NUR 242 Exam 3 – Med-Surg Concepts (2026)
Galen College of Nursing | Actual Questions &
Answers with Rationales
Section 1: Neurological Disorders – Stroke and Seizures (Questions
1-50)
1. A patient is admitted with sudden onset of right-sided weakness
and aphasia. The nurse suspects an ischemic stroke. Which
assessment finding is most consistent with this diagnosis?
A. Gradual onset of symptoms over several days
B. Sudden onset of focal neurologic deficits
C. Headache preceding the event
D. Seizure activity at onset
Answer: B. Sudden onset of focal neurologic deficits
Rationale: Ischemic stroke typically presents with sudden
onset of focal neurologic deficits (weakness, aphasia, sensory
loss) corresponding to a vascular territory .
2. A patient with ischemic stroke presents within 3 hours of
symptom onset. Which intervention is most urgent?
A. Administer aspirin
B. Prepare for IV tPA (alteplase)
C. Obtain CT head
D. Start IV fluids
Answer: C. Obtain CT head
Rationale: Non-contrast CT head must be obtained
,immediately to rule out hemorrhagic stroke before
administering tPA .
3. A patient with ischemic stroke receives IV tPA (alteplase). Which
finding requires immediate action?
A. Blood pressure 150/90 mmHg
B. Headache and neurologic deterioration
C. Heart rate 90 bpm
D. Oxygen saturation 95%
Answer: B. Headache and neurologic deterioration
Rationale: Headache and neurologic deterioration may
indicate intracranial hemorrhage, a serious complication of
tPA .
4. A patient with a stroke has left-sided neglect. Which nursing
intervention is most appropriate?
A. Approach from the left side
B. Place objects on the right side
C. Approach from the right side
D. Ignore the neglect
Answer: C. Approach from the right side
Rationale: Patients with neglect are unaware of the affected
side. Approach from the unaffected side and place objects in
the unaffected visual field .
5. A patient with a stroke has dysphagia. Which assessment is most
important before oral intake?
A. Swallow evaluation
B. Gag reflex
,C. Ability to cough
D. All of the above
Answer: D. All of the above
Rationale: Swallow evaluation, gag reflex, and cough ability
all assess aspiration risk. Formal swallow evaluation by
speech therapy is essential .
6. A patient with a stroke is at risk for aspiration. Which feeding
position is safest?
A. Supine
B. Side-lying with chin tucked
C. Trendelenburg
D. Prone
Answer: B. Side-lying with chin tucked
Rationale: Upright positioning with chin tuck reduces
aspiration risk .
7. A patient with a stroke has right-sided weakness. The nurse
understands that this indicates damage to the:
A. Left hemisphere
B. Right hemisphere
C. Brainstem
D. Cerebellum
Answer: A. Left hemisphere
Rationale: Motor pathways cross at the medulla; right-sided
weakness indicates left hemisphere damage .
8. A patient with a stroke has expressive aphasia (Broca's aphasia).
Which finding is expected?
, A. Difficulty speaking but intact comprehension
B. Fluent speech with poor comprehension
C. No speech output
D. Normal speech
Answer: A. Difficulty speaking but intact comprehension
Rationale: Expressive aphasia involves difficulty producing
speech with preserved comprehension. Receptive aphasia
involves poor comprehension with fluent speech .
9. A patient with a stroke has receptive aphasia (Wernicke's
aphasia). Which finding is expected?
A. Difficulty understanding speech
B. Difficulty speaking
C. Normal comprehension
D. No speech output
Answer: A. Difficulty understanding speech
Rationale: Receptive aphasia involves impaired
comprehension with fluent but nonsensical speech .
10. A patient with a stroke has homonymous hemianopia
(blindness in half of the visual field). Which intervention is most
appropriate?
A. Place objects in the unaffected visual field
B. Place objects in the affected visual field
C. Keep the room dark
D. Use eye patches
Answer: A. Place objects in the unaffected visual field
Rationale: Place objects in the intact visual field to help the
patient compensate for visual loss .
