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NSG 3250 Exam 3 – Adult Health I: Comprehensive
Nursing Assessment, Clinical Concepts, Patient Care
& Exam Review
Summarized Exam Coverage
This comprehensive examination covers adult health nursing concepts including neurological
assessment and disorders, stroke management, headache classification and treatment, seizure
disorders, increased intracranial pressure management, musculoskeletal conditions including
fractures and osteoporosis, sensory disorders including hearing and vision, medication
administration and safety, emergency response protocols, and patient care prioritization.
Additional focus areas include neurological assessment tools like the Glasgow Coma Scale,
aphasia types, cranial nerve function, migraine pathophysiology and treatment, stroke
interventions, seizure safety, and pharmacological management of various conditions.
1. A patient presents with sudden onset of right-sided weakness, facial droop, and difficulty
speaking. What is the priority nursing action?
A) Administer aspirin immediately
B) Prepare for CT scan without contrast
C) Begin IV fluids at 125 mL/hr
D) Obtain a detailed medical history
Prepare for CT scan without contrast - This is the priority to differentiate between ischemic and
hemorrhagic stroke before initiating any treatment such as thrombolytics or antiplatelet therapy.
2. A patient with a history of migraines reports consuming aged cheese and red wine before
developing a severe headache. Which substance is most likely responsible for triggering this
migraine?
, Page 2
A) Caffeine
B) Tyramine
C) Histamine
D) Glutamate
Tyramine - Tyramine is found in aged cheeses, cured meats, and fermented foods and is a well-
documented migraine trigger that can precipitate headache episodes in susceptible individuals.
3. A patient's Glasgow Coma Scale score drops from 15 to 13. What is the most appropriate
nursing interpretation of this finding?
A) This is a normal fluctuation in consciousness
B) The drop indicates a critical change requiring immediate reassessment
C) This change is expected after analgesic administration
D) No intervention is needed until the score drops below 10
The drop indicates a critical change requiring immediate reassessment - A decrease of 2 or more
points on the GCS is considered clinically significant and warrants immediate neurological
reassessment and provider notification.
4. A patient who recently started sumatriptan for migraine management reports chest tightness
and palpitations. What is the most appropriate nursing action?
A) Reassure the patient this is a common side effect
B) Administer the medication with food to reduce symptoms
C) Hold the medication and notify the healthcare provider
D) Increase the dose to achieve better symptom control
Hold the medication and notify the healthcare provider - Sumatriptan can cause coronary
vasospasm and cardiac events; chest tightness and palpitations warrant immediate medication
discontinuation and provider notification.
5. A patient demonstrates the inability to produce speech but can understand spoken language.
Which type of aphasia is this patient experiencing?
A) Receptive aphasia
B) Global aphasia
, Page 3
C) Expressive aphasia
D) Dysarthria
Expressive aphasia - Expressive aphasia (Broca's aphasia) is characterized by difficulty
producing speech while comprehension remains intact, typically resulting from damage to
Broca's area in the frontal lobe.
6. A patient with increased intracranial pressure is positioned with the head of bed elevated to 30
degrees. What is the primary purpose of this positioning?
A) To promote patient comfort during rest
B) To prevent aspiration during meals
C) To facilitate venous drainage and reduce ICP
D) To improve visualization for neurological assessment
To facilitate venous drainage and reduce ICP - Elevating the head of bed promotes venous
drainage from the cranial cavity, which helps reduce intracranial pressure and maintain cerebral
perfusion pressure.
7. A patient with a history of glaucoma is prescribed timolol eye drops. What is the mechanism
of action for this medication?
A) Increases aqueous humor drainage through the trabecular meshwork
B) Decreases aqueous humor production
C) Dilates the pupil to improve outflow
D) Reduces intraocular inflammation
Decreases aqueous humor production - Timolol is a beta-blocker that decreases aqueous humor
production by blocking beta-adrenergic receptors in the ciliary body, reducing intraocular
pressure.
8. Which finding in a patient with a recent fracture would be most concerning for fat embolism
syndrome?
A) Localized pain at the fracture site
B) Petechiae on the chest and axillae
, Page 4
C) Mild swelling around the injury
D) Ecchymosis extending distally
Petechiae on the chest and axillae - Petechiae on the chest, axillae, and conjunctivae are classic
late signs of fat embolism syndrome, indicating systemic fat droplet embolization to the skin and
organs.
9. A patient who has been taking alendronate for osteoporosis reports difficulty swallowing and
mid-chest pain. What is the most likely cause of these symptoms?
A) Gastric ulcer formation
B) Esophageal irritation from improper administration
C) Osteonecrosis of the jaw
D) Hypocalcemia development
Esophageal irritation from improper administration - Alendronate can cause esophageal
irritation and esophagitis if not taken properly with a full glass of water while remaining upright
for at least 30 minutes after administration.
10. A patient experiences a seizure characterized by sudden staring, brief loss of awareness, and
subtle eyelid fluttering. Which type of seizure is this patient most likely experiencing?
A) Tonic-clonic seizure
B) Absence seizure
C) Akinetic seizure
D) Myoclonic seizure
Absence seizure - Absence seizures are characterized by brief episodes of staring, loss of
awareness, and subtle motor manifestations like eyelid fluttering, typically lasting less than 10
seconds with immediate return to baseline.
11. A patient with a left hemisphere stroke is having difficulty understanding written and spoken
language. What type of aphasia is this patient most likely experiencing?
