NURSING 207 Neurologic System Assessment &
Reasoning Case Study: Peter Simpson Actual
Exam 2026/2027 – Complete 45-Question Stroke
& CVA Assessment with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Patient Profile, History, & Presenting Neurologic Symptoms
Q1: Peter Simpson, a 55-year-old male, arrives in the emergency department via EMS
after his wife witnessed sudden onset of left-sided facial droop, left arm weakness, and
slurred speech approximately 90 minutes ago. His medical history includes
hypertension, type 2 diabetes mellitus, hyperlipidemia, atrial fibrillation, and a 30
pack-year smoking history. Based on his risk profile, which factor places him at the
HIGHEST risk for an embolic ischemic stroke?
A. Type 2 diabetes mellitus
B. Hyperlipidemia
C. Atrial fibrillation [CORRECT]
D. Hypertension
Correct Answer: C
Rationale: Atrial fibrillation causes stasis and thrombus formation in the left atrial
appendage, with emboli traveling to the cerebral circulation causing cardioembolic
stroke. While diabetes, hyperlipidemia, and hypertension are significant modifiable risk
,factors, A-fib carries the highest embolic stroke risk and often requires anticoagulation
for prevention.
Q2: Peter's wife reports that while eating breakfast, he suddenly dropped his fork, his
left arm became weak, and his speech became difficult to understand. She immediately
called 911. This sudden onset of focal neurologic deficits is MOST characteristic of:
A. Transient ischemic attack
B. Ischemic or hemorrhagic stroke [CORRECT]
C. Complex partial seizure
D. Hypoglycemic event
Correct Answer: B
Rationale: Sudden onset of focal deficits (unilateral weakness, facial droop, speech
changes) is the hallmark of cerebrovascular accident. TIA symptoms resolve within
minutes to hours without residual deficits, seizures typically involve positive phenomena
(tonic-clonic activity) or altered awareness, and hypoglycemia usually presents with
autonomic symptoms and global confusion rather than isolated focal findings.
Q3: During the initial assessment, the nurse applies the FAST acronym to screen for
stroke. The nurse asks Peter to smile and notes drooping of the left corner of his
mouth. This finding corresponds to which component of FAST?
A. Face [CORRECT]
B. Arms
C. Speech
, D. Time
Correct Answer: A
Rationale: The "F" in FAST stands for Face drooping, assessed by asking the patient to
smile or show teeth. "A" assesses arm weakness, "S" assesses speech difficulty, and "T"
reminds responders that Time is critical for stroke intervention.
Q4: Peter reports a severe headache that began suddenly at the moment of symptom
onset, describing it as "the worst headache of my life." The nurse recognizes this
presentation is MOST suggestive of:
A. Thrombotic ischemic stroke
B. Embolic ischemic stroke
C. Hemorrhagic stroke [CORRECT]
D. Transient ischemic attack
Correct Answer: C
Rationale: A sudden, severe "thunderclap" headache at symptom onset is highly
suggestive of hemorrhagic stroke, particularly subarachnoid or intracerebral
hemorrhage. Ischemic strokes typically have a less dramatic headache profile, and TIAs
do not produce severe headache.
Q5: Reviewing Peter's laboratory results, the nurse notes an HbA1c of 9.2%. The nurse
understands that this finding indicates:
A. Excellent glycemic control over the past 2 weeks
Reasoning Case Study: Peter Simpson Actual
Exam 2026/2027 – Complete 45-Question Stroke
& CVA Assessment with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Patient Profile, History, & Presenting Neurologic Symptoms
Q1: Peter Simpson, a 55-year-old male, arrives in the emergency department via EMS
after his wife witnessed sudden onset of left-sided facial droop, left arm weakness, and
slurred speech approximately 90 minutes ago. His medical history includes
hypertension, type 2 diabetes mellitus, hyperlipidemia, atrial fibrillation, and a 30
pack-year smoking history. Based on his risk profile, which factor places him at the
HIGHEST risk for an embolic ischemic stroke?
A. Type 2 diabetes mellitus
B. Hyperlipidemia
C. Atrial fibrillation [CORRECT]
D. Hypertension
Correct Answer: C
Rationale: Atrial fibrillation causes stasis and thrombus formation in the left atrial
appendage, with emboli traveling to the cerebral circulation causing cardioembolic
stroke. While diabetes, hyperlipidemia, and hypertension are significant modifiable risk
,factors, A-fib carries the highest embolic stroke risk and often requires anticoagulation
for prevention.
Q2: Peter's wife reports that while eating breakfast, he suddenly dropped his fork, his
left arm became weak, and his speech became difficult to understand. She immediately
called 911. This sudden onset of focal neurologic deficits is MOST characteristic of:
A. Transient ischemic attack
B. Ischemic or hemorrhagic stroke [CORRECT]
C. Complex partial seizure
D. Hypoglycemic event
Correct Answer: B
Rationale: Sudden onset of focal deficits (unilateral weakness, facial droop, speech
changes) is the hallmark of cerebrovascular accident. TIA symptoms resolve within
minutes to hours without residual deficits, seizures typically involve positive phenomena
(tonic-clonic activity) or altered awareness, and hypoglycemia usually presents with
autonomic symptoms and global confusion rather than isolated focal findings.
Q3: During the initial assessment, the nurse applies the FAST acronym to screen for
stroke. The nurse asks Peter to smile and notes drooping of the left corner of his
mouth. This finding corresponds to which component of FAST?
A. Face [CORRECT]
B. Arms
C. Speech
, D. Time
Correct Answer: A
Rationale: The "F" in FAST stands for Face drooping, assessed by asking the patient to
smile or show teeth. "A" assesses arm weakness, "S" assesses speech difficulty, and "T"
reminds responders that Time is critical for stroke intervention.
Q4: Peter reports a severe headache that began suddenly at the moment of symptom
onset, describing it as "the worst headache of my life." The nurse recognizes this
presentation is MOST suggestive of:
A. Thrombotic ischemic stroke
B. Embolic ischemic stroke
C. Hemorrhagic stroke [CORRECT]
D. Transient ischemic attack
Correct Answer: C
Rationale: A sudden, severe "thunderclap" headache at symptom onset is highly
suggestive of hemorrhagic stroke, particularly subarachnoid or intracerebral
hemorrhage. Ischemic strokes typically have a less dramatic headache profile, and TIAs
do not produce severe headache.
Q5: Reviewing Peter's laboratory results, the nurse notes an HbA1c of 9.2%. The nurse
understands that this finding indicates:
A. Excellent glycemic control over the past 2 weeks
