NUR 2502 | Multidimensional Care III
Practice Questions With Answers And
Rationales
1. A patient suddenly develops facial drooping, slurred speech, and
weakness of one arm. What should the nurse do first?
A. Give the patient something to eat
B. Activate the appropriate emergency response and determine the time
symptoms began
C. Place the patient in a dark room
D. Encourage the patient to sleep
Correct Answer: B. Activate the appropriate emergency response and
determine the time symptoms began
Rationale: Sudden neurological deficits suggest a possible stroke. Rapid
evaluation is essential, and the time of symptom onset influences
treatment decisions.
2. Which finding is most concerning in a patient with suspected increased
intracranial pressure?
A. Mild headache relieved by rest
B. New decrease in level of consciousness
C. Normal pupil response
D. Increased appetite
Correct Answer: B. New decrease in level of consciousness
Rationale: A change in consciousness can indicate worsening neurological
status and requires immediate assessment.
3. A patient with a head injury becomes increasingly restless and
confused. What is the nurse's priority?
,A. Document the behavior and reassess tomorrow
B. Perform an immediate neurological assessment
C. Encourage the patient to ambulate
D. Offer a large meal
Correct Answer: B. Perform an immediate neurological assessment
Rationale: New restlessness and confusion after head injury may indicate
neurological deterioration.
4. Which assessment is most useful when monitoring neurological status?
A. Glasgow Coma Scale assessment
B. Dietary history
C. Skinfold measurement
D. Bowel history only
Correct Answer: A. Glasgow Coma Scale assessment
Rationale: The Glasgow Coma Scale provides a standardized assessment of
level of consciousness.
5. A patient with a spinal cord injury has sudden severe headache,
flushing, and markedly elevated blood pressure. Which complication
should the nurse suspect?
A. Autonomic dysreflexia
B. Hypoglycemia
C. Dehydration
D. Hypothermia
Correct Answer: A. Autonomic dysreflexia
Rationale: Autonomic dysreflexia can occur after spinal cord injury and
may present with sudden hypertension, headache, and flushing.
6. What should the nurse do first for a patient experiencing suspected
autonomic dysreflexia?
,A. Place the patient in a sitting or upright position
B. Place the patient flat
C. Encourage sleep
D. Give a large meal
Correct Answer: A. Place the patient in a sitting or upright position
Rationale: Sitting the patient upright can help reduce blood pressure while
the underlying trigger is identified and treated.
7. Which symptom is characteristic of Parkinson disease?
A. Resting tremor
B. Sudden severe diarrhea
C. Increased muscle strength
D. Persistent high fever
Correct Answer: A. Resting tremor
Rationale: Parkinson disease commonly involves resting tremor, rigidity,
bradykinesia, and postural instability.
8. Which intervention is appropriate for a patient with Parkinson disease
who has difficulty swallowing?
A. Encourage rapid eating
B. Provide appropriate swallowing precautions
C. Encourage eating while lying down
D. Offer large bites of food
Correct Answer: B. Provide appropriate swallowing precautions
Rationale: Dysphagia can occur with Parkinson disease and increases
aspiration risk.
9. A patient with multiple sclerosis reports worsening fatigue. Which
nursing intervention is appropriate?
A. Encourage continuous strenuous activity
B. Encourage activity with planned rest periods
, C. Eliminate all physical activity
D. Restrict sleep
Correct Answer: B. Encourage activity with planned rest periods
Rationale: Energy conservation and planned rest can help patients with
multiple sclerosis manage fatigue.
10. Which symptom is commonly associated with multiple sclerosis?
A. Visual disturbances
B. Increased bone density
C. Persistent hypertension only
D. Increased appetite
Correct Answer: A. Visual disturbances
Rationale: Multiple sclerosis can affect the central nervous system and
may produce visual, sensory, motor, and coordination problems.
11. A patient with a seizure begins having generalized tonic-clonic
movements. Which action is appropriate?
A. Restrain the patient's arms and legs
B. Place an object in the patient's mouth
C. Protect the patient from injury and maintain airway safety
D. Give oral medication immediately
Correct Answer: C. Protect the patient from injury and maintain airway
safety
Rationale: During a seizure, the priority is preventing injury and
maintaining airway safety without restraining the patient or placing
objects in the mouth.
