NSG 3280 Exam 4 – Pathophysiology for Nurses
(Galen) | Latest 2026/2027 | 100 Verified
Questions & Correct Answers
Question 1
A patient is brought to the emergency department with right-sided weakness, facial droop,
and slurred speech. Symptoms began 60 minutes ago. What is the priority action?
A. Obtain a head CT scan
B. Administer aspirin 324 mg
C. Prepare for IV tPA administration
D. Start oxygen at 2 L/min
Answer: C
Rationale: tPA (tissue plasminogen activator) is most effective when given within 3
hours (ideally 4.5 hours) of ischemic stroke onset. This patient is within the window. A non-
contrast head CT must be done BEFORE tPA to rule out hemorrhage, but the priority action
is to mobilize the stroke team for rapid tPA preparation .
Question 2
A patient with a left-sided cerebrovascular accident (CVA) presents with right-sided
weakness. This indicates involvement of which area?
A. Left cerebral hemisphere, motor cortex
B. Right cerebral hemisphere, motor cortex
C. Brainstem, corticospinal tract
D. Cerebellum, purkinje fibers
Answer: A
Rationale: Motor pathways decussate (cross) in the medulla. A left-sided brain lesion
(especially in the motor cortex of the frontal lobe) causes contralateral (right-sided)
weakness .
,Question 3
A patient with a right-sided stroke is at risk for which condition?
A. Expressive aphasia
B. Left-sided neglect
C. Receptive aphasia
D. Right-sided neglect
Answer: B
Rationale: The right hemisphere is dominant for spatial-perceptual tasks. Right-sided
strokes commonly cause left-sided neglect (hemispatial neglect) where the patient ignores
the left side of the body/environment. Aphasia is associated with left-sided strokes (usually)
.
Question 4
Which finding in a patient with a new stroke is most concerning for increased intracranial
pressure (ICP)?
A. Blood pressure 140/90 mmHg
B. Pupil asymmetry (anisocoria)
C. Heart rate 88 bpm
D. Respiratory rate 18/min
Answer: B
Rationale: Pupil asymmetry (one pupil larger than the other, or sluggish/unreactive to
light) is a late sign of herniation and indicates compression of the oculomotor nerve (CN III)
due to increased ICP. This is a medical emergency .
,Question 5
A patient with a suspected stroke has a blood glucose of 45 mg/dL. What should the nurse
do first?
A. Administer IV tPA immediately
B. Administer IV dextrose (D50)
C. Obtain a stat head CT
D. Call the stroke team
Answer: B
Rationale: Hypoglycemia can mimic stroke symptoms. The priority is to correct
hypoglycemia immediately with IV dextrose. If symptoms resolve, stroke mimics must be
ruled out before tPA is considered .
Question 6
The nurse is caring for a patient 24 hours post-ischemic stroke. The patient's blood
pressure is 185/105 mmHg. Which action is most appropriate?
A. Administer IV antihypertensive immediately
B. Hold all antihypertensive medications unless ordered otherwise
C. Increase the patient's fluid intake
D. Place the patient in Trendelenburg position
Answer: B
Rationale: In acute ischemic stroke, permissive hypertension is often allowed to
maintain cerebral perfusion pressure. Antihypertensives are typically held unless BP
exceeds 185/110 for tPA candidates or 220/120 for non-tPA candidates. Lowering BP too
quickly can worsen the stroke .
Question 7
Which assessment finding indicates that tPA therapy has been effective in a patient with
ischemic stroke?
, A. Improved level of consciousness and motor function
B. Decreased blood pressure
C. Increased heart rate
D. Development of a headache
Answer: A
Rationale: The therapeutic effect of tPA is dissolution of the clot, restoring blood flow to
the affected brain tissue, which should result in improvement of neurological deficits
(improved LOC, motor function, speech). Headache, hypertension, or altered mental status
may indicate intracerebral hemorrhage (a complication) .
Question 8
A patient with a hemorrhagic stroke is at highest risk for which complication in the first 24
hours?
A. Seizures
B. Rebleeding and increased ICP
C. Deep vein thrombosis
D. Urinary tract infection
Answer: B
Rationale: Rebleeding and worsening cerebral edema with increased ICP are the
greatest risks in the first 24-48 hours after hemorrhagic stroke. Blood pressure control and
ICP monitoring are critical .
