Stroke 3.0 Level VII – Comprehensive
Discharge & Prevention Exam
Complete Practice Examination – 100
Questions
SECTION 1: STROKE PATHOPHYSIOLOGY & CLASSIFICATION (Questions 1-25)
Question 1:
A patient presents with sudden onset of right-sided weakness, facial droop, and expressive aphasia. The
patient's symptoms began 45 minutes ago. Which type of stroke is MOST likely?
A) Ischemic stroke in the left middle cerebral artery territory
B) Hemorrhagic stroke in the right hemisphere
C) Ischemic stroke in the right middle cerebral artery territory
D) Hemorrhagic stroke in the left hemisphere
Answer: A) Ischemic stroke in the left middle cerebral artery territory
Rationale: Right-sided weakness and aphasia (expressive) indicate a left hemisphere stroke. The left
middle cerebral artery supplies the motor cortex (controlling the right side) and Broca's area (expressive
speech). Right hemisphere strokes cause left-sided neglect without aphasia. Hemorrhagic strokes may
present with similar symptoms but are less common in the acute setting.
Question 2:
The nurse is assessing a patient with a suspected stroke. Which finding is MOST indicative of a
hemorrhagic stroke rather than an ischemic stroke?
A) Gradual onset of symptoms
B) Sudden onset of severe headache and vomiting
C) Fluctuating neurological symptoms
D) Transient ischemic attacks preceding the event
Answer: B) Sudden onset of severe headache and vomiting
Rationale: Hemorrhagic strokes often present with sudden, severe headache ("thunderclap" headache),
vomiting, and decreased level of consciousness due to increased intracranial pressure. Ischemic strokes
may have a more gradual onset and are less likely to present with severe headache and vomiting.
,Question 3:
A patient is diagnosed with a transient ischemic attack (TIA). The nurse should educate the patient that a
TIA:
A) Is a minor stroke with permanent neurological deficits
B) Is a warning sign for a future stroke
C) Does not require any further evaluation
D) Is always followed by a major stroke within 24 hours
Answer: B) Is a warning sign for a future stroke
Rationale: A TIA is a temporary episode of neurological dysfunction caused by focal brain ischemia
without acute infarction. Symptoms resolve within 24 hours. It is a major warning sign for future stroke,
with approximately 10-15% of patients having a stroke within 90 days. Evaluation and prevention are
essential.
Question 4:
The nurse is caring for a patient who had an ischemic stroke. Which pathophysiological mechanism is
MOST responsible for neuronal injury?
A) Excessive release of excitatory neurotransmitters (glutamate)
B) Decreased release of inhibitory neurotransmitters (GABA)
C) Increased cerebral blood flow
D) Decreased intracranial pressure
Answer: A) Excessive release of excitatory neurotransmitters (glutamate)
Rationale: Ischemic stroke causes energy failure, leading to excessive release of excitatory
neurotransmitters (glutamate). This triggers excitotoxicity, calcium influx, and eventual neuronal death.
This is part of the ischemic cascade. Decreased GABA, increased blood flow, and decreased ICP are not
the primary mechanisms.
Question 5:
A patient is at risk for a lacunar stroke. Which risk factor is MOST associated with lacunar strokes?
A) Atrial fibrillation
B) Hypertension
C) Hyperlipidemia
D) Smoking
Answer: B) Hypertension
Rationale: Lacunar strokes are small infarcts in deep brain structures (basal ganglia, internal capsule)
caused by occlusion of small penetrating arteries. Hypertension is the most significant risk factor. Atrial
fibrillation causes embolic strokes. Hyperlipidemia and smoking are risk factors for atherosclerotic
strokes.
,Question 6:
The nurse is assessing a patient with a right hemisphere stroke. Which finding is MOST consistent?
A) Expressive aphasia
B) Left-sided neglect
C) Right-sided weakness
D) Receptive aphasia
Answer: B) Left-sided neglect
Rationale: Right hemisphere strokes cause left-sided neglect (ignoring the left side of the body and
environment), left-sided weakness, and impaired spatial perception. Expressive aphasia and right-sided
weakness are characteristic of left hemisphere strokes. Receptive aphasia (Wernicke's aphasia) occurs
with left temporal lobe strokes.
Question 7:
A patient with atrial fibrillation is at risk for which type of stroke?
A) Thrombotic stroke
B) Embolic stroke
C) Lacunar stroke
D) Hemorrhagic stroke
Answer: B) Embolic stroke
Rationale: Atrial fibrillation causes stasis of blood in the atria, leading to thrombus formation. These
thrombi can embolize to the cerebral circulation, causing embolic strokes. Thrombotic strokes result from
local atherosclerosis. Lacunar strokes are caused by small vessel disease. Hemorrhagic strokes are less
associated with AF.
