NUR 2755 Multidimensional Care IV (MDC 4) – Exam 1:
100-Question Practice Exam with Detailed Rationales
This comprehensive practice exam is designed to help you prepare for Exam 1 in NUR
2755 Multidimensional Care IV. The questions cover neurological disorders,
genitourinary/renal disorders, oncology, perioperative nursing, and emergency/critical
care topics. Each question includes a detailed rationale to reinforce your understanding.
SECTION 1: NEUROLOGICAL DISORDERS (Questions 1–30)
1. A patient with increased intracranial pressure (ICP) has a Glasgow Coma Scale
(GCS) score of 8. The nurse's priority intervention is:
A) Elevate the head of the bed to 30 degrees
B) Perform a neurological assessment every 4 hours
C) Administer prescribed pain medication
D) Provide oral care
Resolution Result Verified Answers : A
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from
the brain, reducing ICP. A GCS of 8 indicates severe neurological impairment requiring
immediate interventions. Maintaining a neutral head position and avoiding clustering of
nursing interventions are also important to prevent further increases in ICP .
2. A patient with increased ICP has a sudden drop in blood pressure and
bradycardia. This finding is most consistent with:
,A) Cushing's triad
B) Hypovolemic shock
C) Septic shock
D) Cardiac tamponade
Resolution Result Verified Answers : A
Rationale: Cushing's triad consists of hypertension (not hypotension), bradycardia, and
irregular respirations, indicative of increased ICP with impending brainstem herniation.
Hypotension with bradycardia in a patient with ICP suggests brainstem compression and
is a late sign requiring emergency intervention.
3. The nurse is assessing a patient with a suspected cerebrospinal fluid (CSF) leak
after a head injury. Which finding confirms the presence of CSF?
A) Clear nasal drainage that is positive for glucose
B) Yellow nasal drainage that is positive for protein
C) Clear nasal drainage that is positive for ketones
D) Bloody nasal drainage with a halo sign
Resolution Result Verified Answers : A
Rationale: CSF is clear and contains glucose. Testing nasal drainage with a glucose test
strip is a rapid way to identify CSF. The halo sign (ring of blood around clear drainage)
can also indicate CSF leak when blood is mixed with CSF.
4. A patient who has been on phenytoin (Dilantin) for seizure control for 5 years is
noted to have gum overgrowth. The nurse recognizes this as:
,A) A sign of drug toxicity
B) Gingival hyperplasia (a known side effect of Dilantin)
C) A normal age-related change
D) A sign of poor oral hygiene only
Resolution Result Verified Answers : B
Rationale: Gingival hyperplasia (overgrowth of gum tissue) is a well-documented side
effect of long-term phenytoin therapy. Good oral hygiene and regular dental visits can
help manage this side effect, but it is primarily drug-induced. Abruptly discontinuing
phenytoin can precipitate status epilepticus .
5. A patient is experiencing a generalized tonic-clonic seizure. The nurse's priority
action during the seizure is:
A) Restrain the patient to prevent injury
B) Place a padded tongue blade in the patient's mouth
C) Protect the patient's head and maintain a patent airway
D) Administer IV lorazepam immediately
Resolution Result Verified Answers : C
Rationale: During a seizure, the priority is to protect the patient from injury (cushion the
head, move objects away) and maintain a patent airway. Never insert anything into the
mouth during a seizure. IV lorazepam is administered for status epilepticus, not for a
single seizure .
6. A patient is in the post-ictal phase after a generalized seizure. The nurse should
expect the patient to be:
, A) Alert and oriented
B) Drowsy and confused
C) Hyperactive and agitated
D) Unable to speak
Resolution Result Verified Answers : B
Rationale: The post-ictal phase is characterized by drowsiness, confusion, and fatigue.
Some patients may be disoriented for a period of time. Airway protection remains a
priority during this phase.
7. A patient with status epilepticus is not responding to IV lorazepam. The nurse
should prepare to administer:
A) Oral phenytoin
B) IV fosphenytoin
C) IV diazepam
D) IV normal saline
Resolution Result Verified Answers : B
Rationale: Status epilepticus is a medical emergency. If benzodiazepines (lorazepam,
diazepam) fail, fosphenytoin (or phenytoin) is the next-line treatment. Fosphenytoin can
be administered IV more rapidly and with fewer side effects than phenytoin.
8. A patient with a history of seizures is prescribed phenytoin. The nurse should
monitor the patient for which therapeutic drug level?
