(IGGY) Chapter 41: Critical Care of Patients With
Neurologic Emergencies COMPLETE EXAM LATEST
VERSION 2026-2027 QUESTIONS AND 100% Verified
ANSWERS
The nurse is preparing a client for discharge from the emergency department after experiencing a
transient ischemic attack (TIA). Before discharge, which factor would the nurse identify as placing the
client at high risk for a stroke?
a. Age greater than or equal to 75
b. Blood pressure greater than or equal to 160/95
c. Unilateral weakness during a TIA
d. TIA symptoms lasting less than a minute - answer>>>ANS: C
The client who has a TIA is at risk for a stroke is he or she has one-sided (unilateral) weakness during a
TIA. Risk factors also include an age greater than or equal to 60, blood pressure greater than or equal to
140/90 (either or both systolic and diastolic), and/or a long duration of TIA symptoms. One minute is not
a very long time for symptoms to occur.
The nurse is taking a history from a daughter about her father's onset of stroke signs and symptoms.
Which statement by the daughter indicates that the client likely had an embolic stroke?
a. Client's symptoms occurred slowly over several hours.
b. Client because increasingly lethargic and drowsy.
c. Client reported severe headache before other symptoms.
d. Client has a long history of atrial fibrillation. - answer>>>ANS: D
The major cause of embolic strokes is a history of heart disease, especially atrial fibrillation. Most clients
who have an embolic stroke have acute sudden neurologic symptoms but stay alert rather than
lethargic. Decreasing level of consciousness and severe headache are more common in clients who have
hemorrhagic strokes.
A client is admitted with a sudden decline in level of consciousness. What is the nursing action at this
time?
a. Assess the client for hypoglycemia and hypoxia.
b. Place the client on his or her side.
, c. Prepare for administration of a fibrinolytic agent.
d. Start a continuous IV heparin sodium infusion. - answer>>>ANS: A
The cause of a sudden decline in level of consciousness may or may not be related to a neurologic health
problem. Therefore, the client must be evaluated for other common causes, especially hypoglycemia
and hypoxia. Placing the client on his or her side may be helpful to prevent aspiration in case the client
experiences vomiting, but the clinical situation does not indicate that the client has nausea or vomiting.
Administering either an anticoagulant like heparin or a fibrinolytic agent assumes that the client has an
acute ischemic stroke, which has not been confirmed through imaging tests.
The nurse is teaching assistive personnel (AP) about care for a male client diagnosed with acute ischemic
stroke and left-sided weakness. Which statement by the AP indicates understanding of the nurse's
teaching?
a. "I will use "yes" and "no" questions when communicating with the client."
b. "I will remind the client frequently to not get out of bed without help."
c. "I will offer a urinal every hour to the client due to incontinence."
d. "I will feed the client slowly using soft or pureed foods." - answer>>>ANS: B
The client who has left-sided weakness has likely had a right-sided stroke in the brain. Clients who have
strokes on the right side of the brain tend to be very impulsive and exhibit poor judgment. Therefore, to
keep the client safe, the staff will need to remind the client to stay in bed unless he has assistance to
prevent falling. There is no evidence in the clinical situation that the client has aphasia (which is less
common in those with right-sided strokes), difficulty swallowing, or urinary incontinence.
A nurse receives a hand-off report on a female client who had a left-sided stroke with homonymous
hemianopsia. What action by the nurse is most appropriate for this client?
a. Assess for bladder and bowel retention and/or incontinence.
b. Listen to the client's lungs after eating or drinking for diminished breath sounds.
c. Support the client's left side when sitting in a chair or in bed.
d. Remind the client to move her head from side to side to increase her visual field. - answer>>>ANS: D
Homonymous hemianopsia is blindness on the same side of both eyes. The client must turn his or her
head to see the entire visual field. This condition is not related to bladder function, difficulty
swallowing, or lack of trunk control.
A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or
family is most important for the nurse to obtain?