Question 8:
The nurse is assessing a patient who had a stroke 3 days ago. Which finding indicates the patient is
developing cerebral edema?
A) Decreased level of consciousness
B) Improved motor function
C) Decreased blood pressure
D) Increased heart rate
Answer: A) Decreased level of consciousness
Rationale: Cerebral edema is a common complication of stroke, peaking at 3-5 days. It causes increased
intracranial pressure, leading to decreased level of consciousness. Improved motor function, decreased
blood pressure, and increased heart rate are not indicative of cerebral edema.
Question 9:
A patient with a stroke is experiencing homonymous hemianopia. This means the patient:
, A) Has blindness in both eyes
B) Has visual field loss on the same side in both eyes
C) Has double vision
D) Has loss of peripheral vision only
Answer: B) Has visual field loss on the same side in both eyes
Rationale: Homonymous hemianopia is the loss of vision in the same field (e.g., right or left) in both eyes.
It results from damage to the optic tract, optic radiation, or visual cortex on one side. This is a common
finding in stroke patients and affects both right and left visual fields on the same side.
Question 10:
The nurse is educating a patient about stroke prevention. Which modifiable risk factor is MOST
important to address?
A) Age
B) Hypertension
C) Gender
D) Family history
Answer: B) Hypertension
Rationale: Hypertension is the most important modifiable risk factor for stroke. It contributes to both
ischemic and hemorrhagic strokes. Age, gender, and family history are non-modifiable risk factors. Blood
pressure control significantly reduces stroke risk.
Question 11:
A patient with a left hemisphere stroke is experiencing expressive aphasia. Which nursing intervention is
MOST appropriate?
A) Speak loudly to the patient
B) Use gestures, pictures, and writing to communicate
C) Ask complex questions to stimulate the patient
D) Correct the patient's speech errors immediately
Answer: B) Use gestures, pictures, and writing to communicate
Rationale: Expressive aphasia (Broca's aphasia) affects the ability to produce speech. Alternative
communication methods (gestures, pictures, writing) help the patient communicate. Speaking loudly
does not improve comprehension (receptive aphasia is different). Complex questions may frustrate the
patient.
Question 12:
The nurse is assessing a patient with a suspected stroke. Which finding indicates the need for immediate
thrombolytic therapy?
Discharge & Prevention Exam
Complete Practice Examination – 100
Questions
SECTION 1: STROKE PATHOPHYSIOLOGY & CLASSIFICATION (Questions 1-25)
Question 1:
A patient presents with sudden onset of right-sided weakness, facial droop, and expressive aphasia. The
patient's symptoms began 45 minutes ago. Which type of stroke is MOST likely?
A) Ischemic stroke in the left middle cerebral artery territory
B) Hemorrhagic stroke in the right hemisphere
C) Ischemic stroke in the right middle cerebral artery territory
D) Hemorrhagic stroke in the left hemisphere
Answer: A) Ischemic stroke in the left middle cerebral artery territory
Rationale: Right-sided weakness and aphasia (expressive) indicate a left hemisphere stroke. The left
middle cerebral artery supplies the motor cortex (controlling the right side) and Broca's area (expressive
speech). Right hemisphere strokes cause left-sided neglect without aphasia. Hemorrhagic strokes may
present with similar symptoms but are less common in the acute setting.
Question 2:
The nurse is assessing a patient with a suspected stroke. Which finding is MOST indicative of a
hemorrhagic stroke rather than an ischemic stroke?
A) Gradual onset of symptoms
B) Sudden onset of severe headache and vomiting
C) Fluctuating neurological symptoms
D) Transient ischemic attacks preceding the event
Answer: B) Sudden onset of severe headache and vomiting
Rationale: Hemorrhagic strokes often present with sudden, severe headache ("thunderclap" headache),
vomiting, and decreased level of consciousness due to increased intracranial pressure. Ischemic strokes
may have a more gradual onset and are less likely to present with severe headache and vomiting.
,Question 3:
A patient is diagnosed with a transient ischemic attack (TIA). The nurse should educate the patient that a
TIA:
A) Is a minor stroke with permanent neurological deficits
B) Is a warning sign for a future stroke
C) Does not require any further evaluation
D) Is always followed by a major stroke within 24 hours
Answer: B) Is a warning sign for a future stroke
Rationale: A TIA is a temporary episode of neurological dysfunction caused by focal brain ischemia
without acute infarction. Symptoms resolve within 24 hours. It is a major warning sign for future stroke,
with approximately 10-15% of patients having a stroke within 90 days. Evaluation and prevention are
essential.
