Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
NUR 242 Medical-Surgical Nursing Concepts
Exam 4 Comprehensive Examination
2026/2027 | Verified Questions
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts | University-Level Nursing
Students
50 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
Examination 4 Actual Exam | Academic Year 2026/2027
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
,Introduction
This examination contains 50 original Verified Questions organized into four core domains that follow the
official blueprint of the Galen College of Nursing NUR 242 Medical-Surgical Nursing Concepts course:
Domain 1, Neurological System and Alterations, with 13 questions; Domain 2, Sensory System Alterations
(Vision and Hearing), with 13 questions; Domain 3, Musculoskeletal System and Alterations, with 12
questions; and Domain 4, Integumentary System and Burn/Wound Care, with 12 questions. Every
question includes four choices, the correct response, and a rationale that explains the clinical reasoning.
All content in this document is original and has been written to reinforce the official Galen College of
Nursing NUR 242 course objectives for Examination 4, supporting actual exam readiness and clinical
proficiency for University-Level nursing students in the 2026/2027 academic year. The questions and
rationales follow the foundational medical-surgical nursing methodology of the NUR 242 course
materials, Ignatavicius' Medical-Surgical Nursing, and Harding's Medical-Surgical Nursing, and they
align with current evidence-based clinical care and patient safety guidelines. A full answer key and a per-
domain score tracker are provided at the end so that each domain can be checked and used to focus
further study.
Actual Questions
Domain 1: Neurological System and Alterations
Question 1. A nurse assesses a patient who opens eyes only to voice, utters
incomprehensible sounds, and withdraws from painful stimuli. What is the Glasgow Coma
Scale score?
A. 9
B. 7
C. 11
D. 13
Correct Answer: A
Rationale: The Glasgow Coma Scale scores eye opening (4 = spontaneous), verbal response (5 =
oriented), and motor response (6 = obeys commands). Eye opening to sound scores 3, incomprehensible
sounds score 2, and withdrawal from pain scores 4, for a total of 9. A score of 8 or below is a clinical
indicator of severe impairment and often precedes airway protection decisions. Calculating and
serializing this score is a core assessment skill in the NUR 242 course materials and Ignatavicius'
Medical-Surgical Nursing.
Question 2. Which finding in a patient with a head injury suggests early increased
intracranial pressure?
A. Bilaterally equal and briskly reactive pupils with a headache
B. A pupil that is sluggish and becoming less responsive to light on one side
C. A fixed and fully dilated pupil on both sides with no other changes
D. A blood pressure of 98/60 with a pulse of 64
Correct Answer: B
Rationale: An early sign of rising intracranial pressure is a unilateral pupil that becomes sluggish and
less responsive as the third cranial nerve is compressed against the tentorium, followed by the classic
Cushing response of hypertension, bradycardia, and irregular respirations. Bilateral fixed pupils and
severe vital sign changes occur later, when herniation is imminent. Serial neurologic checks are priority
nursing care in the NUR 242 curriculum for any patient with head trauma.
Question 3. A patient arrives 2 hours after sudden onset of right-sided weakness and
slurred speech, with no bleeding on head computed tomography. Which intervention is
appropriate?
A. Immediate aspirin without imaging confirmation
B. Surgical decompression as the first intervention
C. Intravenous thrombolytic therapy within the treatment window, after blood pressure control
D. Observation with repeat imaging in 24 hours
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
, Correct Answer: C
Rationale: For ischemic stroke within 4.5 hours of last known well and without hemorrhage on CT,
intravenous thrombolysis is indicated, with blood pressure kept below 185/110 mm Hg before
administration and antiplatelet agents withheld for 24 hours after therapy. Time from symptom onset
to treatment determines eligibility, and the NUR 242 curriculum reinforces that every minute saved
preserves brain tissue. The absence of blood on CT distinguishes ischemic from hemorrhagic stroke.
Question 4. A patient with sudden severe headache, vomiting, and a left facial droop has
blood in the subarachnoid space on CT. Which priority is correct?
A. Prevent further bleeding with blood pressure control and avoid anticoagulation
B. Administer thrombolytic therapy
C. Start full-dose heparin immediately
D. Give aspirin to prevent clot extension
Correct Answer: A
Rationale: Hemorrhagic stroke, including subarachnoid hemorrhage, is managed with blood pressure
control, reversal of any anticoagulation, and measures to prevent rebleeding; anticoagulants and
antiplatelet agents are avoided because they worsen bleeding. The treatment of hemorrhage is the
opposite of ischemic stroke treatment, which is why CT is obtained before any therapy. This distinction
is a critical nursing concept in the NUR 242 course materials.
