Galen: NUR 265 (NUR265) Advanced Concepts of Medical-Surgical Nursing: Exam 3 (V2) Review Questions & Answers_ Latest .

Galen: NUR 265 (NUR265) Advanced Concepts of Medical-Surgical Nursing: Exam 3 (version 2) Review Questions & Answers_ Latest . ## NUR 265 Advanced Concepts of Medical-Surgical Nursing — Exam 3 ### Questions & Multiple Choices Only **1. Which of the following represents the priority of care for a burn patient during the resuscitation phase?** A. Aggressive administration of oral fluids and nutritional supplements. B. Placing the patient in a prone position and applying ice to the wounds. C. Initiating active range of motion and weight-bearing exercises. D. Prevention of infection and closure of the burn wound. **2. A patient is admitted with a burn injury. The nurse notes that the entire dermal layer is burned, destroying cells and dermal appendages such as sweat glands and hair follicles. What does the nurse understand about this skin change?** A. The skin cannot restore itself because the entire dermal layer and its appendages are destroyed. B. The skin will easily re-grow since parts of the basement membrane remain fully intact. C. The epidermis will grow back normally because nutrients can still diffuse from the subcutaneous tissue. D. The skin will rapidly regrow within 10–21 days with no scar formation. **3. A patient presents with a deep full-thickness burn. Which of the following visual and sensory findings does the nurse expect to assess?** A. Blackened and depressed appearance with completely absent sensation. B. Pink, moist wound bed that blanches rapidly with intense pain. C. Red, dry wound bed with white areas and moderate pain. D. Waxy white appearance with severe edema and exquisite tenderness to touch. **4. During the first 12 hours after a severe burn injury, a massive fluid shift occurs. Which clinical manifestation should the nurse anticipate?** A. Decreased blood viscosity and reduced peripheral edema. B. Significant diuresis and a dramatic rise in serum albumin. C. Tachycardia, hypotension, and rapid weight gain. D. Bradycardia, hypertension, and a severe drop in body weight. **5. Which of the following electrolyte and acid-base imbalances is expected in a patient during the emergent/resuscitation phase of a major burn?** A. Hypovolemia, metabolic alkalosis, hypokalemia, and hyponatremia. B. Hypervolemia, metabolic acidosis, hyperkalemia, and hypernatremia. C. Hypervolemia, respiratory alkalosis, hypokalemia, and hypernatremia. D. Hypovolemia, metabolic acidosis, hyperkalemia, and hyponatremia. **6. Why does hyperkalemia occur during the emergent phase of a burn injury?** A. Potassium is shifted into the cells as a result of metabolic alkalosis. B. The kidneys reabsorb excess potassium under the influence of aldosterone. C. Direct cell injury releases large amounts of intracellular potassium into the blood. D. Massive fluid resuscitation dilutes extracellular sodium, trapping potassium. **7. A nurse is reviewing labs for a patient admitted 10 hours ago with severe burns. The patient has not received adequate fluids. Which lab finding reflects hemoconcentration due to vascular dehydration?** A. Arterial pH of 7.48 and serum bicarbonate of 30 mEq/L. B. Hematocrit of 30% and hemoglobin of 9 g/dL. C. Hematocrit of 54% and hemoglobin of 19 g/dL. D. BUN of 8 mg/dL and serum sodium of 148 mEq/L. **8. A patient who was burned 48 hours ago is entering the diuretic stage of fluid remobilization. Which laboratory and clinical changes should the nurse expect?** A. Increased urinary output, hyponatremia, hypokalemia, and anemia. B. Anuria, hypokalemia, hypernatremia, and a sudden rise in hematocrit. C. Decreased urinary output, hyperkalemia, and severe hemoconcentration. D. Decreased urinary output, hypernatremia, hyperkalemia, and metabolic alkalosis. **9. A patient with 40% TBSA burns is at risk for developing Curling's ulcer. Which statement best describes the etiology of Curling's ulcer?** A. It is a chronic gastric ulcer caused by a bacterial infection from *Helicobacter pylori*. B. It is an acute gastroduodenal ulcer caused by reduced GI blood flow and mucosal damage. C. It is a duodenal ulcer caused by overproduction of pancreatic bicarbonate. D. It is an esophageal ulcer caused by the chronic backflow of acidic stomach secretions. **10. A patient with severe burns is in a hypermetabolic state. The nurse expects which of the following regarding the patient's nutritional and physiological needs?** A. Calorie needs peak within the first 12 hours and return to baseline after 24 hours. B. Calorie needs decrease rapidly to prevent excessive metabolic waste accumulation. C. Calorie needs can double or triple, peaking 4–12 days after the burn and remaining elevated until wounds close. D. Calorie needs remain normal, but protein intake must be completely restricted. **11. An emergency department nurse is caring for a patient who sustained dry chemical burns. What is the correct immediate action by the nurse?** A. Apply a thick layer of sterile water-soluble ointment to trap the chemicals. B. Brush off any dry chemicals present on the skin or clothing; do not wet them. C. Immediately irrigate the burned areas with a high-pressure water hose. D. Neutralize the chemical immediately with an opposite neutralizing agent. **12. What weight is used by the healthcare team to calculate the burn patient's fluid resuscitation rate, energy requirements, and drug dosages?** A. The patient's lowest weight recorded during the diuretic phase. B. The patient's current weight, including the weight of edema fluids. C. Preburn weight (dry weight). D. An estimated ideal body weight based on the patient's age and gender. **13. A nurse is caring for a patient who was rescued from a house fire. The nurse notes progressively hoarse voice, a brassy cough, difficulty swallowing, and drooling. What is the priority nursing interpretation of these findings?