MED SURG/NEURO – COMPREHENSIVE QUESTIONS AND ANSWERS | VERIFIED AND
WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS | LATEST EXAM UPDATE
•
CORE DOMAINS
• Neurological assessment and neurological disorders
• Cardiovascular and peripheral vascular disorders
• Respiratory disorders and oxygenation
• Renal, urinary, and fluid-electrolyte disorders
• Gastrointestinal and hepatobiliary disorders
• Endocrine and metabolic disorders
• Musculoskeletal, integumentary, and mobility disorders
• Hematologic, immune, and infectious disorders
• Perioperative care, complications, safety, and clinical decision-making
INTRODUCTION
This comprehensive assessment is designed to evaluate the knowledge, clinical reasoning,
and practical decision-making required in medical-surgical and neurological nursing. The
questions assess foundational concepts, disease processes, assessment findings, diagnostic
interpretation, treatment principles, nursing priorities, safety, patient education, and
recognition of complications. Multiple-choice questions are used to strengthen the learner’s
ability to distinguish expected findings from abnormalities and identify the most appropriate
response to common clinical situations. Emphasis is placed on understanding underlying
pathophysiology and applying knowledge to patient-care decisions rather than relying solely
on memorization. The material is intended to support focused preparation for examination-
style questions and practical clinical application.
SECTION ONE: QUESTIONS 1–100
Question 1.
A nurse is performing a neurological assessment on a patient. Which finding requires the
most immediate attention?
A. Pupils equal and reactive to light
B. New onset of unequal pupils
C. Symmetric hand grips
D. Alert and oriented to person and place
Correct Answer: B. New onset of unequal pupils
Explanation: A new onset of unequal pupils, or anisocoria, may indicate acute neurological
deterioration, increased intracranial pressure, or compression of cranial nerve III. It requires
,prompt assessment and intervention. The other findings are generally expected neurological
findings.
Question 2.
Which assessment finding is most characteristic of increased intracranial pressure?
A. Bradycardia with widening pulse pressure
B. Tachycardia with hypotension
C. Hyperactive bowel sounds
D. Increased urinary output
Correct Answer: A. Bradycardia with widening pulse pressure
Explanation: Bradycardia, widened pulse pressure, and abnormal respiratory patterns are
components of Cushing’s response, a late and serious sign of increased intracranial pressure.
This finding indicates possible brainstem compression and requires immediate intervention.
Question 3.
A patient with a head injury becomes increasingly difficult to arouse. What is the nurse’s
priority action?
A. Allow the patient to sleep undisturbed
B. Reassess neurological status immediately
C. Offer oral fluids
D. Place the patient in a high-Fowler position and leave the room
Correct Answer: B. Reassess neurological status immediately
Explanation: A declining level of consciousness can be an early indicator of neurological
deterioration or increased intracranial pressure. The nurse should immediately reassess the
neurological status and initiate appropriate emergency measures.
Question 4.
Which finding is most consistent with a left-sided cerebrovascular accident?
A. Right-sided weakness
B. Left-sided neglect only
C. Bilateral lower-extremity paralysis
D. Loss of hearing in both ears
Correct Answer: A. Right-sided weakness
Explanation: Motor pathways generally cross within the central nervous system, so a lesion
in the left cerebral hemisphere commonly produces weakness or paralysis on the right side.
Left-sided strokes may also cause language disturbances because language centers are
usually located in the dominant hemisphere.
,Question 5.
A patient with an acute stroke has difficulty swallowing. Which nursing intervention is most
appropriate?
A. Give thin liquids first
B. Encourage rapid eating
C. Keep the patient NPO until swallowing is evaluated
D. Place food directly into the back of the mouth
Correct Answer: C. Keep the patient NPO until swallowing is evaluated
Explanation: Dysphagia after a stroke increases the risk of aspiration. The patient should
remain NPO until a formal swallowing evaluation determines that oral intake is safe.
Question 6.
Which manifestation is most strongly associated with a right hemispheric stroke?
A. Aphasia
B. Right-sided hemiparesis
C. Left-sided neglect
D. Difficulty understanding written language only
Correct Answer: C. Left-sided neglect
Explanation: Right hemispheric injury commonly causes left-sided neglect, impaired spatial
awareness, impulsivity, and left-sided motor deficits. Aphasia is more commonly associated
with dominant-hemisphere, usually left-sided, injury.