Question 4:
The nurse is caring for a patient who had an ischemic stroke. Which pathophysiological mechanism is
MOST responsible for neuronal injury?
A) Excessive release of excitatory neurotransmitters (glutamate)
B) Decreased release of inhibitory neurotransmitters (GABA)
C) Increased cerebral blood flow
D) Decreased intracranial pressure
Answer: A) Excessive release of excitatory neurotransmitters (glutamate)
Rationale: Ischemic stroke causes energy failure, leading to excessive release of excitatory
neurotransmitters (glutamate). This triggers excitotoxicity, calcium influx, and eventual neuronal death.
This is part of the ischemic cascade. Decreased GABA, increased blood flow, and decreased ICP are not
the primary mechanisms.
Question 5:
A patient is at risk for a lacunar stroke. Which risk factor is MOST associated with lacunar strokes?
A) Atrial fibrillation
B) Hypertension
C) Hyperlipidemia
D) Smoking
Answer: B) Hypertension
Rationale: Lacunar strokes are small infarcts in deep brain structures (basal ganglia, internal capsule)
caused by occlusion of small penetrating arteries. Hypertension is the most significant risk factor. Atrial
fibrillation causes embolic strokes. Hyperlipidemia and smoking are risk factors for atherosclerotic
strokes.
,Question 6:
The nurse is assessing a patient with a right hemisphere stroke. Which finding is MOST consistent?
A) Expressive aphasia
B) Left-sided neglect
C) Right-sided weakness
D) Receptive aphasia
Answer: B) Left-sided neglect
Rationale: Right hemisphere strokes cause left-sided neglect (ignoring the left side of the body and
environment), left-sided weakness, and impaired spatial perception. Expressive aphasia and right-sided
weakness are characteristic of left hemisphere strokes. Receptive aphasia (Wernicke's aphasia) occurs
with left temporal lobe strokes.
Question 7:
A patient with atrial fibrillation is at risk for which type of stroke?
A) Thrombotic stroke
B) Embolic stroke
C) Lacunar stroke
D) Hemorrhagic stroke
Answer: B) Embolic stroke
Rationale: Atrial fibrillation causes stasis of blood in the atria, leading to thrombus formation. These
thrombi can embolize to the cerebral circulation, causing embolic strokes. Thrombotic strokes result from
local atherosclerosis. Lacunar strokes are caused by small vessel disease. Hemorrhagic strokes are less
associated with AF.
Question 8:
The nurse is assessing a patient who had a stroke 3 days ago. Which finding indicates the patient is
developing cerebral edema?
A) Decreased level of consciousness
B) Improved motor function
C) Decreased blood pressure
D) Increased heart rate
Answer: A) Decreased level of consciousness
Rationale: Cerebral edema is a common complication of stroke, peaking at 3-5 days. It causes increased
intracranial pressure, leading to decreased level of consciousness. Improved motor function, decreased
blood pressure, and increased heart rate are not indicative of cerebral edema.
Question 9:
A patient with a stroke is experiencing homonymous hemianopia. This means the patient:
, A) Has blindness in both eyes
B) Has visual field loss on the same side in both eyes
C) Has double vision
D) Has loss of peripheral vision only
Answer: B) Has visual field loss on the same side in both eyes
Rationale: Homonymous hemianopia is the loss of vision in the same field (e.g., right or left) in both eyes.
It results from damage to the optic tract, optic radiation, or visual cortex on one side. This is a common
finding in stroke patients and affects both right and left visual fields on the same side.
Question 10:
The nurse is educating a patient about stroke prevention. Which modifiable risk factor is MOST
important to address?
A) Age
B) Hypertension
C) Gender
D) Family history
Answer: B) Hypertension
Rationale: Hypertension is the most important modifiable risk factor for stroke. It contributes to both
ischemic and hemorrhagic strokes. Age, gender, and family history are non-modifiable risk factors. Blood
pressure control significantly reduces stroke risk.
Question 11:
A patient with a left hemisphere stroke is experiencing expressive aphasia. Which nursing intervention is
MOST appropriate?
A) Speak loudly to the patient
B) Use gestures, pictures, and writing to communicate
C) Ask complex questions to stimulate the patient
D) Correct the patient's speech errors immediately
Answer: B) Use gestures, pictures, and writing to communicate
Rationale: Expressive aphasia (Broca's aphasia) affects the ability to produce speech. Alternative
communication methods (gestures, pictures, writing) help the patient communicate. Speaking loudly
does not improve comprehension (receptive aphasia is different). Complex questions may frustrate the
patient.
Question 12:
The nurse is assessing a patient with a suspected stroke. Which finding indicates the need for immediate
thrombolytic therapy?
