Wilkes University NSG 555 Exam 2 (pdf) | 2026/2027 | Nurse
Practitioners in Primary Care II Q&A | Nursing
1. A 65-year-old patient presents with sudden onset of right-sided weakness,
facial droop, and slurred speech. The symptoms began approximately 45
minutes ago. What is the most appropriate next step?
A) Order a CT scan of the head and consult neurology for possible tPA
B) Administer aspirin 325 mg immediately
C) Start the patient on warfarin therapy
D) Schedule an MRI for the next day
Correct Answer: A) Order a CT scan of the head and consult neurology for
possible tPA
Rationale: Acute ischemic stroke symptoms with onset within 4.5 hours
require immediate evaluation for thrombolytic therapy (tPA). A non-contrast
CT scan must be performed to rule out hemorrhagic stroke before tPA
administration. Aspirin should not be given until hemorrhagic stroke is ruled
out. Warfarin is not indicated for acute stroke management.
2. A patient presents with a sudden, severe headache described as the
"worst headache of my life" followed by loss of consciousness. What is the
most likely diagnosis?
A) Ischemic stroke
B) Subarachnoid hemorrhage
C) Transient ischemic attack
D) Migraine with aura
Correct Answer: B) Subarachnoid hemorrhage
,Rationale: The classic presentation of subarachnoid hemorrhage is a sudden,
severe "thunderclap" headache, often described as the worst headache of
one's life. It may be accompanied by nausea, vomiting, and loss of
consciousness. Immediate CT scan of the head without contrast is the initial
diagnostic test. If CT is negative, lumbar puncture is indicated.
3. A patient is diagnosed with an ischemic stroke. Which medication is most
appropriate for secondary prevention?
A) Aspirin
B) Warfarin
C) Clopidogrel
D) All of the above depending on the etiology
Correct Answer: D) All of the above depending on the etiology
Rationale: Secondary stroke prevention depends on the underlying etiology.
Aspirin or clopidogrel is used for non-cardioembolic stroke. Warfarin or
DOACs are used for cardioembolic stroke (e.g., atrial fibrillation). Carotid
endarterectomy may be indicated for significant carotid stenosis.
4. The leading cause of serious long-term disability in the United States is:
A) Multiple sclerosis
B) Stroke
C) Parkinson's disease
D) Alzheimer's disease
Correct Answer: B) Stroke
Rationale: Stroke is the leading cause of serious long-term disability in the
United States. Approximately 87% of strokes are ischemic. Control of
,hypertension, diabetes mellitus, and high cholesterol contributes to the
decline of stroke mortality.
5. A patient with a history of atrial fibrillation presents with sudden onset of
left-sided weakness and aphasia. What is the most likely mechanism of this
stroke?
A) Thrombosis of a cerebral artery
B) Embolism from the left atrium
C) Hemorrhage from a ruptured aneurysm
D) Vasospasm
Correct Answer: B) Embolism from the left atrium
Rationale: Atrial fibrillation is a major risk factor for cardioembolic stroke due
to thrombus formation in the left atrium. These emboli travel to the cerebral
circulation, causing ischemic stroke. Anticoagulation (warfarin or DOACs) is
indicated for stroke prevention in patients with atrial fibrillation.
6. A patient who had a stroke 6 months ago is now experiencing depression
and difficulty with activities of daily living. What is the most appropriate next
step?
A) Refer to a neurologist for further evaluation
B) Screen for post-stroke depression and initiate treatment
C) Increase physical therapy only
D) Discontinue all medications
Correct Answer: B) Screen for post-stroke depression and initiate treatment
Rationale: Post-stroke depression is common and can significantly impact
recovery and quality of life. Screening for depression using the PHQ-9 or
, other validated tools is essential. Treatment may include antidepressant
medications (SSRIs) and psychotherapy. Physical therapy is important but
does not address the underlying depression.
7. A patient presents with transient episodes of unilateral weakness and
slurred speech lasting 10-15 minutes that have completely resolved. What is
the most likely diagnosis?
A) Ischemic stroke
B) Transient ischemic attack (TIA)
C) Migraine with aura
D) Seizure
Correct Answer: B) Transient ischemic attack (TIA)
Rationale: TIA is a transient episode of neurological dysfunction caused by
focal brain, spinal cord, or retinal ischemia without acute infarction.
Symptoms typically last less than 1 hour. TIA is a warning sign for future
stroke and requires immediate evaluation and management of vascular risk
factors.
8. A patient with a history of hypertension, diabetes, and smoking presents
with sudden onset of right-sided weakness and dysarthria. The patient is
within the 4.5-hour window for tPA. What is the first step in management?
