RN Adult Medical Surgical 2026
Proctored Exam Bundle- All Passing
Versions
SECTION 1: Neurological System
1. A nurse is assessing a client who has had a hemorrhagic stroke. Which of the
following findings requires immediate intervention?
A. Blood pressure 190/100 mm Hg
B. Glasgow Coma Scale score of 14
C. Pupils equal and reactive at 3 mm
D. Report of a mild headache
Correct Answer: A
Rationale: In hemorrhagic stroke, elevated BP increases the risk of continued
bleeding and hematoma expansion. Guidelines support controlled BP lowering
(e.g., systolic ~140 mm Hg) while avoiding hypotension. A GCS of 14, equal
reactive pupils, and mild headache are concerning but not immediately life-
threatening; the severe hypertension is the priority.
2. A client with a new onset of left-sided weakness arrives at the emergency
department. Which action should the nurse take first?
A. Obtain a full set of vital signs
B. Determine the time of symptom onset
C. Administer aspirin 325 mg PO
D. Insert an IV catheter
Correct Answer: B
Rationale: Establishing the "last known well" time determines eligibility for
thrombolytics (within 3–4.5 hours) and mechanical thrombectomy. Aspirin is
,contraindicated until hemorrhage is ruled out by CT. Vital signs and IV access
follow, but time of onset drives immediate treatment decisions.
3. A nurse is caring for a client with increased intracranial pressure (ICP). Which
position should the nurse maintain?
A. Flat, supine with legs elevated
B. Head of bed elevated 30 degrees, head midline
C. Trendelenburg position
D. Prone with head turned to the side
Correct Answer: B
Rationale: Elevating the head of the bed 30 degrees with the head in neutral
alignment promotes venous drainage from the brain, reducing ICP. Flat,
Trendelenburg, and prone positions impede venous return and raise ICP.
4. A nurse is reviewing care for a client with a T4 spinal cord injury. Which finding
indicates autonomic dysreflexia? (SATA)
A. Sudden severe hypertension
B. Bradycardia
C. Flushing above the injury level
D. Profuse diaphoresis
E. Hypothermia
Correct Answers: A, B, C, D
Rationale: Autonomic dysreflexia is a life-threatening emergency in injuries
at/above T6. Classic signs include sudden severe hypertension, bradycardia,
flushing and diaphoresis above the lesion, and severe headache. Hypothermia is
not characteristic; the priority is to identify the trigger (often bladder distention)
and lower BP.
,5. A client is 24 hours post-craniotomy. Which finding should the nurse report
immediately?
A. Incisional pain rated 3/10
B. Clear drainage on the dressing that tests positive for glucose
C. Temperature 37.2°C (99°F)
D. Mild periorbital edema
Correct Answer: B
Rationale: Clear glucose-positive drainage suggests CSF leak, which increases
infection risk (meningitis) and may indicate dural disruption. Mild pain, low-grade
fever, and periorbital edema are expected postoperatively.
6. A nurse is teaching a client about phenytoin. Which statement indicates
understanding?
A. "I should use a soft toothbrush and floss carefully."
B. "I can stop the medication once seizures stop."
C. "I should take it with antacids for stomach upset."
D. "Grapefruit juice increases its effectiveness."
Correct Answer: A
Rationale: Gingival hyperplasia is a common adverse effect of phenytoin, so
meticulous oral hygiene with a soft brush is essential. The drug must not be
stopped abruptly. Antacids reduce absorption, and grapefruit interactions are more
relevant to other drugs.
7. A client with Parkinson's disease is prescribed carbidopa-levodopa. Which
instruction is priority?
A. "Take with a high-protein meal."
B. "Change positions slowly to prevent dizziness."
C. "Take at bedtime only."
D. "Double the dose if symptoms worsen."
, Correct Answer: B
Rationale: Orthostatic hypotension is a common adverse effect of carbidopa-
levodopa; slow position changes prevent falls. High-protein meals decrease
levodopa absorption. Doses are never doubled without a prescription.
8. A nurse assesses a client with Guillain-Barré syndrome. Which finding is most
concerning?
A. Ascending muscle weakness
B. Vital capacity of 10 mL/kg
C. Absent deep tendon reflexes
D. Difficulty swallowing secretions
Correct Answer: D
Rationale: Difficulty managing secretions indicates bulbar involvement and
risk of aspiration/airway obstruction, which is immediately life-threatening.
Ascending weakness and absent reflexes are expected. A vital capacity below 15–
20 mL/kg is also concerning, but the inability to handle secretions is the most acute
airway threat.
9. A client with myasthenia gravis reports increasing weakness. Which medication
should the nurse anticipate administering?
A. Neostigmine
B. Atropine
C. Prednisone
D. Pyridostigmine overdose
Correct Answer: A
Rationale: Neostigmine (or edrophonium in a Tensilon test) is a cholinesterase
inhibitor that rapidly improves strength in myasthenic crisis. Atropine treats
cholinergic crisis symptoms, and prednisone is a long-term immunosuppressant,
not a rescue drug.
