NUR 114 EXAM 2 – MEDICAL-SURGICAL
NURSING
Jefferson State Community College | Complete
100-Question Test Bank | Verified Answers &
Detailed Rationales | 100% Pass Guarantee
EXAM 2 BLUEPRINT
Exam 2 covers medical-surgical nursing concepts
with emphasis on:
Approximate
Topic Area Percentage
Questions
Neurological Disorders &
20% 20
Increased ICP
Oncology & Hematology 20% 20
Perioperative Care & Pain
15% 15
Management
Fluid & Electrolyte
15% 15
Imbalances
, Approximate
Topic Area Percentage
Questions
Infection Control &
10% 10
Immunity
Pharmacology &
10% 10
Medication Administration
Clinical Judgment &
10% 10
Prioritization
SECTION 1: NEUROLOGICAL DISORDERS &
INCREASED ICP (Questions 1–20)
1. The nurse is monitoring a child for bleeding after
surgery for removal of a brain tumor. The nurse
checks the head dressing for the presence of blood
and notes a colorless drainage on the back of the
dressing. Which action should the nurse take
immediately?
,A) Notifythesurgeon
B) Reinforce thedressing
C) Document the findings andcontinuetomonitor
D) Circle theareaof drainage andcontinuetomonitor
Answer: A) Notifythesurgeon
Rationale: Colorless drainage onthedressingaftera
craniotomyindicates thepresenceofcerebrospinal
fluid (CSF) andneedsto be reportedtothesurgeon
immediately. CSF leakagecanleadtoinfectionand
increasedintracranial pressure. Reinforcing the
dressingorcontinuingtomonitordoesnotaddress the
urgentneedforintervention.
2. A child undergoes surgical removal ofa brain tumor.
Duringthepostoperativeperiod, thenurse notes that
the child is restless, thepulserate is elevated, andthe
blood pressure has decreasedsignificantly from the
baseline value. Thenursesuspects which
complication?
A) Increasedintracranial pressure
B) Hemorrhage
, C) Infection
D) Seizure activity
Answer: B) Hemorrhage
Rationale: Restlessness, tachycardia, andhypotension
aresigns ofhypovolemic shock, whichmay indicate
postoperativehemorrhage. Increased ICP would
presentwithbradycardia andhypertension (Cushing's
triad).
3. Thenurse is monitoring a 3-year-old child forsigns
and symptoms ofincreasedintracranial pressure (ICP)
afteracraniotomy. Whichearly signorsymptom
shouldthenursemonitorfor?
A) Bradycardia
B) Hypertension
C) Irritability
D) Fixed dilated pupils
Answer: C) Irritability
Rationale: Early signs ofincreased ICP in children
include irritability, restlessness, andchanges in level of
NURSING
Jefferson State Community College | Complete
100-Question Test Bank | Verified Answers &
Detailed Rationales | 100% Pass Guarantee
EXAM 2 BLUEPRINT
Exam 2 covers medical-surgical nursing concepts
with emphasis on:
Approximate
Topic Area Percentage
Questions
Neurological Disorders &
20% 20
Increased ICP
Oncology & Hematology 20% 20
Perioperative Care & Pain
15% 15
Management
Fluid & Electrolyte
15% 15
Imbalances
, Approximate
Topic Area Percentage
Questions
Infection Control &
10% 10
Immunity
Pharmacology &
10% 10
Medication Administration
Clinical Judgment &
10% 10
Prioritization
SECTION 1: NEUROLOGICAL DISORDERS &
INCREASED ICP (Questions 1–20)
1. The nurse is monitoring a child for bleeding after
surgery for removal of a brain tumor. The nurse
checks the head dressing for the presence of blood
and notes a colorless drainage on the back of the
dressing. Which action should the nurse take
immediately?
,A) Notifythesurgeon
B) Reinforce thedressing
C) Document the findings andcontinuetomonitor
D) Circle theareaof drainage andcontinuetomonitor
Answer: A) Notifythesurgeon
Rationale: Colorless drainage onthedressingaftera
craniotomyindicates thepresenceofcerebrospinal
fluid (CSF) andneedsto be reportedtothesurgeon
immediately. CSF leakagecanleadtoinfectionand
increasedintracranial pressure. Reinforcing the
dressingorcontinuingtomonitordoesnotaddress the
urgentneedforintervention.
2. A child undergoes surgical removal ofa brain tumor.
Duringthepostoperativeperiod, thenurse notes that
the child is restless, thepulserate is elevated, andthe
blood pressure has decreasedsignificantly from the
baseline value. Thenursesuspects which
complication?
A) Increasedintracranial pressure
B) Hemorrhage
, C) Infection
D) Seizure activity
Answer: B) Hemorrhage
Rationale: Restlessness, tachycardia, andhypotension
aresigns ofhypovolemic shock, whichmay indicate
postoperativehemorrhage. Increased ICP would
presentwithbradycardia andhypertension (Cushing's
triad).
3. Thenurse is monitoring a 3-year-old child forsigns
and symptoms ofincreasedintracranial pressure (ICP)
afteracraniotomy. Whichearly signorsymptom
shouldthenursemonitorfor?
A) Bradycardia
B) Hypertension
C) Irritability
D) Fixed dilated pupils
Answer: C) Irritability
Rationale: Early signs ofincreased ICP in children
include irritability, restlessness, andchanges in level of