** A. They indicate severe upper airway injury and impending airway obstruction. B. They are normal signs of transient smoke irritation that do not require intervention. C. They are typical mild signs of carbon monoxide poisoning and will resolve with deep breathing. D. They indicate severe metabolic acidosis and require immediate IV bicarbonate. **14. A burn patient is being monitored for inhalation injury. The patient had been wheezing, but during the assessment, the nurse notes that the wheezing sounds have suddenly disappeared. What is the nurse's immediate action?** A. Encourage the patient to perform coughing and deep-breathing exercises. B. Administer a nebulized bronchodilator and reassess in 1 hour. C. Document that the patient's airway is improving and decrease the oxygen flow rate. D. Anticipate impending airway obstruction and prepare for immediate intubation. **15. Which statement best explains why a non-resuscitated burn patient may initially show delayed upper airway obstruction, only to develop severe airway edema during fluid resuscitation?** A. The direct contact of intravenous fluids with the pharyngeal wall stimulates swelling. B. Administering large volumes of normal saline causes a severe systemic allergic reaction. C. The heat damage occurs slowly, taking several hours to physically burn the larynx. D. Dehydration with hypovolemia limits initial swelling, but fluid resuscitation rehydrates tissues, causing them to swell rapidly. **16. A patient is admitted with carbon monoxide poisoning. What physical appearance and diagnostic finding should the nurse expect?** A. Cherry-red skin color and elevated carboxyhemoglobin levels. B. Cyanosis around the lips and a normal carboxyhemoglobin level. C. Pale, mottled skin and a severe drop in blood pH. D. Jaundice and a normal arterial oxygen saturation on a standard pulse oximeter. **17. A patient is admitted with deep partial-thickness burns on the chest. The nurse observes that chest movement is restricted and airway pressures on the ventilator are rising. What surgical procedure does the nurse anticipate?** A. An escharotomy of the chest. B. An emergency tracheostomy. C. A bilateral chest tube insertion. D. A decompressive craniotomy. **18. The nurse is caring for a patient who is undergoing fluid resuscitation for major burns. The patient's preburn weight is 70 kg, and the burn is estimated at 50% TBSA. Using the Parkland formula (4 mL/kg/%TBSA), how much fluid should be infused during the first 8 hours post-injury?** A. 14,000 mL B. 5,000 mL C. 3,500 mL D. 7,000 mL **19. A burn patient is admitted 2 hours after sustaining a major injury. The nurse calculates that the patient requires 12,000 mL of fluid in the first 24 hours. Over what time frame must the first half (6,000 mL) of the fluid be administered?** A. Over the next 4 hours. B. Over the next 12 hours. C. Over the next 6 hours. D. Over the next 8 hours. **20. What is the primary indicator used by the nurse to determine the adequacy of fluid resuscitation in a burn patient?** A. A complete resolution of peripheral and generalized edema. B. Hourly urine output of 0.5 mL/kg/hr or 30–50 mL/hr. C. A rapid increase in the patient's central venous pressure. D. A return of hematocrit and hemoglobin to baseline values. **21. A burn patient's urine output has dropped below 20 mL/hour. What is the correct nursing action during the resuscitation phase?** A. Administer a dose of furosemide (Lasix) as prescribed. B. Give a rapid bolus of 500 mL of 3% hypertonic saline. C. Titrate and increase the rate of the prescribed IV fluid infusion; do not give diuretics. D. Restrict fluid intake to prevent severe capillary leak and pulmonary edema. **22. Under what circumstance is mannitol, an osmotic diuretic, indicated during burn resuscitation?** A. In patients with electrical burns with muscle damage to flush out myoglobin. B. In patients with minor superficial burns who exhibit mild edema. C. To decrease pulmonary edema in a patient with severe inhalation injury. D. In patients with severe hypovolemia to rapidly increase blood pressure. **23. A nurse is preparing to administer pain medication to a patient in the resuscitation phase of a major burn. What is the correct route of administration and why?** A. Intravenous (IV) route, to prevent delayed rapid absorption leading to lethal blood levels. B. Intramuscular (IM) route, to ensure sustained and slow release of the drug. C. Subcutaneous route, to manage localized pain at the wound edges. D. Oral route, to avoid invading skin integrity and reducing infection risk. **24. A patient with deep partial-thickness burns is scheduled for daily hydrotherapy. What should the nurse include in the plan of care?** A. Use a special shower table and wash with mild soap and room-temperature water; do not immerse the patient in a tub. B. Immerse the patient in a whirlpool tub to facilitate deep mechanical debridement. C. Apply cold water to the wounds to prevent shivering and promote comfort. D. Avoid debriding any loose skin or opening blisters to prevent auto-contamination. **25. A patient who has healed from major burn grafts is prescribed compression garments. How should the nurse instruct the patient to wear these garments?** A. Wear them for 8 hours a night while sleeping for the next 3 weeks. B. Wear them 23 hours a day, every day, for 12 to 24 months. C. Wear them only during active exercise and physical therapy sessions. D. Wear them continuously for 7 days without removal, then discard. **26. Which statement best defines the clinical syndrome of shock?