Question 5. A patient with a seizure disorder is admitted after a tonic-clonic seizure that
lasted 6 minutes. Which intervention is most appropriate?
A. Restrain the patient's limbs until the seizure ends
B. Place a tongue blade between the teeth
C. Allow 15 more minutes of seizure before intervening
D. Administer a benzodiazepine such as lorazepam to terminate the seizure activity
Correct Answer: D
Rationale: A seizure lasting more than 5 minutes is treated as status epilepticus, with intravenous
lorazepam or diazepam as first-line therapy to stop the seizure, because prolonged seizure activity can
cause brain injury. Limbs are never restrained and nothing is placed in the mouth, since these actions
cause injury. After the event, the patient is positioned on the side and monitored for airway patency, a
key component of NUR 242 seizure care.
Question 6. Which nursing action is most important for a patient with bacterial
meningitis?
A. Maintain airborne precautions with negative pressure
B. Use droplet precautions for the first 24 hours of antimicrobial therapy
C. Use standard precautions only throughout the admission
D. Wear a high-efficiency respirator at all times
Correct Answer: B
Rationale: Bacterial meningitis requires droplet precautions for the first 24 hours of effective
antimicrobial therapy, because transmission occurs through respiratory droplets and the patient
becomes noninfectious soon after treatment begins. Airborne precautions are used for tuberculosis and
other airborne diseases, and Neisseria meningitidis, the most common communicable cause, is covered
by droplet isolation. This infection control measure is a key NUR 242 nursing standard.
Question 7. A patient with Parkinson disease is prescribed carbidopa-levodopa 30 minutes
before meals. Which later instruction is correct?
A. Take it at the same time each day before food because protein and the emptying of the stomach
affect absorption
B. Take it with a high-protein meal to improve absorption
C. Take it only when symptoms are severe
D. Crush and mix it with orange juice for faster effect
Correct Answer: A
Rationale: Carbidopa-levodopa is best absorbed on an empty stomach, taken 30 to 60 minutes before
meals, and a high-protein meal competes with levodopa for transport, reducing its effect, so the timing
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
NUR 242 Medical-Surgical Nursing Concepts
Exam 4 Comprehensive Examination
2026/2027 | Verified Questions
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts | University-Level Nursing
Students
50 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Galen College of Nursing | NUR 242 Medical-Surgical Nursing Concepts
Examination 4 Actual Exam | Academic Year 2026/2027
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
,Introduction
This examination contains 50 original Verified Questions organized into four core domains that follow the
official blueprint of the Galen College of Nursing NUR 242 Medical-Surgical Nursing Concepts course:
Domain 1, Neurological System and Alterations, with 13 questions; Domain 2, Sensory System Alterations
(Vision and Hearing), with 13 questions; Domain 3, Musculoskeletal System and Alterations, with 12
questions; and Domain 4, Integumentary System and Burn/Wound Care, with 12 questions. Every
question includes four choices, the correct response, and a rationale that explains the clinical reasoning.
All content in this document is original and has been written to reinforce the official Galen College of
Nursing NUR 242 course objectives for Examination 4, supporting actual exam readiness and clinical
proficiency for University-Level nursing students in the 2026/2027 academic year. The questions and
rationales follow the foundational medical-surgical nursing methodology of the NUR 242 course
materials, Ignatavicius' Medical-Surgical Nursing, and Harding's Medical-Surgical Nursing, and they
align with current evidence-based clinical care and patient safety guidelines. A full answer key and a per-
domain score tracker are provided at the end so that each domain can be checked and used to focus
further study.
Actual Questions
Domain 1: Neurological System and Alterations
Question 1. A nurse assesses a patient who opens eyes only to voice, utters
incomprehensible sounds, and withdraws from painful stimuli. What is the Glasgow Coma
Scale score?
A. 9
B. 7
C. 11
D. 13
Correct Answer: A
Rationale: The Glasgow Coma Scale scores eye opening (4 = spontaneous), verbal response (5 =
oriented), and motor response (6 = obeys commands). Eye opening to sound scores 3, incomprehensible
sounds score 2, and withdrawal from pain scores 4, for a total of 9. A score of 8 or below is a clinical
indicator of severe impairment and often precedes airway protection decisions. Calculating and
serializing this score is a core assessment skill in the NUR 242 course materials and Ignatavicius'
Medical-Surgical Nursing.
Question 2. Which finding in a patient with a head injury suggests early increased
intracranial pressure?