Question 7.
A patient is receiving alteplase for an acute ischemic stroke. Which finding requires
immediate action?
A. Mild nausea
B. New severe headache
C. Blood pressure within the prescribed range
D. Mild fatigue
Correct Answer: B. New severe headache
Explanation: A sudden severe headache during or after thrombolytic therapy may indicate
intracranial hemorrhage. Alteplase increases bleeding risk, so new neurological symptoms or
severe headache require immediate evaluation.
Question 8.
Which assessment finding is most suggestive of a seizure disorder?
, A. Sudden loss of consciousness followed by rhythmic jerking
B. Gradual improvement in orientation over several hours
C. Persistent mild thirst
D. Increased bowel sounds after eating
Correct Answer: A. Sudden loss of consciousness followed by rhythmic jerking
Explanation: Generalized tonic-clonic seizures commonly involve sudden loss of
consciousness followed by tonic stiffening and rhythmic clonic movements. Postictal
confusion and fatigue may follow the seizure.
Question 9.
During a generalized tonic-clonic seizure, which action should the nurse take?
A. Insert a tongue blade
B. Restrain the patient's arms and legs
C. Protect the patient from injury and maintain airway safety
D. Force oral medication into the patient's mouth
Correct Answer: C. Protect the patient from injury and maintain airway safety
Explanation: During a seizure, the priority is safety and airway protection. The nurse should
remove nearby hazards, protect the head, position the patient safely when possible, and
never place objects or fingers in the mouth or forcibly restrain the patient.
Question 10.
A patient is experiencing a seizure. Which intervention is contraindicated?
A. Moving nearby furniture
B. Protecting the patient's head
C. Timing the seizure
D. Forcing the patient's jaw open
Correct Answer: D. Forcing the patient's jaw open
Explanation: Attempting to force the jaw open can cause oral injury, aspiration, or injury to
the person attempting the intervention. Nothing should be placed in the patient's mouth
during a seizure.
Question 11.
Which finding is most characteristic of Parkinson disease?
A. Resting tremor
B. Flaccid paralysis
C. Sudden complete loss of sensation
D. Hyperactive deep tendon reflexes as the primary feature
WELLDETAILED ANSWERS | DETAILED EXPLANATIONS AND RATIONALES | COMPLETE
EXAM PREPARATION STUDY GUIDE | PRACTICE QUESTIONS | LATEST EXAM UPDATE
•
CORE DOMAINS
• Neurological assessment and neurological disorders
• Cardiovascular and peripheral vascular disorders
• Respiratory disorders and oxygenation
• Renal, urinary, and fluid-electrolyte disorders
• Gastrointestinal and hepatobiliary disorders
• Endocrine and metabolic disorders
• Musculoskeletal, integumentary, and mobility disorders
• Hematologic, immune, and infectious disorders
• Perioperative care, complications, safety, and clinical decision-making
INTRODUCTION
This comprehensive assessment is designed to evaluate the knowledge, clinical reasoning,
and practical decision-making required in medical-surgical and neurological nursing. The
questions assess foundational concepts, disease processes, assessment findings, diagnostic
interpretation, treatment principles, nursing priorities, safety, patient education, and
recognition of complications. Multiple-choice questions are used to strengthen the learner’s
ability to distinguish expected findings from abnormalities and identify the most appropriate
response to common clinical situations. Emphasis is placed on understanding underlying
pathophysiology and applying knowledge to patient-care decisions rather than relying solely
on memorization. The material is intended to support focused preparation for examination-
style questions and practical clinical application.
SECTION ONE: QUESTIONS 1–100
Question 1.
A nurse is performing a neurological assessment on a patient. Which finding requires the
most immediate attention?
A. Pupils equal and reactive to light
B. New onset of unequal pupils
C. Symmetric hand grips
D. Alert and oriented to person and place
Correct Answer: B. New onset of unequal pupils
Explanation: A new onset of unequal pupils, or anisocoria, may indicate acute neurological
deterioration, increased intracranial pressure, or compression of cranial nerve III. It requires
,prompt assessment and intervention. The other findings are generally expected neurological
findings.
Question 2.
Which assessment finding is most characteristic of increased intracranial pressure?
A. Bradycardia with widening pulse pressure
B. Tachycardia with hypotension
C. Hyperactive bowel sounds
D. Increased urinary output
Correct Answer: A. Bradycardia with widening pulse pressure
Explanation: Bradycardia, widened pulse pressure, and abnormal respiratory patterns are
components of Cushing’s response, a late and serious sign of increased intracranial pressure.
