vSim Post-Simulation Exam – Vernon Russell (Right-Sided
Ischemic Stroke with Left-Sided Deficits) | Nursing Clinical
Case Questions and Answers Study Guide
Patient Profile: Vernon Russell, 55-year-old Native American male, admitted 2 weeks ago with
right-sided ischemic stroke. History includes hypertension, coronary artery disease, type 2
diabetes, and smoking (1+ pack/day). Presents with mild left hemiplegia (strength 4/5),
dysphagia, NPO status, and Morse Fall Scale score of 40 (moderate risk). Currently on fall
precautions with walker assistance required.
Domain 1: Stroke Pathophysiology & Risk Factors (4 Questions)
Question 1 (Multiple-Choice)
Vernon Russell's CT scan confirmed an ischemic stroke. Which pathophysiological
mechanism best describes the primary cause of cellular injury in his stroke?
A. Rupture of a cerebral blood vessel causing direct tissue destruction and increased intracranial
pressure
B. Embolus or thrombus partially or completely occluding cerebral blood flow, resulting in
cellular hypoxia, edema, and neuronal death [CORRECT]
C. Gradual compression of brain tissue by an expanding tumor mass
D. Bacterial infection causing inflammatory destruction of neural tissue
Rationale: Ischemic stroke results from an embolus or thrombus partially or completely
occluding cerebral blood flow. This occlusion causes cellular hypoxia, leading to cytotoxic edema
and eventual neuronal death. Unlike hemorrhagic stroke (Option A), which involves vessel
rupture, ischemic stroke is characterized by inadequate perfusion. Mr. Russell's history of
hypertension, CAD, and smoking increases his risk for thrombus formation through
atherosclerotic plaque development and hypercoagulability.
, Question 2 (Multiple-Choice)
Mr. Russell has left-sided weakness (4/5 strength) following his right-sided stroke. Which
additional clinical manifestation is most consistent with right hemisphere stroke?
A. Expressive aphasia with intact comprehension
B. Left hemispatial neglect, impulsivity, and poor judgment [CORRECT]
C. Right-sided motor deficits and receptive aphasia
D. Calculating difficulties and finger agnosia
Rationale: Right-sided stroke affects the left side of the body and often produces distinct
neurobehavioral deficits. These include left hemispatial neglect (inattention to left-sided stimuli),
impulsivity, poor judgment, and visual-spatial deficits. These manifestations differ from left
hemisphere stroke, which typically causes aphasia (Options A and C) and right-sided motor
deficits. Mr. Russell's impulsivity increases his fall risk and requires close supervision.
Question 3 (Select-All-That-Apply)
Which of the following are modifiable risk factors for stroke in Vernon Russell's case? (Select
all that apply)
A. Native American ethnicity
B. Hypertension [CORRECT]
C. Type 2 diabetes mellitus [CORRECT]
D. Coronary artery disease [CORRECT]
E. Smoking (1+ pack/day) [CORRECT]
Rationale: Modifiable risk factors are those that can be changed through intervention,
education, or medical management. Mr. Russell's hypertension, diabetes, coronary artery
disease, and smoking are all modifiable through medication compliance, lifestyle changes, and
smoking cessation. Native American ethnicity (Option A) is a non-modifiable risk factor that
increases stroke risk due to higher prevalence of diabetes and hypertension in this population,
but cannot be changed. Patient education must focus on controlling modifiable factors to
prevent recurrent stroke.
Ischemic Stroke with Left-Sided Deficits) | Nursing Clinical
Case Questions and Answers Study Guide
Patient Profile: Vernon Russell, 55-year-old Native American male, admitted 2 weeks ago with
right-sided ischemic stroke. History includes hypertension, coronary artery disease, type 2
diabetes, and smoking (1+ pack/day). Presents with mild left hemiplegia (strength 4/5),
dysphagia, NPO status, and Morse Fall Scale score of 40 (moderate risk). Currently on fall
precautions with walker assistance required.
Domain 1: Stroke Pathophysiology & Risk Factors (4 Questions)
Question 1 (Multiple-Choice)
Vernon Russell's CT scan confirmed an ischemic stroke. Which pathophysiological
mechanism best describes the primary cause of cellular injury in his stroke?
A. Rupture of a cerebral blood vessel causing direct tissue destruction and increased intracranial
pressure
B. Embolus or thrombus partially or completely occluding cerebral blood flow, resulting in
cellular hypoxia, edema, and neuronal death [CORRECT]
C. Gradual compression of brain tissue by an expanding tumor mass
D. Bacterial infection causing inflammatory destruction of neural tissue
Rationale: Ischemic stroke results from an embolus or thrombus partially or completely
occluding cerebral blood flow. This occlusion causes cellular hypoxia, leading to cytotoxic edema
and eventual neuronal death. Unlike hemorrhagic stroke (Option A), which involves vessel
rupture, ischemic stroke is characterized by inadequate perfusion. Mr. Russell's history of
hypertension, CAD, and smoking increases his risk for thrombus formation through
atherosclerotic plaque development and hypercoagulability.
, Question 2 (Multiple-Choice)
Mr. Russell has left-sided weakness (4/5 strength) following his right-sided stroke. Which
additional clinical manifestation is most consistent with right hemisphere stroke?
A. Expressive aphasia with intact comprehension
B. Left hemispatial neglect, impulsivity, and poor judgment [CORRECT]
C. Right-sided motor deficits and receptive aphasia
D. Calculating difficulties and finger agnosia
Rationale: Right-sided stroke affects the left side of the body and often produces distinct
neurobehavioral deficits. These include left hemispatial neglect (inattention to left-sided stimuli),
impulsivity, poor judgment, and visual-spatial deficits. These manifestations differ from left
hemisphere stroke, which typically causes aphasia (Options A and C) and right-sided motor
deficits. Mr. Russell's impulsivity increases his fall risk and requires close supervision.
Question 3 (Select-All-That-Apply)
Which of the following are modifiable risk factors for stroke in Vernon Russell's case? (Select
all that apply)
A. Native American ethnicity
B. Hypertension [CORRECT]
C. Type 2 diabetes mellitus [CORRECT]
D. Coronary artery disease [CORRECT]
E. Smoking (1+ pack/day) [CORRECT]
Rationale: Modifiable risk factors are those that can be changed through intervention,
education, or medical management. Mr. Russell's hypertension, diabetes, coronary artery
disease, and smoking are all modifiable through medication compliance, lifestyle changes, and
smoking cessation. Native American ethnicity (Option A) is a non-modifiable risk factor that
increases stroke risk due to higher prevalence of diabetes and hypertension in this population,
but cannot be changed. Patient education must focus on controlling modifiable factors to
prevent recurrent stroke.
