2026/2027
Galen College NUR 265 Exam 3
Medical-Surgical Nursing Complete
Review Manual for Practice
Questions, Study Notes, and Success
Strategies 2026/2027
Question 1:
A nurse is caring for a patient admitted with suspected encephalitis. Which statement
best describes encephalitis?
A. Inflammation of the peripheral nerves causing muscle paralysis
B. Inflammation or infection of the brain tissue
C. Degeneration of the spinal cord due to trauma
D. Autoimmune destruction of the meninges
Correct Answer: B. Inflammation or infection of the brain tissue
Rationale: Encephalitis is an inflammatory condition affecting the brain tissue itself,
commonly caused by viral infections such as herpes simplex virus or West Nile virus.
Patients may present with fever, altered level of consciousness, seizures, headache,
and neurologic deficits. Option A describes peripheral neuropathies such as Guillain-
Barré syndrome. Option C relates to spinal cord injury, while Option D refers more
closely to meningitis, which affects the meninges rather than the brain tissue.
Question 2:
Which infectious agents are commonly associated with encephalitis?
A. Streptococcus pneumoniae and Neisseria meningitidis
B. West Nile virus and herpes simplex virus
C. Candida albicans and Aspergillus
D. Mycoplasma pneumoniae and tuberculosis
Correct Answer: B. West Nile virus and herpes simplex virus
Rationale: Viral infections are among the most common causes of encephalitis,
especially herpes simplex virus (HSV) and West Nile virus. HSV encephalitis is
particularly dangerous because it can rapidly progress and cause severe neurologic
damage if untreated. Streptococcus pneumoniae and Neisseria meningitidis are more
commonly associated with bacterial meningitis. Fungal organisms such as Candida
,2026/2027
and Aspergillus usually affect immunocompromised patients and are less common
causes of encephalitis.
Question 3:
A patient with encephalitis is being assessed in the emergency department. Which
manifestations should the nurse expect?
A. Bradycardia, hypothermia, and absent reflexes
B. High fever, photophobia, vomiting, and changes in level of consciousness
C. Painless facial paralysis and drooping eyelid
D. Hyperactivity, euphoria, and increased appetite
Correct Answer: B. High fever, photophobia, vomiting, and changes in level of
consciousness
Rationale: Classic manifestations of encephalitis include fever, nausea and vomiting,
stiff neck, photophobia, altered mental status, and neurologic abnormalities such as
pupil changes or seizures. Brain inflammation leads to cerebral irritation and
neurologic dysfunction. Option A is more consistent with spinal shock. Option C
describes Bell’s palsy. Option D is not characteristic of encephalitis and may instead
indicate psychiatric or endocrine disorders.
Question 4:
Which diagnostic test provides the most definitive information regarding central
nervous system infection in a patient suspected of having encephalitis?
A. Chest radiograph
B. Lumbar puncture with cerebrospinal fluid analysis
C. Electrocardiogram
D. Colonoscopy
Correct Answer: B. Lumbar puncture with cerebrospinal fluid analysis
Rationale: A lumbar puncture allows collection and analysis of cerebrospinal fluid
(CSF), which can identify infectious organisms, inflammation, elevated white blood
cells, and abnormal protein or glucose levels associated with encephalitis. Additional
studies such as EEG and CT scans may support diagnosis, but CSF analysis is central
to confirming infection. Chest radiography and colonoscopy do not evaluate
neurologic infections, and ECG primarily evaluates cardiac activity.
Question 5:
The nurse is developing a care plan for a patient with encephalitis and increased
intracranial pressure (ICP). Which intervention is most appropriate?
,2026/2027
A. Place the patient flat in bed
B. Encourage frequent coughing exercises
C. Maintain the head of bed at 30–45 degrees
D. Cluster all nursing care activities together
Correct Answer: C. Maintain the head of bed at 30–45 degrees
Rationale: Elevating the head of the bed to 30–45 degrees promotes venous drainage
from the brain and helps reduce intracranial pressure. Patients with encephalitis are at
risk for cerebral edema and brain herniation. Frequent coughing and clustered care
can increase ICP by raising intrathoracic pressure and stimulating the patient
excessively. Keeping the patient flat can worsen cerebral swelling and impair
drainage.
Question 6:
Which medication is most commonly administered in the treatment of viral
encephalitis caused by herpes simplex virus?
A. Rifampin
B. Mannitol
C. Acyclovir
D. Prednisone
Correct Answer: C. Acyclovir
Rationale: Acyclovir is the antiviral medication of choice for herpes simplex virus
encephalitis and should be started promptly to reduce mortality and neurologic
complications. Rifampin is an antibiotic used for bacterial infections. Mannitol may
help reduce intracranial pressure but does not treat the infection itself. Prednisone is
not the primary treatment for viral encephalitis and may suppress immune response if
used improperly.
