Galen NSG 4100 Exam 4 | Adult Health III (2026) Actual Q&A
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1. A nurse is caring for a client with head trauma. The client's urinary output is 300 mL over 2
hours. Which action should the nurse take first?
A) Document the output as normal
B) Notify the healthcare provider immediately
C) Decrease IV fluids
D) Check specific gravity
Correct Answer: Check specific gravity
Rationale: 300 mL over 2 hours is 150 mL/hr, well above normal (30–80 mL/hr). This polyuria
after head trauma may indicate diabetes insipidus due to posterior pituitary injury. Checking
specific gravity is the best first action to confirm the cause of polyuria; a low specific gravity
(<1.005) suggests diabetes insipidus.
2. A client with traumatic brain injury (TBI) had a peak ICP reading 12 hours ago. Now at 36
hours post-injury, the client becomes unconscious for 1 minute. What should the nurse do first?
A) Reorient the client
B) Notify provider of increased pupil size from 7 to 10 mm
C) Administer oxygen at 2 L/min
D) Check blood glucose
Correct Answer: Notify provider of increased pupil size from 7 to 10 mm
Rationale: Pupil dilation from 7 mm to 10 mm indicates worsening brainstem compression and
imminent herniation. This requires immediate notification of the provider. The client is
unconscious, so reorientation is not possible; oxygen and blood glucose checks are secondary.
,3. A client with a closed head injury is on mechanical ventilation. Which intervention reduces
the risk of increased ICP?
A) Keep the head of the bed flat
B) Elevate the head of the bed 30–45 degrees
C) Turn the client every 4 hours
D) Suction every hour
Correct Answer: Elevate the head of the bed 30–45 degrees
Rationale: Elevating the head of the bed promotes venous drainage from the brain, reducing
intracranial pressure (ICP). Flat positioning increases cerebral venous pressure and raises ICP.
4. A client who had a craniotomy for brain tumor removal notes postnasal drip. What action is
most important?
A) Suction the nasopharynx
B) Notify the primary care provider immediately
C) Give antihistamines
D) Elevate the head of the bed
Correct Answer: Notify the primary care provider immediately
Rationale: Postnasal drip after a craniotomy may indicate a cerebrospinal fluid (CSF) leak, which
can lead to meningitis. Nasopharyngeal suctioning can introduce bacteria and should be
avoided. The provider must be notified immediately.
5. A nurse is assessing a client with a suspected epidural hematoma. Which finding is most
characteristic?
,A) Gradual onset of headache
B) Lucid interval followed by rapid deterioration
C) Bilateral pupil constriction
D) Low-grade fever
Correct Answer: Lucid interval followed by rapid deterioration
Rationale: An epidural hematoma is a medical emergency caused by arterial bleeding, typically
from the middle meningeal artery. It often presents with a brief lucid interval after the initial
injury, followed by rapid neurological deterioration due to expanding hematoma and brain
herniation.
6. Which of the following is a priority nursing intervention for a patient with an epidural
hematoma?
A) Prepare the patient for immediate surgery
B) Administer IV antibiotics
C) Apply ice packs to the head
D) Place the patient in a supine position
Correct Answer: Prepare the patient for immediate surgery
Rationale: An epidural hematoma requires immediate surgical evacuation to prevent brain
herniation. Delays in treatment can lead to irreversible neurological damage or death.
7. A client is admitted with a subdural hematoma. The nurse understands that this type of bleed
is located between which structures?
A) Skull and dura mater
B) Dura mater and arachnoid mater
, C) Arachnoid mater and pia mater
D) Pia mater and brain tissue
Correct Answer: Dura mater and arachnoid mater
Rationale: A subdural hematoma is located between the dura mater and the arachnoid mater. It
is usually caused by tearing of bridging veins due to acceleration-deceleration forces. An
epidural hematoma is between the skull and dura mater.
8. A client with increased ICP is exhibiting Cushing's triad. Which vital sign pattern is consistent
with this finding?
A) Hypertension, bradycardia, irregular respirations
B) Hypotension, tachycardia, tachypnea
C) Hypertension, tachycardia, tachypnea
D) Hypotension, bradycardia, irregular respirations
Correct Answer: Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad—hypertension, bradycardia, and irregular respirations—is a late sign
of increased ICP and indicates brainstem compression. This is a life-threatening emergency
requiring immediate intervention.
9. A nurse is assessing a client with meningitis. Which finding is most consistent with this
diagnosis?
