NUR 265 – Medical-Surgical Nursing II (Neuro,
Shock, Burns) 2025–2026 Study Guide
Neurological emergencies, shock types, burn
management, and high-priority interventions.
Neurological Emergencies (Questions 1-40)
1. The Glasgow Coma Scale (GCS) assesses which three functions?
A) Pupillary response, motor strength, verbal response
B) Eye opening, verbal response, motor response ✓
C) Level of consciousness, cranial nerves, reflexes
D) Sensory response, eye opening, cognitive function
2. A patient presents with a sudden, severe "thunderclap" headache and nuchal rigidity. The
nurse should suspect:
A) Migraine headache
B) Meningitis
C) Ischemic stroke
D) Subarachnoid hemorrhage ✓
3. The most important initial intervention for a patient experiencing a generalized tonic-clonic
seizure is:
A) Placing a tongue blade in the mouth
B) Restraining the patient's limbs
C) Administering IV Diazepam immediately
D) Protecting the patient from injury ✓
4. Early signs of increased intracranial pressure (ICP) include:
A) Cushing's triad (hypertension, bradycardia, irregular respirations)
B) Decreased level of consciousness and confusion ✓
C) Fixed and dilated pupils
D) Decerebrate posturing
5. For a patient with a suspected spinal cord injury, which nursing action is the highest priority
upon arrival to the emergency department?
A) Assessing sensory level
,B) Maintaining spinal immobilization ✓
C) Administering corticosteroids
D) Checking bladder distention
6. The hallmark symptom of Guillain-Barré Syndrome (GBS) is:
A) Ascending symmetric muscle weakness ✓
B) Descending asymmetric paralysis
C) Severe cognitive deficits
D) Intention tremors and ataxia
7. A patient with myasthenia gravis is experiencing a myasthenic crisis. The most critical
assessment is:
A) Muscle strength
B) Pupillary response
C) Respiratory effort and vital capacity ✓
D) Bowel sounds
8. What is the primary goal in the management of a patient with an ischemic stroke who is a
candidate for fibrinolytic therapy?
A) Administer tPA within 3 hours of symptom onset.
B) Administer tPA within 4.5 hours of symptom onset. ✓
C) Control hypertension before administering tPA.
D) Wait for MRI confirmation before administering any treatment.
9. Autonomic dysreflexia is a potential life-threatening emergency for patients with a spinal
cord injury at or above which level?
A) C1-C3
B) T1-T6
C) T6 and above ✓
D) L1-L5
10. The most common trigger for autonomic dysreflexia is:
A) Emotional stress
B) A full bladder or bowel ✓
C) Pain above the level of injury
D) Sudden temperature changes
11. When assessing a patient's pupils, a fixed and dilated pupil is a sign of:
A) Uncal herniation on the same side ✓
B) Brainstem injury
,C) Metabolic encephalopathy
D) Oculomotor nerve palsy only
12. The drug of choice for stopping ongoing status epilepticus is:
A) Phenytoin (Dilantin)
B) Lorazepam (Ativan) ✓
C) Levetiracetam (Keppra)
D) Carbamazepine (Tegretol)
13. A patient with bacterial meningitis will most likely have which finding on cerebrospinal
fluid (CSF) analysis?
