal age-related anisocoria, a benign finding
C. Horner syndrome on the left due to sympathetic disruption
D. Bell palsy on the right causing pupillary dilation
Correct Answer: A
Rationale: A blown pupil is the hallmark of CN III compression from uncal herniation. Rising ICP causes the uncus to herniate through the tentorial
notch, compressing CN III. This is a neurosurgical emergency. Horner causes miosis not mydriasis.
Q7: A post-stroke patient (day 3) on heparin has aPTT 95 sec (therapeutic 60-80) and epistaxis. Priority action?
A. Stop heparin, assess VS, notify provider, prepare protamine sulfate [CORRECT]
B. Administer vitamin K and continue heparin infusion
C. Increase heparin rate for faster anticoagulation
D. Document and continue monitoring as epistaxis is expected
Correct Answer: A
Rationale: aPTT 95 with active bleeding = over-anticoagulation. Stop heparin, assess hemorrhage, notify provider, prepare protamine sulfate (heparin
antidote). Vitamin K reverses warfarin not heparin. Increasing rate worsens bleeding.
Q8: A patient with early Alzheimer disease is hospitalized. Which intervention BEST promotes safety and reduces agitation?
A. Place patient in restraints and assign a sitter
Page 2
, NSG 3130 Fundamental Concepts and Skills for Nursing Practice II | Exam 2 Review
B. Maintain consistent routine, simple communication, familiar objects nearby, adequate lighting, fall prevention
[CORRECT]
C. Administer haloperidol prophylactically to prevent agitation
D. Isolate in private room with minimal stimulation
Correct Answer: B
Rationale: Non-pharmacological interventions are first-line. Consistent routine, simple communication, familiar objects, and lighting reduce confusion.
Restraints increase injury risk. Antipsychotics carry black box warnings for elderly dementia patients.
Q9: A Parkinson patient is at aspiration risk. Which intervention is MOST appropriate?
A. Provide thin liquids to facilitate swallowing
B. Teach chin-tuck, keep upright, offer thickened liquids, monitor for aspiration signs [CORRECT]
C. Place supine during feeding
D. Encourage eating quickly with larger bites
Correct Answer: B
Rationale: Parkinson causes dysphagia from pharyngeal involvement. Chin-tuck protects airway. Upright positioning uses gravity. Thickened liquids
reduce aspiration risk. Thin liquids increase risk in dysphagia.
Q10: After left modified radical mastoidectomy, which discharge instruction is MOST important?
A. Avoid water in ear, no forceful nose blowing, report vertigo/facial weakness/hearing changes, keep site dry [CORRECT]
B. Resume swimming and air travel within 1 week
C. Apply hydrogen peroxide daily to prevent infection
D. Sleep on operative side to promote drainage
Correct Answer: A
Rationale: Post-mastoidectomy: keep ear dry. Forceful nose blowing increases Eustachian tube pressure. Report vertigo/facial weakness (CN VII) or
hearing changes immediately. Swimming/air travel restricted for weeks.
Q11: A patient with acute ischemic stroke has NIHSS score of 18. What does this indicate?
A. Mild stroke with excellent recovery prognosis
B. Moderate stroke; likely discharge home in 48 hours
C. Severe stroke with high risk of poor outcomes, requiring intensive monitoring and rehab planning [CORRECT]
D. TIA that will resolve spontaneously
Correct Answer: C
Rationale: NIHSS 0-42; 18 = severe impairment with high disability/mortality risk. Mild <5, moderate 5-15. Severe scores need intensive monitoring,
early rehab, and comprehensive planning.
Q12: Which differentiates focal impaired awareness seizure from generalized absence seizure?
A. Focal: automatisms, lasts 1-2 min, postictal confusion; Absence: brief staring 5-10 sec, no postictal state [CORRECT]
B. Focal always progresses to generalized; absence never progresses
C. Both identical, differentiated only by EEG
D. Focal causes LOC <5 sec; absence lasts 2-3 min with convulsions
Correct Answer: A
Rationale: Focal impaired awareness involves automatisms (lip smacking), lasts 1-2 min, has postictal confusion. Absence seizures are brief staring
(5-10 sec) with immediate return to baseline. Key differences: duration, automatisms, postictal period.
Q13: A Parkinson patient is prescribed carbidopa-levodopa-entacapone (Stalevo). Why is entacapone added?