Galen College of Nursing | Actual Questions &
Answers with Rationales
Section 1: Neurological Disorders – Stroke and Seizures (Questions
1-50)
1. A patient is admitted with sudden onset of right-sided weakness
and aphasia. The nurse suspects an ischemic stroke. Which
assessment finding is most consistent with this diagnosis?
A. Gradual onset of symptoms over several days
B. Sudden onset of focal neurologic deficits
C. Headache preceding the event
D. Seizure activity at onset
Answer: B. Sudden onset of focal neurologic deficits
Rationale: Ischemic stroke typically presents with sudden
onset of focal neurologic deficits (weakness, aphasia, sensory
loss) corresponding to a vascular territory .
2. A patient with ischemic stroke presents within 3 hours of
symptom onset. Which intervention is most urgent?
A. Administer aspirin
B. Prepare for IV tPA (alteplase)
C. Obtain CT head
D. Start IV fluids
Answer: C. Obtain CT head
Rationale: Non-contrast CT head must be obtained
,immediately to rule out hemorrhagic stroke before
administering tPA .
3. A patient with ischemic stroke receives IV tPA (alteplase). Which
finding requires immediate action?
A. Blood pressure 150/90 mmHg
B. Headache and neurologic deterioration
C. Heart rate 90 bpm
D. Oxygen saturation 95%
Answer: B. Headache and neurologic deterioration
Rationale: Headache and neurologic deterioration may
indicate intracranial hemorrhage, a serious complication of
tPA .
4. A patient with a stroke has left-sided neglect. Which nursing
intervention is most appropriate?
A. Approach from the left side
B. Place objects on the right side
C. Approach from the right side
D. Ignore the neglect
Answer: C. Approach from the right side
Rationale: Patients with neglect are unaware of the affected
side. Approach from the unaffected side and place objects in
the unaffected visual field .
5. A patient with a stroke has dysphagia. Which assessment is most
important before oral intake?
A. Swallow evaluation
B. Gag reflex
,C. Ability to cough
D. All of the above
Answer: D. All of the above
Rationale: Swallow evaluation, gag reflex, and cough ability
all assess aspiration risk. Formal swallow evaluation by
speech therapy is essential .
6. A patient with a stroke is at risk for aspiration. Which feeding
position is safest?
A. Supine
B. Side-lying with chin tucked
C. Trendelenburg
D. Prone
Answer: B. Side-lying with chin tucked
Rationale: Upright positioning with chin tuck reduces
aspiration risk .
7. A patient with a stroke has right-sided weakness. The nurse
understands that this indicates damage to the:
A. Left hemisphere
B. Right hemisphere
C. Brainstem
D. Cerebellum
Answer: A. Left hemisphere
Rationale: Motor pathways cross at the medulla; right-sided
weakness indicates left hemisphere damage .
8. A patient with a stroke has expressive aphasia (Broca's aphasia).
Which finding is expected?
, A. Difficulty speaking but intact comprehension
B. Fluent speech with poor comprehension
C. No speech output
D. Normal speech
Answer: A. Difficulty speaking but intact comprehension
Rationale: Expressive aphasia involves difficulty producing
speech with preserved comprehension. Receptive aphasia
involves poor comprehension with fluent speech .
9. A patient with a stroke has receptive aphasia (Wernicke's
aphasia). Which finding is expected?
A. Difficulty understanding speech
B. Difficulty speaking
C. Normal comprehension
D. No speech output
Answer: A. Difficulty understanding speech
Rationale: Receptive aphasia involves impaired
comprehension with fluent but nonsensical speech .
10. A patient with a stroke has homonymous hemianopia
(blindness in half of the visual field). Which intervention is most
appropriate?
A. Place objects in the unaffected visual field
B. Place objects in the affected visual field
C. Keep the room dark
D. Use eye patches
Answer: A. Place objects in the unaffected visual field
Rationale: Place objects in the intact visual field to help the
patient compensate for visual loss .