A) Administer tPA immediately
B) Perform a non-contrast CT scan of the head
C) Start aspirin therapy
D) Order an MRI of the brain
Correct Answer: B) Perform a non-contrast CT scan of the head
Practitioners in Primary Care II Q&A | Nursing
1. A 65-year-old patient presents with sudden onset of right-sided weakness,
facial droop, and slurred speech. The symptoms began approximately 45
minutes ago. What is the most appropriate next step?
A) Order a CT scan of the head and consult neurology for possible tPA
B) Administer aspirin 325 mg immediately
C) Start the patient on warfarin therapy
D) Schedule an MRI for the next day
Correct Answer: A) Order a CT scan of the head and consult neurology for
possible tPA
Rationale: Acute ischemic stroke symptoms with onset within 4.5 hours
require immediate evaluation for thrombolytic therapy (tPA). A non-contrast
CT scan must be performed to rule out hemorrhagic stroke before tPA
administration. Aspirin should not be given until hemorrhagic stroke is ruled
out. Warfarin is not indicated for acute stroke management.
2. A patient presents with a sudden, severe headache described as the
"worst headache of my life" followed by loss of consciousness. What is the
most likely diagnosis?
A) Ischemic stroke
B) Subarachnoid hemorrhage
C) Transient ischemic attack
D) Migraine with aura
Correct Answer: B) Subarachnoid hemorrhage
,Rationale: The classic presentation of subarachnoid hemorrhage is a sudden,
severe "thunderclap" headache, often described as the worst headache of
one's life. It may be accompanied by nausea, vomiting, and loss of
consciousness. Immediate CT scan of the head without contrast is the initial
diagnostic test. If CT is negative, lumbar puncture is indicated.
3. A patient is diagnosed with an ischemic stroke. Which medication is most
appropriate for secondary prevention?
A) Aspirin
B) Warfarin
C) Clopidogrel
D) All of the above depending on the etiology
Correct Answer: D) All of the above depending on the etiology
Rationale: Secondary stroke prevention depends on the underlying etiology.
Aspirin or clopidogrel is used for non-cardioembolic stroke. Warfarin or
DOACs are used for cardioembolic stroke (e.g., atrial fibrillation). Carotid
endarterectomy may be indicated for significant carotid stenosis.
4. The leading cause of serious long-term disability in the United States is:
A) Multiple sclerosis
B) Stroke
C) Parkinson's disease
D) Alzheimer's disease
Correct Answer: B) Stroke
Rationale: Stroke is the leading cause of serious long-term disability in the
United States. Approximately 87% of strokes are ischemic. Control of
,hypertension, diabetes mellitus, and high cholesterol contributes to the
decline of stroke mortality.
5. A patient with a history of atrial fibrillation presents with sudden onset of
left-sided weakness and aphasia. What is the most likely mechanism of this
stroke?
A) Thrombosis of a cerebral artery
B) Embolism from the left atrium
C) Hemorrhage from a ruptured aneurysm
D) Vasospasm
Correct Answer: B) Embolism from the left atrium
Rationale: Atrial fibrillation is a major risk factor for cardioembolic stroke due
to thrombus formation in the left atrium. These emboli travel to the cerebral
circulation, causing ischemic stroke. Anticoagulation (warfarin or DOACs) is
indicated for stroke prevention in patients with atrial fibrillation.
6. A patient who had a stroke 6 months ago is now experiencing depression
and difficulty with activities of daily living. What is the most appropriate next
step?
A) Refer to a neurologist for further evaluation
B) Screen for post-stroke depression and initiate treatment
C) Increase physical therapy only
D) Discontinue all medications
Correct Answer: B) Screen for post-stroke depression and initiate treatment
Rationale: Post-stroke depression is common and can significantly impact
recovery and quality of life. Screening for depression using the PHQ-9 or
, other validated tools is essential. Treatment may include antidepressant
medications (SSRIs) and psychotherapy. Physical therapy is important but
does not address the underlying depression.
7. A patient presents with transient episodes of unilateral weakness and
slurred speech lasting 10-15 minutes that have completely resolved. What is
the most likely diagnosis?
A) Ischemic stroke
B) Transient ischemic attack (TIA)
C) Migraine with aura
D) Seizure
Correct Answer: B) Transient ischemic attack (TIA)
Rationale: TIA is a transient episode of neurological dysfunction caused by
focal brain, spinal cord, or retinal ischemia without acute infarction.
Symptoms typically last less than 1 hour. TIA is a warning sign for future
stroke and requires immediate evaluation and management of vascular risk
factors.
8. A patient with a history of hypertension, diabetes, and smoking presents
with sudden onset of right-sided weakness and dysarthria. The patient is
within the 4.5-hour window for tPA. What is the first step in management?
A) Administer tPA immediately
B) Perform a non-contrast CT scan of the head
C) Start aspirin therapy
D) Order an MRI of the brain
Correct Answer: B) Perform a non-contrast CT scan of the head