** A. Widespread blood vessel constriction that elevates systemic arterial pressure. B. Abnormal cellular metabolism that occurs when tissue perfusion and gas exchange needs are not met. C. A chronic cardiac disease characterized by structural damage to the myocardium. D. An acute drop in blood pressure caused solely by a lack of circulating red blood cells. **27. What is the minimum Mean Arterial Pressure (MAP) required to maintain organ and tissue perfusion, and what occurs when MAP falls below 65 mmHg in shock?** A. A MAP of 50 mmHg is required, and a MAP 40 mmHg causes immediate cardiac arrest. B. A MAP of 80 mmHg is required, and a MAP 75 mmHg triggers irreversible cellular death. C. A MAP of 100 mmHg is required, and a MAP 90 mmHg indicates distributive shock. D. A MAP of 60 mmHg is needed to perfuse tissues, but a MAP 65 mmHg is seen in shock. **28. What is the earliest compensatory clinical sign of shock that a nurse should recognize?** A. Decreased respiratory rate (bradypnea). B. Increased heart rate (tachycardia). C. A sudden drop in systolic blood pressure. D. Profuse sweating and generalized warmth. **29. The nurse is caring for a patient who has experienced direct pump failure due to a myocardial infarction. What type of shock is this patient experiencing?** A. Cardiogenic shock. B. Hypovolemic shock. C. Obstructive shock. D. Distributive shock. **30. Which of the following occurs in distributive shock?** A. Blood volume is distributed to the interstitial tissues, where it cannot perfuse organs. B. The total body fluid volume is severely decreased due to external hemorrhage. C. The heart muscle is structurally damaged, causing a decrease in contractility. D. Physical conditions outside the heart prevent the ventricles from filling properly. **31. A patient is admitted with neurogenic shock after a severe spinal cord injury. Which hemodynamic finding is unique to neurogenic shock compared to other types of shock?** A. Hypotension and severe tachycardia. B. Hypotension and bradycardia. C. Hypertension and bradycardia. D. Narrowed pulse pressure and extreme tachypnea. **32. A patient experiences severe burns and is diagnosed with distributive shock. The nurse understands this capillary leak syndrome is a response to which chemical?** A. Histamine and other substances that enlarge capillary pores. B. Antidiuretic hormone causing massive fluid retention in the intravascular space. C. Excessive amounts of epinephrine causing coronary vasoconstriction. D. Acetylcholine blocking receptors at the neuromuscular junction. **33. A patient is diagnosed with obstructive shock. Which of the following conditions is a common cause of this type of shock?** A. Myocardial infarction and ventricular dysrhythmias. B. Anaphylaxis and widespread septicemia. C. Severe dehydration and heavy diarrhea. D. Cardiac tamponade and pulmonary embolism. **34. During the initial stage of shock, which of the following physiological changes occurs?** A. MAP decreases by more than 20 mmHg, and vital organs experience profound anoxia. B. MAP decreases by 10–15 mmHg, lactic acid rises significantly, and the patient reports intense thirst. C. MAP decreases by less than 10 mmHg, heart rate increases slightly, and mild vasoconstriction occurs. D. Severe metabolic acidosis and hyperkalemia occur as compensatory mechanisms completely fail. **35. A patient in shock is anxious, has a 12 mmHg drop in MAP, reports intense thirst, and has a decreased urine output. The nurse recognizes the patient is in which stage of shock?** A. Progressive (decompensated) stage. B. Initial stage. C. Non-progressive (compensatory) stage. D. Refractory (irreversible) stage. **36. A nurse is assessing a patient in the progressive stage of shock. Which clinical findings are expected?** A. Rapid loss of consciousness, non-palpable pulses, and unmeasurable oxygen saturation. B. Rapid weak pulse, hypotension, anuria, cyanosis of the oral mucosa, and a 5%–20% decrease in oxygen saturation. C. Slight increase in diastolic blood pressure, warm extremities, and normal urine output. D. Severe hypertension, bradycardia, and a bounding peripheral pulse. **37. A patient in shock has been in the progressive stage for over an hour without intervention. For which complication is the patient at highest risk?** A. Multiple organ dysfunction syndrome (MODS) and permanent brain/kidney damage. B. A sudden increase in the glomerular filtration rate (GFR). C. Severe respiratory alkalosis and profound hypokalemia. D. An immediate transition back to the reversible initial stage of shock. **38. A nurse assesses a patient in the refractory stage of shock. Which of the following statements is true regarding this stage?** A. The cardiovascular symptoms are highly reversible with coronary artery dilation. B. Therapy, including fluid replacement, is not effective in saving the patient's life, even if the cause is corrected and MAP temporarily normalizes. C. The patient's oxygen saturation rises rapidly due to hyperventilation. D. The patient can easily be saved if high doses of vasopressors and crystalloids are administered. **39. Why are anxiety and restlessness the earliest neuromuscular manifestations of shock?** A. Because of a sudden increase in the central venous pressure. B. Because of a rapid shift of potassium into the intracellular fluid. C. Because of a systemic allergic reaction to circulating lactic acid. D. Because the brain is highly vulnerable to oxygen and glucose deprivation. **40. A nurse is preparing to administer blood products to a patient in hypovolemic shock. What fluid must be used to prime the tubing, and why?