G A L E N C O L L E G E O F N U R S I N G · A S S O C I AT E D E G R E E N U R S I N G P R O G R A M
NUR 254 Exam #4
Practice Question Bank
NCLEX-Style Practice Questions with Rationales
Topic Focus: Emergency & Critical Care — Shock, Trauma, & Emergency
Management
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales — Emergency & Critical Care 2
NUR 254 · Galen College of Nursing Page 1
,NUR 254 EXAM #4 PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is.
Category: Emergency & Critical Care — Shock, Trauma, & Emergency
Management
1 The nurse is caring for a patient who is receiving a neuromuscular blocking agent.
The train-of-four testing is being performed. What does the train-of-four twitches
indicate?
A Giving electrostimulation to determine if the patient is adequately paralyzed
B Testing the patient's level of consciousness
C Assessing the patient's pain level
D Monitoring the patient's oxygen saturation
Correct Answer: A Train-of-four testing uses electrostimulation to determine the level of
neuromuscular blockade and whether the patient is adequately paralyzed.
B — Train-of-four tests neuromuscular blockade, not LOC.
C — Train-of-four does not assess pain.
D — Train-of-four is not used for oxygen saturation monitoring.
Tested Concept: Train-of-four testing
Source Concept: giving electrostim to determine if pt is adequately paralyzed
,2 The nurse is caring for a patient who is receiving a neuromuscular blocking agent.
What should the train-of-four response be for a patient who is adequately
paralyzed?
A Zero twitches
B One twitch
C Two twitches
D Four twitches
Correct Answer: A For a patient who is adequately paralyzed, the train-of-four response
should be zero twitches, indicating complete neuromuscular blockade.
B — One twitch indicates incomplete paralysis.
C — Two twitches indicates incomplete paralysis.
D — Four twitches indicates no neuromuscular blockade.
Tested Concept: Train-of-four — adequate paralysis
Source Concept: we want this to be zero for paralyzed pt
3 The nurse is preparing to administer epinephrine during a cardiac arrest. What is the
correct dosing for epinephrine in cardiac arrest?
A 1 mg every 3–5 minutes
B 1 mg every 1–2 minutes
C 0.5 mg every 5–10 minutes
D 2 mg every 3–5 minutes
Correct Answer: A The correct dosing for epinephrine in cardiac arrest is 1 mg every 3–5
minutes. This is the standard ACLS protocol.
B — 1 mg every 1–2 minutes is too frequent.
C — 0.5 mg is too low for cardiac arrest dosing.
D — 2 mg is too high for cardiac arrest dosing.
Tested Concept: Epinephrine dosing in cardiac arrest
Source Concept: 1mg every 3-5 minutes
, 4 The nurse is caring for a patient receiving propofol in the ICU. Which laboratory
values should the nurse monitor while the patient is on this medication?
A Lipids and triglycerides
B Liver function tests
C Complete blood count
D Thyroid function tests
Correct Answer: A Propofol is formulated with lipids and can cause hypertriglyceridemia.
The nurse should monitor lipids and triglycerides.
B — Liver function tests are not the primary monitoring parameter for propofol.
C — CBC is not specifically monitored for propofol.
D — Thyroid function is not affected by propofol.
Tested Concept: Propofol — monitoring
Source Concept: monitor lipids/triglycerides while pt is on this drug!
5 The nurse is caring for a patient receiving dexmedetomidine (Precedex). Which
assessment finding would the nurse expect?
A The patient is awake, supporting their own airway, but very calm
B The patient is deeply sedated and requires mechanical ventilation
C The patient is agitated and restless
D The patient is hypertensive and tachycardic
Correct Answer: A Precedex (dexmedetomidine) provides sedation while allowing the
patient to remain awake and maintain their own airway. It is great for ICU delirium.
B — Precedex does not typically cause deep sedation requiring mechanical ventilation.
C — Precedex provides calming, not agitation.
D — Precedex can cause bradycardia, not hypertension or tachycardia.
