Medical Surgical Neurological Nursing 2026 Practice
Test Questions Answer Explanations Stroke Seizures
Neurological Disorders Assessment Interventions
Patient Safety
Section 1: Stroke & Cerebrovascular Disorders (Questions 1-40)
1. A patient presents to the emergency department with sudden onset of right-
sided weakness and difficulty speaking. The nurse should prioritize which of
the following interventions?
A. Administer aspirin immediately.
B. Determine the time of symptom onset and obtain a CT scan of the head.
C. Lower the blood pressure aggressively.
D. Place the patient in a supine position.
Rationale: The priority for a patient with suspected stroke is to determine if they
are a candidate for thrombolytic therapy (e.g., tPA). This requires establishing the
exact time of symptom onset (the patient must be within the 3-4.5 hour window)
and obtaining a CT scan to rule out hemorrhagic stroke. Thrombolytics cannot be
given until hemorrhage is excluded.
2. A patient is diagnosed with an ischemic stroke. The nurse understands that
the primary goal of treatment is to:
A. Lower blood pressure.
B. Restore blood flow to the affected area of the brain.
C. Prevent seizures.
D. Reduce cerebral edema.
Rationale: An ischemic stroke is caused by a blockage in a cerebral blood vessel.
The primary goal is to restore blood flow (reperfusion) as quickly as possible to
minimize brain damage. This can be achieved with thrombolytic therapy or
mechanical thrombectomy.
,3. A patient with an ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would be a contraindication?
A. Blood pressure of 150/90 mmHg
B. Platelet count of 80,000/mm³
C. Blood glucose of 150 mg/dL
D. Age of 70 years
Rationale: Thrombolytic therapy is contraindicated in patients with a low platelet
count (<100,000/mm³) due to the increased risk of bleeding. Other
contraindications include recent surgery, active bleeding, and severe hypertension
that cannot be controlled.
4. A patient with a hemorrhagic stroke is admitted. The nurse should
prioritize which of the following interventions?
A. Administer a thrombolytic agent.
B. Maintain a patent airway and monitor neurological status.
C. Lower the blood pressure aggressively.
D. Administer aspirin.
Rationale: The priority for a patient with a hemorrhagic stroke is to maintain
airway, breathing, and circulation (ABCs) and to monitor neurological status
closely. Thrombolytics and aspirin are contraindicated as they would worsen
bleeding. Blood pressure management is important but should be done cautiously.
5. A nurse is assessing a patient with a suspected stroke. Which finding is most
consistent with a left hemisphere stroke?
A. Left-sided neglect
B. Right-sided hemiparesis and aphasia
C. Impulsivity and poor judgment
D. Left visual field deficit
Rationale: A left hemisphere stroke typically causes right-sided hemiparesis
(weakness) and aphasia (difficulty with language). Right hemisphere strokes cause
left-sided neglect, impulsivity, and left visual field deficits.
6. A patient with a right hemisphere stroke is experiencing left-sided neglect.
The nurse should:
A. Place all items on the patient's right side.
B. Approach the patient from the left side and encourage them to scan the left
side of their environment.
,C. Ignore the neglect as it will resolve on its own.
D. Restrain the patient's left arm.
Rationale: Left-sided neglect occurs when the patient ignores the left side of their
body and environment. The nurse should approach from the left side, place items
on the left side, and encourage the patient to consciously attend to the left side.
This helps to retrain the brain.
7. A patient is admitted with a transient ischemic attack (TIA). The nurse
understands that this condition is:
A. A minor stroke with permanent deficits.
B. A temporary episode of neurological dysfunction that resolves within 24
hours.
C. A type of migraine headache.
D. A seizure disorder.
Rationale: A transient ischemic attack (TIA) is a temporary episode of
neurological dysfunction caused by a brief interruption of blood flow to the brain.
Symptoms typically resolve within 24 hours. A TIA is a major warning sign of an
impending stroke.
8. A patient with a TIA is being discharged. Which instruction is most
important for the nurse to include?
A. "You can resume all normal activities immediately."
B. "You should take your antiplatelet medications as prescribed and follow up
with your provider."
C. "You should stop taking your medications once you feel better."
D. "You should avoid all physical activity."
Rationale: Patients who have had a TIA are at high risk for a future stroke.