A. COMT inhibitor preventing peripheral levodopa breakdown, increasing brain availability [CORRECT]
B. Dopamine agonist directly stimulating dopamine receptors
C. MAO-B inhibitor reducing central dopamine metabolism
D. Anticholinergic blocking acetylcholine in basal ganglia
Page 3
NSG 3130 Fundamental Concepts and Skills for Nursing Practice II
Exam 2 Latest Practice Test with 100% Correct Verified Answers
Galen College of Nursing | 100 Questions (A-D) | With Evidence-Based Rationales
Section 1: Neurological and Sensory Disorders (Q1-Q20)
Stroke, Seizures, Alzheimer, Parkinson, Vision/Hearing, Neurological Assessments
Section 2: Musculoskeletal Disorders and Mobility (Q21-Q35)
OA, Osteoporosis, Fractures, Amputations, Joint Replacement, Mobility Aids
Section 3: GI and Nutritional Disorders (Q36-Q50)
GERD, PUD, IBD, Cirrhosis, Hepatitis, Pancreatitis, EN/PN, Bariatric Surgery
Section 4: Endocrine and Metabolic Disorders (Q51-Q65)
DM Types 1/2, DKA, HHS, Thyroid, Adrenal Disorders
Section 5: Renal and Urinary Disorders (Q66-Q78)
AKI, CKD, UTI, Incontinence, Dialysis, Fluid/Electrolytes
Section 6: Skin Integrity and Wound Care (Q79-Q88)
Pressure Injuries, Wound Healing, Assessment, Dressings, Ostomy Care
Section 7: Comprehensive Clinical Case Scenarios (Q89-Q100)
Integrated Nursing Care Across Multiple Systems
Q1: A 68-year-old arrives at the ED with sudden right hemiparesis and aphasia onset 45 minutes ago. CT shows no hemorrhage.
Which medication should the nurse prepare to administer?
A. Alteplase (tPA) IV within 3 hours of symptom onset, as the patient meets criteria for thrombolytic therapy with
CT-confirmed ischemia [CORRECT]
B. Heparin sodium IV, as anticoagulation is first-line for all acute stroke presentations
C. Aspirin 325 mg PO, because antiplatelet therapy is the priority for acute ischemic stroke
D. Mannitol 20% IV, as osmotic diuretics are primary treatment to reduce ICP
Correct Answer: A
Rationale: tPA is the gold-standard thrombolytic for acute ischemic stroke within 3 hours (up to 4.5h in select patients). This patient has confirmed
ischemia and is within the window. Heparin is not indicated acutely. Aspirin is given after tPA is ruled out or 24h post-thrombolytics. Mannitol treats
ICP but does not dissolve the clot.
Q2: The nurse assesses a patient using the Glasgow Coma Scale. Eyes open to pain only, incomprehensible sounds, withdraws from
pain with all extremities. What is the GCS score?
A. GCS of 8, indicating severe brain injury and critical need for airway protection [CORRECT]
B. GCS of 10, indicating moderate brain injury requiring close monitoring
C. GCS of 6, indicating deep coma with no brainstem function
D. GCS of 12, indicating mild brain injury with favorable prognosis
Correct Answer: A
Rationale: GCS: Eyes to pain=2, Verbal incomprehensible=2, Motor withdrawal=4, total=8. A GCS of 8 or less is severe brain injury, the critical
threshold for airway protection, typically requiring intubation. Scores 9-12 moderate, 13-15 mild.
Q3: A patient with epilepsy has a generalized tonic-clonic seizure lasting 35 minutes despite lorazepam 4 mg IV. What condition and
priority intervention?
Page 1
, NSG 3130 Fundamental Concepts and Skills for Nursing Practice II | Exam 2 Review
A. Status epilepticus; administer second-line antiepileptic (fosphenytoin) while preparing for intubation and continuous EEG
[CORRECT]
B. Cluster seizure; reposition patient and document activity
C. Status epilepticus; apply physical restraints to prevent injury
D. Psychogenic nonepileptic seizure; provide emotional support
Correct Answer: A
Rationale: Status epilepticus is seizure activity >5 minutes or recurrent seizures without recovery. After benzodiazepines fail, second-line agents
(fosphenytoin, valproic acid) are needed. Airway management and EEG monitoring essential. Restraints contraindicated during seizures.
Q4: A 74-year-old with moderate Alzheimer disease is started on donepezil (Aricept). How does this medication work?
A. Cholinesterase inhibitor preventing acetylcholine breakdown, temporarily improving cognition and function [CORRECT]
B. Cures Alzheimer disease by regenerating damaged neurons
C. Dopamine replacement that reduces tremors and improves mobility
D. Reduces amyloid plaques, stopping disease progression
Correct Answer: A
Rationale: Donepezil inhibits acetylcholinesterase, increasing acetylcholine at synapses. It provides modest temporary cognitive improvement but does
not cure disease, replace dopamine, or remove amyloid plaques.
Q5: A Parkinson patient on levodopa/carbidopa shows worsening tremor and rigidity 30 minutes before the next dose. What is this
phenomenon?
A. On-off phenomenon; document and reassure patient
B. Wearing-off effect; consult provider about adjusting dosing, adding COMT inhibitor, or using extended-release
[CORRECT]
C. Dyskinesia; hold next dose and notify provider
D. Medication toxicity; prepare antidote and discontinue drug
Correct Answer: B
Rationale: Wearing-off occurs when levodopa effect diminishes before the next dose. Report to provider who may adjust frequency, add entacapone
(COMT inhibitor), or switch to extended-release. Dyskinesia occurs at peak dose, not before next dose.