12. What should the nurse document after a seizure?
A. Only that the patient had a seizure
B. Duration, characteristics, and patient response
Practice Questions With Answers And
Rationales
1. A patient suddenly develops facial drooping, slurred speech, and
weakness of one arm. What should the nurse do first?
A. Give the patient something to eat
B. Activate the appropriate emergency response and determine the time
symptoms began
C. Place the patient in a dark room
D. Encourage the patient to sleep
Correct Answer: B. Activate the appropriate emergency response and
determine the time symptoms began
Rationale: Sudden neurological deficits suggest a possible stroke. Rapid
evaluation is essential, and the time of symptom onset influences
treatment decisions.
2. Which finding is most concerning in a patient with suspected increased
intracranial pressure?
A. Mild headache relieved by rest
B. New decrease in level of consciousness
C. Normal pupil response
D. Increased appetite
Correct Answer: B. New decrease in level of consciousness
Rationale: A change in consciousness can indicate worsening neurological
status and requires immediate assessment.
3. A patient with a head injury becomes increasingly restless and
confused. What is the nurse's priority?
,A. Document the behavior and reassess tomorrow
B. Perform an immediate neurological assessment
C. Encourage the patient to ambulate
D. Offer a large meal
Correct Answer: B. Perform an immediate neurological assessment
Rationale: New restlessness and confusion after head injury may indicate
neurological deterioration.
4. Which assessment is most useful when monitoring neurological status?
A. Glasgow Coma Scale assessment
B. Dietary history
C. Skinfold measurement
D. Bowel history only
Correct Answer: A. Glasgow Coma Scale assessment
Rationale: The Glasgow Coma Scale provides a standardized assessment of
level of consciousness.
5. A patient with a spinal cord injury has sudden severe headache,
flushing, and markedly elevated blood pressure. Which complication
should the nurse suspect?
A. Autonomic dysreflexia
B. Hypoglycemia
C. Dehydration
D. Hypothermia
Correct Answer: A. Autonomic dysreflexia
Rationale: Autonomic dysreflexia can occur after spinal cord injury and
may present with sudden hypertension, headache, and flushing.
6. What should the nurse do first for a patient experiencing suspected
autonomic dysreflexia?
,A. Place the patient in a sitting or upright position
B. Place the patient flat
C. Encourage sleep
D. Give a large meal
Correct Answer: A. Place the patient in a sitting or upright position
Rationale: Sitting the patient upright can help reduce blood pressure while
the underlying trigger is identified and treated.
7. Which symptom is characteristic of Parkinson disease?
A. Resting tremor
B. Sudden severe diarrhea
C. Increased muscle strength
D. Persistent high fever
Correct Answer: A. Resting tremor
Rationale: Parkinson disease commonly involves resting tremor, rigidity,
bradykinesia, and postural instability.
8. Which intervention is appropriate for a patient with Parkinson disease
who has difficulty swallowing?
A. Encourage rapid eating
B. Provide appropriate swallowing precautions
C. Encourage eating while lying down
D. Offer large bites of food
Correct Answer: B. Provide appropriate swallowing precautions
Rationale: Dysphagia can occur with Parkinson disease and increases
aspiration risk.
9. A patient with multiple sclerosis reports worsening fatigue. Which
nursing intervention is appropriate?
A. Encourage continuous strenuous activity
B. Encourage activity with planned rest periods
, C. Eliminate all physical activity
D. Restrict sleep
Correct Answer: B. Encourage activity with planned rest periods
Rationale: Energy conservation and planned rest can help patients with
multiple sclerosis manage fatigue.
10. Which symptom is commonly associated with multiple sclerosis?
A. Visual disturbances
B. Increased bone density
C. Persistent hypertension only
D. Increased appetite
Correct Answer: A. Visual disturbances
Rationale: Multiple sclerosis can affect the central nervous system and
may produce visual, sensory, motor, and coordination problems.
11. A patient with a seizure begins having generalized tonic-clonic
movements. Which action is appropriate?
A. Restrain the patient's arms and legs
B. Place an object in the patient's mouth
C. Protect the patient from injury and maintain airway safety
D. Give oral medication immediately
Correct Answer: C. Protect the patient from injury and maintain airway
safety
Rationale: During a seizure, the priority is preventing injury and
maintaining airway safety without restraining the patient or placing
objects in the mouth.
12. What should the nurse document after a seizure?
A. Only that the patient had a seizure
B. Duration, characteristics, and patient response