NSG 3280 Exam 3: NSG 3280 Exam 3 Study Guide:
Questions & Answers
1. A nurse is teaching a family about stroke mechanisms. Which statements are accurate? Select
all that apply.
A. A thrombotic stroke develops from plaque within a cerebral artery.
B. An embolic stroke forms locally in the brain after head trauma.
C. An embolic stroke is caused by a clot that travels to the brain.
D. A hemorrhagic stroke results from a ruptured cerebral vessel.
E. A thrombotic stroke is most often caused by an aneurysm rupture.
ANS: A, C, D
Rationale:
• A (Correct): Thrombotic = in-situ clot formation, often atherosclerotic plaque in cerebral
arteries.
• C (Correct): Embolic = clot travels from elsewhere (e.g., heart) and lodges in cerebral
circulation.
• D (Correct): Hemorrhagic = bleeding due to vessel rupture.
• B (Incorrect): Describes local clot; embolic travels. Could be correct if the stem said
“thrombotic.”
• E (Incorrect): Aneurysm rupture causes hemorrhagic, not thrombotic, stroke; could be
correct if asking about hemorrhagic etiologies.
2. A client with severe headache and sudden neuro deficit arrives to the ED.
Which diagnostic action should the nurse anticipate first?
A. CT head with IV contrast
B. CT head without contrast
C. MRI brain with gadolinium
D. Cerebral angiography
ANS: B
Rationale:
• B (Correct): Non-contrast CT first—rapidly detects acute blood and guides next steps.
, • A (Incorrect): Contrast can obscure acute blood and is avoided initially; can follow a
clear non-contrast CT.
• C (Incorrect): MRI is sensitive but takes longer; not first in acute suspected bleed.
• D (Incorrect): Angio evaluates vessels/interventions later; not firstline in the crashing
patient.
3. Which ED triage note requires the most immediate stroke risk counseling?
A. 58-year-old with controlled HTN on meds
B. 52-year-old with uncontrolled hypertension
C. 60-year-old with migraines
D. 63-year-old with hyperlipidemia on statin
ANS: B
Rationale:
• B (Correct): Uncontrolled HTN is a major precipitant of vessel rupture → hemorrhagic
stroke.
• A (Incorrect): Controlled HTN still a risk, but urgency is lower.
• C (Incorrect): Migraine ≠ primary hemorrhagic risk.
• D (Incorrect): Lipids relate more to ischemic atherosclerosis than to acute hemorrhage
risk.
4. A client’s GCS drops from 14 to 12 over 30 minutes. What is the priority action?
A. Reassess in 1 hour
B. Document and continue routine care
C. Notify the provider now
D. Administer PRN analgesic
ANS: C
Rationale:
• C (Correct): A ≥2-point decrease is clinically significant and must be reported promptly.
• A (Incorrect): Delay risks missing deterioration.
• B (Incorrect): Documentation alone is insufficient.
• D (Incorrect): Pain control may be needed, but neuro change takes priority.
, 5. Which GCS combination reflects moderate disability?
A. E4 V5 M6
B. E3 V3 M4C. E1 V1 M1 D. E2 V2 M2
ANS: B
Rationale:
• B (Correct): Total = 10 → moderate disability (9–12).
• A (Incorrect): Total 15 = normal/mild (13–15).
• C (Incorrect): Total 3 = lowest possible, severe coma.
• D (Incorrect): Total 6 = severe (3–8).
6. Which assessment findings most directly indicate dysfunction of CN III, IV, or VI? Select all
that apply.
A. Nystagmus
B. Dysconjugate gaze
C. Ocular palsy in one eye
D. Loss of corneal reflex
E. Pupillary dilation unreactive to light
ANS: A, B, C, E Rationale:
• A/B/C (Correct): Extraocular muscle control (III, IV, VI) → nystagmus, dysconjugate gaze,
ocular palsy.
• E (Correct): CN III controls pupillary constrictor fibers; dysfunction → dilated,
sluggish/absent light response.
• D (Incorrect): Corneal reflex is CN V (sensory) and CN VII (motor); could be correct if the
question targeted V/VII.
7. Which statement from a client with facial pain shows understanding of trigeminal neuralgia?
A. “It’s due to a viral infection of my facial nerve.”
B. “It’s often caused by vascular compression of my trigeminal nerve.”
C. “It means I will lose vision in my eye.”
D. “It’s a problem with my spinal nerves.”
ANS: B
Rationale:
Questions & Answers
1. A nurse is teaching a family about stroke mechanisms. Which statements are accurate? Select
all that apply.
