NSG 3250 Exam 3 Adult Health I
Study Guide & Practice Questions
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your NSG 3250 Exam 3 on Adult Health I with this comprehensive study bundle. This guide
features highly targeted practice questions, exact answers, and rationales tailored for nursing
students. Dominate your upcoming exam by mastering critical test concepts: acute ischemic stroke
protocols, tPA parameters, intracranial pressure (ICP) management, seizure safety, and sensory
vision disorders like glaucoma or cataracts. Perfect for fast revision and guaranteed clinical
confidence
1. Which criteria must be met regarding blood pressure before administering tissue
plasminogen activator (tPA) to a client with an acute ischemic stroke?
A) Blood pressure must be above 220/120 mmHg.
B) Blood pressure must be less than or equal to 185/110 mmHg.
C) Blood pressure must be exactly 120/80 mmHg.
D) Blood pressure must be lower than 90/60 mmHg.
B) Blood pressure must be less than or equal to 185/110 mmHg.
Rationale: To minimize the risk of hemorrhagic transformation after receiving a
thrombolytic agent, the client's blood pressure must be maintained at or below
185/110 mmHg. Option A is incorrect because a blood pressure that high requires
controlled lowering before tPA. Option C is unrealistic for an acute stroke response.
Option D indicates hypotension, which compromises cerebral perfusion.
2. Within what time frame from the baseline onset of symptoms must tPA be
administered to a client experiencing an acute ischemic stroke?
A) Within 1 hour
B) Within 4.5 hours
C) Within 12 hours
D) Within 24 hours
B) Within 4.5 hours
Rationale: The established therapeutic window for safety and efficacy in treating an
eligible ischemic stroke with intravenous tPA is within 3 to 4.5 hours of when the
patient was last known normal. Options A, C, and D do not reflect standard clinical
guidelines.
,3. A client is admitted with a suspected stroke. Which nursing action is an
absolute priority before administering anything by mouth?
A) Weighing the client to calculate medication dosages.
B) Keeping the client NPO until a formal swallow study is completed.
C) Administering oral aspirin immediately.
D) Assisting the client to sip clear liquids to check for coughing.
B) Keeping the client NPO until a formal swallow study is completed.
Rationale: Dysphagia is highly prevalent after a stroke and poses a severe risk for
silent aspiration and pneumonia. The client must remain strictly nothing by mouth
(NPO) until speech therapy evaluates swallowing safety. Option A is important but
secondary. Option C is unsafe until hemorrhagic stroke is ruled out and swallowing is
checked. Option D bypasses professional testing protocols.
4. Which lab result serves as a strict exclusion criterion for a client being
evaluated for tPA therapy?
A) Platelet count of 150,000/mm³
B) International Normalized Ratio (INR) of 1.9
C) Partial thromboplastin time (PTT) of 12 seconds
D) Hemoglobin level of 13 g/dL
B) International Normalized Ratio (INR) of 1.9
Rationale: An INR greater than 1.7 signifies a heightened risk for profound systemic
or intracranial bleeding, making it a definitive contraindication for thrombolytics.
Option A is acceptable as platelets must be
100,000. Option C is normal (
15 seconds). Option D does not preclude tPA therapy.
5. When caring for an acute stroke patient, how frequently should the nurse
perform comprehensive neurological assessments during the initial hours?
A) Every 2 hours
B) Every 8 hours
C) Once per shift
D) Only when the patient reports a change
A) Every 2 hours
Rationale: Frequent neurological checks (every 1 to 2 hours) are essential during the
acute post-stroke window to detect early signs of deterioration, such as stroke
,extension, re-occlusion, or increased intracranial pressure. Options B, C, and D are
dangerously infrequent and passive.
6. A client presents with left-sided homonymous hemianopsia following a right
hemisphere cerebrovascular accident. Which clinical manifestation will the nurse
observe?
A) The client cannot see objects on the right side of both eyes.
B) The client cannot see objects on the left side of both eyes.
C) The client experiences double vision when looking straight ahead.
D) The client can only see objects clearly in the far peripheral field.
B) The client cannot see objects on the left side of both eyes.
Rationale: Homonymous hemianopsia is the loss of the same half of the visual field
in both eyes. A right-sided brain injury results in a visual deficit in the left visual fields
of both the left and right eye. Option A describes right hemianopsia. Option C
describes diplopia. Option D describes tunnel vision.
7. During the acute phase of care for a client with left-sided homonymous
hemianopsia, where should the nurse place the patient's call light and personal
items?
A) Directly on the client's left side
B) Directly on the client's right side
C) Suspended from the ceiling track
D) Hidden under the pillow for safekeeping
B) Directly on the client's right side
Rationale: During the early acute phase, safety and accessibility are maintained by
placing essential tools within the client's functioning field of vision (the right side).
Options A, C, and D make it impossible or unsafe for the client to locate items.
