NUR 242 EXAM 4 | NUR 242 MED SURG EXAM QUESTIONS
AND CORRECT ANSWERS LATEST AND COMPLETE
VERSION 2026-2027 WITH VERIFIED SOLUTIONS ||
ASSURED PASS | GALEN
1|Page
,NUR 242 EXAM 4 | MED SURG EXAM QUESTIONS AND CORRECT ANSWERS
2026/2027 Examination
Total Questions: 200
Instructions:
• Answer all questions.
• Select the single best answer.
• Each question has four answer choices: A, B, C, and D.
• Select only ONE answer for each question.
SECTION 1: Neurological System Disorders
Questions 1–40
Q1. A patient with increased intracranial pressure (ICP) is receiving mannitol. Which clinical
finding best indicates that the medication is having its therapeutic effect?
A. Blood pressure decreases from 140/90 mmHg to 120/80 mmHg
B. Urine output increases significantly to over 100 mL/hr
C. Serum osmolality decreases to 275 mOsm/kg
D. The patient exhibits a reactive bilateral pupillary light reflex
Correct Answer: B. Urine output increases significantly to over 100 mL/hr
Rationale: Mannitol is an osmotic diuretic that pulls fluid from the intracellular and interstitial
spaces into the vascular space, which is then excreted by the kidneys, resulting in a high urine output
and reduced ICP. A significant increase in urine output demonstrates effective osmotic diuresis.
Option A reflects blood pressure management but is not the primary indicator of mannitol's
therapeutic effect. Option C is incorrect because mannitol should increase serum osmolality, not
decrease it. Option D indicates intact pupillary function but does not specifically reflect the
medication's diuretic action.
Q2. A nurse is caring for a client admitted with acute ischemic stroke who is being evaluated for
recombinant tissue plasminogen activator (rt-PA) administration. Which finding represents an
absolute contraindication to thrombolytic therapy?
A. Onset of stroke symptoms 2.5 hours ago
B. Blood pressure of 170/95 mmHg
C. History of a non-traumatic hemorrhagic stroke 6 months ago
D. Serum glucose level of 180 mg/dL
Correct Answer: C. History of a non-traumatic hemorrhagic stroke 6 months ago
Rationale: A history of intracranial hemorrhage or prior hemorrhagic stroke at any time is an
absolute contraindication for thrombolytic therapy due to the catastrophic risk of recurrent
bleeding. Symptom onset within 3 hours (option A) is within the treatment window. Blood pressure
can be safely managed below 185/110 mmHg prior to infusion (option B), and a glucose of 180
mg/dL (option D) does not rule out rt-PA.
2|Page
, Q3. A patient with a spinal cord injury at T4 suddenly develops a severe pounding headache,
profuse sweating above the level of injury, and a blood pressure of 210/110 mmHg. What is the
priority nursing action?
A. Administer antihypertensive medication as ordered
B. Place the patient in a supine position
C. Check for bladder distention or fecal impaction
D. Document the findings and reassess in 15 minutes
Correct Answer: C. Check for bladder distention or fecal impaction
Rationale: This patient is experiencing autonomic dysreflexia, a life-threatening emergency
characterized by severe hypertension, pounding headache, and diaphoresis above the level of injury.
The priority intervention is to identify and remove the triggering stimulus, most commonly bladder
distention or fecal impaction. Positioning should be high-Fowler's, not supine (option B).
Antihypertensives are used if the trigger cannot be identified or resolved quickly, but finding the
cause is the first action.
Q4. A nurse is assessing a patient with a suspected basilar skull fracture. Which finding requires
immediate intervention?
A. Clear fluid leaking from the nose
B. Periorbital ecchymosis
C. Battle's sign behind the ear
D. Nuchal rigidity
Correct Answer: A. Clear fluid leaking from the nose
Rationale: Clear fluid leaking from the nose (CSF rhinorrhea) indicates a dural tear with
communication between the subarachnoid space and the outside environment, placing the patient
at high risk for meningitis. Immediate intervention includes placing a sterile gauze under the nose
(not packing the nares) and notifying the provider. Periorbital ecchymosis (raccoon eyes) and Battle's
sign are classic indicators of basilar skull fracture but do not require immediate intervention beyond
monitoring. Nuchal rigidity may indicate meningeal irritation but is not the priority over active CSF
leak.
Q5. A patient is admitted with a Glasgow Coma Scale (GCS) score of 8. What is the most
appropriate nursing action?
A. Document the score and continue monitoring
B. Prepare for endotracheal intubation
C. Stimulate the patient with a sternal rub every 15 minutes
D. Place the patient in a supine position with the head flat
Correct Answer: B. Prepare for endotracheal intubation
Rationale: A GCS score of 8 or less indicates severe neurological impairment and the need for
airway protection. Patients with a GCS of 8 or below typically require endotracheal intubation to
prevent aspiration and maintain oxygenation. Option A is inadequate because a score of 8 is a critical
finding. Option C is inappropriate as frequent noxious stimulation is not indicated. Option D is
incorrect because the head should be elevated 30 degrees to promote venous drainage and reduce
ICP.
