HURST REVIEW NCLEX RN READINESS
EXAM 4 MEDICAL SURGICAL COMPLEX
SCENARIOS 2026 FULL PRACTICE
QUESTIONS AND ANSWERS
◉ CASE STUDY 1
Complete the following sentence by choosing from the list of
options.
Based on the nurse's assessment of the client, the nurse determine
that the client has likely developed ________ as evidenced by the
classic triad of ________, _________, and ________
1. increased ICP, meningitis, migraine
2. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
3. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
4. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
Answer: 1. meningitis
,2. nuchal rigidity
3. irritability
4. fever
◉ CASE STUDY 1
The primary healthcare provider diagnoses the client with
meningitis, likely bacterial. Drag the potential interventions the
nurse should take to care for this client to the box on the right.
Choose only the options that are appropriate.
- darken the room
- place client side lying with head of bed elevated 10 degrees
- assess neuro status every 15 minutes
- initiate droplet precautions
- pad side rails
- set up for lumbar puncture
Answer: - darken the room
- assess neuro status every 15 minutes
- initiate droplet precautions
- pad side rails
- set up for a lumbar puncture
,Rationale:
- assess neuro status every 15 minutes: deterioration in clinical
status can occur rapidly, so frequently assess the patient's neuro
status, especially level of consciousness and vital signs. Report new
focal signs immediately.
- darken the room: try to minimize increases in the patient's ICP.
Appropriate measures include using sedation and keeping the room
quiet and dark.
- initiate droplet precautions: the CDC recommends that clients with
suspected or proven meningitis caused by either N. meningitidis or
H. influenzae type b be placed on droplet precautions for the first 24
hours of antibiotic therapy. You don a regular mask to protect
yourself in case the client has meningococcal meningitis, which can
be transmitted through respiratory and throat secretions.
- pad side rails: during the early stages of bacterial meningitis,
seizures may result from swelling and pressure in the brain, as well
as bacterial toxins in the fluids surrounding the brain. As the
meningitis infection progresses, there may be focal seizures,
seizures that involve one limb or one part of the body.
- set up for lumbar puncture: anytime bacterial meningitis is
suspected, a lumbar puncture should be performed as soon as
possible (unless contraindicated) to obtain cerebral spinal fluid
specimens for analysis, including culture and sensitivity. In general,
a low CSF glucose level, an elevated CSF protein concentration, and a
high CSF leukocyte count indicate bacterial meningitis. The nurse
, will assist the primary healthcare provider with lumbar puncture on
the client to obtain CSF.
◉ CASE STUDY 1
The ICU nurse has reviewed all nurses' notes and received
prescriptions from the primary healthcare provider. Which
prescriptions should the nurse perform immediately? SATA
a. initiate droplet precautions
b. hourly neuro checks utilizing Glasgow Coma Scale
c. ibuprofen 400 mg PO every 6 hours as needed for fever or pain
d. IV NS at 125 mL/hr
e. ceftriaxone 2 g IVPB every 12 hours
f. educate client and family on infection control measures
g. initiate seizure precautions
h. notify primary healthcare provider of lab results
Answer: a. initiate droplet precautions
b. hourly neuro checks utilizing Glasgow Coma Scale
d. IV NS at 125 mL/hr
e. ceftriaxone 2 g IVPB every 12 hours
g. initiate seizure precautions
EXAM 4 MEDICAL SURGICAL COMPLEX
SCENARIOS 2026 FULL PRACTICE
QUESTIONS AND ANSWERS
◉ CASE STUDY 1
Complete the following sentence by choosing from the list of
options.
Based on the nurse's assessment of the client, the nurse determine
that the client has likely developed ________ as evidenced by the
classic triad of ________, _________, and ________
1. increased ICP, meningitis, migraine
2. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
3. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
4. N/V, photophobia, fever, petechial rash, irritability, nuchal rigidity,
headache
Answer: 1. meningitis
,2. nuchal rigidity
3. irritability
4. fever
◉ CASE STUDY 1
The primary healthcare provider diagnoses the client with
meningitis, likely bacterial. Drag the potential interventions the
nurse should take to care for this client to the box on the right.
Choose only the options that are appropriate.
- darken the room
- place client side lying with head of bed elevated 10 degrees
- assess neuro status every 15 minutes
- initiate droplet precautions
- pad side rails
- set up for lumbar puncture
Answer: - darken the room
- assess neuro status every 15 minutes
- initiate droplet precautions
- pad side rails
- set up for a lumbar puncture
,Rationale:
- assess neuro status every 15 minutes: deterioration in clinical
status can occur rapidly, so frequently assess the patient's neuro
status, especially level of consciousness and vital signs. Report new
focal signs immediately.
- darken the room: try to minimize increases in the patient's ICP.
Appropriate measures include using sedation and keeping the room
quiet and dark.
- initiate droplet precautions: the CDC recommends that clients with
suspected or proven meningitis caused by either N. meningitidis or
H. influenzae type b be placed on droplet precautions for the first 24
hours of antibiotic therapy. You don a regular mask to protect
yourself in case the client has meningococcal meningitis, which can
be transmitted through respiratory and throat secretions.
- pad side rails: during the early stages of bacterial meningitis,
seizures may result from swelling and pressure in the brain, as well
as bacterial toxins in the fluids surrounding the brain. As the
meningitis infection progresses, there may be focal seizures,
seizures that involve one limb or one part of the body.
- set up for lumbar puncture: anytime bacterial meningitis is
suspected, a lumbar puncture should be performed as soon as
possible (unless contraindicated) to obtain cerebral spinal fluid
specimens for analysis, including culture and sensitivity. In general,
a low CSF glucose level, an elevated CSF protein concentration, and a
high CSF leukocyte count indicate bacterial meningitis. The nurse
, will assist the primary healthcare provider with lumbar puncture on
the client to obtain CSF.
◉ CASE STUDY 1
The ICU nurse has reviewed all nurses' notes and received
prescriptions from the primary healthcare provider. Which
prescriptions should the nurse perform immediately? SATA
a. initiate droplet precautions
b. hourly neuro checks utilizing Glasgow Coma Scale
c. ibuprofen 400 mg PO every 6 hours as needed for fever or pain
d. IV NS at 125 mL/hr
e. ceftriaxone 2 g IVPB every 12 hours
f. educate client and family on infection control measures
g. initiate seizure precautions
h. notify primary healthcare provider of lab results
Answer: a. initiate droplet precautions
b. hourly neuro checks utilizing Glasgow Coma Scale
d. IV NS at 125 mL/hr
e. ceftriaxone 2 g IVPB every 12 hours
g. initiate seizure precautions
