Med-Surg 3 Exam 2

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Sample questions from Med-Surg 3 Exam 2

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.During a home visit, a client recovering from a recent head injury becomes difficult to awaken. The client opens the eyes only to painful stimulation, makes incomprehensible sounds, and withdraws from pain. Which action is the priority?

   • A.Place the client in a dark room and reduce stimulation for several hours.
   • B.Ask the family to encourage oral fluids and observe for improvement.
   • C.Repeat the focused neurologic assessment and arrange immediate emergency evaluation.
   • D.Document the Glasgow Coma Scale score and reassess at the next scheduled visit.

   Rationale: The findings indicate a substantially depressed level of consciousness and require prompt reassessment and emergency escalation because neurologic deterioration can reflect evolving intracranial injury. The described responses produce a Glasgow Coma Scale score of 8, which is not appropriate for routine observation at home. Waiting for a scheduled reassessment, offering fluids, or using rest as the sole response could delay treatment of a life-threatening change.

2. 2.Refer to the client's chart. Which actions are appropriate in response to the neurologic changes? Select all that apply.

   • A.Encourage repeated coughing and deep suctioning to clear the airway, even if the client is not obstructing.
   • B.Repeat and document the focused neurologic assessment, including level of consciousness and pupil response.
   • C.Elevate the head of the bed about 30 degrees and keep the head and neck midline.
   • D.Notify the appropriate clinician immediately and report the trend in neurologic findings and vital signs.
   • E.Place the client flat with the neck flexed to improve blood flow to the brain.

   Rationale: The decline from following commands at 0800 to responding only to pain at 1000, together with a new pupil-size difference and rising blood pressure with a falling heart rate, signals possible worsening intracranial pressure and requires urgent escalation. Head elevation with a neutral neck can support cerebral venous drainage, and a repeated focused assessment helps establish the current degree of deterioration. Unnecessary coughing or suctioning can raise intracranial pressure, while a flat position with neck flexion can impede venous drainage.

3. 3.Which client should have a noncontrast head CT before lumbar puncture is considered?

   • A.A client with a long history of tension headaches and a normal focused neurologic assessment.
   • B.A client with fever and headache who has new unilateral arm weakness and decreasing alertness.
   • C.A client with fever and neck discomfort who is alert and has equal, reactive pupils and symmetric strength.
   • D.A client with fever and headache who is alert, has no focal findings, and has no history of neurologic disease.

   Rationale: New focal weakness and declining alertness raise concern for a space-occupying process or increased intracranial pressure, making imaging before lumbar puncture important because removal of cerebrospinal fluid could precipitate herniation in some conditions. The other clients do not have the described focal deficit or declining consciousness that makes imaging before lumbar puncture a priority. A normal assessment does not eliminate every risk, but the acute focal findings distinguish the highest-risk client here.

4. 4.At change of shift, a client with a suspected neurologic event has a Glasgow Coma Scale score that decreases from 14 to 11 over 30 minutes. Which interpretation is most appropriate?

   • A.The change is expected during sleep and should be reassessed after the client wakes naturally.
   • B.The change is most likely caused by anxiety and should be managed with reassurance first.
   • C.The score is useful only after a confirmed stroke diagnosis, so no action is needed yet.
   • D.The decline may indicate neurologic deterioration and requires prompt reassessment and escalation.

   Answer and rationale are in the full material.

5. 5.Before a client undergoes MRI for evaluation of new neurologic symptoms, which information is most important to obtain?

   • A.Whether the client has any implanted device or metallic foreign body.
   • B.Whether the client has a family history of migraine.
   • C.Whether the client has previously undergone a CT scan.
   • D.Whether the client has eaten within the last 4 hours.

   Answer and rationale are in the full material.