Galen NUR 265 Exam 3 – Medical-Surgical Nursing
Practice Exam.
Based on the available course materials, Galen NUR 265 Exam 3 covers advanced
medical-surgical concepts including neurological disorders (TBI, increased ICP,
meningitis, spinal cord injury, myasthenia gravis, Guillain-Barré syndrome),
musculoskeletal trauma (burns, fractures, compartment syndrome), shock states, critical
care concepts, and complex multi-system conditions . Each question is followed by the
correct answer and a simple explanation in italic.
Section 1: Neurological Disorders and Critical Neurologic
Concepts
Question 1
A client with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 6. What is
the priority nursing action?
A) Obtain a CT scan immediately
B) Prepare for intubation and mechanical ventilation
C) Administer mannitol as prescribed
D) Place the client in a supine position
Correct Answer: B
A GCS score of 8 or less indicates coma and an inability to protect the airway. Per the
ABCs, securing the airway via intubation is the priority to prevent hypoxia and secondary
brain injury. While imaging and medications are important, airway protection comes first .
,Question 2
A client with a C5 spinal cord injury develops a severe headache, blood pressure of
210/110 mm Hg, and bradycardia. What condition is suspected?
A) Spinal shock
B) Autonomic dysreflexia
C) Neurogenic shock
D) Pulmonary embolism
Correct Answer: B
Autonomic dysreflexia occurs in injuries at T6 or above due to unopposed sympathetic
response to noxious stimuli below the level of injury, most commonly a full bladder or
distended bowel. Symptoms include severe hypertension, bradycardia, headache, and
flushing above the lesion. This is a medical emergency requiring immediate intervention .
Question 3
A client who sustained a spinal cord injury at the level of C5 one hour ago requires
which priority nursing intervention?
A) Monitor for urinary retention
B) Elevate the head of the bed to prevent pressure ulcers
C) Closely monitor respirations and respiratory effort
D) Encourage active range of motion exercises
Correct Answer: C
A C5 spinal cord injury places the client at significant risk for respiratory compromise due
to impaired diaphragmatic and intercostal muscle function. Respiratory failure is the
leading cause of early mortality following cervical spinal cord injury .
Question 4
The nurse is assessing a client suspected of having myasthenia gravis. Which findings
are expected?
,A) Only fatigue and muscle weakness
B) Fatigue, dysphagia, and double vision
C) Fatigue, dysphagia, double vision, and muscle weakness
D) Dysphagia and fatigue only
Correct Answer: C
Myasthenia gravis is characterized by fluctuating muscle weakness that worsens with
activity and improves with rest. Common symptoms include fatigue, dysphagia (difficulty
swallowing), diplopia (double vision), and generalized muscle weakness due to impaired
neuromuscular transmission .
Question 5
A client with myasthenia gravis is receiving the prescribed cholinesterase inhibitor,
pyridostigmine. Which finding would indicate the client is experiencing a therapeutic
effect?
A) Increased muscle strength
B) Decreased heart rate
C) Increased respiratory secretions
D) Decreased urine output
Correct Answer: A
Pyridostigmine works by inhibiting acetylcholinesterase, allowing acetylcholine to
accumulate at the neuromuscular junction. This improves neuromuscular transmission,
resulting in increased muscle strength. The other options represent adverse effects or
unrelated findings .
Question 6
The nurse is caring for a client with Guillain-Barré syndrome (GBS). Which treatment
should the nurse anticipate will be prescribed?
, A) IV immunoglobulin (IVIG)
B) Cholinesterase inhibitor
C) Immunosuppressant
D) Corticosteroids
Correct Answer: A
IV immunoglobulin (IVIG) and plasmapheresis are the primary treatments for Guillain-
Barré syndrome. These therapies help modulate the immune response and reduce the
severity of the autoimmune attack on peripheral nerves. Cholinesterase inhibitors are used
for myasthenia gravis .
Question 7
The nurse is caring for a client with bacterial meningitis. Which finding requires priority
follow-up?
A) Complaints of headache
B) Temperature of 100.4°F
C) Change in blood pressure from 132/75 to 160/56 mm Hg
D) Reports photophobia
Correct Answer: C
A significant change in blood pressure, especially elevated systolic pressure with a widened
pulse pressure, can indicate worsening neurological status or increased intracranial
pressure. This is a priority finding requiring immediate intervention .
Question 8
A college student living in a dormitory presents to the emergency department with
chills, nuchal rigidity, and a temperature of 101.5°F. Which action should the nurse take
first?