Question 7:
A patient with encephalitis suddenly develops fixed pupils, severe hypertension, and
decreased responsiveness. Which complication should the nurse suspect?
A. Myasthenic crisis
B. Brain herniation from increased intracranial pressure
C. Bell’s palsy
D. Guillain-Barré syndrome
Correct Answer: B. Brain herniation from increased intracranial pressure
Rationale: Severe increased intracranial pressure may lead to brain herniation, a life-
threatening emergency characterized by altered consciousness, abnormal pupil
responses, Cushing’s triad, and respiratory changes. Encephalitis can cause cerebral
, 2026/2027
edema that compresses brain structures. Myasthenic crisis affects neuromuscular
transmission, Bell’s palsy affects the facial nerve, and Guillain-Barré syndrome
primarily involves peripheral nerves.
Question 8:
Which statement best describes myasthenia gravis?
A. A bacterial infection causing spinal cord inflammation
B. An autoimmune disorder causing skeletal muscle weakness
C. A degenerative disorder of the cerebral cortex
D. A viral infection of the peripheral nerves
Correct Answer: B. An autoimmune disorder causing skeletal muscle weakness
Rationale: Myasthenia gravis is an autoimmune disorder characterized by destruction
or blocking of acetylcholine receptor sites at the neuromuscular junction, resulting in
muscle weakness and fatigue. Symptoms commonly worsen with activity and
improve with rest. It does not involve infection or degeneration of the brain tissue.
The disorder specifically impairs voluntary muscle function.
Question 9:
The pathophysiology of myasthenia gravis involves which mechanism?
A. Excess dopamine production
B. Destruction of acetylcholine receptor sites
C. Increased myelin production
D. Excessive serotonin stimulation
Correct Answer: B. Destruction of acetylcholine receptor sites
Rationale: In myasthenia gravis, autoantibodies attack acetylcholine receptor sites at
the neuromuscular junction, preventing effective nerve impulse transmission and
resulting in muscle weakness. Dopamine and serotonin are neurotransmitters
associated with other neurologic or psychiatric disorders. Increased myelin production
is not associated with this disease process.
Question 10:
Which assessment finding is most characteristic of myasthenia gravis?
A. Resting tremors and shuffling gait
B. Bilateral facial drooping and ascending paralysis
C. Ptosis and diplopia that worsen with activity
D. Hyperactive reflexes and muscle rigidity
Galen College NUR 265 Exam 3
Medical-Surgical Nursing Complete
Review Manual for Practice
Questions, Study Notes, and Success
Strategies 2026/2027
Question 1:
A nurse is caring for a patient admitted with suspected encephalitis. Which statement
best describes encephalitis?
A. Inflammation of the peripheral nerves causing muscle paralysis
B. Inflammation or infection of the brain tissue
C. Degeneration of the spinal cord due to trauma
D. Autoimmune destruction of the meninges
Correct Answer: B. Inflammation or infection of the brain tissue
Rationale: Encephalitis is an inflammatory condition affecting the brain tissue itself,
commonly caused by viral infections such as herpes simplex virus or West Nile virus.
Patients may present with fever, altered level of consciousness, seizures, headache,
and neurologic deficits. Option A describes peripheral neuropathies such as Guillain-
Barré syndrome. Option C relates to spinal cord injury, while Option D refers more
closely to meningitis, which affects the meninges rather than the brain tissue.
Question 2:
Which infectious agents are commonly associated with encephalitis?
A. Streptococcus pneumoniae and Neisseria meningitidis
B. West Nile virus and herpes simplex virus
C. Candida albicans and Aspergillus
D. Mycoplasma pneumoniae and tuberculosis
Correct Answer: B. West Nile virus and herpes simplex virus
Rationale: Viral infections are among the most common causes of encephalitis,
especially herpes simplex virus (HSV) and West Nile virus. HSV encephalitis is
particularly dangerous because it can rapidly progress and cause severe neurologic
damage if untreated. Streptococcus pneumoniae and Neisseria meningitidis are more
commonly associated with bacterial meningitis. Fungal organisms such as Candida
,2026/2027
and Aspergillus usually affect immunocompromised patients and are less common
causes of encephalitis.
Question 3:
A patient with encephalitis is being assessed in the emergency department. Which
manifestations should the nurse expect?
A. Bradycardia, hypothermia, and absent reflexes
B. High fever, photophobia, vomiting, and changes in level of consciousness
C. Painless facial paralysis and drooping eyelid
D. Hyperactivity, euphoria, and increased appetite
Correct Answer: B. High fever, photophobia, vomiting, and changes in level of
consciousness
Rationale: Classic manifestations of encephalitis include fever, nausea and vomiting,
stiff neck, photophobia, altered mental status, and neurologic abnormalities such as
pupil changes or seizures. Brain inflammation leads to cerebral irritation and
neurologic dysfunction. Option A is more consistent with spinal shock. Option C
describes Bell’s palsy. Option D is not characteristic of encephalitis and may instead
indicate psychiatric or endocrine disorders.