Antiplatelet medications (e.g., aspirin, clopidogrel) are often prescribed to prevent
clot formation. Patients should be taught to take these medications as prescribed
and to follow up regularly with their provider.
9. A nurse is assessing a patient using the NIH Stroke Scale (NIHSS). Which
of the following is NOT assessed by this scale?
A. Level of consciousness
B. Deep tendon reflexes
C. Motor function
D. Language
, Rationale: The NIH Stroke Scale (NIHSS) assesses level of consciousness, gaze,
visual fields, motor function, ataxia, sensation, language, and dysarthria. Deep
tendon reflexes are not part of the NIHSS.
10. A patient is admitted with a suspected stroke. The nurse should place the
patient in which position?
A. Supine with the head flat.
B. Head of bed elevated 30 degrees.
C. Prone.
D. Trendelenburg.
Rationale: For a patient with a suspected stroke, the head of the bed should be
elevated to 30 degrees to promote venous drainage from the brain and reduce
intracranial pressure. The head should be maintained in a neutral position.
11. A patient with an ischemic stroke is receiving thrombolytic therapy.
Which finding indicates a complication of this therapy?
A. Improved neurological status
B. Sudden onset of severe headache and vomiting
C. Blood pressure of 140/90 mmHg
D. Heart rate of 80 beats per minute
Rationale: Sudden onset of severe headache and vomiting may indicate
intracranial hemorrhage, a serious complication of thrombolytic therapy. The nurse
should stop the infusion immediately and notify the provider.
12. A nurse is teaching a patient about modifiable risk factors for stroke.
Which statement indicates a need for further teaching?
A. "I should control my blood pressure."
B. "I should stop taking my blood thinners because I feel fine."
C. "I should quit smoking."
D. "I should manage my diabetes."
Rationale: Patients with a history of stroke or TIA are often prescribed
anticoagulants or antiplatelets to prevent future strokes. Stopping these
medications without consulting a provider can increase the risk of a recurrent
stroke. This statement indicates a need for further teaching.
13. A patient with a stroke is experiencing dysphagia. Which intervention
should the nurse prioritize?
A. Encourage the patient to eat quickly.
B. Perform a swallowing evaluation before administering oral medications or
Test Questions Answer Explanations Stroke Seizures
Neurological Disorders Assessment Interventions
Patient Safety
Section 1: Stroke & Cerebrovascular Disorders (Questions 1-40)
1. A patient presents to the emergency department with sudden onset of right-
sided weakness and difficulty speaking. The nurse should prioritize which of
the following interventions?
A. Administer aspirin immediately.
B. Determine the time of symptom onset and obtain a CT scan of the head.
C. Lower the blood pressure aggressively.
D. Place the patient in a supine position.
Rationale: The priority for a patient with suspected stroke is to determine if they
are a candidate for thrombolytic therapy (e.g., tPA). This requires establishing the
exact time of symptom onset (the patient must be within the 3-4.5 hour window)
and obtaining a CT scan to rule out hemorrhagic stroke. Thrombolytics cannot be
given until hemorrhage is excluded.
2. A patient is diagnosed with an ischemic stroke. The nurse understands that
the primary goal of treatment is to:
A. Lower blood pressure.
B. Restore blood flow to the affected area of the brain.
C. Prevent seizures.
D. Reduce cerebral edema.
Rationale: An ischemic stroke is caused by a blockage in a cerebral blood vessel.
The primary goal is to restore blood flow (reperfusion) as quickly as possible to
minimize brain damage. This can be achieved with thrombolytic therapy or
mechanical thrombectomy.
,3. A patient with an ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would be a contraindication?
A. Blood pressure of 150/90 mmHg
B. Platelet count of 80,000/mm³
C. Blood glucose of 150 mg/dL
D. Age of 70 years
Rationale: Thrombolytic therapy is contraindicated in patients with a low platelet
count (<100,000/mm³) due to the increased risk of bleeding. Other
contraindications include recent surgery, active bleeding, and severe hypertension
that cannot be controlled.
4. A patient with a hemorrhagic stroke is admitted. The nurse should
prioritize which of the following interventions?
