,NUR 224 Final Exam Advanced Concepts of Medical-Surgical Nursing
Questions And Answers 2026/2027 Jersey College
Q1. A patient admitted after traumatic brain injury had a Glasgow
Coma Scale score of 15 two hours ago. The current score is 11.
Which interpretation is most appropriate?
A) The decline represents significant neurologic deterioration requiring
immediate evaluation
B) The change is expected after any head injury
C) A decrease of four points is clinically insignificant
D) The score indicates improving cerebral function
Correct Answer: A) The decline represents significant neurologic deterioration
requiring immediate evaluation
Rationale: A meaningful decline in Glasgow Coma Scale score may indicate
expanding hemorrhage, cerebral edema, or other intracranial deterioration
requiring urgent assessment.
Q2. A patient arrives with sudden unilateral weakness and aphasia.
Which reversible disorder should be rapidly excluded because it can
mimic an acute stroke?
A) Chronic hyperlipidemia
B) Osteoporosis
C) Hypoglycemia
D) Chronic venous insufficiency
Correct Answer: C) Hypoglycemia
Rationale: Severe hypoglycemia can produce focal neurologic deficits and
altered consciousness that resemble acute stroke.
Q3. Five days after treatment of an aneurysmal subarachnoid
hemorrhage, a patient develops new confusion and unilateral
weakness. Which complication should be suspected?
A) Chronic migraine
B) Bell palsy
C) Expected posthemorrhage fatigue
D) Cerebral vasospasm causing delayed cerebral ischemia
Correct Answer: D) Cerebral vasospasm causing delayed cerebral ischemia
,Rationale: Cerebral vasospasm can occur several days after subarachnoid
hemorrhage and reduce cerebral blood flow enough to produce new
neurologic deficits.
Q4. A patient's mean arterial pressure is 70 mm Hg and intracranial
pressure is 30 mm Hg. What is the cerebral perfusion pressure, and
how should it be interpreted?
A) 100 mm Hg; excessively high
B) 70 mm Hg; normal
C) 40 mm Hg; critically reduced cerebral perfusion
D) 30 mm Hg; adequate cerebral perfusion
Correct Answer: C) 40 mm Hg; critically reduced cerebral perfusion
Rationale: Cerebral perfusion pressure equals mean arterial pressure minus
intracranial pressure. A value of 40 mm Hg indicates seriously compromised
cerebral blood flow.
Q5. A patient with Guillain-Barré syndrome develops rapid
fluctuations between hypertension and hypotension with
intermittent bradycardia. Which complication best explains these
findings?
A) Autonomic nervous system dysfunction
B) Chronic kidney disease
C) Cerebral edema
D) Hyperthyroidism
Correct Answer: A) Autonomic nervous system dysfunction
Rationale: Guillain-Barré syndrome can affect autonomic fibers, producing
dangerous fluctuations in heart rate, vascular tone, and blood pressure.
Q6. Which assessment provides the most useful early indication that
respiratory muscle weakness is progressing in myasthenia gravis?
A) Serum sodium concentration
B) Serial forced vital capacity and inspiratory-force measurements
C) Bowel sounds
D) Peripheral edema
Correct Answer: B) Serial forced vital capacity and inspiratory-force
measurements
, Rationale: Serial respiratory measurements can detect declining ventilatory
strength before severe hypoxemia or respiratory arrest occurs.
Q7. A patient with Parkinson disease develops coughing during
meals, recurrent low-grade fever, and coarse crackles at the lung
bases. Which complication is most likely?
A) Aspiration pneumonia related to dysphagia
B) Pulmonary embolism
C) Acute glaucoma
D) Neurogenic shock
Correct Answer: A) Aspiration pneumonia related to dysphagia
Rationale: Parkinson-related swallowing dysfunction can allow food or
secretions to enter the airway, leading to recurrent aspiration and
pneumonia.
Q8. A patient with a T5 spinal cord injury suddenly develops
pounding headache and blood pressure of 210/108 mm Hg. The
urinary catheter tubing is visibly kinked. What should the nurse do
after positioning the patient upright?
A) Correct the catheter obstruction immediately
B) Encourage oral fluids
C) Place the patient flat
D) Apply compression stockings
Correct Answer: A) Correct the catheter obstruction immediately
Rationale: Bladder distention is a common trigger of autonomic dysreflexia.
Relieving the precipitating stimulus is essential while severe hypertension is
monitored and treated.
Q9. A patient with multiple sclerosis develops temporary worsening
of old weakness during a febrile urinary tract infection. Symptoms
return to baseline after the fever resolves. How should this episode
be interpreted?
