,NSG3250/NSG 3250 Exam 3 | Adult Health I |
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the primary cause of an ischemic stroke?
A) Rupture of a cerebral aneurysm leading to bleeding in the brain
B) A sudden decrease in systemic blood pressure causing global hypoperfusion
C) Sudden occlusion of a cerebral artery due to a thrombus or embolus
D) An autoimmune inflammatory response affecting the cerebral vasculature
Correct Answer: Sudden occlusion of a cerebral artery due to a thrombus or embolus
Rationale: An ischemic stroke is caused by a sudden occlusion of a cerebral artery, which can be due to a
thrombus forming locally at the site of atherosclerosis or an embolus traveling from elsewhere, such as
the heart (e.g., in atrial fibrillation). This blockage deprives brain tissue of oxygen and nutrients, leading
to infarction.
2. A 68-year-old patient presents with sudden onset of right-sided weakness and difficulty speaking.
Using the FAST acronym, which finding would the nurse assess for first?
A) Facial droop
B) Arm drift
C) Speech difficulty
D) Time of symptom onset
Correct Answer: Time of symptom onset
Rationale: While all components of FAST are critical, determining the **Time** of symptom onset is the
priority because it dictates the window for thrombolytic therapy with tPA, which must be administered
within 4.5 hours of symptom onset. Every minute counts in stroke care.
3. A patient who had a stroke exhibits difficulty with math problems, is aware of their deficits, and has
language problems. This clinical picture is most consistent with which type of stroke?
,A) Right-sided stroke
B) Left-sided stroke
C) Brainstem stroke
D) Cerebellar stroke
Correct Answer: Left-sided stroke
Rationale: The acronym "MALL" (Math problems, Aware of deficits, Language problems, Logic problems)
is used to remember the classic manifestations of a left-sided stroke. The left hemisphere is typically
dominant for language and logical functions.
4. A 72-year-old patient is brought to the emergency department with stroke symptoms that started 2
hours ago. The patient's blood pressure is 180/95 mmHg, and they have a history of a seizure disorder.
Which of the following is a contraindication for administering tPA?
A) Blood pressure of 180/95 mmHg
B) History of a seizure disorder
C) Age greater than 70 years
D) Onset of symptoms 2 hours ago
Correct Answer: History of a seizure disorder
Rationale: A history of seizure is a contraindication for tPA because seizures can mimic stroke symptoms,
and the patient's condition might not be a true ischemic stroke. Other contraindications include head
injury or major surgery within the last 3 months, and systolic BP >185 mmHg or diastolic >110 mmHg.
5. A patient with a hemorrhagic stroke is at increased risk for which of the following complications,
which carries a worse prognosis than an ischemic stroke?
A) Hypovolemic shock
B) Increased intracranial pressure (ICP)
C) Hyperglycemia
D) Myocardial infarction
, Correct Answer: Increased intracranial pressure (ICP)
Rationale: Hemorrhagic strokes involve bleeding into the brain tissue, which occupies space within the
rigid skull and can rapidly lead to increased intracranial pressure (ICP). This can cause herniation and
brain death, making the prognosis generally worse than for ischemic strokes.
6. What is the primary medical management goal for a patient with a hemorrhagic stroke?
A) Administer thrombolytics to dissolve the clot
B) Maintain a systolic blood pressure above 180 mmHg
C) Decrease intracranial pressure and prevent further bleeding
D) Initiate anticoagulation therapy immediately
Correct Answer: Decrease intracranial pressure and prevent further bleeding
Rationale: Management of hemorrhagic stroke focuses on decreasing ICP through measures like
elevating the head of the bed to 30 degrees, osmotic diuretics (e.g., mannitol), and ventricular drains,
while also controlling blood pressure to prevent rebleeding. Thrombolytics and anticoagulants are
contraindicated.
7. A patient with a brain injury has a Glasgow Coma Scale (GCS) score of 13. How should the nurse
interpret this score?
A) Severe brain injury
B) Moderate brain injury
C) Mild brain injury
D) No brain injury
Correct Answer: Mild brain injury
Rationale: The GCS assesses eye opening, verbal response, and motor response, with scores ranging
from 3 to 15. A score of 13-15 indicates a mild brain injury, 9-12 indicates a moderate injury, and 8 or
less indicates a severe injury.