A. Administer a thrombolytic agent.
B. Maintain a patent airway and monitor neurological status.
C. Lower the blood pressure aggressively.
D. Administer aspirin.
Rationale: The priority for a patient with a hemorrhagic stroke is to maintain
airway, breathing, and circulation (ABCs) and to monitor neurological status
closely. Thrombolytics and aspirin are contraindicated as they would worsen
bleeding. Blood pressure management is important but should be done cautiously.
5. A nurse is assessing a patient with a suspected stroke. Which finding is most
consistent with a left hemisphere stroke?
A. Left-sided neglect
B. Right-sided hemiparesis and aphasia
C. Impulsivity and poor judgment
D. Left visual field deficit
Rationale: A left hemisphere stroke typically causes right-sided hemiparesis
(weakness) and aphasia (difficulty with language). Right hemisphere strokes cause
left-sided neglect, impulsivity, and left visual field deficits.
6. A patient with a right hemisphere stroke is experiencing left-sided neglect.
The nurse should:
A. Place all items on the patient's right side.
B. Approach the patient from the left side and encourage them to scan the left
side of their environment.
,C. Ignore the neglect as it will resolve on its own.
D. Restrain the patient's left arm.
Rationale: Left-sided neglect occurs when the patient ignores the left side of their
body and environment. The nurse should approach from the left side, place items
on the left side, and encourage the patient to consciously attend to the left side.
This helps to retrain the brain.
7. A patient is admitted with a transient ischemic attack (TIA). The nurse
understands that this condition is:
A. A minor stroke with permanent deficits.
B. A temporary episode of neurological dysfunction that resolves within 24
hours.
C. A type of migraine headache.
D. A seizure disorder.
Rationale: A transient ischemic attack (TIA) is a temporary episode of
neurological dysfunction caused by a brief interruption of blood flow to the brain.
Symptoms typically resolve within 24 hours. A TIA is a major warning sign of an
impending stroke.
8. A patient with a TIA is being discharged. Which instruction is most
important for the nurse to include?
A. "You can resume all normal activities immediately."
B. "You should take your antiplatelet medications as prescribed and follow up
with your provider."
C. "You should stop taking your medications once you feel better."
D. "You should avoid all physical activity."
Rationale: Patients who have had a TIA are at high risk for a future stroke.
Antiplatelet medications (e.g., aspirin, clopidogrel) are often prescribed to prevent
clot formation. Patients should be taught to take these medications as prescribed
and to follow up regularly with their provider.
9. A nurse is assessing a patient using the NIH Stroke Scale (NIHSS). Which
of the following is NOT assessed by this scale?
A. Level of consciousness
B. Deep tendon reflexes
C. Motor function
D. Language
, Rationale: The NIH Stroke Scale (NIHSS) assesses level of consciousness, gaze,
visual fields, motor function, ataxia, sensation, language, and dysarthria. Deep
tendon reflexes are not part of the NIHSS.
10. A patient is admitted with a suspected stroke. The nurse should place the
patient in which position?
A. Supine with the head flat.
B. Head of bed elevated 30 degrees.
C. Prone.
D. Trendelenburg.
Rationale: For a patient with a suspected stroke, the head of the bed should be
elevated to 30 degrees to promote venous drainage from the brain and reduce
intracranial pressure. The head should be maintained in a neutral position.
11. A patient with an ischemic stroke is receiving thrombolytic therapy.
Which finding indicates a complication of this therapy?
A. Improved neurological status
B. Sudden onset of severe headache and vomiting
C. Blood pressure of 140/90 mmHg
D. Heart rate of 80 beats per minute
Rationale: Sudden onset of severe headache and vomiting may indicate
intracranial hemorrhage, a serious complication of thrombolytic therapy. The nurse
should stop the infusion immediately and notify the provider.
12. A nurse is teaching a patient about modifiable risk factors for stroke.
Which statement indicates a need for further teaching?
A. "I should control my blood pressure."
B. "I should stop taking my blood thinners because I feel fine."
C. "I should quit smoking."
D. "I should manage my diabetes."
Rationale: Patients with a history of stroke or TIA are often prescribed
anticoagulants or antiplatelets to prevent future strokes. Stopping these
medications without consulting a provider can increase the risk of a recurrent
stroke. This statement indicates a need for further teaching.
13. A patient with a stroke is experiencing dysphagia. Which intervention
should the nurse prioritize?
A. Encourage the patient to eat quickly.
B. Perform a swallowing evaluation before administering oral medications or