Proctored Exam Bundle- All Passing
Versions
SECTION 1: Neurological System
1. A nurse is assessing a client who has had a hemorrhagic stroke. Which of the
following findings requires immediate intervention?
A. Blood pressure 190/100 mm Hg
B. Glasgow Coma Scale score of 14
C. Pupils equal and reactive at 3 mm
D. Report of a mild headache
Correct Answer: A
Rationale: In hemorrhagic stroke, elevated BP increases the risk of continued
bleeding and hematoma expansion. Guidelines support controlled BP lowering
(e.g., systolic ~140 mm Hg) while avoiding hypotension. A GCS of 14, equal
reactive pupils, and mild headache are concerning but not immediately life-
threatening; the severe hypertension is the priority.
2. A client with a new onset of left-sided weakness arrives at the emergency
department. Which action should the nurse take first?
A. Obtain a full set of vital signs
B. Determine the time of symptom onset
C. Administer aspirin 325 mg PO
D. Insert an IV catheter
Correct Answer: B
Rationale: Establishing the "last known well" time determines eligibility for
thrombolytics (within 3–4.5 hours) and mechanical thrombectomy. Aspirin is
,contraindicated until hemorrhage is ruled out by CT. Vital signs and IV access
follow, but time of onset drives immediate treatment decisions.
3. A nurse is caring for a client with increased intracranial pressure (ICP). Which
position should the nurse maintain?
A. Flat, supine with legs elevated
B. Head of bed elevated 30 degrees, head midline
C. Trendelenburg position
D. Prone with head turned to the side
Correct Answer: B
Rationale: Elevating the head of the bed 30 degrees with the head in neutral
alignment promotes venous drainage from the brain, reducing ICP. Flat,
Trendelenburg, and prone positions impede venous return and raise ICP.
4. A nurse is reviewing care for a client with a T4 spinal cord injury. Which finding
indicates autonomic dysreflexia? (SATA)
A. Sudden severe hypertension
B. Bradycardia
C. Flushing above the injury level
D. Profuse diaphoresis
E. Hypothermia
Correct Answers: A, B, C, D
Rationale: Autonomic dysreflexia is a life-threatening emergency in injuries
at/above T6. Classic signs include sudden severe hypertension, bradycardia,
flushing and diaphoresis above the lesion, and severe headache. Hypothermia is
not characteristic; the priority is to identify the trigger (often bladder distention)
and lower BP.
,5. A client is 24 hours post-craniotomy. Which finding should the nurse report
immediately?
A. Incisional pain rated 3/10
B. Clear drainage on the dressing that tests positive for glucose
C. Temperature 37.2°C (99°F)
D. Mild periorbital edema
Correct Answer: B
Rationale: Clear glucose-positive drainage suggests CSF leak, which increases
infection risk (meningitis) and may indicate dural disruption. Mild pain, low-grade
fever, and periorbital edema are expected postoperatively.
6. A nurse is teaching a client about phenytoin. Which statement indicates
understanding?
A. "I should use a soft toothbrush and floss carefully."
B. "I can stop the medication once seizures stop."
C. "I should take it with antacids for stomach upset."
D. "Grapefruit juice increases its effectiveness."
Correct Answer: A
Rationale: Gingival hyperplasia is a common adverse effect of phenytoin, so
meticulous oral hygiene with a soft brush is essential. The drug must not be
stopped abruptly. Antacids reduce absorption, and grapefruit interactions are more
relevant to other drugs.
7. A client with Parkinson's disease is prescribed carbidopa-levodopa. Which
instruction is priority?
A. "Take with a high-protein meal."
B. "Change positions slowly to prevent dizziness."
C. "Take at bedtime only."
D. "Double the dose if symptoms worsen."
, Correct Answer: B
Rationale: Orthostatic hypotension is a common adverse effect of carbidopa-
levodopa; slow position changes prevent falls. High-protein meals decrease
levodopa absorption. Doses are never doubled without a prescription.
8. A nurse assesses a client with Guillain-Barré syndrome. Which finding is most
concerning?
A. Ascending muscle weakness
B. Vital capacity of 10 mL/kg
C. Absent deep tendon reflexes
D. Difficulty swallowing secretions
Correct Answer: D
Rationale: Difficulty managing secretions indicates bulbar involvement and
risk of aspiration/airway obstruction, which is immediately life-threatening.
Ascending weakness and absent reflexes are expected. A vital capacity below 15–
20 mL/kg is also concerning, but the inability to handle secretions is the most acute
airway threat.
9. A client with myasthenia gravis reports increasing weakness. Which medication
should the nurse anticipate administering?
A. Neostigmine
B. Atropine
C. Prednisone
D. Pyridostigmine overdose
Correct Answer: A
Rationale: Neostigmine (or edrophonium in a Tensilon test) is a cholinesterase
inhibitor that rapidly improves strength in myasthenic crisis. Atropine treats
cholinergic crisis symptoms, and prednisone is a long-term immunosuppressant,
not a rescue drug.
