MDC 4 EXAM 2 /APPROVED MDC 4 (NUR 2755) EXAM 2
ACTUAL TEST BANK 2026/2027 PRACTICE QUESTIONS
AND STUDY GUIDE COMPLETE ACCURATE EXAM REAL
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
DETAILED RATIONALES (100% RELIABLE SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION
|GUARANTEED PASS A+ (BRAND NEW!) |INSTANT
DOWNLOAD PDF
1. A client has been in a motor vehicle collision and presents with
signs and symptoms of increased intracranial pressure. What is the
most significant sign or symptom in increased ICP?
A. Pupil changes
B. Ipsilateral paralysis
C. Vomiting
D. Decrease in LOC
CORRECT ANSWER: D. Decrease in LOC
Rationale: A decrease in level of consciousness (LOC) is the most
significant and earliest indicator of increased intracranial pressure.
LOC changes reflect the brain's inability to maintain adequate
perfusion and function. While pupil changes, ipsilateral paralysis,
and vomiting can occur with increased ICP, they are later signs or
,may indicate specific locations of injury. Declining LOC requires
immediate intervention to prevent further neurological deterioration.
2. A client has recently suffered a stroke with left-sided weakness. A
nurse assesses for dysphagia, especially with thin liquids. Which
nursing intervention is most helpful in assessing this client to
swallow safely?
A. The client should avoid all liquids
B. Instructing to tuck the chin when swallowing
C. Give sips of water with each bite
D. Turn head to the left
CORRECT ANSWER: B. Instructing to tuck the chin when
swallowing
Rationale: Chin tucking (chin-down posture) is a compensatory
swallowing technique that helps protect the airway by narrowing the
airway entrance and slowing the transit of food through the pharynx.
This technique is particularly useful for patients with dysphagia
following a stroke. Complete avoidance of liquids is not therapeutic,
and turning the head to the left is not indicated. Giving sips of water
with each bite increases aspiration risk in a client with known
dysphagia.
3. A nurse assesses a 27-year-old female client who presents with
muscle weakness and decreased muscle coordination over the past
,few months. What nervous system disease is she most likely suffering
from?
A. Systemic lupus erythematosus
B. Multiple sclerosis
C. Guillain-Barré syndrome
D. Myasthenia gravis
CORRECT ANSWER: B. Multiple sclerosis
Rationale: Multiple sclerosis (MS) typically presents in young adults
(ages 20-40) with a gradual onset of symptoms including muscle
weakness, decreased coordination, and sensory disturbances. MS is
more common in women and is characterized by demyelination of
the central nervous system. Systemic lupus erythematosus can have
neurological symptoms but is primarily an autoimmune connective
tissue disease. Guillain-Barré syndrome typically presents with
ascending paralysis following an infection, and myasthenia gravis
presents with fluctuating muscle weakness that worsens with activity.
4. During an assessment of a recent seizure client, the nurse
interprets which finding is congruent with the postictal state?
A. The client's motor function is returning to baseline
B. The client states there is a visible aura
C. The client has brief jerking of the extremities
, D. The client's O2 saturation is 80%
CORRECT ANSWER: A. The client's motor function is returning to
baseline
Rationale: The postictal state is the recovery period following a
seizure, during which the client's motor function gradually returns to
baseline. This phase is characterized by confusion, fatigue, and
gradual return of normal neurological function. A visible aura occurs
before a seizure (preictal phase). Brief jerking of the extremities is
characteristic of the ictal phase. An O2 saturation of 80% indicates
hypoxia requiring immediate intervention, not a normal postictal
finding.
5. The client has a head injury and is presenting with signs and
symptoms of increased ICP. Which nursing intervention would be
helpful in reducing this pressure?
