,NU189/NU 189 Exam 1 | Medical-Surgical Nursing II |
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the earliest and most sensitive indicator of rising intracranial
pressure?
A) Bradycardia with a widening pulse pressure
B) Irregular respirations and Cheyne-Stokes pattern
C) Lethargy and decreased level of consciousness
D) Hypertension with a widening pulse pressure
Correct Answer: Lethargy and decreased level of consciousness
Expert Rationale: A change in level of consciousness, such as lethargy or delayed responses, is the
earliest and most sensitive indicator of rising ICP. Cushing's triad (hypertension, bradycardia, irregular
respirations) is a late, ominous sign of brainstem compression that requires immediate intervention.
2. A patient with Lyme disease presents with a characteristic skin lesion. Which finding would the nurse
expect to observe?
A) Diffuse, red, sandpaper-like rash across the trunk
B) Bull's-eye rash with central clearing (erythema migrans)
C) Vesicular rash in a dermatomal pattern
D) Purple, non-blanching petechiae on the extremities
Correct Answer: Bull's-eye rash with central clearing (erythema migrans)
Expert Rationale: Erythema migrans, a red ring with central clearing, is the hallmark of early localized
Lyme disease. It appears at the site of the tick bite and is neither vesicular nor petechial. A sandpaper-
like rash is more typical of scarlet fever.
3. A patient is admitted with sudden onset of severe pain, redness, and swelling in the right great toe.
Which condition should the nurse suspect?
,A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Lyme disease
Correct Answer: Gout
Expert Rationale: Acute gouty arthritis typically presents with sudden, intense pain, erythema, and
swelling of the first metatarsophalangeal joint, a condition known as podagra. Rheumatoid arthritis and
osteoarthritis have more gradual onsets and different joint distribution patterns.
4. A nurse is caring for a patient with systemic scleroderma. Which body system requires priority
monitoring due to potential cardiac involvement?
A) Respiratory system
B) Cardiovascular system
C) Musculoskeletal system
D) Gastrointestinal system
Correct Answer: Cardiovascular system
Expert Rationale: Systemic scleroderma can cause myocardial fibrosis, pericarditis, and dysrhythmias,
making cardiovascular monitoring a priority. While pulmonary and renal involvement also occur, cardiac
complications are a leading cause of mortality in these patients.
5. A patient is demonstrating decorticate posturing. Which assessment finding best matches this
description?
A) Abduction of arms with extension of elbows and wrists
B) Adduction of arms with flexion of elbows and wrists
C) Flaccid paralysis with no motor response
D) Opisthotonos with rigid extension of the spine
, Correct Answer: Adduction of arms with flexion of elbows and wrists
Expert Rationale: Decorticate posturing, also called "flexor posturing" or "mummy baby," involves
adduction of arms with flexion of elbows and wrists. This indicates damage to the corticospinal tracts
above the brainstem. Decerebrate posturing involves extension and is more severe.
6. Which of the following is a complication of prolonged immobility affecting the gastrointestinal
system?
A) Muscle atrophy and joint contractures
B) Urinary stasis and renal calculi
C) Constipation and bowel impaction
D) Atelectasis and pneumonia
Correct Answer: Constipation and bowel impaction
Expert Rationale: Prolonged immobility decreases peristalsis, leading to constipation and, if severe,
bowel impaction. Muscle atrophy affects the musculoskeletal system, urinary stasis affects the
genitourinary system, and atelectasis affects the respiratory system.
7. A patient with localized scleroderma asks the nurse about the expected skin changes. Which
description is most accurate?
A) Red, raised, scaly plaques
B) Thick, pale center with a purple border
C) Fluid-filled blisters
D) Black, necrotic eschar
Correct Answer: Thick, pale center with a purple border
Expert Rationale: Localized scleroderma presents with skin and connective tissue that harden and
tighten, forming patches that are thick, white or pale in the center, surrounded by a purple border. The
other options describe other dermatologic conditions.