A) Permanent disease progression
B) Acute ischemic stroke
C) Pseudoexacerbation triggered by increased body temperature
D) Myasthenic crisis
Questions And Answers 2026/2027 Jersey College
Q1. A patient admitted after traumatic brain injury had a Glasgow
Coma Scale score of 15 two hours ago. The current score is 11.
Which interpretation is most appropriate?
A) The decline represents significant neurologic deterioration requiring
immediate evaluation
B) The change is expected after any head injury
C) A decrease of four points is clinically insignificant
D) The score indicates improving cerebral function
Correct Answer: A) The decline represents significant neurologic deterioration
requiring immediate evaluation
Rationale: A meaningful decline in Glasgow Coma Scale score may indicate
expanding hemorrhage, cerebral edema, or other intracranial deterioration
requiring urgent assessment.
Q2. A patient arrives with sudden unilateral weakness and aphasia.
Which reversible disorder should be rapidly excluded because it can
mimic an acute stroke?
A) Chronic hyperlipidemia
B) Osteoporosis
C) Hypoglycemia
D) Chronic venous insufficiency
Correct Answer: C) Hypoglycemia
Rationale: Severe hypoglycemia can produce focal neurologic deficits and
altered consciousness that resemble acute stroke.
Q3. Five days after treatment of an aneurysmal subarachnoid
hemorrhage, a patient develops new confusion and unilateral
weakness. Which complication should be suspected?
A) Chronic migraine
B) Bell palsy
C) Expected posthemorrhage fatigue
D) Cerebral vasospasm causing delayed cerebral ischemia
Correct Answer: D) Cerebral vasospasm causing delayed cerebral ischemia
,Rationale: Cerebral vasospasm can occur several days after subarachnoid
hemorrhage and reduce cerebral blood flow enough to produce new
neurologic deficits.
Q4. A patient's mean arterial pressure is 70 mm Hg and intracranial
pressure is 30 mm Hg. What is the cerebral perfusion pressure, and
how should it be interpreted?
A) 100 mm Hg; excessively high
B) 70 mm Hg; normal
C) 40 mm Hg; critically reduced cerebral perfusion
D) 30 mm Hg; adequate cerebral perfusion
Correct Answer: C) 40 mm Hg; critically reduced cerebral perfusion
Rationale: Cerebral perfusion pressure equals mean arterial pressure minus
intracranial pressure. A value of 40 mm Hg indicates seriously compromised
cerebral blood flow.
Q5. A patient with Guillain-Barré syndrome develops rapid
fluctuations between hypertension and hypotension with
intermittent bradycardia. Which complication best explains these
findings?
A) Autonomic nervous system dysfunction
B) Chronic kidney disease
C) Cerebral edema
D) Hyperthyroidism
Correct Answer: A) Autonomic nervous system dysfunction
Rationale: Guillain-Barré syndrome can affect autonomic fibers, producing
dangerous fluctuations in heart rate, vascular tone, and blood pressure.
Q6. Which assessment provides the most useful early indication that
respiratory muscle weakness is progressing in myasthenia gravis?
A) Serum sodium concentration
B) Serial forced vital capacity and inspiratory-force measurements
C) Bowel sounds
D) Peripheral edema
Correct Answer: B) Serial forced vital capacity and inspiratory-force
measurements
, Rationale: Serial respiratory measurements can detect declining ventilatory
strength before severe hypoxemia or respiratory arrest occurs.
Q7. A patient with Parkinson disease develops coughing during
meals, recurrent low-grade fever, and coarse crackles at the lung
bases. Which complication is most likely?
A) Aspiration pneumonia related to dysphagia
B) Pulmonary embolism
C) Acute glaucoma
D) Neurogenic shock
Correct Answer: A) Aspiration pneumonia related to dysphagia
Rationale: Parkinson-related swallowing dysfunction can allow food or
secretions to enter the airway, leading to recurrent aspiration and
pneumonia.
Q8. A patient with a T5 spinal cord injury suddenly develops
pounding headache and blood pressure of 210/108 mm Hg. The
urinary catheter tubing is visibly kinked. What should the nurse do
after positioning the patient upright?
A) Correct the catheter obstruction immediately
B) Encourage oral fluids
C) Place the patient flat
D) Apply compression stockings
Correct Answer: A) Correct the catheter obstruction immediately
Rationale: Bladder distention is a common trigger of autonomic dysreflexia.
Relieving the precipitating stimulus is essential while severe hypertension is
monitored and treated.
Q9. A patient with multiple sclerosis develops temporary worsening
of old weakness during a febrile urinary tract infection. Symptoms
return to baseline after the fever resolves. How should this episode
be interpreted?
A) Permanent disease progression
B) Acute ischemic stroke
C) Pseudoexacerbation triggered by increased body temperature
D) Myasthenic crisis
