NUR 242 Medical-Surgical Nursing Exam 2
Comprehensive Examination 2026/2027: Verified
Practice Questions & Detailed Rationales |
Neurological, Cardiovascular, Respiratory,
Gastrointestinal, Renal, Endocrine, Hematologic,
and Integumentary Disord
NEUROLOGICAL DISORDERS
1. A nurse assesses a client with a suspected stroke. Which finding is most
important to report immediately?
A. Blood pressure 150/90 mmHg
B. Sudden onset of symptoms 45 minutes ago
C. History of atrial fibrillation
D. Mild headache
Answer: B
Rationale: Time of onset is critical because thrombolytic therapy (tPA) must be
administered within 3–4.5 hours of symptom onset. The nurse must establish the
exact time symptoms began to determine eligibility. While AFib and BP are
relevant, the time window is the priority for treatment decisions.
2. A client with increased intracranial pressure (ICP) demonstrates bradycardia,
hypertension, and irregular respirations. The nurse recognizes these as:
A. Normal post-ictal findings
B. Cushing's triad
C. Signs of shock
D. Expected findings after lumbar puncture
Answer: B
Rationale: Cushing's triad (bradycardia, systolic hypertension, irregular
respirations) is a late sign of increased ICP and indicates brainstem compression.
This is a medical emergency requiring immediate intervention.
,3. Which position is most appropriate for a client with increased ICP?
A. Flat supine
B. Trendelenburg
C. Head of bed elevated 30 degrees
D. Prone
Answer: C
Rationale: Elevating the HOB to 30 degrees promotes venous drainage from the
head, reducing ICP. Flat supine and Trendelenburg increase ICP. Prone is
contraindicated.
4. A nurse is caring for a client during a tonic-clonic seizure. Which action should
the nurse take first?
A. Restrain the client's arms and legs
B. Insert a tongue blade into the mouth
C. Protect the client's head and position on the side
D. Administer diazepam immediately
Answer: C
Rationale: Priority during a seizure is safety — protect the head, turn the client to
the side to maintain airway and prevent aspiration. Never restrain or insert
objects into the mouth. Medication is given after the seizure if it persists.
5. A client with meningitis is admitted. Which isolation precaution is required?
A. Airborne
B. Droplet
C. Contact
D. Standard only
Answer: B
Rationale: Bacterial meningitis (especially from Neisseria meningitidis) requires
droplet precautions until 24 hours of antibiotic therapy is complete. Airborne is
for TB, measles, varicella.
,6. Which assessment finding indicates meningeal irritation?
A. Positive Brudzinski's sign
B. Positive Babinski sign
C. Decreased deep tendon reflexes
D. Unilateral pupil dilation
Answer: A
Rationale: Brudzinski's sign (involuntary hip/knee flexion when neck is flexed) and
Kernig's sign indicate meningeal irritation. Babinski is a normal infant reflex;
positive in adults indicates upper motor neuron damage.
7. A client with a left hemisphere stroke is most likely to exhibit:
A. Neglect of the left side
B. Impulsive behavior
C. Aphasia
D. Spatial-perceptual deficits
Answer: C
Rationale: Left hemisphere damage typically causes language deficits (aphasia,
aphasia), right-sided hemiplegia, and slow, cautious behavior. Right hemisphere
damage causes neglect, impulsivity, and spatial deficits.
8. The nurse is teaching a client about phenytoin (Dilantin). Which statement
indicates understanding?
A. "I should brush my teeth gently and see my dentist regularly."
B. "I can stop the medication once I feel better."
C. "I should take this with a full meal."
D. "Grapefruit juice will increase absorption."
Answer: A
Rationale: Phenytoin causes gingival hyperplasia, so good oral hygiene and dental
care are essential. The medication should not be stopped abruptly. It should be
taken with food to reduce GI upset, but the priority teaching is oral care.
, 9. A client with Parkinson's disease is prescribed levodopa-carbidopa (Sinemet).
The nurse should teach the client to:
A. Take the medication with a high-protein meal
B. Report darkening of urine as a dangerous side effect
C. Change positions slowly to prevent orthostatic hypotension
D. Expect immediate improvement in symptoms
Answer: C
Rationale: Orthostatic hypotension is a common side effect of levodopa. High-
protein meals decrease absorption. Darkened urine/sweat is harmless.
Therapeutic effects may take weeks.
10. Which finding in a client with a head injury requires immediate notification
of the provider?
A. Headache relieved by acetaminophen
B. Clear fluid leaking from the nose
C. Blood pressure 110/70 mmHg
D. Pupils equal and reactive
Answer: B
Rationale: Clear fluid from the nose or ears indicates CSF leak, which signals a
basilar skull fracture and risk for infection. The nurse should test for glucose (CSF
is positive) and notify the provider.
11. A client is scheduled for a lumbar puncture. Which action is most important
post-procedure?
