MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
What topic should the nurse anticipate teaching a patient who had a brief episode of tinnitus, diplopia,
dysarthria with no residual effects?
A. Cerebral aneurysm clipping
B. Heparin intravenous infusion
C. Oral low-dose aspirin therapy
D. Tissue plasminogen activator (tPA) - (ANSWER)ANS: C
Rationale:
The patient's symptoms are consistent with transient ischemic attack (TIA), and drugs that inhibit
platelet aggregation are prescribed after a TIA to prevent a stroke. Continuous heparin infusion is not
routinely used after TIA or with acute ischemic stroke. The patient's symptoms are not consistent with a
cerebral aneurysm. tPA is used only for acute ischemic stroke, not for TIA.
A patient is being admitted with a possible stroke. Which information from the assessment indicates
that the nurse should consult with the health care provider before giving a prescribed dose of aspirin?
A. The patient has dysphasia.
B. The patient has atrial fibrillation.
C. The patient reports that symptoms began with a severe headache.
D. The patient has a history of brief episodes of right-sided hemiplegia. - (ANSWER)ANS: C
Rationale:
,MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is contraindicated. Atrial
fibrillation, dysphasia, and transient ischemic attack are not contraindications to aspirin use.
A patient being admitted with a stroke has right-sided facial drooping and right-sided arm and leg
paralysis. Which finding should the nurse expect?
A. Impulsive behavior
B. Right-sided neglect
C. Hyperactive left-sided tendon reflexes
D. Difficulty comprehending instructions - (ANSWER)ANS: D
Rationale:
Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with comprehension and
use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more
likely with a right-side stroke.
During change of shift report, a nurse is told that a patient has an occluded left posterior cerebral artery.
What finding should the nurse anticipate?
A. Dysphasia
B. Confusion
C. Visual deficits
D. Poor judgment - (ANSWER)ANS: C
,MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
Rationale:
Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle
cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior
cerebral artery occlusion.
What will the nurse tell the patient who has cerebral atherosclerosis about taking clopidogrel (Plavix)?
A. Monitor and record the blood pressure daily.
B. Call the health care provider if stools are tarry.
C. Clopidogrel will dissolve clots in the cerebral arteries.
D. Clopidogrel will reduce cerebral artery plaque formation. - (ANSWER)ANS: B
Rationale:
Clopidogrel inhibits platelet function and increases the risk for gastrointestinal bleeding, so patients
should be advised to notify the health care provider about any signs of bleeding. The medication does
not lower blood pressure, decrease plaque formation, or dissolve clots.
A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which
response by the nurse is accurate?
A. "The diseased portion of the artery is replaced with a synthetic graft."
B. "The obstructing plaque is surgically removed from inside an artery in the neck."
C. "A wire is threaded through an artery in the leg to the clots in the carotid artery, and clots are
removed."
, MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
D. "A catheter with a deflated balloon is positioned at the narrow area, and the balloon flattens the
plaque." - (ANSWER)ANS: B
Rationale:
In a carotid endarterectomy, the carotid artery is incised, and the plaque is removed. The response
beginning, "The diseased portion of the artery is replaced" describes an arterial graft procedure. The
answer beginning, "A catheter with a deflated balloon is positioned at the narrow area" describes an
angioplasty. The final response beginning, "A wire is threaded through the artery" describes the
mechanical embolus removal in cerebral ischemia (MERCI) procedure.
A patient admitted with possible stroke has been aphasic for 3 hours and has a current blood pressure
(BP) of 174/94 mm Hg. Which order by the health care provider should the nurse question?
A. Keep head of bed elevated at least 30 degrees.
B. Infuse normal saline intravenously at 75 mL/hr.
C. Start a labetalol drip to keep BP less than 140/90 mm Hg.
D. Begin tissue plasminogen activator (tPA) intravenously per protocol. - (ANSWER)ANS: C
Rationale:
Because elevated BP may be a protective response to maintain cerebral perfusion, antihypertensive
therapy is recommended only if mean arterial pressure (MAP) is greater than130 mm Hg or systolic
pressure is greater than 220 mm Hg. Fluid intake should be 1500 to 2000 mL/day to maintain cerebral
blood flow. The head of the bed should be elevated to at least 30 degrees unless the patient has
symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for
tPA use.
AND ANSWERS | WITH COMPLETE SOLUTION
What topic should the nurse anticipate teaching a patient who had a brief episode of tinnitus, diplopia,
dysarthria with no residual effects?