3|Page
, Q6. A nurse is caring for a patient receiving phenytoin for seizure prevention. Which laboratory
value requires immediate follow-up?
A. Serum phenytoin level of 8 mcg/mL
B. Serum phenytoin level of 25 mcg/mL
C. Albumin level of 3.5 g/dL
D. White blood cell count of 7,500/mm³
Correct Answer: B. Serum phenytoin level of 25 mcg/mL
Rationale: The therapeutic range for phenytoin is typically 10–20 mcg/mL. A level of 25 mcg/mL
indicates toxicity, which can cause ataxia, nystagmus, confusion, and seizures. The nurse should hold
the medication and notify the provider. A level of 8 mcg/mL (option A) is subtherapeutic and would
require dose adjustment but is not immediately dangerous. Albumin and WBC values are within
normal limits.
Q7. A patient with myasthenia gravis is admitted with muscle weakness and difficulty
swallowing. Which medication should the nurse anticipate administering?
A. Atropine sulfate
B. Pyridostigmine
C. Phenytoin
D. Levodopa
Correct Answer: B. Pyridostigmine
Rationale: Pyridostigmine is an acetylcholinesterase inhibitor that increases the availability of
acetylcholine at the neuromuscular junction, improving muscle strength in patients with myasthenia
gravis. Atropine (option A) is used to counteract cholinergic side effects but does not treat the
underlying weakness. Phenytoin (option C) is an anticonvulsant. Levodopa (option D) is used for
Parkinson's disease.
Q8. A nurse is assessing a patient for signs of meningococcal meningitis. Which finding is most
concerning?
A. Temperature of 101.2°F
B. Petechial rash on the trunk and extremities
C. Complaint of photophobia
D. Nuchal rigidity
Correct Answer: B. Petechial rash on the trunk and extremities
Rationale: A petechial rash in the setting of suspected meningitis is highly concerning for
meningococcemia, which can progress rapidly to disseminated intravascular coagulation (DIC) and
septic shock. This finding requires immediate notification of the provider and implementation of
droplet precautions. Fever, photophobia, and nuchal rigidity are common findings in meningitis but
do not indicate the same level of immediate danger as a petechial rash.
Q9. A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which instruction
should the nurse include in patient teaching?
A. "Take this medication with a high-protein meal to improve absorption."
B. "You may experience darkening of your urine and sweat."
4|Page
AND CORRECT ANSWERS LATEST AND COMPLETE
VERSION 2026-2027 WITH VERIFIED SOLUTIONS ||
ASSURED PASS | GALEN
1|Page
,NUR 242 EXAM 4 | MED SURG EXAM QUESTIONS AND CORRECT ANSWERS
2026/2027 Examination
Total Questions: 200
Instructions:
• Answer all questions.
• Select the single best answer.
• Each question has four answer choices: A, B, C, and D.
• Select only ONE answer for each question.
SECTION 1: Neurological System Disorders
Questions 1–40
Q1. A patient with increased intracranial pressure (ICP) is receiving mannitol. Which clinical
finding best indicates that the medication is having its therapeutic effect?
A. Blood pressure decreases from 140/90 mmHg to 120/80 mmHg
B. Urine output increases significantly to over 100 mL/hr
C. Serum osmolality decreases to 275 mOsm/kg
D. The patient exhibits a reactive bilateral pupillary light reflex
Correct Answer: B. Urine output increases significantly to over 100 mL/hr
Rationale: Mannitol is an osmotic diuretic that pulls fluid from the intracellular and interstitial
spaces into the vascular space, which is then excreted by the kidneys, resulting in a high urine output
and reduced ICP. A significant increase in urine output demonstrates effective osmotic diuresis.
Option A reflects blood pressure management but is not the primary indicator of mannitol's
therapeutic effect. Option C is incorrect because mannitol should increase serum osmolality, not
decrease it. Option D indicates intact pupillary function but does not specifically reflect the
medication's diuretic action.
Q2. A nurse is caring for a client admitted with acute ischemic stroke who is being evaluated for
recombinant tissue plasminogen activator (rt-PA) administration. Which finding represents an
absolute contraindication to thrombolytic therapy?
A. Onset of stroke symptoms 2.5 hours ago
B. Blood pressure of 170/95 mmHg
C. History of a non-traumatic hemorrhagic stroke 6 months ago
D. Serum glucose level of 180 mg/dL
Correct Answer: C. History of a non-traumatic hemorrhagic stroke 6 months ago
Rationale: A history of intracranial hemorrhage or prior hemorrhagic stroke at any time is an
absolute contraindication for thrombolytic therapy due to the catastrophic risk of recurrent
bleeding. Symptom onset within 3 hours (option A) is within the treatment window. Blood pressure
can be safely managed below 185/110 mmHg prior to infusion (option B), and a glucose of 180
mg/dL (option D) does not rule out rt-PA.