A. Keep the client flat for several hours
B. Encourage immediate ambulation
C. Administer a diuretic
D. Elevate the head of the bed 45 degrees
Comprehensive Examination 2026/2027: Verified
Practice Questions & Detailed Rationales |
Neurological, Cardiovascular, Respiratory,
Gastrointestinal, Renal, Endocrine, Hematologic,
and Integumentary Disord
NEUROLOGICAL DISORDERS
1. A nurse assesses a client with a suspected stroke. Which finding is most
important to report immediately?
A. Blood pressure 150/90 mmHg
B. Sudden onset of symptoms 45 minutes ago
C. History of atrial fibrillation
D. Mild headache
Answer: B
Rationale: Time of onset is critical because thrombolytic therapy (tPA) must be
administered within 3–4.5 hours of symptom onset. The nurse must establish the
exact time symptoms began to determine eligibility. While AFib and BP are
relevant, the time window is the priority for treatment decisions.
2. A client with increased intracranial pressure (ICP) demonstrates bradycardia,
hypertension, and irregular respirations. The nurse recognizes these as:
A. Normal post-ictal findings
B. Cushing's triad
C. Signs of shock
D. Expected findings after lumbar puncture
Answer: B
Rationale: Cushing's triad (bradycardia, systolic hypertension, irregular
respirations) is a late sign of increased ICP and indicates brainstem compression.
This is a medical emergency requiring immediate intervention.
,3. Which position is most appropriate for a client with increased ICP?
A. Flat supine
B. Trendelenburg
C. Head of bed elevated 30 degrees
D. Prone
Answer: C
Rationale: Elevating the HOB to 30 degrees promotes venous drainage from the
head, reducing ICP. Flat supine and Trendelenburg increase ICP. Prone is
contraindicated.
4. A nurse is caring for a client during a tonic-clonic seizure. Which action should
the nurse take first?
A. Restrain the client's arms and legs
B. Insert a tongue blade into the mouth
C. Protect the client's head and position on the side
D. Administer diazepam immediately
Answer: C
Rationale: Priority during a seizure is safety — protect the head, turn the client to
the side to maintain airway and prevent aspiration. Never restrain or insert
objects into the mouth. Medication is given after the seizure if it persists.
5. A client with meningitis is admitted. Which isolation precaution is required?
A. Airborne
B. Droplet
C. Contact
D. Standard only
Answer: B
Rationale: Bacterial meningitis (especially from Neisseria meningitidis) requires
droplet precautions until 24 hours of antibiotic therapy is complete. Airborne is
for TB, measles, varicella.
,6. Which assessment finding indicates meningeal irritation?
A. Positive Brudzinski's sign
B. Positive Babinski sign
C. Decreased deep tendon reflexes
D. Unilateral pupil dilation
Answer: A
Rationale: Brudzinski's sign (involuntary hip/knee flexion when neck is flexed) and
Kernig's sign indicate meningeal irritation. Babinski is a normal infant reflex;
positive in adults indicates upper motor neuron damage.
7. A client with a left hemisphere stroke is most likely to exhibit:
A. Neglect of the left side
B. Impulsive behavior
C. Aphasia
D. Spatial-perceptual deficits
Answer: C
Rationale: Left hemisphere damage typically causes language deficits (aphasia,
aphasia), right-sided hemiplegia, and slow, cautious behavior. Right hemisphere
damage causes neglect, impulsivity, and spatial deficits.
8. The nurse is teaching a client about phenytoin (Dilantin). Which statement
indicates understanding?
A. "I should brush my teeth gently and see my dentist regularly."
B. "I can stop the medication once I feel better."
C. "I should take this with a full meal."
D. "Grapefruit juice will increase absorption."
Answer: A
Rationale: Phenytoin causes gingival hyperplasia, so good oral hygiene and dental
care are essential. The medication should not be stopped abruptly. It should be
taken with food to reduce GI upset, but the priority teaching is oral care.
, 9. A client with Parkinson's disease is prescribed levodopa-carbidopa (Sinemet).
The nurse should teach the client to:
A. Take the medication with a high-protein meal
B. Report darkening of urine as a dangerous side effect
C. Change positions slowly to prevent orthostatic hypotension
D. Expect immediate improvement in symptoms
Answer: C
Rationale: Orthostatic hypotension is a common side effect of levodopa. High-
protein meals decrease absorption. Darkened urine/sweat is harmless.
Therapeutic effects may take weeks.
10. Which finding in a client with a head injury requires immediate notification
of the provider?
A. Headache relieved by acetaminophen
B. Clear fluid leaking from the nose
C. Blood pressure 110/70 mmHg
D. Pupils equal and reactive
Answer: B
Rationale: Clear fluid from the nose or ears indicates CSF leak, which signals a
basilar skull fracture and risk for infection. The nurse should test for glucose (CSF
is positive) and notify the provider.
11. A client is scheduled for a lumbar puncture. Which action is most important
post-procedure?
A. Keep the client flat for several hours
B. Encourage immediate ambulation
C. Administer a diuretic
D. Elevate the head of the bed 45 degrees