A. Bilaterally equal and briskly reactive pupils with a headache
B. A pupil that is sluggish and becoming less responsive to light on one side
C. A fixed and fully dilated pupil on both sides with no other changes
D. A blood pressure of 98/60 with a pulse of 64
Correct Answer: B
Rationale: An early sign of rising intracranial pressure is a unilateral pupil that becomes sluggish and
less responsive as the third cranial nerve is compressed against the tentorium, followed by the classic
Cushing response of hypertension, bradycardia, and irregular respirations. Bilateral fixed pupils and
severe vital sign changes occur later, when herniation is imminent. Serial neurologic checks are priority
nursing care in the NUR 242 curriculum for any patient with head trauma.
Question 3. A patient arrives 2 hours after sudden onset of right-sided weakness and
slurred speech, with no bleeding on head computed tomography. Which intervention is
appropriate?
A. Immediate aspirin without imaging confirmation
B. Surgical decompression as the first intervention
C. Intravenous thrombolytic therapy within the treatment window, after blood pressure control
D. Observation with repeat imaging in 24 hours
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
, Correct Answer: C
Rationale: For ischemic stroke within 4.5 hours of last known well and without hemorrhage on CT,
intravenous thrombolysis is indicated, with blood pressure kept below 185/110 mm Hg before
administration and antiplatelet agents withheld for 24 hours after therapy. Time from symptom onset
to treatment determines eligibility, and the NUR 242 curriculum reinforces that every minute saved
preserves brain tissue. The absence of blood on CT distinguishes ischemic from hemorrhagic stroke.
Question 4. A patient with sudden severe headache, vomiting, and a left facial droop has
blood in the subarachnoid space on CT. Which priority is correct?
A. Prevent further bleeding with blood pressure control and avoid anticoagulation
B. Administer thrombolytic therapy
C. Start full-dose heparin immediately
D. Give aspirin to prevent clot extension
Correct Answer: A
Rationale: Hemorrhagic stroke, including subarachnoid hemorrhage, is managed with blood pressure
control, reversal of any anticoagulation, and measures to prevent rebleeding; anticoagulants and
antiplatelet agents are avoided because they worsen bleeding. The treatment of hemorrhage is the
opposite of ischemic stroke treatment, which is why CT is obtained before any therapy. This distinction
is a critical nursing concept in the NUR 242 course materials.
Question 5. A patient with a seizure disorder is admitted after a tonic-clonic seizure that
lasted 6 minutes. Which intervention is most appropriate?
A. Restrain the patient's limbs until the seizure ends
B. Place a tongue blade between the teeth
C. Allow 15 more minutes of seizure before intervening
D. Administer a benzodiazepine such as lorazepam to terminate the seizure activity
Correct Answer: D
Rationale: A seizure lasting more than 5 minutes is treated as status epilepticus, with intravenous
lorazepam or diazepam as first-line therapy to stop the seizure, because prolonged seizure activity can
cause brain injury. Limbs are never restrained and nothing is placed in the mouth, since these actions
cause injury. After the event, the patient is positioned on the side and monitored for airway patency, a
key component of NUR 242 seizure care.
Question 6. Which nursing action is most important for a patient with bacterial
meningitis?
A. Maintain airborne precautions with negative pressure
B. Use droplet precautions for the first 24 hours of antimicrobial therapy
C. Use standard precautions only throughout the admission
D. Wear a high-efficiency respirator at all times
Correct Answer: B
Rationale: Bacterial meningitis requires droplet precautions for the first 24 hours of effective
antimicrobial therapy, because transmission occurs through respiratory droplets and the patient
becomes noninfectious soon after treatment begins. Airborne precautions are used for tuberculosis and
other airborne diseases, and Neisseria meningitidis, the most common communicable cause, is covered
by droplet isolation. This infection control measure is a key NUR 242 nursing standard.
Question 7. A patient with Parkinson disease is prescribed carbidopa-levodopa 30 minutes
before meals. Which later instruction is correct?
A. Take it at the same time each day before food because protein and the emptying of the stomach
affect absorption
B. Take it with a high-protein meal to improve absorption
C. Take it only when symptoms are severe
D. Crush and mix it with orange juice for faster effect
Correct Answer: A
Rationale: Carbidopa-levodopa is best absorbed on an empty stomach, taken 30 to 60 minutes before
meals, and a high-protein meal competes with levodopa for transport, reducing its effect, so the timing
NUR 242 Medical-Surgical Nursing Concepts Exam 4 Comprehensive Examination 2026/2027 | Verified Questions
