,NSG3250/NSG 3250 Exam 3 | Adult Health
I | Galen College | 26/27 Updated (PDF)
1. A patient presents with a sudden onset of slurred speech and right-sided weakness that completely
resolves within 30 minutes. The emergency department nurse recognizes that a transient ischemic
attack differs from a stroke primarily because a TIA:
A) Is diagnosed with MRI rather than CT imaging
B) Causes permanent necrosis and irreversible brain damage
C) Produces transient symptoms without necrosis or lasting damage
D) Presents with completely different symptoms than a stroke
Correct Answer: Produces transient symptoms without necrosis or lasting damage
Rationale: A transient ischemic attack is a transient episode with no necrosis or irreversible damage,
and it may present with stroke symptoms that resolve without lasting damage. TIA is diagnosed with
CT, not MRI (Option A is incorrect). Stroke causes permanent damage (Option B describes stroke, not
TIA). A TIA can present with the same symptoms as a stroke (Option D is incorrect).
2. A patient is admitted with a suspected stroke. Which diagnostic study is used to evaluate a
transient ischemic attack?
A) CT scan only
B) MRI only
C) CT scan or MRI
D) Lumbar puncture
Correct Answer: CT scan only
Rationale: A transient ischemic attack is diagnosed with CT, not MRI. Stroke is a condition with
permanent damage that is diagnosed with CT or MRI. Lumbar puncture is not the standard diagnostic
tool for TIA or stroke evaluation.
,3. A patient is diagnosed with right-sided heart failure. Which clinical manifestation should the nurse
expect to find during the physical assessment?
A) Crackles in the lungs
B) Orthopnea
C) Pink, frothy sputum
D) Jugular venous distention
Correct Answer: Jugular venous distention
Rationale: Right-sided heart failure results in systemic venous congestion because the right ventricle
cannot pump blood forward effectively. This leads to symptoms such as jugular venous distention,
peripheral edema, and hepatomegaly. Left-sided heart failure, conversely, causes pulmonary
symptoms like crackles and orthopnea.
4. A nurse is preparing to administer tissue plasminogen activator (tPA) to a patient with an acute
ischemic stroke. Which assessment finding is a contraindication to tPA administration?
A) Onset of symptoms 2 hours ago
B) Blood pressure of 150/90 mm Hg
C) Current use of an oral anticoagulant with an elevated INR
D) National Institutes of Health Stroke Scale (NIHSS) score of 12
Correct Answer: Current use of an oral anticoagulant with an elevated INR
Rationale: The use of oral anticoagulants with an elevated INR is a contraindication to tPA due to the
increased risk of bleeding. tPA is most effective when given within 3 to 4.5 hours of symptom onset
(making Option A a candidate, not a contraindication). Blood pressure must be controlled (below
185/110) before administration, and an NIHSS score of 12 does not preclude treatment.
5. A patient with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation.
Which arterial blood gas (ABG) result would the nurse anticipate?
A) pH 7.50, PaCO2 30, HCO3 22
B) pH 7.33, PaCO2 55, HCO3 28
, C) pH 7.48, PaCO2 40, HCO3 30
D) pH 7.25, PaCO2 35, HCO3 18
Correct Answer: pH 7.33, PaCO2 55, HCO3 28
Rationale: Patients with COPD often experience chronic respiratory acidosis due to air trapping and
impaired gas exchange. This is characterized by a low pH and an elevated PaCO2 level. The
bicarbonate (HCO3) level may be slightly elevated as the kidneys attempt to compensate for the
chronic acidotic state.
6. The nurse is assessing a patient who had a stroke 24 hours ago. Which finding would indicate the
development of increased intracranial pressure (ICP)?
A) A decrease in the patient's level of consciousness
B) A decrease in the patient's blood pressure
C) An increase in the patient's respiratory rate
D) Pinpoint pupils that are reactive to light
Correct Answer: A decrease in the patient's level of consciousness
Rationale: A decrease in level of consciousness is the earliest and most sensitive indicator of
increasing ICP. As ICP rises, the patient may become confused, lethargic, or difficult to arouse. Blood
pressure typically increases (Cushing's reflex), and respiratory rate may decrease or become irregular.
7. A patient is taking digoxin for heart failure and reports seeing yellow-green halos around lights.
What is the nurse's priority action?