A. Cerebral aneurysm clipping
B. Heparin intravenous infusion
C. Oral low-dose aspirin therapy
D. Tissue plasminogen activator (tPA) - (ANSWER)ANS: C
Rationale:
The patient's symptoms are consistent with transient ischemic attack (TIA), and drugs that inhibit
platelet aggregation are prescribed after a TIA to prevent a stroke. Continuous heparin infusion is not
routinely used after TIA or with acute ischemic stroke. The patient's symptoms are not consistent with a
cerebral aneurysm. tPA is used only for acute ischemic stroke, not for TIA.
A patient is being admitted with a possible stroke. Which information from the assessment indicates
that the nurse should consult with the health care provider before giving a prescribed dose of aspirin?
A. The patient has dysphasia.
B. The patient has atrial fibrillation.
C. The patient reports that symptoms began with a severe headache.
D. The patient has a history of brief episodes of right-sided hemiplegia. - (ANSWER)ANS: C
Rationale:
,MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is contraindicated. Atrial
fibrillation, dysphasia, and transient ischemic attack are not contraindications to aspirin use.
A patient being admitted with a stroke has right-sided facial drooping and right-sided arm and leg
paralysis. Which finding should the nurse expect?
A. Impulsive behavior
B. Right-sided neglect
C. Hyperactive left-sided tendon reflexes
D. Difficulty comprehending instructions - (ANSWER)ANS: D
Rationale:
Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with comprehension and
use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more
likely with a right-side stroke.
During change of shift report, a nurse is told that a patient has an occluded left posterior cerebral artery.
What finding should the nurse anticipate?
A. Dysphasia
B. Confusion
C. Visual deficits
D. Poor judgment - (ANSWER)ANS: C
,MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
Rationale:
Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle
cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior
cerebral artery occlusion.
What will the nurse tell the patient who has cerebral atherosclerosis about taking clopidogrel (Plavix)?
A. Monitor and record the blood pressure daily.
B. Call the health care provider if stools are tarry.
C. Clopidogrel will dissolve clots in the cerebral arteries.
D. Clopidogrel will reduce cerebral artery plaque formation. - (ANSWER)ANS: B
Rationale:
Clopidogrel inhibits platelet function and increases the risk for gastrointestinal bleeding, so patients
should be advised to notify the health care provider about any signs of bleeding. The medication does
not lower blood pressure, decrease plaque formation, or dissolve clots.
A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which
response by the nurse is accurate?
A. "The diseased portion of the artery is replaced with a synthetic graft."
B. "The obstructing plaque is surgically removed from inside an artery in the neck."
C. "A wire is threaded through an artery in the leg to the clots in the carotid artery, and clots are
removed."
, MS2- EXAM 3- STROKE | CHAPTER 57: STROKE (LEWIS BOOK) | 2026 UPDATE | QUESTIONS
AND ANSWERS | WITH COMPLETE SOLUTION
D. "A catheter with a deflated balloon is positioned at the narrow area, and the balloon flattens the
plaque." - (ANSWER)ANS: B
Rationale:
In a carotid endarterectomy, the carotid artery is incised, and the plaque is removed. The response
beginning, "The diseased portion of the artery is replaced" describes an arterial graft procedure. The
answer beginning, "A catheter with a deflated balloon is positioned at the narrow area" describes an
angioplasty. The final response beginning, "A wire is threaded through the artery" describes the
mechanical embolus removal in cerebral ischemia (MERCI) procedure.
A patient admitted with possible stroke has been aphasic for 3 hours and has a current blood pressure
(BP) of 174/94 mm Hg. Which order by the health care provider should the nurse question?
A. Keep head of bed elevated at least 30 degrees.
B. Infuse normal saline intravenously at 75 mL/hr.
C. Start a labetalol drip to keep BP less than 140/90 mm Hg.
D. Begin tissue plasminogen activator (tPA) intravenously per protocol. - (ANSWER)ANS: C
Rationale:
Because elevated BP may be a protective response to maintain cerebral perfusion, antihypertensive
therapy is recommended only if mean arterial pressure (MAP) is greater than130 mm Hg or systolic
pressure is greater than 220 mm Hg. Fluid intake should be 1500 to 2000 mL/day to maintain cerebral
blood flow. The head of the bed should be elevated to at least 30 degrees unless the patient has
symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for
tPA use.
