Exam 4: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 22-year-old male is brought to the ED after a motorcycle crash. He was unconscious at the
scene, then briefly awake and conversant in the ambulance, and is now becoming increasingly
lethargic with a fixed dilated right pupil. CT scan reveals a lens-shaped hyperdense collection.
Which artery is most commonly responsible?
A. Anterior cerebral artery
B. Posterior communicating artery
C. Middle meningeal artery
D. Vertebral artery
Correct Answer: C
Rationale: Correct because the middle meningeal artery is the most common source of bleeding
in epidural hematomas, which typically result from temporal bone fractures that lacerate this
artery as it courses through the epidural space. This patient's presentation with the classic lucid
interval followed by rapid deterioration is pathognomonic for an arterial epidural hematoma
expanding under high pressure. The priority nursing action is to recognize this neurosurgical
emergency and prepare the patient for immediate surgical evacuation via burr holes or
craniotomy to prevent brain herniation and death.
,Q2: A 38-year-old female with severe sepsis from pneumonia develops worsening hypoxemia
despite 100% oxygen via non-rebreather mask. ABG shows PaO₂ 58 mmHg on FiO₂ 1.0. Chest
X-ray reveals bilateral diffuse infiltrates. What is the calculated PaO₂/FiO₂ ratio?
A. 58 mmHg
B. 100 mmHg
C. 158 mmHg
D. 200 mmHg
Correct Answer: A
Rationale: Correct because the PaO₂/FiO₂ ratio is calculated by dividing the arterial oxygen
tension by the fraction of inspired oxygen, so 58 mmHg divided by 1.0 equals 58 mmHg, which
meets the criteria for severe ARDS according to the Berlin Definition. This patient's presentation
with refractory hypoxemia despite 100% oxygen and bilateral infiltrates is consistent with the
inflammatory alveolar-capillary permeability disruption that characterizes ARDS. The nurse
must anticipate lung-protective ventilation strategies including low tidal volumes and appropriate
PEEP to minimize ventilator-induced lung injury while improving oxygenation.
Q3: A 29-year-old male sustained a basilar skull fracture 24 hours ago. The nurse notes clear
fluid draining from his right ear. To differentiate CSF from nasal secretions, the nurse places a
drop of fluid on sterile gauze and observes a blood center with a clear ring surrounding it. This
finding is called:
A. Kernig's sign
B. Brudzinski's sign
C. Cushing's triad
D. Halo sign
Correct Answer: D
Rationale: Correct because the halo sign, demonstrated by a blood center with a clear
surrounding ring when drainage is placed on sterile gauze, occurs because cerebrospinal fluid
spreads outward while blood remains centralized, differentiating CSF from nasal secretions or
blood. This patient's presentation with a basilar skull fracture and clear ear drainage requires
careful assessment for CSF otorrhea because unrecognized leaks increase the risk of meningitis
from bacterial ascent. The nurse must never pack the ear canal tightly, must place a loose sterile
collection pad, and must maintain the head of bed elevated to reduce intracranial pressure while
monitoring for signs of infection.
, Q4: A 68-year-old female is 3 days post-ischemic stroke involving the right cerebral hemisphere.
During morning care, the nurse places items on the patient's left side, but the patient consistently
fails to acknowledge or use them. This behavior is most consistent with:
A. Broca's aphasia
B. Unilateral neglect syndrome
C. Wernicke's aphasia
D. Homonymous hemianopsia
Correct Answer: B
Rationale: Correct because unilateral neglect syndrome, most commonly associated with right
hemisphere strokes, is characterized by failure to attend to or acknowledge stimuli on the
contralateral left side despite intact visual fields and primary sensory pathways. This patient's
presentation requires the nurse to approach from the unaffected side, place essential items on the
unaffected side, and teach scanning techniques to compensate for the perceptual deficit. The
condition is distinct from homonymous hemianopsia, which is a visual field defect, and from
aphasia, which involves language impairment rather than spatial inattention.
Q5: A 45-year-old female with myasthenia gravis reports increasing muscle weakness that
worsens as the day progresses and improves after resting. She has difficulty keeping her eyelids
open in the evening. This pattern of weakness is most consistent with:
A. Fatigable weakness that improves with rest
B. Fixed paralysis without fluctuation
C. Weakness that improves with activity
D. Progressive spasticity without remission
Correct Answer: A
Rationale: Correct because myasthenia gravis produces fatigable weakness that worsens with
sustained activity and improves with rest, due to antibody-mediated destruction of acetylcholine
receptors at the neuromuscular junction leading to decreased receptor availability with repeated
stimulation. This patient's presentation with ptosis and generalized weakness that worsens in the
evening is the hallmark clinical pattern of myasthenia gravis and distinguishes it from other
neuromuscular disorders. The nurse must teach the patient to plan activities during peak
medication effect, avoid precipitating factors such as infection and stress, and recognize early
signs of myasthenic crisis requiring emergency intervention.