Galen College | Q & A | 2026/2027 Edition (PDF)
1. Which of the following best describes the primary cause of an ischemic stroke?
A) Rupture of a cerebral aneurysm leading to bleeding in the brain
B) A sudden decrease in systemic blood pressure causing global hypoperfusion
C) Sudden occlusion of a cerebral artery due to a thrombus or embolus
D) An autoimmune inflammatory response affecting the cerebral vasculature
Correct Answer: Sudden occlusion of a cerebral artery due to a thrombus or embolus
Rationale: An ischemic stroke is caused by a sudden occlusion of a cerebral artery, which can be due to a
thrombus forming locally at the site of atherosclerosis or an embolus traveling from elsewhere, such as
the heart (e.g., in atrial fibrillation). This blockage deprives brain tissue of oxygen and nutrients, leading
to infarction.
2. A 68-year-old patient presents with sudden onset of right-sided weakness and difficulty speaking.
Using the FAST acronym, which finding would the nurse assess for first?
A) Facial droop
B) Arm drift
C) Speech difficulty
D) Time of symptom onset
Correct Answer: Time of symptom onset
Rationale: While all components of FAST are critical, determining the **Time** of symptom onset is the
priority because it dictates the window for thrombolytic therapy with tPA, which must be administered
within 4.5 hours of symptom onset. Every minute counts in stroke care.
3. A patient who had a stroke exhibits difficulty with math problems, is aware of their deficits, and has
language problems. This clinical picture is most consistent with which type of stroke?
,A) Right-sided stroke
B) Left-sided stroke
C) Brainstem stroke
D) Cerebellar stroke
Correct Answer: Left-sided stroke
Rationale: The acronym "MALL" (Math problems, Aware of deficits, Language problems, Logic problems)
is used to remember the classic manifestations of a left-sided stroke. The left hemisphere is typically
dominant for language and logical functions.
4. A 72-year-old patient is brought to the emergency department with stroke symptoms that started 2
hours ago. The patient's blood pressure is 180/95 mmHg, and they have a history of a seizure disorder.
Which of the following is a contraindication for administering tPA?
A) Blood pressure of 180/95 mmHg
B) History of a seizure disorder
C) Age greater than 70 years
D) Onset of symptoms 2 hours ago
Correct Answer: History of a seizure disorder
Rationale: A history of seizure is a contraindication for tPA because seizures can mimic stroke symptoms,
and the patient's condition might not be a true ischemic stroke. Other contraindications include head
injury or major surgery within the last 3 months, and systolic BP >185 mmHg or diastolic >110 mmHg.
5. A patient with a hemorrhagic stroke is at increased risk for which of the following complications,
which carries a worse prognosis than an ischemic stroke?
A) Hypovolemic shock
B) Increased intracranial pressure (ICP)
C) Hyperglycemia
D) Myocardial infarction
, Correct Answer: Increased intracranial pressure (ICP)
Rationale: Hemorrhagic strokes involve bleeding into the brain tissue, which occupies space within the
rigid skull and can rapidly lead to increased intracranial pressure (ICP). This can cause herniation and
brain death, making the prognosis generally worse than for ischemic strokes.
6. What is the primary medical management goal for a patient with a hemorrhagic stroke?
A) Administer thrombolytics to dissolve the clot
B) Maintain a systolic blood pressure above 180 mmHg
C) Decrease intracranial pressure and prevent further bleeding
D) Initiate anticoagulation therapy immediately
Correct Answer: Decrease intracranial pressure and prevent further bleeding
Rationale: Management of hemorrhagic stroke focuses on decreasing ICP through measures like
elevating the head of the bed to 30 degrees, osmotic diuretics (e.g., mannitol), and ventricular drains,
while also controlling blood pressure to prevent rebleeding. Thrombolytics and anticoagulants are
contraindicated.
7. A patient with a brain injury has a Glasgow Coma Scale (GCS) score of 13. How should the nurse
interpret this score?
A) Severe brain injury
B) Moderate brain injury
C) Mild brain injury
D) No brain injury
Correct Answer: Mild brain injury
Rationale: The GCS assesses eye opening, verbal response, and motor response, with scores ranging
from 3 to 15. A score of 13-15 indicates a mild brain injury, 9-12 indicates a moderate injury, and 8 or
less indicates a severe injury.
