GALEN COLLEGE OF NURSING · PRACTICAL NURSING PROGRAM
NUR 242 Exam 4
Comprehensive Practice
Question Bank
Neurological Nursing · Stroke · Spinal Cord Injury · Head Injury
Medical-Surgical Nursing Concepts · NCLEX-Style Review
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Stroke — Assessment & Clinical Manifestations 2
3. Stroke — Nursing Interventions & Rehabilitation 4
4. Stroke — Complications & ICP Monitoring 6
5. Stroke — Medications & Discharge Teaching 7
,6. Heat Stroke & Emergency Interventions 8
7. Spinal Cord Injury — Assessment & Interventions 9
8. Spinal Cord Injury — Autonomic Dysreflexia 10
9. Spinal Cord Injury — Rehabilitation & Complications 11
10. Head Injury & Increased ICP 12
11. Hydrocephalus & Ventriculoperitoneal Shunt 14
NUR 242 · Galen College of Nursing Page 1
,NUR 242 EXAM 4 PRACTICE GUIDE INSTRUCTIONS & QUESTIONS
How to Use This Guide
Read each question stem carefully, select your answer, then review the rationale to understand the clinical
reasoning behind the correct choice. Each question includes the tested concept and the source concept
from your course material. Questions marked with SATA require selecting all that apply.
Stroke — Assessment & Clinical Manifestations
1 The nurse is planning care for an immobilized client who had a stroke with right-sided
hemiparesis. Which activity would the nurse include in the plan of care?
A Assist the client to perform range-of-motion (ROM) exercises every 1 to 2 hours
B Keep the client on strict bed rest for 48 hours
C Perform passive range-of-motion exercises once daily
D Encourage the client to remain in one position for extended periods
CORRECT ANSWER: A
Rationale: Frequent ROM exercises every 1 to 2 hours prevent contractures, maintain joint mobility, and
promote circulation in the immobilized client. This is especially important for the affected side in a client
with hemiparesis.
Tested Concept: Stroke — ROM exercises for immobilized client
Source Concept: Assist the client to perform range-of-motion (ROM) exercises every 1 to 2 hours.
, 2 Which is the priority nursing action for a client admitted to the hospital in a coma after
having a stroke?
A Assess neurological status
B Maintain an open airway
C Obtain vital signs
D Start intravenous fluids
CORRECT ANSWER: B
Rationale: Maintaining an open airway is the priority for any unconscious client. Airway obstruction can
lead to hypoxia, further brain damage, and death. The ABCs (Airway, Breathing, Circulation) always take
precedence.
Tested Concept: Stroke — priority nursing action for comatose client
Source Concept: Maintain an open airway.
3 Which position would the nurse plan to use for the client who is having a hypertensive crisis
and evolving stroke?
A Supine
B Side-lying
C Trendelenburg
D High Fowler
CORRECT ANSWER: B
Rationale: The side-lying position is recommended for clients with hypertensive crisis and evolving
stroke. This position helps reduce intracranial pressure, prevents aspiration, and promotes drainage of
oral secretions.
Tested Concept: Stroke — positioning during hypertensive crisis
Source Concept: Side-lying.
NUR 242 Exam 4
Comprehensive Practice
Question Bank
Neurological Nursing · Stroke · Spinal Cord Injury · Head Injury
Medical-Surgical Nursing Concepts · NCLEX-Style Review
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Stroke — Assessment & Clinical Manifestations 2
3. Stroke — Nursing Interventions & Rehabilitation 4
4. Stroke — Complications & ICP Monitoring 6
5. Stroke — Medications & Discharge Teaching 7
,6. Heat Stroke & Emergency Interventions 8
7. Spinal Cord Injury — Assessment & Interventions 9
8. Spinal Cord Injury — Autonomic Dysreflexia 10
9. Spinal Cord Injury — Rehabilitation & Complications 11
10. Head Injury & Increased ICP 12
11. Hydrocephalus & Ventriculoperitoneal Shunt 14
NUR 242 · Galen College of Nursing Page 1
,NUR 242 EXAM 4 PRACTICE GUIDE INSTRUCTIONS & QUESTIONS
How to Use This Guide
Read each question stem carefully, select your answer, then review the rationale to understand the clinical
reasoning behind the correct choice. Each question includes the tested concept and the source concept
from your course material. Questions marked with SATA require selecting all that apply.
Stroke — Assessment & Clinical Manifestations
1 The nurse is planning care for an immobilized client who had a stroke with right-sided
hemiparesis. Which activity would the nurse include in the plan of care?
A Assist the client to perform range-of-motion (ROM) exercises every 1 to 2 hours
B Keep the client on strict bed rest for 48 hours
C Perform passive range-of-motion exercises once daily
D Encourage the client to remain in one position for extended periods
CORRECT ANSWER: A
Rationale: Frequent ROM exercises every 1 to 2 hours prevent contractures, maintain joint mobility, and
promote circulation in the immobilized client. This is especially important for the affected side in a client
with hemiparesis.
Tested Concept: Stroke — ROM exercises for immobilized client
Source Concept: Assist the client to perform range-of-motion (ROM) exercises every 1 to 2 hours.
, 2 Which is the priority nursing action for a client admitted to the hospital in a coma after
having a stroke?
A Assess neurological status
B Maintain an open airway
C Obtain vital signs
D Start intravenous fluids
CORRECT ANSWER: B
Rationale: Maintaining an open airway is the priority for any unconscious client. Airway obstruction can
lead to hypoxia, further brain damage, and death. The ABCs (Airway, Breathing, Circulation) always take
precedence.
Tested Concept: Stroke — priority nursing action for comatose client
Source Concept: Maintain an open airway.
3 Which position would the nurse plan to use for the client who is having a hypertensive crisis
and evolving stroke?
A Supine
B Side-lying
C Trendelenburg
D High Fowler
CORRECT ANSWER: B
Rationale: The side-lying position is recommended for clients with hypertensive crisis and evolving
stroke. This position helps reduce intracranial pressure, prevents aspiration, and promotes drainage of
oral secretions.
Tested Concept: Stroke — positioning during hypertensive crisis
Source Concept: Side-lying.