A) Clear fluid, low protein, normal glucose
B) Cloudy fluid, elevated protein, low glucose ✓
C) Cloudy fluid, low protein, high glucose
D) Xanthochromia, elevated protein, normal glucose
14. The priority nursing diagnosis for a patient in the acute phase of a stroke is:
A) Risk for Impaired Verbal Communication
B) Impaired Physical Mobility
C) Ineffective Airway Clearance ✓
D) Unilateral Neglect
15. Which positioning is contraindicated in a patient with increased ICP?
A) Head of bed elevated 30 degrees
B) Neck in a neutral position
C) Trendelenburg position ✓
D) Supine with head on a pillow
16. Decorticate posturing (flexion) indicates damage to the:
A) Spinal cord
B) Cerebral hemispheres ✓
C) Brainstem
D) Cerebellum
17. The classic triad of symptoms for normal pressure hydrocephalus (NPH) is:
A) Headache, vomiting, papilledema
B) Ataxia, dementia, urinary incontinence ✓
C) Tremor, rigidity, bradykinesia
D) Aphasia, apraxia, agnosia
, 18. A key difference between a migraine with aura and a transient ischemic attack (TIA) is:
A) The severity of the headache
B) The presence of motor or sensory symptoms
C) The speed of symptom onset (migraine symptoms spread over minutes, TIA is sudden)
D) The "positive" symptoms of migraine (e.g., scintillating scotoma) vs. "negative" symptoms of
TIA (e.g., loss of function) ✓
19. For a patient with a traumatic brain injury, maintaining PaCO2 within a normal range (35-
45 mmHg) is critical because:
A) Hypocapnia causes cerebral vasodilation, increasing ICP.
B) Hypercapnia causes cerebral vasoconstriction, decreasing ICP.
C) Hypercapnia causes cerebral vasodilation, increasing ICP. ✓
D) Hypocapnia has no effect on cerebral blood flow.
20. Which diagnostic test is the most sensitive for detecting an acute ischemic stroke?
A) Non-contrast CT scan
B) Magnetic Resonance Imaging (MRI) with diffusion-weighted imaging ✓
C) Cerebral Angiography
D) Skull X-ray
21. Parkinson's disease is characterized by a loss of neurons in the substantia nigra that
produce:
A) Acetylcholine
B) Dopamine ✓
C) Serotonin
D) GABA
22. The primary symptom of Bell's Palsy is:
A) Bilateral facial drooping
B) Unilateral facial paralysis/weakness ✓
C) Arm and leg weakness on one side
D) Drooping of the eyelid only
23. A patient with a cerebellar disorder will likely exhibit:
A) Hemiparesis
B) Ataxia and intention tremor ✓
C) Flaccid paralysis
D) Spasticity
Shock, Burns) 2025–2026 Study Guide
Neurological emergencies, shock types, burn
management, and high-priority interventions.
Neurological Emergencies (Questions 1-40)
1. The Glasgow Coma Scale (GCS) assesses which three functions?
A) Pupillary response, motor strength, verbal response
B) Eye opening, verbal response, motor response ✓
C) Level of consciousness, cranial nerves, reflexes
D) Sensory response, eye opening, cognitive function
2. A patient presents with a sudden, severe "thunderclap" headache and nuchal rigidity. The
nurse should suspect:
A) Migraine headache
B) Meningitis
C) Ischemic stroke
D) Subarachnoid hemorrhage ✓
3. The most important initial intervention for a patient experiencing a generalized tonic-clonic
seizure is:
A) Placing a tongue blade in the mouth
B) Restraining the patient's limbs
C) Administering IV Diazepam immediately
D) Protecting the patient from injury ✓
4. Early signs of increased intracranial pressure (ICP) include:
A) Cushing's triad (hypertension, bradycardia, irregular respirations)
B) Decreased level of consciousness and confusion ✓
C) Fixed and dilated pupils
D) Decerebrate posturing
5. For a patient with a suspected spinal cord injury, which nursing action is the highest priority
upon arrival to the emergency department?
A) Assessing sensory level
,B) Maintaining spinal immobilization ✓
C) Administering corticosteroids
D) Checking bladder distention
6. The hallmark symptom of Guillain-Barré Syndrome (GBS) is:
A) Ascending symmetric muscle weakness ✓
B) Descending asymmetric paralysis
C) Severe cognitive deficits
D) Intention tremors and ataxia
7. A patient with myasthenia gravis is experiencing a myasthenic crisis. The most critical
assessment is:
A) Muscle strength
B) Pupillary response
C) Respiratory effort and vital capacity ✓
D) Bowel sounds
8. What is the primary goal in the management of a patient with an ischemic stroke who is a
candidate for fibrinolytic therapy?