** A. Lactated Ringer's, to prevent metabolic acidosis in the infusing blood. B. Sterile water, to maintain normal blood viscosity and prevent hemoconcentration. C. Dextrose 5% in water, to prevent rapid hemolysis of red blood cells. D. Normal saline (0.9% NaCl), because the calcium in Lactated Ringer's induces clotting of the infusing blood. **41. A patient is suspected of having early sepsis. Which clinical findings would meet the criteria for Systemic Inflammatory Response Syndrome (SIRS)?** A. Absent bowel sounds, platelet count of 150,000/mm³, and blood glucose of 90 mg/dL. B. WBC of 8,000/mm³, blood pressure of 120/80 mmHg, and urine output of 50 mL/hr. C. Heart rate 90 bpm, respiratory rate 20 breaths/min, and temperature 101°F (38.3°C). D. Heart rate 60 bpm, respiratory rate 12 breaths/min, and temperature of 98.6°F. **42. A nurse is implementing the Surviving Sepsis Care Bundle for a patient with suspected severe sepsis. Which intervention must be completed within the first 3 hours?** A. Measure serum lactate levels, obtain blood cultures, and administer broad-spectrum antibiotics. B. Administer vasopressors and measure central venous pressure (CVP). C. Insert an arterial line and restrict fluid intake to 1,500 mL daily. D. Perform a lumbar puncture and initiate therapeutic hypothermia. **43. If a septic patient's hypotension does not respond to initial fluid resuscitation, which intervention is required within 6 hours of initial manifestations?** A. Initiate a barbiturate coma to decrease metabolic demand. B. Give intravenous fludrocortisone to expand the blood volume. C. Administer vasopressors, such as norepinephrine, to maintain a MAP ≥65 mmHg. D. Administer a large dose of a loop diuretic to promote renal blood flow. **44. During severe sepsis, what occurs in the "hyperdynamic" state, and why is it often missed?** A. The patient experiences a sudden drop in cardiac output and cold extremities; it is missed because the patient appears to be sleeping. B. The patient has increased cardiac output, warm extremities, and rapid respirations; it is missed because of its short duration. C. The patient develops severe bradycardia and hypertension; it is missed because the blood pressure seems normal. D. The patient has a normal heart rate and high urine output; it is missed because the labs are completely normal. **45. A patient in septic shock is suspected of developing Disseminated Intravascular Coagulation (DIC). What is the earliest clinical sign of DIC that the nurse should monitor for?** A. Severe chest pain and sudden shortness of breath. B. Oozing of blood from IV sites, stick sites, or gums. C. Rapidly increasing urine output with low specific gravity. D. A sudden increase in the platelet count above 450,000/mm³. **46. A patient in shock requires vasoactive medications. How should the nurse administer these drugs?** A. Through a large-bore peripheral line at a fixed, unchangeable infusion rate. B. Through a peripheral IV line, administered as a rapid, repeated IV bolus. C. Through a central line, with the dosage titrated to the patient's response. D. Orally on an empty stomach to facilitate rapid absorption. **47. Which of the following is a key nursing assessment specific to the administration of vasoconstrictor drugs like dopamine or norepinephrine?** A. Monitor for profound hypoglycemia and severe metabolic alkalosis. B. Assess for a decrease in body temperature and monitor pupil sizes hourly. C. Assess the infusion site every 30 minutes for extravasation, and monitor for chest pain and headache. D. Assess for signs of severe hypoxemia by checking carboxyhemoglobin levels. **48. What is the primary action and nursing precaution associated with coronary vasodilating agents like sodium nitroprusside in shock management?** A. They cause profound renal vasoconstriction, leading to immediate acute kidney injury. B. They enhance myocardial perfusion but can cause systemic vasodilation and worsen shock if the patient is volume-depleted. C. They increase heart rate and must be avoided in patients with bradycardia. D. They decrease cardiac output and must only be given to hypervolemic patients. **49. Which of the following is a key target outcome for a patient being treated with the Surviving Sepsis Care Bundle?** A. Systolic blood pressure 90 mmHg and heart rate 60 bpm. B. CVP of 8 mmHg or higher, central venous O₂ saturation of at least 70%, and normal lactate levels. C. Total fluid restriction to 1,500 mL and a serum sodium of 130 mEq/L. D. CVP of 3–8 mmHg, arterial pH of 7.45, and a urine specific gravity of 1.035. **50. In Multiple Organ Dysfunction Syndrome (MODS), which organ system is the most profound and critical to lose first?** A. The liver. B. The gastrointestinal tract. C. The kidneys. D. The heart. **51. A patient presents with a highly contagious inflammation of the meninges of the brain and spinal cord. If untreated, how quickly can this medical emergency become fatal?** A. Within 48 hours. B. Within 12 hours. C. Within 24 hours. D. Within 4 hours. **52. Which population has the highest rate of infection from life-threatening *Neisseria meningitidis* meningococcal meningitis?** A. Adults over 65 years of age. B. Infants under 1 year of age. C. Children between ages 5 and 10. D. People ages 16–21 years. **53. A nurse is assessing a patient for classic signs of meningitis. Which of the following findings should the nurse expect?** A. Nuchal rigidity, photophobia, phonophobia, severe unrelenting headache, and fever. B. Flaccid facial paralysis, loss of taste, and severe pain behind the ears. C. Ascending flaccid paralysis beginning in the lower extremities with normal temperature. D. Unilateral sharp facial spasms triggered by light touch or chewing. **54. The nurse is performing Kernig's sign on a patient suspected of having meningitis. How is this sign assessed, and what constitutes a positive result?