NSG 3250 Exam 3 Adult Health Nursing:
Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your Med-Surg Nursing I test with this comprehensive study guide for NSG 3250 Exam 3.
Includes high-yield practice questions and clinical rationales covering Neurological Disorders
(Ischemic & Hemorrhagic Strokes, Seizures, Status Epilepticus), Sensory Alterations (Glaucoma,
Cataracts, Retinal Detachment), and Neuro/Ocular Pharmacology (tPA, Phenytoin, Mannitol,
Timolol). Perfect for active recall and exam prep to secure your high score
1. Which clinical assessment finding is an absolute contraindication for administering
tissue plasminogen activator (tPA) to a patient presenting with acute ischemic stroke
symptoms?
A) Age of 78 years old
B) Blood pressure reading of 170/90 mmHg
C) Blood pressure reading of 195/115 mmHg
D) Symptom onset exactly 2 hours ago
Rationale: tPA administration requires a blood pressure of less than 185/110 mmHg
to reduce the risk of hemorrhagic conversion. Patients with a blood pressure higher
than this threshold must have their blood pressure lowered safely with
antihypertensives before tPA can be given.
2. A nurse cares for a patient with a suspected stroke. Which diagnostic test
must be completed first before any anticoagulant or fibrinolytic therapy is initiated?
A) Non-contrast Head CT scan
B) Magnetic Resonance Imaging (MRI)
C) Carotid Doppler ultrasound
D) 12-lead Electrocardiogram (ECG)
Rationale: A non-contrast head CT scan is the gold standard diagnostic tool used
immediately to differentiate between an ischemic stroke and a hemorrhagic stroke,
as fibrinolytic therapy is fatal in patients with bleeding.
3. A patient diagnosed with an ischemic stroke has a blood pressure of 190/100
mmHg. The patient is not a candidate for fibrinolytic therapy. Which action should the
nurse take?
A) Administer IV bolus antihypertensives immediately.
B) Monitor the blood pressure and maintain head of bed at 30 degrees.
,C) Apply a cooling blanket to induce mild therapeutic hypothermia.
D) Request an immediate prescription for a continuous nitroprusside infusion.
Rationale: In patients with acute ischemic stroke who are not candidates for
fibrinolytic therapy, permissive hypertension (up to 220/120 mmHg) is often allowed
to maintain collateral perfusion to the penumbra. Blood pressure is not treated
unless it exceeds these extreme limits.
4. A nurse assesses a patient who experienced a stroke involving the right
hemisphere of the brain. Which clinical manifestation should the nurse anticipate?
A) Aphasia and slow, cautious behavior
B) Right-sided hemiplegia and hemiparesis
C) Impulsiveness and left-sided neglect
D) Agraphia and math comprehension deficits
Rationale: Right-brain strokes characteristically present with left-sided hemiplegia,
spatial-perceptual deficits, extreme impulsivity, a tendency to deny or minimize
problems, and left-sided neglect.
5. When assessing a patient with a left-hemisphere stroke, which functional
deficit should the nurse expect to document?
A) Aphasia and slow, cautious behavior
B) Confabulation and high risk for falls
C) Left-sided facial drooping and hemiparesis
D) Loss of depth perception and impulsivity
Rationale: The left hemisphere of the brain houses the primary speech and language
centers (Broca's and Wernicke's areas) for most individuals. Patients with left-sided
lesions exhibit aphasia, altered intellectual performance, and a cautious, anxious
behavioral style.
6. A patient displays a total loss of the left half of the visual field in both eyes
following a right-sided cerebrovascular accident. Which term should the nurse use to
document this finding?
A) Diplopia
B) Nystagmus
C) Homonymous hemianopsia
D) Presbyopia
Rationale: Homonymous hemianopsia is the loss of half of the visual field in both
eyes, corresponding to the opposite side of the cerebral lesion. This condition
significantly impairs the patient's spatial awareness.
,7. Which nursing intervention is most effective for a patient experiencing
homonymous hemianopsia to ensure safety during mealtime?
A) Feed the patient the entire meal to avoid frustration.
B) Place all food containers exclusively on the affected blind side.
C) Teach the patient to consciously scan the entire plate from side to side.
D) Turn the patient's head away from the food tray to minimize distraction.
Rationale: Teaching the patient to consciously scan their environment allows them to
compensate for the blind visual field, promoting autonomy while ensuring they see
and consume all food items safely.
8. A patient recovering from a stroke struggles to understand spoken words and
sentences. When speaking, the patient produces fluent but meaningless speech.
The nurse recognizes these symptoms as which condition?
A) Expressive aphasia
B) Receptive aphasia
C) Global dysarthria
D) Apraxia
Rationale: Receptive aphasia (Wernicke's aphasia) involves damage to the
temporoparietal area, causing an inability to comprehend spoken or written
language. Speech remains fluent but lacks meaning.
9. A patient with expressive aphasia becomes frustrated while trying to ask for a
glass of water. Which strategy should the nurse implement to facilitate
communication?
A) Speak very loudly and slowly directly into the patient's ear.
B) Complete the patient's sentences quickly to save time.