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Content Focus :
Advanced Neuro-Trauma, Stroke Rehabilitation & Critical Care Respiratory Emergencies
Q1: A 22-year-old male is brought to the ED after a motorcycle crash. He was unconscious at the
scene, then briefly awake and conversant in the ambulance, and is now becoming increasingly
lethargic with a fixed dilated right pupil. CT scan reveals a lens-shaped hyperdense collection.
Which artery is most commonly responsible?
A. Anterior cerebral artery
B. Posterior communicating artery
C. Middle meningeal artery
D. Vertebral artery
Correct Answer: C
Rationale: Correct because the middle meningeal artery is the most common source of bleeding
in epidural hematomas, which typically result from temporal bone fractures that lacerate this
artery as it courses through the epidural space. This patient's presentation with the classic lucid
interval followed by rapid deterioration is pathognomonic for an arterial epidural hematoma
expanding under high pressure. The priority nursing action is to recognize this neurosurgical
emergency and prepare the patient for immediate surgical evacuation via burr holes or
craniotomy to prevent brain herniation and death.
,Q2: A 38-year-old female with severe sepsis from pneumonia develops worsening hypoxemia
despite 100% oxygen via non-rebreather mask. ABG shows PaO₂ 58 mmHg on FiO₂ 1.0. Chest
X-ray reveals bilateral diffuse infiltrates. What is the calculated PaO₂/FiO₂ ratio?
A. 58 mmHg
B. 100 mmHg
C. 158 mmHg
D. 200 mmHg
Correct Answer: A
Rationale: Correct because the PaO₂/FiO₂ ratio is calculated by dividing the arterial oxygen
tension by the fraction of inspired oxygen, so 58 mmHg divided by 1.0 equals 58 mmHg, which
meets the criteria for severe ARDS according to the Berlin Definition. This patient's presentation
with refractory hypoxemia despite 100% oxygen and bilateral infiltrates is consistent with the
inflammatory alveolar-capillary permeability disruption that characterizes ARDS. The nurse
must anticipate lung-protective ventilation strategies including low tidal volumes and appropriate
PEEP to minimize ventilator-induced lung injury while improving oxygenation.
Q3: A 29-year-old male sustained a basilar skull fracture 24 hours ago. The nurse notes clear
fluid draining from his right ear. To differentiate CSF from nasal secretions, the nurse places a
drop of fluid on sterile gauze and observes a blood center with a clear ring surrounding it. This
finding is called:
A. Kernig's sign
B. Brudzinski's sign
C. Cushing's triad
D. Halo sign
Correct Answer: D
Rationale: Correct because the halo sign, demonstrated by a blood center with a clear
surrounding ring when drainage is placed on sterile gauze, occurs because cerebrospinal fluid
spreads outward while blood remains centralized, differentiating CSF from nasal secretions or
blood. This patient's presentation with a basilar skull fracture and clear ear drainage requires
careful assessment for CSF otorrhea because unrecognized leaks increase the risk of meningitis
from bacterial ascent. The nurse must never pack the ear canal tightly, must place a loose sterile
collection pad, and must maintain the head of bed elevated to reduce intracranial pressure while
monitoring for signs of infection.
, Q4: A 68-year-old female is 3 days post-ischemic stroke involving the right cerebral hemisphere.
During morning care, the nurse places items on the patient's left side, but the patient consistently
fails to acknowledge or use them. This behavior is most consistent with:
A. Broca's aphasia
B. Unilateral neglect syndrome
C. Wernicke's aphasia
D. Homonymous hemianopsia
Correct Answer: B
Rationale: Correct because unilateral neglect syndrome, most commonly associated with right
hemisphere strokes, is characterized by failure to attend to or acknowledge stimuli on the
contralateral left side despite intact visual fields and primary sensory pathways. This patient's
presentation requires the nurse to approach from the unaffected side, place essential items on the
unaffected side, and teach scanning techniques to compensate for the perceptual deficit. The
condition is distinct from homonymous hemianopsia, which is a visual field defect, and from
aphasia, which involves language impairment rather than spatial inattention.
Q5: A 45-year-old female with myasthenia gravis reports increasing muscle weakness that
worsens as the day progresses and improves after resting. She has difficulty keeping her eyelids
open in the evening. This pattern of weakness is most consistent with:
A. Fatigable weakness that improves with rest
B. Fixed paralysis without fluctuation
C. Weakness that improves with activity
D. Progressive spasticity without remission
Correct Answer: A
Rationale: Correct because myasthenia gravis produces fatigable weakness that worsens with
sustained activity and improves with rest, due to antibody-mediated destruction of acetylcholine
receptors at the neuromuscular junction leading to decreased receptor availability with repeated
stimulation. This patient's presentation with ptosis and generalized weakness that worsens in the
evening is the hallmark clinical pattern of myasthenia gravis and distinguishes it from other
neuromuscular disorders. The nurse must teach the patient to plan activities during peak
medication effect, avoid precipitating factors such as infection and stress, and recognize early
signs of myasthenic crisis requiring emergency intervention.