** A. The nurse applies light pressure to the temporal area; a positive result is severe bilateral facial twitching. B. The nurse flexes the patient's hip 90 degrees and then extends the knee; a positive result is pain upon knee extension. C. The nurse rapidly flexes the patient's neck; a positive result is involuntary flexion of the hips and knees. D. The nurse pinches the patient's trapezius muscle; a positive result is spontaneous upward eye deviation. **55. The nurse is performing Brudzinski's sign on a patient. What is the correct technique and positive finding?** A. The nurse hyperextends the patient's neck; a positive sign is pupillary constriction and bradycardia. B. The nurse rapidly flexes the patient's neck while supine; a positive sign is involuntary flexion of the knees and ankles. C. The nurse strokes the lateral aspect of the sole of the foot; a positive sign is fanning of the toes. D. The nurse pinches the Achilles tendon; a positive sign is plantar flexion and hip abduction. **56. A nurse is comparing clinical findings to differentiate between bacterial and viral meningitis. Which of the following is a key clinical differentiator?** A. Bacterial meningitis causes ascending flaccid paralysis; viral meningitis causes unilateral facial droop. B. Bacterial meningitis presents with a temperature 104°F (40°C) and a petechial rash; viral meningitis has a temperature 104°F and no petechial rash. C. Viral meningitis is associated with severe nuchal rigidity, while bacterial meningitis lacks neck stiffness. D. Bacterial meningitis causes pupillary dilation, whereas viral meningitis causes pinpoint pupils. **57. The healthcare team is performing a lumbar puncture on a patient suspected of having meningitis. What are the typical cerebrospinal fluid (CSF) findings in bacterial meningitis?** A. Cloudy appearance, increased WBCs, increased protein, and decreased glucose. B. Clear appearance, increased WBCs, increased protein, and normal glucose. C. Cloudy appearance, decreased WBCs, decreased protein, and elevated glucose. D. Clear appearance, decreased WBCs, normal protein, and decreased glucose. **58. What are the typical cerebrospinal fluid (CSF) findings in viral meningitis?** A. Cloudy appearance, increased WBCs, increased protein, and decreased glucose. B. Clear appearance, increased WBCs, increased protein, and normal glucose. C. Clear appearance, decreased WBCs, decreased protein, and elevated glucose. D. Cloudy appearance, normal WBCs, decreased protein, and normal glucose. **59. A patient is admitted with suspected meningococcal meningitis. What isolation precautions must the nurse implement?** A. Standard precautions only, as meningococcal meningitis is not transmitted person-to-person. B. Airborne precautions, requiring a negative-pressure room and an N95 respirator. C. Contact precautions only, requiring gowns and gloves for all patient interactions. D. Droplet precautions in addition to standard precautions, in a private room, staying at least 3 feet away unless wearing a mask. **60. During a neurological assessment of a patient with meningitis, the nurse notes a defect in cranial nerve VI (abducens nerve), manifested by an inability to move the eyes laterally. What does this finding indicate?** A. An expected, harmless side effect of high-dose corticosteroids. B. A temporary visual deficit caused by extreme photophobia. C. The onset of Herpes Simplex Virus type 1 reactivation. D. The development of hydrocephalus and increased intracranial pressure (ICP). **61. A patient is diagnosed with *Neisseria meningitidis*. Which prophylaxis treatment should be prescribed for close contacts of this patient?** A. Acyclovir, famciclovir, or valacyclovir. B. Gentamycin sulfate and polymyxin B. C. High-dose dexamethasone and mannitol. D. Rifampin, ciprofloxacin, or ceftriaxone. **62. A nurse is caring for a patient with encephalitis. What is a key clinical differentiator in the presentation of encephalitis compared to meningitis?** A. Encephalitis is characterized by a thick purulent exudate (pus) in the CSF. B. Mental status changes, such as acute confusion, irritability, and personality changes, are much more extensive in encephalitis. C. Encephalitis is always a non-viral, sterile inflammation of the spinal cord. D. Encephalitis presents with a normal temperature and a complete absence of nuchal rigidity. **63. Which of the following is the drug of choice for Herpes Simplex Virus (HSV) encephalitis?** A. Riluzole. B. Acyclovir. C. Pyridostigmine. D. Carbamazepine. **64. A nurse is caring for a patient with severe encephalitis who has increased intracranial pressure (ICP). What is the correct action regarding airway management?** A. Delegate the UAP to perform deep tracheal suctioning every 30 minutes. B. Perform deep tracheal suctioning if the respiratory status is compromised, even if ICP is present. C. Keep the head of the bed flat at 0 degrees to prevent cerebrospinal fluid leakage. D. Avoid all tracheal suctioning entirely, as suctioning is strictly contraindicated in patients with elevated ICP. **65. A nurse is assessing a patient with Trigeminal Neuralgia (Tic Douloureux). What are the key features of this condition?** A. Progressive ascending weakness in facial muscles accompanied by loss of taste. B. Constant dull, throbbing pain radiating to both shoulders, worse when lying supine. C. Unilateral, sudden, intense, excruciating, sharp, shooting, or burning facial pain provoked by minimal stimulation. D. Bilateral flaccid facial paralysis with drooping of the mouth and excessive tearing. **66. Which of the following is the first-choice drug therapy for Trigeminal Neuralgia?** A. Carbamazepine. B. Acyclovir. C. Pyridostigmine. D. Riluzole. **67. A patient has undergone a Percutaneous Stereotactic Rhizotomy (PSR) for Trigeminal Neuralgia. What should the nurse include in the post-procedure teaching?