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the earliest and most sensitive indicator of rising intracranial
pressure?
A) Bradycardia with a widening pulse pressure
B) Irregular respirations and Cheyne-Stokes pattern
C) Lethargy and decreased level of consciousness
D) Hypertension with a widening pulse pressure
Correct Answer: Lethargy and decreased level of consciousness
Expert Rationale: A change in level of consciousness, such as lethargy or delayed responses, is the
earliest and most sensitive indicator of rising ICP. Cushing's triad (hypertension, bradycardia, irregular
respirations) is a late, ominous sign of brainstem compression that requires immediate intervention.
2. A patient with Lyme disease presents with a characteristic skin lesion. Which finding would the nurse
expect to observe?
A) Diffuse, red, sandpaper-like rash across the trunk
B) Bull's-eye rash with central clearing (erythema migrans)
C) Vesicular rash in a dermatomal pattern
D) Purple, non-blanching petechiae on the extremities
Correct Answer: Bull's-eye rash with central clearing (erythema migrans)
Expert Rationale: Erythema migrans, a red ring with central clearing, is the hallmark of early localized
Lyme disease. It appears at the site of the tick bite and is neither vesicular nor petechial. A sandpaper-
like rash is more typical of scarlet fever.
3. A patient is admitted with sudden onset of severe pain, redness, and swelling in the right great toe.
Which condition should the nurse suspect?
,A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Lyme disease
Correct Answer: Gout
Expert Rationale: Acute gouty arthritis typically presents with sudden, intense pain, erythema, and
swelling of the first metatarsophalangeal joint, a condition known as podagra. Rheumatoid arthritis and
osteoarthritis have more gradual onsets and different joint distribution patterns.
4. A nurse is caring for a patient with systemic scleroderma. Which body system requires priority
monitoring due to potential cardiac involvement?
A) Respiratory system
B) Cardiovascular system
C) Musculoskeletal system
D) Gastrointestinal system
Correct Answer: Cardiovascular system
Expert Rationale: Systemic scleroderma can cause myocardial fibrosis, pericarditis, and dysrhythmias,
making cardiovascular monitoring a priority. While pulmonary and renal involvement also occur, cardiac
complications are a leading cause of mortality in these patients.
5. A patient is demonstrating decorticate posturing. Which assessment finding best matches this
description?
A) Abduction of arms with extension of elbows and wrists
B) Adduction of arms with flexion of elbows and wrists
C) Flaccid paralysis with no motor response
D) Opisthotonos with rigid extension of the spine
, Correct Answer: Adduction of arms with flexion of elbows and wrists
Expert Rationale: Decorticate posturing, also called "flexor posturing" or "mummy baby," involves
adduction of arms with flexion of elbows and wrists. This indicates damage to the corticospinal tracts
above the brainstem. Decerebrate posturing involves extension and is more severe.
6. Which of the following is a complication of prolonged immobility affecting the gastrointestinal
system?
A) Muscle atrophy and joint contractures
B) Urinary stasis and renal calculi
C) Constipation and bowel impaction
D) Atelectasis and pneumonia
Correct Answer: Constipation and bowel impaction
Expert Rationale: Prolonged immobility decreases peristalsis, leading to constipation and, if severe,
bowel impaction. Muscle atrophy affects the musculoskeletal system, urinary stasis affects the
genitourinary system, and atelectasis affects the respiratory system.
7. A patient with localized scleroderma asks the nurse about the expected skin changes. Which
description is most accurate?
A) Red, raised, scaly plaques
B) Thick, pale center with a purple border
C) Fluid-filled blisters
D) Black, necrotic eschar
Correct Answer: Thick, pale center with a purple border
Expert Rationale: Localized scleroderma presents with skin and connective tissue that harden and
tighten, forming patches that are thick, white or pale in the center, surrounded by a purple border. The
other options describe other dermatologic conditions.