Question 9
A patient with a new stroke has difficulty swallowing. The priority nursing action is:
A. Begin a pureed diet
B. Keep the patient NPO until a formal swallow evaluation is completed
C. Encourage thin liquids to prevent dehydration
D. Place the patient in supine position for feeding
(Galen) | Latest 2026/2027 | 100 Verified
Questions & Correct Answers
Question 1
A patient is brought to the emergency department with right-sided weakness, facial droop,
and slurred speech. Symptoms began 60 minutes ago. What is the priority action?
A. Obtain a head CT scan
B. Administer aspirin 324 mg
C. Prepare for IV tPA administration
D. Start oxygen at 2 L/min
Answer: C
Rationale: tPA (tissue plasminogen activator) is most effective when given within 3
hours (ideally 4.5 hours) of ischemic stroke onset. This patient is within the window. A non-
contrast head CT must be done BEFORE tPA to rule out hemorrhage, but the priority action
is to mobilize the stroke team for rapid tPA preparation .
Question 2
A patient with a left-sided cerebrovascular accident (CVA) presents with right-sided
weakness. This indicates involvement of which area?
A. Left cerebral hemisphere, motor cortex
B. Right cerebral hemisphere, motor cortex
C. Brainstem, corticospinal tract
D. Cerebellum, purkinje fibers
Answer: A
Rationale: Motor pathways decussate (cross) in the medulla. A left-sided brain lesion
(especially in the motor cortex of the frontal lobe) causes contralateral (right-sided)
weakness .
,Question 3
A patient with a right-sided stroke is at risk for which condition?
A. Expressive aphasia
B. Left-sided neglect
C. Receptive aphasia
D. Right-sided neglect
Answer: B
Rationale: The right hemisphere is dominant for spatial-perceptual tasks. Right-sided
strokes commonly cause left-sided neglect (hemispatial neglect) where the patient ignores
the left side of the body/environment. Aphasia is associated with left-sided strokes (usually)
.
Question 4
Which finding in a patient with a new stroke is most concerning for increased intracranial
pressure (ICP)?
A. Blood pressure 140/90 mmHg
B. Pupil asymmetry (anisocoria)
C. Heart rate 88 bpm
D. Respiratory rate 18/min
Answer: B
Rationale: Pupil asymmetry (one pupil larger than the other, or sluggish/unreactive to
light) is a late sign of herniation and indicates compression of the oculomotor nerve (CN III)
due to increased ICP. This is a medical emergency .
,Question 5
A patient with a suspected stroke has a blood glucose of 45 mg/dL. What should the nurse
do first?
A. Administer IV tPA immediately
B. Administer IV dextrose (D50)
C. Obtain a stat head CT
D. Call the stroke team
Answer: B
Rationale: Hypoglycemia can mimic stroke symptoms. The priority is to correct
hypoglycemia immediately with IV dextrose. If symptoms resolve, stroke mimics must be
ruled out before tPA is considered .
Question 6
The nurse is caring for a patient 24 hours post-ischemic stroke. The patient's blood
pressure is 185/105 mmHg. Which action is most appropriate?
A. Administer IV antihypertensive immediately
B. Hold all antihypertensive medications unless ordered otherwise
C. Increase the patient's fluid intake
D. Place the patient in Trendelenburg position
Answer: B
Rationale: In acute ischemic stroke, permissive hypertension is often allowed to
maintain cerebral perfusion pressure. Antihypertensives are typically held unless BP
exceeds 185/110 for tPA candidates or 220/120 for non-tPA candidates. Lowering BP too
quickly can worsen the stroke .
Question 7
Which assessment finding indicates that tPA therapy has been effective in a patient with
ischemic stroke?
, A. Improved level of consciousness and motor function
B. Decreased blood pressure
C. Increased heart rate
D. Development of a headache
Answer: A
Rationale: The therapeutic effect of tPA is dissolution of the clot, restoring blood flow to
the affected brain tissue, which should result in improvement of neurological deficits
(improved LOC, motor function, speech). Headache, hypertension, or altered mental status
may indicate intracerebral hemorrhage (a complication) .
Question 8
A patient with a hemorrhagic stroke is at highest risk for which complication in the first 24
hours?
A. Seizures
B. Rebleeding and increased ICP
C. Deep vein thrombosis
D. Urinary tract infection
Answer: B
Rationale: Rebleeding and worsening cerebral edema with increased ICP are the
greatest risks in the first 24-48 hours after hemorrhagic stroke. Blood pressure control and
ICP monitoring are critical .
Question 9
A patient with a new stroke has difficulty swallowing. The priority nursing action is:
A. Begin a pureed diet
B. Keep the patient NPO until a formal swallow evaluation is completed
C. Encourage thin liquids to prevent dehydration
D. Place the patient in supine position for feeding