** A. Chew on the affected side of the mouth immediately to promote healing of the trigeminal fiber. B. Rub the eye vigorously to stimulate nerve recovery, and avoid brushing the teeth entirely. C. Avoid rubbing the eye on the affected side, inspect the eye daily for redness, and get regular dental exams. D. Expect severe, throbbing headaches and immediately notify the surgeon if any numbness occurs. **68. What is the hallmark clinical presentation of Bell's Palsy (Facial Paralysis)?** A. A high fever accompanied by a petechial/hemorrhagic rash on the neck. B. Sudden, excruciating facial spasms triggered by chewing or light touch. C. Rapid onset of unilateral facial paralysis that often occurs overnight. D. Slow, progressive bilateral facial wasting occurring over several months. **69. Which cranial nerves are affected in Bell's Palsy?** A. Acute paralysis of cranial nerve VII (facial), but may also affect V (trigeminal) and VIII (auditory). B. Paralysis of cranial nerve IX (glossopharyngeal) and X (vagus). C. Paralysis of cranial nerve XI (accessory) and XII (hypoglossal). D. Isolated paralysis of cranial nerve III (oculomotor) and IV (trochlear). **70. A nurse is planning care for a patient with Bell's Palsy. Which intervention is essential to prevent corneal ulceration?** A. Teach the patient to manually close the eyelid, instill artificial tears during the day, and apply ointment with an eye patch at night. B. Apply warm, dry compresses to the affected eye every 15 minutes. C. Instruct the patient to keep the affected eye wide open and exposed to bright light to stimulate the nerve. D. Administer high-dose mannitol to decompress the facial nerve root. **71. Which of the following best describes the pathophysiology of Myasthenia Gravis (MG)?** A. An acute autoimmune attack that destroys the myelin sheath of peripheral nerves, causing ascending paralysis. B. A progressive demyelination of the central nervous system axons in the brain and spinal cord. C. An autoimmune disease where antibodies attach to and destroy acetylcholine receptors (AChRs), reducing nerve impulse transmission. D. A chronic degeneration of both upper and lower motor neurons, causing muscle wasting and spasticity. **72. A patient with Myasthenia Gravis presents with muscle weakness. What is the classic pattern of muscle weakness and fatigue in this disease?** A. Muscle strength increases during repetitive contractions, then rapidly declines. B. Weakness worsens with repetitive muscle use or exercise and improves with rest. C. Weakness is constant, does not improve with rest, and is accompanied by loss of sensation. D. Weakness begins in the lower extremities and rapidly ascends to the face within hours. **73. What is bulbar involvement in Myasthenia Gravis, and what are its clinical manifestations?** A. Involvement of the lower motor neurons of the leg, resulting in a stiff, clumsy, ataxic gait. B. Involvement of the autonomic vagus nerve, causing extreme bradycardia and severe bronchospasms. C. Involvement of facial expression, chewing, and speech muscles, resulting in a snarl-like smile, a hanging jaw, dysphagia, and dysarthria. D. Involvement of the ocular muscles, causing ptosis, diplopia, and incomplete eyelid closure. **74. A healthcare provider performs a Tensilon (edrophonium chloride) test on a patient. What is the mechanism of Tensilon, and what is a positive finding for Myasthenia Gravis?** A. It stimulates the release of calcium; a positive result is a severe muscle spasm around the eyes. B. It destroys circulating antibodies; a positive result is a sustained increase in muscle strength lasting several weeks. C. It inhibits the breakdown of acetylcholine; a positive result is a rapid, temporary improvement in muscle tone. D. It blocks acetylcholine receptors; a positive result is a temporary flaccid paralysis of the facial muscles. **75. What life-threatening adverse reaction can occur during a Tensilon (edrophonium) test, and what antidote must be available at the bedside?** A. Cardiac dysrhythmias or arrest; the antidote is atropine sulfate. B. Severe respiratory depression; the antidote is naloxone. C. Acute kidney failure; the antidote is high-dose mannitol. D. Severe anaphylaxis; the antidote is epinephrine. **76. A nurse is caring for a patient with Myasthenia Gravis who is hospitalized. What emergency equipment must the nurse maintain at the bedside?** A. A chest tube insertion tray, central venous line kit, and a defibrillator. B. A bag-valve-mask setup (Ambu bag), oxygen administration equipment, and suction equipment. C. An emergency tracheostomy kit, a lumbar puncture tray, and a cooling blanket. D. Double bulldog clamps, a shunt patency assessment device, and calcium gluconate. **77. Which of the following is the first-line management drug for Myasthenia Gravis, and what is the primary nursing instruction regarding its administration?** A. Riluzole; it must be taken on an empty stomach with a full glass of water. B. Carbamazepine; it must be taken only when severe facial spasms occur. C. High-dose dexamethasone; it must be taken immediately before bedtime. D. Pyridostigmine (Mestinon); it must be taken on time, 45 to 60 minutes before meals. **78. Which of the following drugs should be strictly avoided in patients with Myasthenia Gravis because they can increase muscle weakness?** A. Pyridostigmine, atropine sulfate, and normal saline. B. Magnesium, morphine, beta-blockers, and certain antibiotics like neomycin. C. Epinephrine, diphenhydramine, and insulin. D. Corticosteroids, NSAIDs, and acetaminophen. **79. A patient with Myasthenia Gravis has undergone a thymectomy. Postoperatively, the nurse assesses for which sudden, life-threatening complications?