A) Brudzinski's sign
B) Kernig's sign
C) Photophobia
D) All of the above
1. A nurse is caring for a client with head trauma. The client's urinary output is 300 mL over 2
hours. Which action should the nurse take first?
A) Document the output as normal
B) Notify the healthcare provider immediately
C) Decrease IV fluids
D) Check specific gravity
Correct Answer: Check specific gravity
Rationale: 300 mL over 2 hours is 150 mL/hr, well above normal (30–80 mL/hr). This polyuria
after head trauma may indicate diabetes insipidus due to posterior pituitary injury. Checking
specific gravity is the best first action to confirm the cause of polyuria; a low specific gravity
(<1.005) suggests diabetes insipidus.
2. A client with traumatic brain injury (TBI) had a peak ICP reading 12 hours ago. Now at 36
hours post-injury, the client becomes unconscious for 1 minute. What should the nurse do first?
A) Reorient the client
B) Notify provider of increased pupil size from 7 to 10 mm
C) Administer oxygen at 2 L/min
D) Check blood glucose
Correct Answer: Notify provider of increased pupil size from 7 to 10 mm
Rationale: Pupil dilation from 7 mm to 10 mm indicates worsening brainstem compression and
imminent herniation. This requires immediate notification of the provider. The client is
unconscious, so reorientation is not possible; oxygen and blood glucose checks are secondary.
,3. A client with a closed head injury is on mechanical ventilation. Which intervention reduces
the risk of increased ICP?
A) Keep the head of the bed flat
B) Elevate the head of the bed 30–45 degrees
C) Turn the client every 4 hours
D) Suction every hour
Correct Answer: Elevate the head of the bed 30–45 degrees
Rationale: Elevating the head of the bed promotes venous drainage from the brain, reducing
intracranial pressure (ICP). Flat positioning increases cerebral venous pressure and raises ICP.
4. A client who had a craniotomy for brain tumor removal notes postnasal drip. What action is
most important?
A) Suction the nasopharynx
B) Notify the primary care provider immediately
C) Give antihistamines
D) Elevate the head of the bed
Correct Answer: Notify the primary care provider immediately
Rationale: Postnasal drip after a craniotomy may indicate a cerebrospinal fluid (CSF) leak, which
can lead to meningitis. Nasopharyngeal suctioning can introduce bacteria and should be
avoided. The provider must be notified immediately.
5. A nurse is assessing a client with a suspected epidural hematoma. Which finding is most
characteristic?
,A) Gradual onset of headache
B) Lucid interval followed by rapid deterioration
C) Bilateral pupil constriction
D) Low-grade fever
Correct Answer: Lucid interval followed by rapid deterioration
Rationale: An epidural hematoma is a medical emergency caused by arterial bleeding, typically
from the middle meningeal artery. It often presents with a brief lucid interval after the initial
injury, followed by rapid neurological deterioration due to expanding hematoma and brain
herniation.
6. Which of the following is a priority nursing intervention for a patient with an epidural
hematoma?
A) Prepare the patient for immediate surgery
B) Administer IV antibiotics
C) Apply ice packs to the head
D) Place the patient in a supine position
Correct Answer: Prepare the patient for immediate surgery
Rationale: An epidural hematoma requires immediate surgical evacuation to prevent brain
herniation. Delays in treatment can lead to irreversible neurological damage or death.
7. A client is admitted with a subdural hematoma. The nurse understands that this type of bleed
is located between which structures?
A) Skull and dura mater
B) Dura mater and arachnoid mater
, C) Arachnoid mater and pia mater
D) Pia mater and brain tissue
Correct Answer: Dura mater and arachnoid mater
Rationale: A subdural hematoma is located between the dura mater and the arachnoid mater. It
is usually caused by tearing of bridging veins due to acceleration-deceleration forces. An
epidural hematoma is between the skull and dura mater.
8. A client with increased ICP is exhibiting Cushing's triad. Which vital sign pattern is consistent
with this finding?
A) Hypertension, bradycardia, irregular respirations
B) Hypotension, tachycardia, tachypnea
C) Hypertension, tachycardia, tachypnea
D) Hypotension, bradycardia, irregular respirations
Correct Answer: Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad—hypertension, bradycardia, and irregular respirations—is a late sign
of increased ICP and indicates brainstem compression. This is a life-threatening emergency
requiring immediate intervention.
9. A nurse is assessing a client with meningitis. Which finding is most consistent with this
diagnosis?
A) Brudzinski's sign
B) Kernig's sign
C) Photophobia
D) All of the above