A) Administer tPA within 3 hours of symptom onset.
B) Administer tPA within 4.5 hours of symptom onset. ✓
C) Control hypertension before administering tPA.
D) Wait for MRI confirmation before administering any treatment.
9. Autonomic dysreflexia is a potential life-threatening emergency for patients with a spinal
cord injury at or above which level?
A) C1-C3
B) T1-T6
C) T6 and above ✓
D) L1-L5
10. The most common trigger for autonomic dysreflexia is:
A) Emotional stress
B) A full bladder or bowel ✓
C) Pain above the level of injury
D) Sudden temperature changes
11. When assessing a patient's pupils, a fixed and dilated pupil is a sign of:
A) Uncal herniation on the same side ✓
B) Brainstem injury
,C) Metabolic encephalopathy
D) Oculomotor nerve palsy only
12. The drug of choice for stopping ongoing status epilepticus is:
A) Phenytoin (Dilantin)
B) Lorazepam (Ativan) ✓
C) Levetiracetam (Keppra)
D) Carbamazepine (Tegretol)
13. A patient with bacterial meningitis will most likely have which finding on cerebrospinal
fluid (CSF) analysis?
A) Clear fluid, low protein, normal glucose
B) Cloudy fluid, elevated protein, low glucose ✓
C) Cloudy fluid, low protein, high glucose
D) Xanthochromia, elevated protein, normal glucose
14. The priority nursing diagnosis for a patient in the acute phase of a stroke is:
A) Risk for Impaired Verbal Communication
B) Impaired Physical Mobility
C) Ineffective Airway Clearance ✓
D) Unilateral Neglect
15. Which positioning is contraindicated in a patient with increased ICP?
A) Head of bed elevated 30 degrees
B) Neck in a neutral position
C) Trendelenburg position ✓
D) Supine with head on a pillow
16. Decorticate posturing (flexion) indicates damage to the:
A) Spinal cord
B) Cerebral hemispheres ✓
C) Brainstem
D) Cerebellum
17. The classic triad of symptoms for normal pressure hydrocephalus (NPH) is:
A) Headache, vomiting, papilledema
B) Ataxia, dementia, urinary incontinence ✓
C) Tremor, rigidity, bradykinesia
D) Aphasia, apraxia, agnosia
, 18. A key difference between a migraine with aura and a transient ischemic attack (TIA) is:
A) The severity of the headache
B) The presence of motor or sensory symptoms
C) The speed of symptom onset (migraine symptoms spread over minutes, TIA is sudden)
D) The "positive" symptoms of migraine (e.g., scintillating scotoma) vs. "negative" symptoms of
TIA (e.g., loss of function) ✓
19. For a patient with a traumatic brain injury, maintaining PaCO2 within a normal range (35-
45 mmHg) is critical because:
A) Hypocapnia causes cerebral vasodilation, increasing ICP.
B) Hypercapnia causes cerebral vasoconstriction, decreasing ICP.
C) Hypercapnia causes cerebral vasodilation, increasing ICP. ✓
D) Hypocapnia has no effect on cerebral blood flow.
20. Which diagnostic test is the most sensitive for detecting an acute ischemic stroke?
A) Non-contrast CT scan
B) Magnetic Resonance Imaging (MRI) with diffusion-weighted imaging ✓
C) Cerebral Angiography
D) Skull X-ray
21. Parkinson's disease is characterized by a loss of neurons in the substantia nigra that
produce:
A) Acetylcholine
B) Dopamine ✓
C) Serotonin
D) GABA
22. The primary symptom of Bell's Palsy is:
A) Bilateral facial drooping
B) Unilateral facial paralysis/weakness ✓
C) Arm and leg weakness on one side
D) Drooping of the eyelid only
23. A patient with a cerebellar disorder will likely exhibit:
A) Hemiparesis
B) Ataxia and intention tremor ✓
C) Flaccid paralysis
D) Spasticity