** A. SIADH with a severe drop in urine output. B. Ascending flaccid paralysis and severe diarrhea. C. Severe facial spasms and intense unilateral facial pain. D. Pneumothorax or hemothorax, manifested by sudden shortness of breath, chest pain, and diminished breath sounds. **80. A nurse is assessing a patient experiencing a Myasthenic Crisis. What are the expected clinical features?** A. Increased pulse, respirations, and blood pressure; absence of cough and swallow reflex; and improvement of symptoms with Tensilon. B. Sudden severe hypertension, bradycardia, and profuse sweating above the level of injury. C. Profound hypotension, bradycardia, hypothermia, and flaccid bowel. D. Severe bradycardia, bronchospasm, flaccid paralysis, pupillary constriction (miosis), and worsening of symptoms with Tensilon. **81. A patient is experiencing a Cholinergic Crisis. What is the cause of this crisis, what are the key clinical features, and what is the treatment?** A. Cause is under-medication; features include tachycardia, severe dry mouth, and improvement with Tensilon; treatment is pyridostigmine. B. Cause is over-medication; features include bradycardia, bronchospasm, hypersecretion (wet/moist), and worsening with Tensilon; treatment is IV atropine. C. Cause is severe hypovolemia; features include anuria and hemoconcentration; treatment is normal saline. D. Cause is stress or infection; features include autonomic dysreflexia and hypotension; treatment is nifedipine. **82. To improve nutrition and prevent aspiration in a patient with Myasthenia Gravis, which of the following should the nurse include in the plan of care?** A. Position the patient in a prone position and encourage large, fast bites. B. Instruct the patient to speak extensively during meals to maintain muscle strength. C. Serve thin liquids and encourage the patient to eat rapidly while lying supine. D. Thicken liquids, have the patient sit upright, eat slowly, and swallow with the chin tilted downward. **83. Which of the following is a progressive, fatal neuromuscular disease characterized by both upper and lower motor neuron degeneration, causing progressive muscle weakness, wasting, and spasticity leading to respiratory paralysis?** A. Myasthenia Gravis (MG). B. Guillain-Barré Syndrome (GBS). C. Amyotrophic Lateral Sclerosis (ALS). D. Trigeminal Neuralgia (TN). **84. A patient is diagnosed with Amyotrophic Lateral Sclerosis (ALS). What drug is approved to slow the disease/extend survival time, and what is key patient education regarding this drug?** A. Acyclovir; it must be taken with a high-fat meal, and the patient must monitor for acute renal failure. B. Carbamazepine; it must be taken at bedtime, and the patient must watch for visual hallucinations. C. Pyridostigmine; it must be taken 45 minutes before meals, and the patient must monitor for cholinergic crisis. D. Riluzole; it must be taken on an empty stomach, and the patient must monitor for liver toxicity (jaundice, vomiting) with frequent liver enzyme tests. **85. A patient with ALS is coughing and drooling. What does the nurse interpret from these findings, and what is the patient at high risk for?** A. The patient has developed autonomic dysreflexia and is at risk for a hypertensive stroke. B. The patient is experiencing a cholinergic crisis and is at risk for ventricular fibrillation. C. The patient has a temporary viral infection of the throat and is at risk for bacterial meningitis. D. The patient has severe dysphagia and is at high risk for choking and aspiration pneumonia. **86. What is the normal range for intracranial pressure (ICP), and at what level does pressure begin to impair cerebral circulation?** A. Normal ICP is 0–5 mmHg; pressures 10 mmHg impair cerebral circulation. B. Normal ICP is 10–15 mmHg; pressures 20 mmHg impair cerebral circulation. C. Normal ICP is 5–10 mmHg; pressures 15 mmHg impair cerebral circulation. D. Normal ICP is 15–25 mmHg; pressures 30 mmHg impair cerebral circulation. **87. How is Cerebral Perfusion Pressure (CPP) calculated, what is the normal target range, and what is the minimum CPP required to maintain adequate brain oxygenation?** A. CPP = MAP / ICP; target is 50–70 mmHg; must be maintained above 50 mmHg. B. CPP = MAP − ICP; target is 70–100 mmHg; must be maintained above 70 mmHg. C. CPP = MAP + ICP; target is 80–120 mmHg; must be maintained above 80 mmHg. D. CPP = (2 × DBP) + SBP; target is 60–80 mmHg; must be maintained above 60 mmHg. **88. What is the first and most sensitive clinical sign of increased intracranial pressure (ICP)?** A. Dilated, nonreactive pupils (blown pupils) and abnormal posturing. B. A declining level of consciousness (LOC), such as restlessness, irritability, or confusion. C. The development of Cushing's Triad (severe hypertension and bradycardia). D. Projectile vomiting without preceding nausea and a severe headache. **89. What are the components of Cushing's Triad, and what does its presence indicate in a patient with a head injury?** A. Hypotension, bradycardia, and poikilothermia; it indicates neurogenic shock. B. Severe hypertension, tachycardia, and hyperthermia; it indicates Systemic Inflammatory Response Syndrome (SIRS). C. Hypotension, tachycardia, and rapid shallow respirations; it indicates hypovolemic shock. D. Severe hypertension with a widened pulse pressure and bradycardia; it indicates severe ICP with loss of autoregulation and imminent brain herniation. **90. A nurse assesses a comatose patient and notes abnormal posturing. The patient's arms are crossed and flexed over the chest, wrists are flexed, and legs are extended with plantar flexion. How should the nurse document this posturing and what is its clinical significance?