A. Place the neck in a neutral position to promote venous drainage
B. Suction hourly to stimulate the cough reflex
C. Add extra blankets to keep the client warm
D. Turn the client frequently to prevent skin impairment
CORRECT ANSWER: A. Place the neck in a neutral position to
promote venous drainage
ACTUAL TEST BANK 2026/2027 PRACTICE QUESTIONS
AND STUDY GUIDE COMPLETE ACCURATE EXAM REAL
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH
DETAILED RATIONALES (100% RELIABLE SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION
|GUARANTEED PASS A+ (BRAND NEW!) |INSTANT
DOWNLOAD PDF
1. A client has been in a motor vehicle collision and presents with
signs and symptoms of increased intracranial pressure. What is the
most significant sign or symptom in increased ICP?
A. Pupil changes
B. Ipsilateral paralysis
C. Vomiting
D. Decrease in LOC
CORRECT ANSWER: D. Decrease in LOC
Rationale: A decrease in level of consciousness (LOC) is the most
significant and earliest indicator of increased intracranial pressure.
LOC changes reflect the brain's inability to maintain adequate
perfusion and function. While pupil changes, ipsilateral paralysis,
and vomiting can occur with increased ICP, they are later signs or
,may indicate specific locations of injury. Declining LOC requires
immediate intervention to prevent further neurological deterioration.
2. A client has recently suffered a stroke with left-sided weakness. A
nurse assesses for dysphagia, especially with thin liquids. Which
nursing intervention is most helpful in assessing this client to
swallow safely?
A. The client should avoid all liquids
B. Instructing to tuck the chin when swallowing
C. Give sips of water with each bite
D. Turn head to the left
CORRECT ANSWER: B. Instructing to tuck the chin when
swallowing
Rationale: Chin tucking (chin-down posture) is a compensatory
swallowing technique that helps protect the airway by narrowing the
airway entrance and slowing the transit of food through the pharynx.
This technique is particularly useful for patients with dysphagia
following a stroke. Complete avoidance of liquids is not therapeutic,
and turning the head to the left is not indicated. Giving sips of water
with each bite increases aspiration risk in a client with known
dysphagia.
3. A nurse assesses a 27-year-old female client who presents with
muscle weakness and decreased muscle coordination over the past
,few months. What nervous system disease is she most likely suffering
from?
A. Systemic lupus erythematosus
B. Multiple sclerosis
C. Guillain-Barré syndrome
D. Myasthenia gravis
CORRECT ANSWER: B. Multiple sclerosis
Rationale: Multiple sclerosis (MS) typically presents in young adults
(ages 20-40) with a gradual onset of symptoms including muscle
weakness, decreased coordination, and sensory disturbances. MS is
more common in women and is characterized by demyelination of
the central nervous system. Systemic lupus erythematosus can have
neurological symptoms but is primarily an autoimmune connective
tissue disease. Guillain-Barré syndrome typically presents with
ascending paralysis following an infection, and myasthenia gravis
presents with fluctuating muscle weakness that worsens with activity.
4. During an assessment of a recent seizure client, the nurse
interprets which finding is congruent with the postictal state?
A. The client's motor function is returning to baseline
B. The client states there is a visible aura
C. The client has brief jerking of the extremities
, D. The client's O2 saturation is 80%
CORRECT ANSWER: A. The client's motor function is returning to
baseline
Rationale: The postictal state is the recovery period following a
seizure, during which the client's motor function gradually returns to
baseline. This phase is characterized by confusion, fatigue, and
gradual return of normal neurological function. A visible aura occurs
before a seizure (preictal phase). Brief jerking of the extremities is
characteristic of the ictal phase. An O2 saturation of 80% indicates
hypoxia requiring immediate intervention, not a normal postictal
finding.
5. The client has a head injury and is presenting with signs and
symptoms of increased ICP. Which nursing intervention would be
helpful in reducing this pressure?
A. Place the neck in a neutral position to promote venous drainage
B. Suction hourly to stimulate the cough reflex
C. Add extra blankets to keep the client warm
D. Turn the client frequently to prevent skin impairment
CORRECT ANSWER: A. Place the neck in a neutral position to
promote venous drainage