A) Expressive aphasia
B) Receptive aphasia
NSG 3250 Exam 3 – Adult Health I: Comprehensive
Nursing Assessment, Clinical Concepts, Patient Care
& Exam Review
Summarized Exam Coverage
This comprehensive examination covers adult health nursing concepts including neurological
assessment and disorders, stroke management, headache classification and treatment, seizure
disorders, increased intracranial pressure management, musculoskeletal conditions including
fractures and osteoporosis, sensory disorders including hearing and vision, medication
administration and safety, emergency response protocols, and patient care prioritization.
Additional focus areas include neurological assessment tools like the Glasgow Coma Scale,
aphasia types, cranial nerve function, migraine pathophysiology and treatment, stroke
interventions, seizure safety, and pharmacological management of various conditions.
1. A patient presents with sudden onset of right-sided weakness, facial droop, and difficulty
speaking. What is the priority nursing action?
A) Administer aspirin immediately
B) Prepare for CT scan without contrast
C) Begin IV fluids at 125 mL/hr
D) Obtain a detailed medical history
Prepare for CT scan without contrast - This is the priority to differentiate between ischemic and
hemorrhagic stroke before initiating any treatment such as thrombolytics or antiplatelet therapy.
2. A patient with a history of migraines reports consuming aged cheese and red wine before
developing a severe headache. Which substance is most likely responsible for triggering this
migraine?
, Page 2
A) Caffeine
B) Tyramine
C) Histamine
D) Glutamate
Tyramine - Tyramine is found in aged cheeses, cured meats, and fermented foods and is a well-
documented migraine trigger that can precipitate headache episodes in susceptible individuals.
3. A patient's Glasgow Coma Scale score drops from 15 to 13. What is the most appropriate
nursing interpretation of this finding?
A) This is a normal fluctuation in consciousness
B) The drop indicates a critical change requiring immediate reassessment
C) This change is expected after analgesic administration
D) No intervention is needed until the score drops below 10
The drop indicates a critical change requiring immediate reassessment - A decrease of 2 or more
points on the GCS is considered clinically significant and warrants immediate neurological
reassessment and provider notification.
4. A patient who recently started sumatriptan for migraine management reports chest tightness
and palpitations. What is the most appropriate nursing action?
A) Reassure the patient this is a common side effect
B) Administer the medication with food to reduce symptoms
C) Hold the medication and notify the healthcare provider
D) Increase the dose to achieve better symptom control
Hold the medication and notify the healthcare provider - Sumatriptan can cause coronary
vasospasm and cardiac events; chest tightness and palpitations warrant immediate medication
discontinuation and provider notification.
5. A patient demonstrates the inability to produce speech but can understand spoken language.
Which type of aphasia is this patient experiencing?
A) Receptive aphasia
B) Global aphasia
, Page 3
C) Expressive aphasia
D) Dysarthria
Expressive aphasia - Expressive aphasia (Broca's aphasia) is characterized by difficulty
producing speech while comprehension remains intact, typically resulting from damage to
Broca's area in the frontal lobe.
6. A patient with increased intracranial pressure is positioned with the head of bed elevated to 30
degrees. What is the primary purpose of this positioning?
A) To promote patient comfort during rest
B) To prevent aspiration during meals
C) To facilitate venous drainage and reduce ICP
D) To improve visualization for neurological assessment
To facilitate venous drainage and reduce ICP - Elevating the head of bed promotes venous
drainage from the cranial cavity, which helps reduce intracranial pressure and maintain cerebral
perfusion pressure.
7. A patient with a history of glaucoma is prescribed timolol eye drops. What is the mechanism
of action for this medication?
A) Increases aqueous humor drainage through the trabecular meshwork
B) Decreases aqueous humor production
C) Dilates the pupil to improve outflow
D) Reduces intraocular inflammation
Decreases aqueous humor production - Timolol is a beta-blocker that decreases aqueous humor
production by blocking beta-adrenergic receptors in the ciliary body, reducing intraocular
pressure.
8. Which finding in a patient with a recent fracture would be most concerning for fat embolism
syndrome?
A) Localized pain at the fracture site
B) Petechiae on the chest and axillae
, Page 4
C) Mild swelling around the injury
D) Ecchymosis extending distally
Petechiae on the chest and axillae - Petechiae on the chest, axillae, and conjunctivae are classic
late signs of fat embolism syndrome, indicating systemic fat droplet embolization to the skin and
organs.
9. A patient who has been taking alendronate for osteoporosis reports difficulty swallowing and
mid-chest pain. What is the most likely cause of these symptoms?
A) Gastric ulcer formation
B) Esophageal irritation from improper administration
C) Osteonecrosis of the jaw
D) Hypocalcemia development
Esophageal irritation from improper administration - Alendronate can cause esophageal
irritation and esophagitis if not taken properly with a full glass of water while remaining upright
for at least 30 minutes after administration.
10. A patient experiences a seizure characterized by sudden staring, brief loss of awareness, and
subtle eyelid fluttering. Which type of seizure is this patient most likely experiencing?
A) Tonic-clonic seizure
B) Absence seizure
C) Akinetic seizure
D) Myoclonic seizure
Absence seizure - Absence seizures are characterized by brief episodes of staring, loss of
awareness, and subtle motor manifestations like eyelid fluttering, typically lasting less than 10
seconds with immediate return to baseline.
11. A patient with a left hemisphere stroke is having difficulty understanding written and spoken
language. What type of aphasia is this patient most likely experiencing?
A) Expressive aphasia
B) Receptive aphasia