Tested Concept: Precedex (dexmedetomidine) effects
Source Concept: awake, supporting own airway but super chill — great for ICU delirium
NUR 254 Exam #4
Practice Question Bank
NCLEX-Style Practice Questions with Rationales
Topic Focus: Emergency & Critical Care — Shock, Trauma, & Emergency
Management
Edition 1 · September 2026
Table of Contents
1. Instructions for Use 2
2. Practice Questions with Answers & Rationales — Emergency & Critical Care 2
NUR 254 · Galen College of Nursing Page 1
,NUR 254 EXAM #4 PRACTICE GUIDE INSTRUCTIONS & PRACTICE QUESTIONS
How to Use This Guide
Read each stem, choose your answer, then check the rationale directly below it. The correct
option is marked, and each wrong option is explained so you understand why it's wrong — not
just that it is.
Category: Emergency & Critical Care — Shock, Trauma, & Emergency
Management
1 The nurse is caring for a patient who is receiving a neuromuscular blocking agent.
The train-of-four testing is being performed. What does the train-of-four twitches
indicate?
A Giving electrostimulation to determine if the patient is adequately paralyzed
B Testing the patient's level of consciousness
C Assessing the patient's pain level
D Monitoring the patient's oxygen saturation
Correct Answer: A Train-of-four testing uses electrostimulation to determine the level of
neuromuscular blockade and whether the patient is adequately paralyzed.
B — Train-of-four tests neuromuscular blockade, not LOC.
C — Train-of-four does not assess pain.
D — Train-of-four is not used for oxygen saturation monitoring.
Tested Concept: Train-of-four testing
Source Concept: giving electrostim to determine if pt is adequately paralyzed
,2 The nurse is caring for a patient who is receiving a neuromuscular blocking agent.
What should the train-of-four response be for a patient who is adequately
paralyzed?
A Zero twitches
B One twitch
C Two twitches
D Four twitches
Correct Answer: A For a patient who is adequately paralyzed, the train-of-four response
should be zero twitches, indicating complete neuromuscular blockade.
B — One twitch indicates incomplete paralysis.
C — Two twitches indicates incomplete paralysis.
D — Four twitches indicates no neuromuscular blockade.
Tested Concept: Train-of-four — adequate paralysis
Source Concept: we want this to be zero for paralyzed pt
3 The nurse is preparing to administer epinephrine during a cardiac arrest. What is the
correct dosing for epinephrine in cardiac arrest?
A 1 mg every 3–5 minutes
B 1 mg every 1–2 minutes
C 0.5 mg every 5–10 minutes
D 2 mg every 3–5 minutes
Correct Answer: A The correct dosing for epinephrine in cardiac arrest is 1 mg every 3–5
minutes. This is the standard ACLS protocol.
B — 1 mg every 1–2 minutes is too frequent.
C — 0.5 mg is too low for cardiac arrest dosing.
D — 2 mg is too high for cardiac arrest dosing.
Tested Concept: Epinephrine dosing in cardiac arrest
Source Concept: 1mg every 3-5 minutes
, 4 The nurse is caring for a patient receiving propofol in the ICU. Which laboratory
values should the nurse monitor while the patient is on this medication?
A Lipids and triglycerides
B Liver function tests
C Complete blood count
D Thyroid function tests
Correct Answer: A Propofol is formulated with lipids and can cause hypertriglyceridemia.
The nurse should monitor lipids and triglycerides.
B — Liver function tests are not the primary monitoring parameter for propofol.
C — CBC is not specifically monitored for propofol.
D — Thyroid function is not affected by propofol.
Tested Concept: Propofol — monitoring
Source Concept: monitor lipids/triglycerides while pt is on this drug!
5 The nurse is caring for a patient receiving dexmedetomidine (Precedex). Which
assessment finding would the nurse expect?
A The patient is awake, supporting their own airway, but very calm
B The patient is deeply sedated and requires mechanical ventilation
C The patient is agitated and restless
D The patient is hypertensive and tachycardic
Correct Answer: A Precedex (dexmedetomidine) provides sedation while allowing the
patient to remain awake and maintain their own airway. It is great for ICU delirium.
B — Precedex does not typically cause deep sedation requiring mechanical ventilation.
C — Precedex provides calming, not agitation.
D — Precedex can cause bradycardia, not hypertension or tachycardia.
Tested Concept: Precedex (dexmedetomidine) effects
Source Concept: awake, supporting own airway but super chill — great for ICU delirium