2|Page
, Q3. A patient with a spinal cord injury at T4 suddenly develops a severe pounding headache,
profuse sweating above the level of injury, and a blood pressure of 210/110 mmHg. What is the
priority nursing action?
A. Administer antihypertensive medication as ordered
B. Place the patient in a supine position
C. Check for bladder distention or fecal impaction
D. Document the findings and reassess in 15 minutes
Correct Answer: C. Check for bladder distention or fecal impaction
Rationale: This patient is experiencing autonomic dysreflexia, a life-threatening emergency
characterized by severe hypertension, pounding headache, and diaphoresis above the level of injury.
The priority intervention is to identify and remove the triggering stimulus, most commonly bladder
distention or fecal impaction. Positioning should be high-Fowler's, not supine (option B).
Antihypertensives are used if the trigger cannot be identified or resolved quickly, but finding the
cause is the first action.
Q4. A nurse is assessing a patient with a suspected basilar skull fracture. Which finding requires
immediate intervention?
A. Clear fluid leaking from the nose
B. Periorbital ecchymosis
C. Battle's sign behind the ear
D. Nuchal rigidity
Correct Answer: A. Clear fluid leaking from the nose
Rationale: Clear fluid leaking from the nose (CSF rhinorrhea) indicates a dural tear with
communication between the subarachnoid space and the outside environment, placing the patient
at high risk for meningitis. Immediate intervention includes placing a sterile gauze under the nose
(not packing the nares) and notifying the provider. Periorbital ecchymosis (raccoon eyes) and Battle's
sign are classic indicators of basilar skull fracture but do not require immediate intervention beyond
monitoring. Nuchal rigidity may indicate meningeal irritation but is not the priority over active CSF
leak.
Q5. A patient is admitted with a Glasgow Coma Scale (GCS) score of 8. What is the most
appropriate nursing action?
A. Document the score and continue monitoring
B. Prepare for endotracheal intubation
C. Stimulate the patient with a sternal rub every 15 minutes
D. Place the patient in a supine position with the head flat
Correct Answer: B. Prepare for endotracheal intubation
Rationale: A GCS score of 8 or less indicates severe neurological impairment and the need for
airway protection. Patients with a GCS of 8 or below typically require endotracheal intubation to
prevent aspiration and maintain oxygenation. Option A is inadequate because a score of 8 is a critical
finding. Option C is inappropriate as frequent noxious stimulation is not indicated. Option D is
incorrect because the head should be elevated 30 degrees to promote venous drainage and reduce
ICP.
3|Page
, Q6. A nurse is caring for a patient receiving phenytoin for seizure prevention. Which laboratory
value requires immediate follow-up?
A. Serum phenytoin level of 8 mcg/mL
B. Serum phenytoin level of 25 mcg/mL
C. Albumin level of 3.5 g/dL
D. White blood cell count of 7,500/mm³
Correct Answer: B. Serum phenytoin level of 25 mcg/mL
Rationale: The therapeutic range for phenytoin is typically 10–20 mcg/mL. A level of 25 mcg/mL
indicates toxicity, which can cause ataxia, nystagmus, confusion, and seizures. The nurse should hold
the medication and notify the provider. A level of 8 mcg/mL (option A) is subtherapeutic and would
require dose adjustment but is not immediately dangerous. Albumin and WBC values are within
normal limits.
Q7. A patient with myasthenia gravis is admitted with muscle weakness and difficulty
swallowing. Which medication should the nurse anticipate administering?
A. Atropine sulfate
B. Pyridostigmine
C. Phenytoin
D. Levodopa
Correct Answer: B. Pyridostigmine
Rationale: Pyridostigmine is an acetylcholinesterase inhibitor that increases the availability of
acetylcholine at the neuromuscular junction, improving muscle strength in patients with myasthenia
gravis. Atropine (option A) is used to counteract cholinergic side effects but does not treat the
underlying weakness. Phenytoin (option C) is an anticonvulsant. Levodopa (option D) is used for
Parkinson's disease.
Q8. A nurse is assessing a patient for signs of meningococcal meningitis. Which finding is most
concerning?
A. Temperature of 101.2°F
B. Petechial rash on the trunk and extremities
C. Complaint of photophobia
D. Nuchal rigidity
Correct Answer: B. Petechial rash on the trunk and extremities
Rationale: A petechial rash in the setting of suspected meningitis is highly concerning for
meningococcemia, which can progress rapidly to disseminated intravascular coagulation (DIC) and
septic shock. This finding requires immediate notification of the provider and implementation of
droplet precautions. Fever, photophobia, and nuchal rigidity are common findings in meningitis but
do not indicate the same level of immediate danger as a petechial rash.
Q9. A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which instruction
should the nurse include in patient teaching?
A. "Take this medication with a high-protein meal to improve absorption."
B. "You may experience darkening of your urine and sweat."
4|Page