** A. Decerebrate posturing; indicates a severe problem with the midbrain or pons. B. Decorticate posturing; indicates a complete transection of the lower lumbar spinal cord. C. Decorticate posturing; indicates a problem/lesion in the corticospinal pathway or cerebral hemispheres. D. Decerebrate posturing; indicates a temporary spinal shock state. **91. A comatose patient's arms and legs are straight out and stiff, toes are pointed down, and the head and neck are arched backward. How should the nurse document this posturing and what does it indicate?** A. Decorticate posturing; indicates a lesion in the cerebral hemispheres. B. Decerebrate posturing; indicates resolving spinal shock. C. Flaccid posturing; indicates damage to the upper cervical nerve roots. D. Decerebrate posturing; indicates a severe dysfunction in the brainstem, midbrain, or pons, associated with a very poor prognosis. **92. Which of the following are essential nursing interventions to manage and lower increased intracranial pressure (ICP) in a head injury patient?** A. Keep the head of the bed flat, turn the head to the side, and cluster all nursing care to allow long rest periods. B. Place the patient in a prone position, flex the hips and knees to 90 degrees, and keep the room bright. C. Elevate HOB 30–45 degrees, maintain head in a midline neutral position, avoid hip/neck flexion, and do not cluster care. D. Elevate HOB 90 degrees, encourage vigorous coughing and deep breathing, and perform deep suctioning every 15 minutes. **93. A patient with increased ICP is prescribed mannitol. What is the mechanism of mannitol, what is a key nursing precaution during its administration, and how does the nurse know it is effective?** A. It is an osmotic diuretic that pulls water out of the brain tissue; it must be administered through a filter; effectiveness is shown by increased urine output. B. It is a glucocorticoid that reduces inflammation; it must be given on an empty stomach; effectiveness is shown by a normal body temperature. C. It is a loop diuretic that blocks sodium reabsorption; it must be given as a slow continuous infusion; effectiveness is shown by decreased blood pressure. D. It is a plasma expander that increases blood pressure; it must be given through a central line; effectiveness is shown by a decrease in urine output. **94. Why is furosemide (Lasix) often used as an adjunct to mannitol in patients with increased ICP?** A. It increases the uptake of sodium by the brain cells to prevent seizures. B. It prevents the crystallization of mannitol in the intravenous tubing. C. It directly dilates the cerebral blood vessels, rapidly increasing cerebral blood flow. D. It reduces the incidence of rebound increased ICP from mannitol, decreases blood volume, and decreases CSF production. **95. A nurse is caring for a patient with a traumatic brain injury. The nurse calculates a Glasgow Coma Scale (GCS) score. What change in the GCS score requires immediate notification to the healthcare provider?** A. A change of 2 points or more. B. Any change, regardless of the score. C. A change of 0.5 points. D. A change of 1 point. **96. A patient is admitted with a suspected basilar skull fracture. Which clinical assessment findings are characteristic of this injury?** A. Sudden flaccid paralysis of the face, drooling, and bilateral pupillary constriction. B. Cerebrospinal fluid (CSF) leaking from the nose or ears, halo sign, Battle's sign, and raccoon eyes. C. Severe hypertension, bradycardia, and a widened pulse pressure. D. Unilateral sharp facial pain triggered by light touch, eating, or talking. **97. A patient with a head injury is suspected of having an epidural hematoma. Which classic presentation should the nurse closely monitor for?** A. A brief loss of consciousness followed by a lucid interval where the patient is awake and talking, followed by a rapid neurological decline. B. A slow, progressive decrease in level of consciousness accompanied by a chronic, worsening headache over several months. C. Ascending flaccid paralysis starting in the lower extremities and spreading to the respiratory muscles. D. Severe, throbbing facial pain provoked by light touch, smiling, or dental procedures. **98. Why does a subdural hematoma (SDH) typically have a higher mortality rate and slower bleeding than an epidural hematoma?** A. It involves venous bleeding, meaning it accumulates more slowly and can go unrecognized until severe neurological compromise occurs. B. It is caused by a fracture of the temporal bone, which is close to the carotid artery. C. It involves arterial bleeding into the space between the dura and the inner skull, causing immediate brainstem compression. D. It is a sterile, non-bleeding growth that arises solely from the pituitary gland. **99. What is the purpose of therapeutic hypothermia in a patient with a moderate-to-severe traumatic brain injury (TBI)?** A. To increase the production of cerebrospinal fluid to flush out microscopic blood clots. B. To freeze circulating antibodies responsible for destroying acetylcholine receptors in the brain. C. To promote systemic vasodilation and rapidly lower the patient's mean arterial pressure below 50 mmHg. D. To rapidly cool the core temperature to 89.6–93.2°F (32–34°C) for 24–48 hours to reduce brain metabolism and prevent secondary injury. **100. A patient has undergone a craniotomy for a supratentorial brain tumor. How should the nurse position the patient postoperatively?** A. Keep the head of the bed flat, and place the patient in a modified Trendelenburg position. B. Place the patient in a prone position with the head turned to the side where the bone fragment was removed. C. Keep the head of the bed completely flat or at a 10-degree angle, and place the patient side-lying. D. Elevate the HOB at least 30 degrees, avoid extreme hip or neck flexion, and maintain the head in a midline, neutral position.