8. As a long-term rehabilitation strategy for a client with persistent homonymous
hemianopsia, which technique should the nurse teach?
A) Relying entirely on others to manipulate the environment.
B) Keeping the head completely still and moving only the eyes.
C) Consciously turning the head from side to side to scan the environment.
D) Patching the unaffected eye to force the weak eye to adjust.
C) Consciously turning the head from side to side to scan the environment.
Rationale: Scanning training encourages the patient to deliberately turn their head
toward the blind field to compensate visually for the missing field of view. Option B
restricts the visual arc. Option A reduces independence. Option D does not address
a neurological field deficit.
, 9. A client is admitted with an acute hemorrhagic stroke. Which medical
intervention should the nurse anticipate to manage increased intracranial pressure
(ICP)?
A) Administering a large fluid bolus of hypotonic saline.
B) Lowering the head of the bed to a flat position.
C) Administering osmotic diuretics such as mannitol.
D) Encouraging frequent coughing and deep breathing exercises.
C) Administering osmotic diuretics such as mannitol.
Rationale: Mannitol is an osmotic diuretic that pulls water out of edematous brain
tissue into the vascular space to reduce ICP. Option A worsens cerebral edema.
Option B impairs venous drainage from the brain. Option D raises intrathoracic
pressure, which directly elevates ICP.
10. What is the optimal head-of-bed (HOB) positioning for a client recovering from
a hemorrhagic stroke to lower intracranial pressure?
A) Kept completely flat (0 degrees)
B) Elevated to 30 degrees
C) Placed in High-Fowler's position (90 degrees)
D) Positioned in Trendelenburg position
B) Elevated to 30 degrees
Rationale: Elevating the HOB to 30 degrees maximizes jugular venous outflow from
the brain, effectively lowering intracranial pressure while maintaining an adequate
cerebral perfusion pressure. Option A and D dangerously raise ICP. Option C can
drastically decrease systemic blood pressure, reducing cerebral perfusion.
11. A client with a history of a brain bleed is showing signs of escalating
intracranial pressure. Which medication class should be anticipated to avoid
secondary brain injury from shivering or restlessness?
A) Anticoagulants
B) Sedatives
C) Vasodilators
D) Thrombolytics
B) Sedatives
Rationale: Sedation decreases metabolic demands on brain tissue, controls
agitation, and suppresses shivering, all of which prevent spikes in ICP. Options A
and D are heavily contraindicated due to the risk of re-bleeding. Option C can cause
cerebral vasodilation, increasing intracranial volume and pressure.
Study Guide & Practice Questions
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your NSG 3250 Exam 3 on Adult Health I with this comprehensive study bundle. This guide
features highly targeted practice questions, exact answers, and rationales tailored for nursing
students. Dominate your upcoming exam by mastering critical test concepts: acute ischemic stroke
protocols, tPA parameters, intracranial pressure (ICP) management, seizure safety, and sensory
vision disorders like glaucoma or cataracts. Perfect for fast revision and guaranteed clinical
confidence
1. Which criteria must be met regarding blood pressure before administering tissue
plasminogen activator (tPA) to a client with an acute ischemic stroke?
A) Blood pressure must be above 220/120 mmHg.
B) Blood pressure must be less than or equal to 185/110 mmHg.
C) Blood pressure must be exactly 120/80 mmHg.
D) Blood pressure must be lower than 90/60 mmHg.
B) Blood pressure must be less than or equal to 185/110 mmHg.
Rationale: To minimize the risk of hemorrhagic transformation after receiving a
thrombolytic agent, the client's blood pressure must be maintained at or below
185/110 mmHg. Option A is incorrect because a blood pressure that high requires
controlled lowering before tPA. Option C is unrealistic for an acute stroke response.
Option D indicates hypotension, which compromises cerebral perfusion.
2. Within what time frame from the baseline onset of symptoms must tPA be
administered to a client experiencing an acute ischemic stroke?
A) Within 1 hour
B) Within 4.5 hours
C) Within 12 hours
D) Within 24 hours
B) Within 4.5 hours
Rationale: The established therapeutic window for safety and efficacy in treating an
eligible ischemic stroke with intravenous tPA is within 3 to 4.5 hours of when the
patient was last known normal. Options A, C, and D do not reflect standard clinical
guidelines.
,3. A client is admitted with a suspected stroke. Which nursing action is an
absolute priority before administering anything by mouth?
A) Weighing the client to calculate medication dosages.
B) Keeping the client NPO until a formal swallow study is completed.
C) Administering oral aspirin immediately.
D) Assisting the client to sip clear liquids to check for coughing.
B) Keeping the client NPO until a formal swallow study is completed.
Rationale: Dysphagia is highly prevalent after a stroke and poses a severe risk for
silent aspiration and pneumonia. The client must remain strictly nothing by mouth
(NPO) until speech therapy evaluates swallowing safety. Option A is important but
secondary. Option C is unsafe until hemorrhagic stroke is ruled out and swallowing is
checked. Option D bypasses professional testing protocols.