A) Assess the patient's heart rate and notify the provider
B) Administer the next scheduled dose
C) Document the finding as a normal side effect
D) Increase the patient's potassium intake
Correct Answer: Assess the patient's heart rate and notify the provider
I | Galen College | 26/27 Updated (PDF)
1. A patient presents with a sudden onset of slurred speech and right-sided weakness that completely
resolves within 30 minutes. The emergency department nurse recognizes that a transient ischemic
attack differs from a stroke primarily because a TIA:
A) Is diagnosed with MRI rather than CT imaging
B) Causes permanent necrosis and irreversible brain damage
C) Produces transient symptoms without necrosis or lasting damage
D) Presents with completely different symptoms than a stroke
Correct Answer: Produces transient symptoms without necrosis or lasting damage
Rationale: A transient ischemic attack is a transient episode with no necrosis or irreversible damage,
and it may present with stroke symptoms that resolve without lasting damage. TIA is diagnosed with
CT, not MRI (Option A is incorrect). Stroke causes permanent damage (Option B describes stroke, not
TIA). A TIA can present with the same symptoms as a stroke (Option D is incorrect).
2. A patient is admitted with a suspected stroke. Which diagnostic study is used to evaluate a
transient ischemic attack?
A) CT scan only
B) MRI only
C) CT scan or MRI
D) Lumbar puncture
Correct Answer: CT scan only
Rationale: A transient ischemic attack is diagnosed with CT, not MRI. Stroke is a condition with
permanent damage that is diagnosed with CT or MRI. Lumbar puncture is not the standard diagnostic
tool for TIA or stroke evaluation.
,3. A patient is diagnosed with right-sided heart failure. Which clinical manifestation should the nurse
expect to find during the physical assessment?
A) Crackles in the lungs
B) Orthopnea
C) Pink, frothy sputum
D) Jugular venous distention
Correct Answer: Jugular venous distention
Rationale: Right-sided heart failure results in systemic venous congestion because the right ventricle
cannot pump blood forward effectively. This leads to symptoms such as jugular venous distention,
peripheral edema, and hepatomegaly. Left-sided heart failure, conversely, causes pulmonary
symptoms like crackles and orthopnea.
4. A nurse is preparing to administer tissue plasminogen activator (tPA) to a patient with an acute
ischemic stroke. Which assessment finding is a contraindication to tPA administration?
A) Onset of symptoms 2 hours ago
B) Blood pressure of 150/90 mm Hg
C) Current use of an oral anticoagulant with an elevated INR
D) National Institutes of Health Stroke Scale (NIHSS) score of 12
Correct Answer: Current use of an oral anticoagulant with an elevated INR
Rationale: The use of oral anticoagulants with an elevated INR is a contraindication to tPA due to the
increased risk of bleeding. tPA is most effective when given within 3 to 4.5 hours of symptom onset
(making Option A a candidate, not a contraindication). Blood pressure must be controlled (below
185/110) before administration, and an NIHSS score of 12 does not preclude treatment.
5. A patient with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation.
Which arterial blood gas (ABG) result would the nurse anticipate?
A) pH 7.50, PaCO2 30, HCO3 22
B) pH 7.33, PaCO2 55, HCO3 28
, C) pH 7.48, PaCO2 40, HCO3 30
D) pH 7.25, PaCO2 35, HCO3 18
Correct Answer: pH 7.33, PaCO2 55, HCO3 28
Rationale: Patients with COPD often experience chronic respiratory acidosis due to air trapping and
impaired gas exchange. This is characterized by a low pH and an elevated PaCO2 level. The
bicarbonate (HCO3) level may be slightly elevated as the kidneys attempt to compensate for the
chronic acidotic state.
6. The nurse is assessing a patient who had a stroke 24 hours ago. Which finding would indicate the
development of increased intracranial pressure (ICP)?
A) A decrease in the patient's level of consciousness
B) A decrease in the patient's blood pressure
C) An increase in the patient's respiratory rate
D) Pinpoint pupils that are reactive to light
Correct Answer: A decrease in the patient's level of consciousness
Rationale: A decrease in level of consciousness is the earliest and most sensitive indicator of
increasing ICP. As ICP rises, the patient may become confused, lethargic, or difficult to arouse. Blood
pressure typically increases (Cushing's reflex), and respiratory rate may decrease or become irregular.
7. A patient is taking digoxin for heart failure and reports seeing yellow-green halos around lights.
What is the nurse's priority action?
A) Assess the patient's heart rate and notify the provider
B) Administer the next scheduled dose
C) Document the finding as a normal side effect
D) Increase the patient's potassium intake
Correct Answer: Assess the patient's heart rate and notify the provider