This finding indicates possible brainstem compression and requires immediate intervention.
Question 3.
A patient with a head injury becomes increasingly difficult to arouse. What is the nurse’s
priority action?
A. Allow the patient to sleep undisturbed
B. Reassess neurological status immediately
C. Offer oral fluids
D. Place the patient in a high-Fowler position and leave the room
Correct Answer: B. Reassess neurological status immediately
Explanation: A declining level of consciousness can be an early indicator of neurological
deterioration or increased intracranial pressure. The nurse should immediately reassess the
neurological status and initiate appropriate emergency measures.
Question 4.
Which finding is most consistent with a left-sided cerebrovascular accident?
A. Right-sided weakness
B. Left-sided neglect only
C. Bilateral lower-extremity paralysis
D. Loss of hearing in both ears
Correct Answer: A. Right-sided weakness
Explanation: Motor pathways generally cross within the central nervous system, so a lesion
in the left cerebral hemisphere commonly produces weakness or paralysis on the right side.
Left-sided strokes may also cause language disturbances because language centers are
usually located in the dominant hemisphere.
,Question 5.
A patient with an acute stroke has difficulty swallowing. Which nursing intervention is most
appropriate?
A. Give thin liquids first
B. Encourage rapid eating
C. Keep the patient NPO until swallowing is evaluated
D. Place food directly into the back of the mouth
Correct Answer: C. Keep the patient NPO until swallowing is evaluated
Explanation: Dysphagia after a stroke increases the risk of aspiration. The patient should
remain NPO until a formal swallowing evaluation determines that oral intake is safe.
Question 6.
Which manifestation is most strongly associated with a right hemispheric stroke?
A. Aphasia
B. Right-sided hemiparesis
C. Left-sided neglect
D. Difficulty understanding written language only
Correct Answer: C. Left-sided neglect
Explanation: Right hemispheric injury commonly causes left-sided neglect, impaired spatial
awareness, impulsivity, and left-sided motor deficits. Aphasia is more commonly associated
with dominant-hemisphere, usually left-sided, injury.
Question 7.
A patient is receiving alteplase for an acute ischemic stroke. Which finding requires
immediate action?
A. Mild nausea
B. New severe headache
C. Blood pressure within the prescribed range
D. Mild fatigue
Correct Answer: B. New severe headache
Explanation: A sudden severe headache during or after thrombolytic therapy may indicate
intracranial hemorrhage. Alteplase increases bleeding risk, so new neurological symptoms or
severe headache require immediate evaluation.
Question 8.
Which assessment finding is most suggestive of a seizure disorder?
, A. Sudden loss of consciousness followed by rhythmic jerking
B. Gradual improvement in orientation over several hours
C. Persistent mild thirst
D. Increased bowel sounds after eating
Correct Answer: A. Sudden loss of consciousness followed by rhythmic jerking
Explanation: Generalized tonic-clonic seizures commonly involve sudden loss of
consciousness followed by tonic stiffening and rhythmic clonic movements. Postictal
confusion and fatigue may follow the seizure.
Question 9.
During a generalized tonic-clonic seizure, which action should the nurse take?
A. Insert a tongue blade
B. Restrain the patient's arms and legs
C. Protect the patient from injury and maintain airway safety
D. Force oral medication into the patient's mouth
Correct Answer: C. Protect the patient from injury and maintain airway safety
Explanation: During a seizure, the priority is safety and airway protection. The nurse should
remove nearby hazards, protect the head, position the patient safely when possible, and
never place objects or fingers in the mouth or forcibly restrain the patient.
Question 10.
A patient is experiencing a seizure. Which intervention is contraindicated?
A. Moving nearby furniture
B. Protecting the patient's head
C. Timing the seizure
D. Forcing the patient's jaw open
Correct Answer: D. Forcing the patient's jaw open
Explanation: Attempting to force the jaw open can cause oral injury, aspiration, or injury to
the person attempting the intervention. Nothing should be placed in the patient's mouth
during a seizure.
Question 11.
Which finding is most characteristic of Parkinson disease?
A. Resting tremor
B. Flaccid paralysis
C. Sudden complete loss of sensation
D. Hyperactive deep tendon reflexes as the primary feature
