Exam 4 NSG 4100 – Advanced Medical-Surgical
Nursing: Comprehensive Practice Questions
(2026 Edition)
Introduction
Welcome to the NSG 4100 Exam 4 Comprehensive Practice Question Set, specifically
designed for nursing students preparing for advanced medical-surgical nursing assessments in
2026. This set contains 120 meticulously crafted questions in mixed formats—multiple-choice
(MCQs), select-all-that-apply (SATA), and short-answer questions—covering high-yield topics
that are critical for success on Exam 4.
These questions are aligned with current evidence-based nursing practices and core
competencies, emphasizing both critical thinking and clinical decision-making. Students who
complete this set will develop a deeper understanding of complex patient care scenarios
encountered in acute and critical care settings.
Key Content Areas Covered:
Neurological Emergencies: Stroke, traumatic brain injury, seizure management,
increased intracranial pressure (ICP), and meningitis.
Cardiovascular Emergencies: Acute myocardial infarction, cardiogenic shock,
arrhythmias, heart failure, and hemodynamic monitoring.
Respiratory Emergencies: ARDS, acute respiratory failure, mechanical ventilation
management, and prevention of ventilator-associated complications.
Endocrine Emergencies: Diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic
state (HHS), thyroid storm, and adrenal crisis.
Renal and Electrolyte Disorders: Acute kidney injury, hyperkalemia, hyponatremia,
hypernatremia, and fluid-electrolyte management.
Critical Care Nursing Skills: Prioritization, rapid assessment, airway management,
infection prevention, and patient safety.
Pharmacology and Therapeutics: Emergency medications, IV therapy, titration
protocols, and monitoring for adverse effects.
Learning Objectives:
1. Enhance Critical Thinking: Apply knowledge to complex, real-world clinical scenarios.
2. Strengthen Clinical Decision-Making: Prioritize interventions and anticipate
complications in critically ill patients.
3. Test Knowledge Retention: Evaluate understanding of pathophysiology, pharmacology,
and evidence-based nursing interventions.
4. Prepare for Exam Success: Each question includes a rationale, explaining the correct
answer and highlighting key nursing concepts
,1. A patient is admitted with a suspected stroke. Which assessment finding is
most concerning?
A. Facial droop on one side
B. Slurred speech
C. Sudden severe headache
D. Mild dizziness
Answer: C. Sudden severe headache
Rationale: A sudden severe headache may indicate hemorrhagic stroke, which is life-threatening
and requires immediate intervention. Facial droop and slurred speech are concerning but may
indicate ischemic stroke.
2. SATA: Which are early signs of increased intracranial pressure (ICP)?
A. Headache
B. Vomiting
C. Confusion
D. Bradycardia
E. Pupillary changes
Answer: A, B, C, E
Rationale: Early ICP manifests as headache, nausea/vomiting, confusion, and pupil changes.
Bradycardia is usually a late sign (Cushing’s triad).
3. A patient with TBI (traumatic brain injury) has unequal pupils and decreased
LOC. What is the nurse’s priority action?
A. Document findings
B. Notify the provider immediately
C. Administer pain medication
D. Reposition the patient
Answer: B. Notify the provider immediately
Rationale: Unequal pupils and decreased LOC indicate possible herniation, a neurological
emergency.
,4. Short Answer: Name two priority assessments for a patient with suspected
stroke.
Answer:
1. Neurological assessment (GCS, motor function, speech)
2. Vital signs, including blood pressure and oxygen saturation
Rationale: Rapid assessment identifies stroke type and guides urgent interventions.
5. A patient with suspected ischemic stroke is scheduled for tPA therapy. Which
intervention is priority?
A. Monitor for bleeding
B. Encourage oral fluids
C. Administer antihypertensives
D. Elevate legs
Answer: A. Monitor for bleeding
Rationale: tPA is a thrombolytic that increases bleeding risk; close monitoring is critical.
6. SATA: Which patients require airborne precautions?
A. Measles
B. TB
C. Influenza
D. Varicella
E. MRSA
Answer: A, B, D
Rationale: Airborne precautions are for infections transmitted via tiny aerosolized particles.
Influenza is droplet; MRSA is contact.
7. A patient in ICU develops sudden hypotension, tachycardia, and cold, clammy
skin. What type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
, C. Distributive (septic)
D. Neurogenic
Answer: B. Cardiogenic
Rationale: Cardiogenic shock is due to heart failure; hypotension, tachycardia, and cold clammy
skin are classic signs. Hypovolemic shock may have similar signs but usually follows fluid loss.
8. Short Answer: List two nursing interventions for cardiogenic shock.
Answer:
1. Administer prescribed vasoactive medications (e.g., dopamine, norepinephrine)
2. Monitor hemodynamic parameters and oxygen saturation
Rationale: Maintaining perfusion and oxygenation is critical to prevent organ failure.
9. SATA: Which are signs of right-sided heart failure?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in lungs
D. Ascites
E. Dyspnea
Answer: A, B, D
Rationale: Right-sided HF causes systemic congestion (JVD, edema, ascites). Dyspnea and
crackles are more prominent in left-sided HF.
10. A patient with COPD on mechanical ventilation has a sudden drop in oxygen
saturation and absent breath sounds on the right. What is the nurse’s priority
action?
A. Reposition the patient
B. Notify the provider immediately
C. Administer bronchodilator
D. Increase oxygen flow
Answer: B. Notify the provider immediately
Rationale: Sudden desaturation and absent breath sounds suggest pneumothorax, requiring
urgent intervention.