Neurologic Emergencies COMPLETE EXAM LATEST
VERSION 2026-2027 QUESTIONS AND 100% Verified
ANSWERS
The nurse is preparing a client for discharge from the emergency department after experiencing a
transient ischemic attack (TIA). Before discharge, which factor would the nurse identify as placing the
client at high risk for a stroke?
a. Age greater than or equal to 75
b. Blood pressure greater than or equal to 160/95
c. Unilateral weakness during a TIA
d. TIA symptoms lasting less than a minute - answer>>>ANS: C
The client who has a TIA is at risk for a stroke is he or she has one-sided (unilateral) weakness during a
TIA. Risk factors also include an age greater than or equal to 60, blood pressure greater than or equal to
140/90 (either or both systolic and diastolic), and/or a long duration of TIA symptoms. One minute is not
a very long time for symptoms to occur.
The nurse is taking a history from a daughter about her father's onset of stroke signs and symptoms.
Which statement by the daughter indicates that the client likely had an embolic stroke?
a. Client's symptoms occurred slowly over several hours.
b. Client because increasingly lethargic and drowsy.
c. Client reported severe headache before other symptoms.
d. Client has a long history of atrial fibrillation. - answer>>>ANS: D
The major cause of embolic strokes is a history of heart disease, especially atrial fibrillation. Most clients
who have an embolic stroke have acute sudden neurologic symptoms but stay alert rather than
lethargic. Decreasing level of consciousness and severe headache are more common in clients who have
hemorrhagic strokes.
A client is admitted with a sudden decline in level of consciousness. What is the nursing action at this
time?
a. Assess the client for hypoglycemia and hypoxia.
b. Place the client on his or her side.
, c. Prepare for administration of a fibrinolytic agent.
d. Start a continuous IV heparin sodium infusion. - answer>>>ANS: A
The cause of a sudden decline in level of consciousness may or may not be related to a neurologic health
problem. Therefore, the client must be evaluated for other common causes, especially hypoglycemia
and hypoxia. Placing the client on his or her side may be helpful to prevent aspiration in case the client
experiences vomiting, but the clinical situation does not indicate that the client has nausea or vomiting.
Administering either an anticoagulant like heparin or a fibrinolytic agent assumes that the client has an
acute ischemic stroke, which has not been confirmed through imaging tests.
The nurse is teaching assistive personnel (AP) about care for a male client diagnosed with acute ischemic
stroke and left-sided weakness. Which statement by the AP indicates understanding of the nurse's
teaching?
a. "I will use "yes" and "no" questions when communicating with the client."
b. "I will remind the client frequently to not get out of bed without help."
c. "I will offer a urinal every hour to the client due to incontinence."
d. "I will feed the client slowly using soft or pureed foods." - answer>>>ANS: B
The client who has left-sided weakness has likely had a right-sided stroke in the brain. Clients who have
strokes on the right side of the brain tend to be very impulsive and exhibit poor judgment. Therefore, to
keep the client safe, the staff will need to remind the client to stay in bed unless he has assistance to
prevent falling. There is no evidence in the clinical situation that the client has aphasia (which is less
common in those with right-sided strokes), difficulty swallowing, or urinary incontinence.
A nurse receives a hand-off report on a female client who had a left-sided stroke with homonymous
hemianopsia. What action by the nurse is most appropriate for this client?
a. Assess for bladder and bowel retention and/or incontinence.
b. Listen to the client's lungs after eating or drinking for diminished breath sounds.
c. Support the client's left side when sitting in a chair or in bed.
d. Remind the client to move her head from side to side to increase her visual field. - answer>>>ANS: D
Homonymous hemianopsia is blindness on the same side of both eyes. The client must turn his or her
head to see the entire visual field. This condition is not related to bladder function, difficulty
swallowing, or lack of trunk control.
A client with a stroke is being evaluated for fibrinolytic therapy. What information from the client or
family is most important for the nurse to obtain?