A) Obtain a blood culture and start IV antibiotics
B) Administer antipyretics as prescribed
Practice Exam.
Based on the available course materials, Galen NUR 265 Exam 3 covers advanced
medical-surgical concepts including neurological disorders (TBI, increased ICP,
meningitis, spinal cord injury, myasthenia gravis, Guillain-Barré syndrome),
musculoskeletal trauma (burns, fractures, compartment syndrome), shock states, critical
care concepts, and complex multi-system conditions . Each question is followed by the
correct answer and a simple explanation in italic.
Section 1: Neurological Disorders and Critical Neurologic
Concepts
Question 1
A client with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 6. What is
the priority nursing action?
A) Obtain a CT scan immediately
B) Prepare for intubation and mechanical ventilation
C) Administer mannitol as prescribed
D) Place the client in a supine position
Correct Answer: B
A GCS score of 8 or less indicates coma and an inability to protect the airway. Per the
ABCs, securing the airway via intubation is the priority to prevent hypoxia and secondary
brain injury. While imaging and medications are important, airway protection comes first .
,Question 2
A client with a C5 spinal cord injury develops a severe headache, blood pressure of
210/110 mm Hg, and bradycardia. What condition is suspected?
A) Spinal shock
B) Autonomic dysreflexia
C) Neurogenic shock
D) Pulmonary embolism
Correct Answer: B
Autonomic dysreflexia occurs in injuries at T6 or above due to unopposed sympathetic
response to noxious stimuli below the level of injury, most commonly a full bladder or
distended bowel. Symptoms include severe hypertension, bradycardia, headache, and
flushing above the lesion. This is a medical emergency requiring immediate intervention .
Question 3
A client who sustained a spinal cord injury at the level of C5 one hour ago requires
which priority nursing intervention?
A) Monitor for urinary retention
B) Elevate the head of the bed to prevent pressure ulcers
C) Closely monitor respirations and respiratory effort
D) Encourage active range of motion exercises
Correct Answer: C
A C5 spinal cord injury places the client at significant risk for respiratory compromise due
to impaired diaphragmatic and intercostal muscle function. Respiratory failure is the
leading cause of early mortality following cervical spinal cord injury .
Question 4
The nurse is assessing a client suspected of having myasthenia gravis. Which findings
are expected?
,A) Only fatigue and muscle weakness
B) Fatigue, dysphagia, and double vision
C) Fatigue, dysphagia, double vision, and muscle weakness
D) Dysphagia and fatigue only
Correct Answer: C
Myasthenia gravis is characterized by fluctuating muscle weakness that worsens with
activity and improves with rest. Common symptoms include fatigue, dysphagia (difficulty
swallowing), diplopia (double vision), and generalized muscle weakness due to impaired
neuromuscular transmission .
Question 5
A client with myasthenia gravis is receiving the prescribed cholinesterase inhibitor,
pyridostigmine. Which finding would indicate the client is experiencing a therapeutic
effect?
A) Increased muscle strength
B) Decreased heart rate
C) Increased respiratory secretions
D) Decreased urine output
Correct Answer: A
Pyridostigmine works by inhibiting acetylcholinesterase, allowing acetylcholine to
accumulate at the neuromuscular junction. This improves neuromuscular transmission,
resulting in increased muscle strength. The other options represent adverse effects or
unrelated findings .
Question 6
The nurse is caring for a client with Guillain-Barré syndrome (GBS). Which treatment
should the nurse anticipate will be prescribed?
, A) IV immunoglobulin (IVIG)
B) Cholinesterase inhibitor
C) Immunosuppressant
D) Corticosteroids
Correct Answer: A
IV immunoglobulin (IVIG) and plasmapheresis are the primary treatments for Guillain-
Barré syndrome. These therapies help modulate the immune response and reduce the
severity of the autoimmune attack on peripheral nerves. Cholinesterase inhibitors are used
for myasthenia gravis .
Question 7
The nurse is caring for a client with bacterial meningitis. Which finding requires priority
follow-up?
A) Complaints of headache
B) Temperature of 100.4°F
C) Change in blood pressure from 132/75 to 160/56 mm Hg
D) Reports photophobia
Correct Answer: C
A significant change in blood pressure, especially elevated systolic pressure with a widened
pulse pressure, can indicate worsening neurological status or increased intracranial
pressure. This is a priority finding requiring immediate intervention .
Question 8
A college student living in a dormitory presents to the emergency department with
chills, nuchal rigidity, and a temperature of 101.5°F. Which action should the nurse take
first?
A) Obtain a blood culture and start IV antibiotics
B) Administer antipyretics as prescribed