A) 5-10 mcg/mL
B) 10-20 mcg/mL
100-Question Practice Exam with Detailed Rationales
This comprehensive practice exam is designed to help you prepare for Exam 1 in NUR
2755 Multidimensional Care IV. The questions cover neurological disorders,
genitourinary/renal disorders, oncology, perioperative nursing, and emergency/critical
care topics. Each question includes a detailed rationale to reinforce your understanding.
SECTION 1: NEUROLOGICAL DISORDERS (Questions 1–30)
1. A patient with increased intracranial pressure (ICP) has a Glasgow Coma Scale
(GCS) score of 8. The nurse's priority intervention is:
A) Elevate the head of the bed to 30 degrees
B) Perform a neurological assessment every 4 hours
C) Administer prescribed pain medication
D) Provide oral care
Resolution Result Verified Answers : A
Rationale: Elevating the head of the bed to 30 degrees promotes venous drainage from
the brain, reducing ICP. A GCS of 8 indicates severe neurological impairment requiring
immediate interventions. Maintaining a neutral head position and avoiding clustering of
nursing interventions are also important to prevent further increases in ICP .
2. A patient with increased ICP has a sudden drop in blood pressure and
bradycardia. This finding is most consistent with:
,A) Cushing's triad
B) Hypovolemic shock
C) Septic shock
D) Cardiac tamponade
Resolution Result Verified Answers : A
Rationale: Cushing's triad consists of hypertension (not hypotension), bradycardia, and
irregular respirations, indicative of increased ICP with impending brainstem herniation.
Hypotension with bradycardia in a patient with ICP suggests brainstem compression and
is a late sign requiring emergency intervention.
3. The nurse is assessing a patient with a suspected cerebrospinal fluid (CSF) leak
after a head injury. Which finding confirms the presence of CSF?
A) Clear nasal drainage that is positive for glucose
B) Yellow nasal drainage that is positive for protein
C) Clear nasal drainage that is positive for ketones
D) Bloody nasal drainage with a halo sign
Resolution Result Verified Answers : A
Rationale: CSF is clear and contains glucose. Testing nasal drainage with a glucose test
strip is a rapid way to identify CSF. The halo sign (ring of blood around clear drainage)
can also indicate CSF leak when blood is mixed with CSF.
4. A patient who has been on phenytoin (Dilantin) for seizure control for 5 years is
noted to have gum overgrowth. The nurse recognizes this as:
,A) A sign of drug toxicity
B) Gingival hyperplasia (a known side effect of Dilantin)
C) A normal age-related change
D) A sign of poor oral hygiene only
Resolution Result Verified Answers : B
Rationale: Gingival hyperplasia (overgrowth of gum tissue) is a well-documented side
effect of long-term phenytoin therapy. Good oral hygiene and regular dental visits can
help manage this side effect, but it is primarily drug-induced. Abruptly discontinuing
phenytoin can precipitate status epilepticus .
5. A patient is experiencing a generalized tonic-clonic seizure. The nurse's priority
action during the seizure is:
A) Restrain the patient to prevent injury
B) Place a padded tongue blade in the patient's mouth
C) Protect the patient's head and maintain a patent airway
D) Administer IV lorazepam immediately
Resolution Result Verified Answers : C
Rationale: During a seizure, the priority is to protect the patient from injury (cushion the
head, move objects away) and maintain a patent airway. Never insert anything into the
mouth during a seizure. IV lorazepam is administered for status epilepticus, not for a
single seizure .
6. A patient is in the post-ictal phase after a generalized seizure. The nurse should
expect the patient to be:
, A) Alert and oriented
B) Drowsy and confused
C) Hyperactive and agitated
D) Unable to speak
Resolution Result Verified Answers : B
Rationale: The post-ictal phase is characterized by drowsiness, confusion, and fatigue.
Some patients may be disoriented for a period of time. Airway protection remains a
priority during this phase.
7. A patient with status epilepticus is not responding to IV lorazepam. The nurse
should prepare to administer:
A) Oral phenytoin
B) IV fosphenytoin
C) IV diazepam
D) IV normal saline
Resolution Result Verified Answers : B
Rationale: Status epilepticus is a medical emergency. If benzodiazepines (lorazepam,
diazepam) fail, fosphenytoin (or phenytoin) is the next-line treatment. Fosphenytoin can
be administered IV more rapidly and with fewer side effects than phenytoin.
8. A patient with a history of seizures is prescribed phenytoin. The nurse should
monitor the patient for which therapeutic drug level?
A) 5-10 mcg/mL
B) 10-20 mcg/mL