Question 4:
Which diagnostic test provides the most definitive information regarding central
nervous system infection in a patient suspected of having encephalitis?
A. Chest radiograph
B. Lumbar puncture with cerebrospinal fluid analysis
C. Electrocardiogram
D. Colonoscopy
Correct Answer: B. Lumbar puncture with cerebrospinal fluid analysis
Rationale: A lumbar puncture allows collection and analysis of cerebrospinal fluid
(CSF), which can identify infectious organisms, inflammation, elevated white blood
cells, and abnormal protein or glucose levels associated with encephalitis. Additional
studies such as EEG and CT scans may support diagnosis, but CSF analysis is central
to confirming infection. Chest radiography and colonoscopy do not evaluate
neurologic infections, and ECG primarily evaluates cardiac activity.
Question 5:
The nurse is developing a care plan for a patient with encephalitis and increased
intracranial pressure (ICP). Which intervention is most appropriate?
,2026/2027
A. Place the patient flat in bed
B. Encourage frequent coughing exercises
C. Maintain the head of bed at 30–45 degrees
D. Cluster all nursing care activities together
Correct Answer: C. Maintain the head of bed at 30–45 degrees
Rationale: Elevating the head of the bed to 30–45 degrees promotes venous drainage
from the brain and helps reduce intracranial pressure. Patients with encephalitis are at
risk for cerebral edema and brain herniation. Frequent coughing and clustered care
can increase ICP by raising intrathoracic pressure and stimulating the patient
excessively. Keeping the patient flat can worsen cerebral swelling and impair
drainage.
Question 6:
Which medication is most commonly administered in the treatment of viral
encephalitis caused by herpes simplex virus?
A. Rifampin
B. Mannitol
C. Acyclovir
D. Prednisone
Correct Answer: C. Acyclovir
Rationale: Acyclovir is the antiviral medication of choice for herpes simplex virus
encephalitis and should be started promptly to reduce mortality and neurologic
complications. Rifampin is an antibiotic used for bacterial infections. Mannitol may
help reduce intracranial pressure but does not treat the infection itself. Prednisone is
not the primary treatment for viral encephalitis and may suppress immune response if
used improperly.
Question 7:
A patient with encephalitis suddenly develops fixed pupils, severe hypertension, and
decreased responsiveness. Which complication should the nurse suspect?
A. Myasthenic crisis
B. Brain herniation from increased intracranial pressure
C. Bell’s palsy
D. Guillain-Barré syndrome
Correct Answer: B. Brain herniation from increased intracranial pressure
Rationale: Severe increased intracranial pressure may lead to brain herniation, a life-
threatening emergency characterized by altered consciousness, abnormal pupil
responses, Cushing’s triad, and respiratory changes. Encephalitis can cause cerebral
, 2026/2027
edema that compresses brain structures. Myasthenic crisis affects neuromuscular
transmission, Bell’s palsy affects the facial nerve, and Guillain-Barré syndrome
primarily involves peripheral nerves.
Question 8:
Which statement best describes myasthenia gravis?
A. A bacterial infection causing spinal cord inflammation
B. An autoimmune disorder causing skeletal muscle weakness
C. A degenerative disorder of the cerebral cortex
D. A viral infection of the peripheral nerves
Correct Answer: B. An autoimmune disorder causing skeletal muscle weakness
Rationale: Myasthenia gravis is an autoimmune disorder characterized by destruction
or blocking of acetylcholine receptor sites at the neuromuscular junction, resulting in
muscle weakness and fatigue. Symptoms commonly worsen with activity and
improve with rest. It does not involve infection or degeneration of the brain tissue.
The disorder specifically impairs voluntary muscle function.
Question 9:
The pathophysiology of myasthenia gravis involves which mechanism?
A. Excess dopamine production
B. Destruction of acetylcholine receptor sites
C. Increased myelin production
D. Excessive serotonin stimulation
Correct Answer: B. Destruction of acetylcholine receptor sites
Rationale: In myasthenia gravis, autoantibodies attack acetylcholine receptor sites at
the neuromuscular junction, preventing effective nerve impulse transmission and
resulting in muscle weakness. Dopamine and serotonin are neurotransmitters
associated with other neurologic or psychiatric disorders. Increased myelin production
is not associated with this disease process.
Question 10:
Which assessment finding is most characteristic of myasthenia gravis?
A. Resting tremors and shuffling gait
B. Bilateral facial drooping and ascending paralysis
C. Ptosis and diplopia that worsen with activity
D. Hyperactive reflexes and muscle rigidity