C) Provide a picture board or a dry-erase white board.
D) Insist that the patient verbalize the exact words before helping.
Rationale: Expressive aphasia (Broca's aphasia) impairs speech production but
preserves comprehension. Providing visual alternative communication tools, like
picture boards, decreases frustration and preserves dignity.
10. A nurse plans care for a patient with dysphagia secondary to an acute stroke.
Which intervention should be included to minimize the risk of aspiration?
A) Serve thin liquids through a straw to control volume.
B) Position the patient in a semi-Fowler's position during meals.
C) Instruct the patient to perform a chin-tuck maneuver when swallowing.
D) Offer large, frequent boluses of food to stimulate the swallow reflex.
, Rationale: The chin-tuck maneuver widens the vallecula and pushes the epiglottis
backward, closing off the airway protective mechanism to minimize the risk of food or
liquid entering the trachea.
11. A patient with a history of hypertension reports a sudden, severe headache
described as "the worst headache of my life," accompanied by neck stiffness. The
nurse suspects which medical emergency?
A) Ischemic penumbra extension
B) Subarachnoid hemorrhagic stroke
C) Transient ischemic attack (TIA)
D) Status epilepticus
Rationale: A sudden, excruciating "thunderclap" headache coupled with signs of
meningeal irritation (nuchal rigidity) is a classic presentation of a ruptured intracranial
aneurysm causing a subarachnoid hemorrhage.
12. A nurse prepares to administer a continuous intravenous infusion of mannitol
to a patient with increased intracranial pressure (ICP) following a brain injury. Which
action is essential?
A) Push the medication rapidly over 1 minute via a peripheral line.
B) Use an in-line filter to administer the medication.
C) Restrict all other intravenous fluid intake to 10 mL per hour.
D) Withhold the medication if the patient's serum osmolality is 280 mOsm/kg.
Rationale: Mannitol is an osmotic diuretic that easily crystallizes at room
temperature. An in-line filter must be used during administration to prevent
microscopic crystals from entering the patient's circulation.
13. Which physiological parameter represents an early sign of increased
intracranial pressure (ICP) that the nurse must monitor for closely?
A) Decerebrate posturing
B) Dilated, fixed pupils
C) Change in the level of consciousness
D) Cushing's triad
Rationale: A alteration in the level of consciousness (such as restlessness, irritability,
or mild confusion) is the earliest and most sensitive indicator of changing intracranial
pressure.
14. The nurse notes that a patient with an intracranial hemorrhage has a widening
pulse pressure, bradycardia, and irregular respirations. How should the nurse
interpret this cluster of signs?
Questions And Well Graded Solutions
With Rationales Updated 2026-2027
Master your Med-Surg Nursing I test with this comprehensive study guide for NSG 3250 Exam 3.
Includes high-yield practice questions and clinical rationales covering Neurological Disorders
(Ischemic & Hemorrhagic Strokes, Seizures, Status Epilepticus), Sensory Alterations (Glaucoma,
Cataracts, Retinal Detachment), and Neuro/Ocular Pharmacology (tPA, Phenytoin, Mannitol,
Timolol). Perfect for active recall and exam prep to secure your high score
1. Which clinical assessment finding is an absolute contraindication for administering
tissue plasminogen activator (tPA) to a patient presenting with acute ischemic stroke
symptoms?
A) Age of 78 years old
B) Blood pressure reading of 170/90 mmHg
C) Blood pressure reading of 195/115 mmHg
D) Symptom onset exactly 2 hours ago
Rationale: tPA administration requires a blood pressure of less than 185/110 mmHg
to reduce the risk of hemorrhagic conversion. Patients with a blood pressure higher
than this threshold must have their blood pressure lowered safely with
antihypertensives before tPA can be given.
2. A nurse cares for a patient with a suspected stroke. Which diagnostic test
must be completed first before any anticoagulant or fibrinolytic therapy is initiated?
A) Non-contrast Head CT scan
B) Magnetic Resonance Imaging (MRI)
C) Carotid Doppler ultrasound
D) 12-lead Electrocardiogram (ECG)
Rationale: A non-contrast head CT scan is the gold standard diagnostic tool used
immediately to differentiate between an ischemic stroke and a hemorrhagic stroke,
as fibrinolytic therapy is fatal in patients with bleeding.
3. A patient diagnosed with an ischemic stroke has a blood pressure of 190/100
mmHg. The patient is not a candidate for fibrinolytic therapy. Which action should the
nurse take?
A) Administer IV bolus antihypertensives immediately.
B) Monitor the blood pressure and maintain head of bed at 30 degrees.
,C) Apply a cooling blanket to induce mild therapeutic hypothermia.
D) Request an immediate prescription for a continuous nitroprusside infusion.
Rationale: In patients with acute ischemic stroke who are not candidates for
fibrinolytic therapy, permissive hypertension (up to 220/120 mmHg) is often allowed
to maintain collateral perfusion to the penumbra. Blood pressure is not treated
unless it exceeds these extreme limits.
4. A nurse assesses a patient who experienced a stroke involving the right
hemisphere of the brain. Which clinical manifestation should the nurse anticipate?