4. Which lab result serves as a strict exclusion criterion for a client being
evaluated for tPA therapy?
A) Platelet count of 150,000/mm³
B) International Normalized Ratio (INR) of 1.9
C) Partial thromboplastin time (PTT) of 12 seconds
D) Hemoglobin level of 13 g/dL
B) International Normalized Ratio (INR) of 1.9
Rationale: An INR greater than 1.7 signifies a heightened risk for profound systemic
or intracranial bleeding, making it a definitive contraindication for thrombolytics.
Option A is acceptable as platelets must be
100,000. Option C is normal (
15 seconds). Option D does not preclude tPA therapy.
5. When caring for an acute stroke patient, how frequently should the nurse
perform comprehensive neurological assessments during the initial hours?
A) Every 2 hours
B) Every 8 hours
C) Once per shift
D) Only when the patient reports a change
A) Every 2 hours
Rationale: Frequent neurological checks (every 1 to 2 hours) are essential during the
acute post-stroke window to detect early signs of deterioration, such as stroke
,extension, re-occlusion, or increased intracranial pressure. Options B, C, and D are
dangerously infrequent and passive.
6. A client presents with left-sided homonymous hemianopsia following a right
hemisphere cerebrovascular accident. Which clinical manifestation will the nurse
observe?
A) The client cannot see objects on the right side of both eyes.
B) The client cannot see objects on the left side of both eyes.
C) The client experiences double vision when looking straight ahead.
D) The client can only see objects clearly in the far peripheral field.
B) The client cannot see objects on the left side of both eyes.
Rationale: Homonymous hemianopsia is the loss of the same half of the visual field
in both eyes. A right-sided brain injury results in a visual deficit in the left visual fields
of both the left and right eye. Option A describes right hemianopsia. Option C
describes diplopia. Option D describes tunnel vision.
7. During the acute phase of care for a client with left-sided homonymous
hemianopsia, where should the nurse place the patient's call light and personal
items?
A) Directly on the client's left side
B) Directly on the client's right side
C) Suspended from the ceiling track
D) Hidden under the pillow for safekeeping
B) Directly on the client's right side
Rationale: During the early acute phase, safety and accessibility are maintained by
placing essential tools within the client's functioning field of vision (the right side).
Options A, C, and D make it impossible or unsafe for the client to locate items.
8. As a long-term rehabilitation strategy for a client with persistent homonymous
hemianopsia, which technique should the nurse teach?
A) Relying entirely on others to manipulate the environment.
B) Keeping the head completely still and moving only the eyes.
C) Consciously turning the head from side to side to scan the environment.
D) Patching the unaffected eye to force the weak eye to adjust.
C) Consciously turning the head from side to side to scan the environment.
Rationale: Scanning training encourages the patient to deliberately turn their head
toward the blind field to compensate visually for the missing field of view. Option B
restricts the visual arc. Option A reduces independence. Option D does not address
a neurological field deficit.
, 9. A client is admitted with an acute hemorrhagic stroke. Which medical
intervention should the nurse anticipate to manage increased intracranial pressure
(ICP)?
A) Administering a large fluid bolus of hypotonic saline.
B) Lowering the head of the bed to a flat position.
C) Administering osmotic diuretics such as mannitol.
D) Encouraging frequent coughing and deep breathing exercises.
C) Administering osmotic diuretics such as mannitol.
Rationale: Mannitol is an osmotic diuretic that pulls water out of edematous brain
tissue into the vascular space to reduce ICP. Option A worsens cerebral edema.
Option B impairs venous drainage from the brain. Option D raises intrathoracic
pressure, which directly elevates ICP.
10. What is the optimal head-of-bed (HOB) positioning for a client recovering from
a hemorrhagic stroke to lower intracranial pressure?
A) Kept completely flat (0 degrees)
B) Elevated to 30 degrees
C) Placed in High-Fowler's position (90 degrees)
D) Positioned in Trendelenburg position
B) Elevated to 30 degrees
Rationale: Elevating the HOB to 30 degrees maximizes jugular venous outflow from
the brain, effectively lowering intracranial pressure while maintaining an adequate
cerebral perfusion pressure. Option A and D dangerously raise ICP. Option C can
drastically decrease systemic blood pressure, reducing cerebral perfusion.
11. A client with a history of a brain bleed is showing signs of escalating
intracranial pressure. Which medication class should be anticipated to avoid
secondary brain injury from shivering or restlessness?
A) Anticoagulants
B) Sedatives
C) Vasodilators
D) Thrombolytics
B) Sedatives
Rationale: Sedation decreases metabolic demands on brain tissue, controls
agitation, and suppresses shivering, all of which prevent spikes in ICP. Options A
and D are heavily contraindicated due to the risk of re-bleeding. Option C can cause
cerebral vasodilation, increasing intracranial volume and pressure.