Q6: A head injury patient has right pupil 7mm round non-reactive; left pupil 3mm reactive. What does this indicate?
A. CN III compression on right, classic sign of uncal herniation requiring immediate intervention [CORRECT]
B. Normal age-related anisocoria, a benign finding
C. Horner syndrome on the left due to sympathetic disruption
D. Bell palsy on the right causing pupillary dilation
Correct Answer: A
Rationale: A blown pupil is the hallmark of CN III compression from uncal herniation. Rising ICP causes the uncus to herniate through the tentorial
notch, compressing CN III. This is a neurosurgical emergency. Horner causes miosis not mydriasis.
Q7: A post-stroke patient (day 3) on heparin has aPTT 95 sec (therapeutic 60-80) and epistaxis. Priority action?
A. Stop heparin, assess VS, notify provider, prepare protamine sulfate [CORRECT]
B. Administer vitamin K and continue heparin infusion
C. Increase heparin rate for faster anticoagulation
D. Document and continue monitoring as epistaxis is expected
Correct Answer: A
Rationale: aPTT 95 with active bleeding = over-anticoagulation. Stop heparin, assess hemorrhage, notify provider, prepare protamine sulfate (heparin
antidote). Vitamin K reverses warfarin not heparin. Increasing rate worsens bleeding.
Q8: A patient with early Alzheimer disease is hospitalized. Which intervention BEST promotes safety and reduces agitation?
A. Place patient in restraints and assign a sitter
Page 2
, NSG 3130 Fundamental Concepts and Skills for Nursing Practice II | Exam 2 Review
B. Maintain consistent routine, simple communication, familiar objects nearby, adequate lighting, fall prevention
[CORRECT]
C. Administer haloperidol prophylactically to prevent agitation
D. Isolate in private room with minimal stimulation
Correct Answer: B
Rationale: Non-pharmacological interventions are first-line. Consistent routine, simple communication, familiar objects, and lighting reduce confusion.
Restraints increase injury risk. Antipsychotics carry black box warnings for elderly dementia patients.
Q9: A Parkinson patient is at aspiration risk. Which intervention is MOST appropriate?
A. Provide thin liquids to facilitate swallowing
B. Teach chin-tuck, keep upright, offer thickened liquids, monitor for aspiration signs [CORRECT]
C. Place supine during feeding
D. Encourage eating quickly with larger bites
Correct Answer: B
Rationale: Parkinson causes dysphagia from pharyngeal involvement. Chin-tuck protects airway. Upright positioning uses gravity. Thickened liquids
reduce aspiration risk. Thin liquids increase risk in dysphagia.
Q10: After left modified radical mastoidectomy, which discharge instruction is MOST important?
A. Avoid water in ear, no forceful nose blowing, report vertigo/facial weakness/hearing changes, keep site dry [CORRECT]
B. Resume swimming and air travel within 1 week
C. Apply hydrogen peroxide daily to prevent infection
D. Sleep on operative side to promote drainage
Correct Answer: A
Rationale: Post-mastoidectomy: keep ear dry. Forceful nose blowing increases Eustachian tube pressure. Report vertigo/facial weakness (CN VII) or
hearing changes immediately. Swimming/air travel restricted for weeks.
Q11: A patient with acute ischemic stroke has NIHSS score of 18. What does this indicate?
A. Mild stroke with excellent recovery prognosis
B. Moderate stroke; likely discharge home in 48 hours
C. Severe stroke with high risk of poor outcomes, requiring intensive monitoring and rehab planning [CORRECT]
D. TIA that will resolve spontaneously
Correct Answer: C
Rationale: NIHSS 0-42; 18 = severe impairment with high disability/mortality risk. Mild <5, moderate 5-15. Severe scores need intensive monitoring,
early rehab, and comprehensive planning.
Q12: Which differentiates focal impaired awareness seizure from generalized absence seizure?
A. Focal: automatisms, lasts 1-2 min, postictal confusion; Absence: brief staring 5-10 sec, no postictal state [CORRECT]
B. Focal always progresses to generalized; absence never progresses
C. Both identical, differentiated only by EEG
D. Focal causes LOC <5 sec; absence lasts 2-3 min with convulsions
Correct Answer: A
Rationale: Focal impaired awareness involves automatisms (lip smacking), lasts 1-2 min, has postictal confusion. Absence seizures are brief staring
(5-10 sec) with immediate return to baseline. Key differences: duration, automatisms, postictal period.
Q13: A Parkinson patient is prescribed carbidopa-levodopa-entacapone (Stalevo). Why is entacapone added?
A. COMT inhibitor preventing peripheral levodopa breakdown, increasing brain availability [CORRECT]
B. Dopamine agonist directly stimulating dopamine receptors
C. MAO-B inhibitor reducing central dopamine metabolism
D. Anticholinergic blocking acetylcholine in basal ganglia
Page 3