A) Aphasia and slow, cautious behavior
B) Right-sided hemiplegia and hemiparesis
C) Impulsiveness and left-sided neglect
D) Agraphia and math comprehension deficits
Rationale: Right-brain strokes characteristically present with left-sided hemiplegia,
spatial-perceptual deficits, extreme impulsivity, a tendency to deny or minimize
problems, and left-sided neglect.
5. When assessing a patient with a left-hemisphere stroke, which functional
deficit should the nurse expect to document?
A) Aphasia and slow, cautious behavior
B) Confabulation and high risk for falls
C) Left-sided facial drooping and hemiparesis
D) Loss of depth perception and impulsivity
Rationale: The left hemisphere of the brain houses the primary speech and language
centers (Broca's and Wernicke's areas) for most individuals. Patients with left-sided
lesions exhibit aphasia, altered intellectual performance, and a cautious, anxious
behavioral style.
6. A patient displays a total loss of the left half of the visual field in both eyes
following a right-sided cerebrovascular accident. Which term should the nurse use to
document this finding?
A) Diplopia
B) Nystagmus
C) Homonymous hemianopsia
D) Presbyopia
Rationale: Homonymous hemianopsia is the loss of half of the visual field in both
eyes, corresponding to the opposite side of the cerebral lesion. This condition
significantly impairs the patient's spatial awareness.
,7. Which nursing intervention is most effective for a patient experiencing
homonymous hemianopsia to ensure safety during mealtime?
A) Feed the patient the entire meal to avoid frustration.
B) Place all food containers exclusively on the affected blind side.
C) Teach the patient to consciously scan the entire plate from side to side.
D) Turn the patient's head away from the food tray to minimize distraction.
Rationale: Teaching the patient to consciously scan their environment allows them to
compensate for the blind visual field, promoting autonomy while ensuring they see
and consume all food items safely.
8. A patient recovering from a stroke struggles to understand spoken words and
sentences. When speaking, the patient produces fluent but meaningless speech.
The nurse recognizes these symptoms as which condition?
A) Expressive aphasia
B) Receptive aphasia
C) Global dysarthria
D) Apraxia
Rationale: Receptive aphasia (Wernicke's aphasia) involves damage to the
temporoparietal area, causing an inability to comprehend spoken or written
language. Speech remains fluent but lacks meaning.
9. A patient with expressive aphasia becomes frustrated while trying to ask for a
glass of water. Which strategy should the nurse implement to facilitate
communication?
A) Speak very loudly and slowly directly into the patient's ear.
B) Complete the patient's sentences quickly to save time.
C) Provide a picture board or a dry-erase white board.
D) Insist that the patient verbalize the exact words before helping.
Rationale: Expressive aphasia (Broca's aphasia) impairs speech production but
preserves comprehension. Providing visual alternative communication tools, like
picture boards, decreases frustration and preserves dignity.
10. A nurse plans care for a patient with dysphagia secondary to an acute stroke.
Which intervention should be included to minimize the risk of aspiration?
A) Serve thin liquids through a straw to control volume.
B) Position the patient in a semi-Fowler's position during meals.
C) Instruct the patient to perform a chin-tuck maneuver when swallowing.
D) Offer large, frequent boluses of food to stimulate the swallow reflex.
, Rationale: The chin-tuck maneuver widens the vallecula and pushes the epiglottis
backward, closing off the airway protective mechanism to minimize the risk of food or
liquid entering the trachea.
11. A patient with a history of hypertension reports a sudden, severe headache
described as "the worst headache of my life," accompanied by neck stiffness. The
nurse suspects which medical emergency?
A) Ischemic penumbra extension
B) Subarachnoid hemorrhagic stroke
C) Transient ischemic attack (TIA)
D) Status epilepticus
Rationale: A sudden, excruciating "thunderclap" headache coupled with signs of
meningeal irritation (nuchal rigidity) is a classic presentation of a ruptured intracranial
aneurysm causing a subarachnoid hemorrhage.
12. A nurse prepares to administer a continuous intravenous infusion of mannitol
to a patient with increased intracranial pressure (ICP) following a brain injury. Which
action is essential?
A) Push the medication rapidly over 1 minute via a peripheral line.
B) Use an in-line filter to administer the medication.
C) Restrict all other intravenous fluid intake to 10 mL per hour.
D) Withhold the medication if the patient's serum osmolality is 280 mOsm/kg.
Rationale: Mannitol is an osmotic diuretic that easily crystallizes at room
temperature. An in-line filter must be used during administration to prevent
microscopic crystals from entering the patient's circulation.
13. Which physiological parameter represents an early sign of increased
intracranial pressure (ICP) that the nurse must monitor for closely?
A) Decerebrate posturing
B) Dilated, fixed pupils
C) Change in the level of consciousness
D) Cushing's triad
Rationale: A alteration in the level of consciousness (such as restlessness, irritability,
or mild confusion) is the earliest and most sensitive indicator of changing intracranial
pressure.
14. The nurse notes that a patient with an intracranial hemorrhage has a widening
pulse pressure, bradycardia, and irregular respirations. How should the nurse
interpret this cluster of signs?