Nursing: Comprehensive Practice Questions
(2026 Edition)
Introduction
Welcome to the NSG 4100 Exam 4 Comprehensive Practice Question Set, specifically
designed for nursing students preparing for advanced medical-surgical nursing assessments in
2026. This set contains 120 meticulously crafted questions in mixed formats—multiple-choice
(MCQs), select-all-that-apply (SATA), and short-answer questions—covering high-yield topics
that are critical for success on Exam 4.
These questions are aligned with current evidence-based nursing practices and core
competencies, emphasizing both critical thinking and clinical decision-making. Students who
complete this set will develop a deeper understanding of complex patient care scenarios
encountered in acute and critical care settings.
Key Content Areas Covered:
Neurological Emergencies: Stroke, traumatic brain injury, seizure management,
increased intracranial pressure (ICP), and meningitis.
Cardiovascular Emergencies: Acute myocardial infarction, cardiogenic shock,
arrhythmias, heart failure, and hemodynamic monitoring.
Respiratory Emergencies: ARDS, acute respiratory failure, mechanical ventilation
management, and prevention of ventilator-associated complications.
Endocrine Emergencies: Diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic
state (HHS), thyroid storm, and adrenal crisis.
Renal and Electrolyte Disorders: Acute kidney injury, hyperkalemia, hyponatremia,
hypernatremia, and fluid-electrolyte management.
Critical Care Nursing Skills: Prioritization, rapid assessment, airway management,
infection prevention, and patient safety.
Pharmacology and Therapeutics: Emergency medications, IV therapy, titration
protocols, and monitoring for adverse effects.
Learning Objectives:
1. Enhance Critical Thinking: Apply knowledge to complex, real-world clinical scenarios.
2. Strengthen Clinical Decision-Making: Prioritize interventions and anticipate
complications in critically ill patients.
3. Test Knowledge Retention: Evaluate understanding of pathophysiology, pharmacology,
and evidence-based nursing interventions.
4. Prepare for Exam Success: Each question includes a rationale, explaining the correct
answer and highlighting key nursing concepts
,1. A patient is admitted with a suspected stroke. Which assessment finding is
most concerning?
A. Facial droop on one side
B. Slurred speech
C. Sudden severe headache
D. Mild dizziness
Answer: C. Sudden severe headache
Rationale: A sudden severe headache may indicate hemorrhagic stroke, which is life-threatening
and requires immediate intervention. Facial droop and slurred speech are concerning but may
indicate ischemic stroke.
2. SATA: Which are early signs of increased intracranial pressure (ICP)?
A. Headache
B. Vomiting
C. Confusion
D. Bradycardia
E. Pupillary changes
Answer: A, B, C, E
Rationale: Early ICP manifests as headache, nausea/vomiting, confusion, and pupil changes.
Bradycardia is usually a late sign (Cushing’s triad).
3. A patient with TBI (traumatic brain injury) has unequal pupils and decreased
LOC. What is the nurse’s priority action?
A. Document findings
B. Notify the provider immediately
C. Administer pain medication
D. Reposition the patient
Answer: B. Notify the provider immediately
Rationale: Unequal pupils and decreased LOC indicate possible herniation, a neurological
emergency.
,4. Short Answer: Name two priority assessments for a patient with suspected
stroke.
Answer:
1. Neurological assessment (GCS, motor function, speech)
2. Vital signs, including blood pressure and oxygen saturation
Rationale: Rapid assessment identifies stroke type and guides urgent interventions.
5. A patient with suspected ischemic stroke is scheduled for tPA therapy. Which
intervention is priority?
A. Monitor for bleeding
B. Encourage oral fluids
C. Administer antihypertensives
D. Elevate legs
Answer: A. Monitor for bleeding
Rationale: tPA is a thrombolytic that increases bleeding risk; close monitoring is critical.
6. SATA: Which patients require airborne precautions?
A. Measles
B. TB
C. Influenza
D. Varicella
E. MRSA
Answer: A, B, D
Rationale: Airborne precautions are for infections transmitted via tiny aerosolized particles.
Influenza is droplet; MRSA is contact.
7. A patient in ICU develops sudden hypotension, tachycardia, and cold, clammy
skin. What type of shock is most likely?
A. Hypovolemic
B. Cardiogenic
, C. Distributive (septic)
D. Neurogenic
Answer: B. Cardiogenic
Rationale: Cardiogenic shock is due to heart failure; hypotension, tachycardia, and cold clammy
skin are classic signs. Hypovolemic shock may have similar signs but usually follows fluid loss.
8. Short Answer: List two nursing interventions for cardiogenic shock.
Answer:
1. Administer prescribed vasoactive medications (e.g., dopamine, norepinephrine)
2. Monitor hemodynamic parameters and oxygen saturation
Rationale: Maintaining perfusion and oxygenation is critical to prevent organ failure.
9. SATA: Which are signs of right-sided heart failure?
A. Jugular vein distention
B. Peripheral edema
C. Crackles in lungs
D. Ascites
E. Dyspnea
Answer: A, B, D
Rationale: Right-sided HF causes systemic congestion (JVD, edema, ascites). Dyspnea and
crackles are more prominent in left-sided HF.
10. A patient with COPD on mechanical ventilation has a sudden drop in oxygen
saturation and absent breath sounds on the right. What is the nurse’s priority
action?
A. Reposition the patient
B. Notify the provider immediately
C. Administer bronchodilator
D. Increase oxygen flow
Answer: B. Notify the provider immediately
Rationale: Sudden desaturation and absent breath sounds suggest pneumothorax, requiring
urgent intervention.