A. A thrombotic stroke develops from plaque within a cerebral artery.
B. An embolic stroke forms locally in the brain after head trauma.
C. An embolic stroke is caused by a clot that travels to the brain.
D. A hemorrhagic stroke results from a ruptured cerebral vessel.
E. A thrombotic stroke is most often caused by an aneurysm rupture.
ANS: A, C, D
Rationale:
• A (Correct): Thrombotic = in-situ clot formation, often atherosclerotic plaque in cerebral
arteries.
• C (Correct): Embolic = clot travels from elsewhere (e.g., heart) and lodges in cerebral
circulation.
• D (Correct): Hemorrhagic = bleeding due to vessel rupture.
• B (Incorrect): Describes local clot; embolic travels. Could be correct if the stem said
“thrombotic.”
• E (Incorrect): Aneurysm rupture causes hemorrhagic, not thrombotic, stroke; could be
correct if asking about hemorrhagic etiologies.
2. A client with severe headache and sudden neuro deficit arrives to the ED.
Which diagnostic action should the nurse anticipate first?
A. CT head with IV contrast
B. CT head without contrast
C. MRI brain with gadolinium
D. Cerebral angiography
ANS: B
Rationale:
• B (Correct): Non-contrast CT first—rapidly detects acute blood and guides next steps.
, • A (Incorrect): Contrast can obscure acute blood and is avoided initially; can follow a
clear non-contrast CT.
• C (Incorrect): MRI is sensitive but takes longer; not first in acute suspected bleed.
• D (Incorrect): Angio evaluates vessels/interventions later; not firstline in the crashing
patient.
3. Which ED triage note requires the most immediate stroke risk counseling?
A. 58-year-old with controlled HTN on meds
B. 52-year-old with uncontrolled hypertension
C. 60-year-old with migraines
D. 63-year-old with hyperlipidemia on statin
ANS: B
Rationale:
• B (Correct): Uncontrolled HTN is a major precipitant of vessel rupture → hemorrhagic
stroke.
• A (Incorrect): Controlled HTN still a risk, but urgency is lower.
• C (Incorrect): Migraine ≠ primary hemorrhagic risk.
• D (Incorrect): Lipids relate more to ischemic atherosclerosis than to acute hemorrhage
risk.
4. A client’s GCS drops from 14 to 12 over 30 minutes. What is the priority action?
A. Reassess in 1 hour
B. Document and continue routine care
C. Notify the provider now
D. Administer PRN analgesic
ANS: C
Rationale:
• C (Correct): A ≥2-point decrease is clinically significant and must be reported promptly.
• A (Incorrect): Delay risks missing deterioration.
• B (Incorrect): Documentation alone is insufficient.
• D (Incorrect): Pain control may be needed, but neuro change takes priority.
, 5. Which GCS combination reflects moderate disability?
A. E4 V5 M6
B. E3 V3 M4C. E1 V1 M1 D. E2 V2 M2
ANS: B
Rationale:
• B (Correct): Total = 10 → moderate disability (9–12).
• A (Incorrect): Total 15 = normal/mild (13–15).
• C (Incorrect): Total 3 = lowest possible, severe coma.
• D (Incorrect): Total 6 = severe (3–8).
6. Which assessment findings most directly indicate dysfunction of CN III, IV, or VI? Select all
that apply.
A. Nystagmus
B. Dysconjugate gaze
C. Ocular palsy in one eye
D. Loss of corneal reflex
E. Pupillary dilation unreactive to light
ANS: A, B, C, E Rationale:
• A/B/C (Correct): Extraocular muscle control (III, IV, VI) → nystagmus, dysconjugate gaze,
ocular palsy.
• E (Correct): CN III controls pupillary constrictor fibers; dysfunction → dilated,
sluggish/absent light response.
• D (Incorrect): Corneal reflex is CN V (sensory) and CN VII (motor); could be correct if the
question targeted V/VII.
7. Which statement from a client with facial pain shows understanding of trigeminal neuralgia?
A. “It’s due to a viral infection of my facial nerve.”
B. “It’s often caused by vascular compression of my trigeminal nerve.”
C. “It means I will lose vision in my eye.”
D. “It’s a problem with my spinal nerves.”
ANS: B
Rationale:
