NSG 3250 Exam 3 Questions and
Answers| Updated
Neurological Disorders (Questions 1–40)
1. A patient is brought to the ED with sudden weakness on the right
side, slurred speech, and facial droop. What is the priority nursing
action?
• A) Obtain a CT scan of the head
• B) Check blood glucose level
• C) Assess airway, breathing, and circulation
• D) Start IV fluids
Correct ,,,,answer,,,: C) Assess airway, breathing, and circulation
Rationale: ABCs always take priority in any emergency, including
suspected stroke. Airway compromise can occur due to decreased LOC
or dysphagia. After ABCs, obtaining a CT (A) is critical to rule out
hemorrhage before tPA, but airway comes first.
2. Which finding indicates a patient with a stroke is at risk for
aspiration?
• A) Right-sided weakness
, • B) Gag reflex absent
• C) Blood pressure 160/90
• D) Pupils equal and reactive
Correct ,,,,answer,,,: B) Gag reflex absent
Rationale: Absent gag reflex eliminates the protective airway reflex,
allowing food or liquid to enter the trachea. Right-sided weakness (A)
does not directly affect swallowing. Hypertension (C) is common post-
stroke but not a direct aspiration risk.
3. A patient with ischemic stroke receives tPA. What is the most
critical monitoring parameter for the first 24 hours?
• A) Blood pressure every 15 minutes
• B) Blood glucose every hour
• C) Temperature every 4 hours
• D) Urine output every shift
Correct ,,,,answer,,,: A) Blood pressure every 15 minutes
Rationale: tPA increases bleeding risk. Elevated BP can cause
intracranial hemorrhage. Strict BP monitoring (≤185/110) is required per
tPA protocols. Glucose (B) is important but not the most critical post-
tPA.
4. Which assessment finding suggests increased intracranial
pressure (ICP) in a head-injured patient?
• A) Narrowing pulse pressure
, • B) Tachycardia
• C) Widening pulse pressure with bradycardia
• D) Hypotension
Correct ,,,,answer,,,: C) Widening pulse pressure with bradycardia
Rationale: Widening pulse pressure (increasing systolic, stable or
decreasing diastolic) + bradycardia = Cushing’s triad, a late sign of
increased ICP. Narrowing pulse pressure (A) is seen in shock.
Tachycardia (B) is not typical with increased ICP.
5. What is the earliest sign of worsening neurological status in a
patient with a hemorrhagic stroke?
• A) Dilated pupils
• B) Change in level of consciousness
• C) Seizure activity
• D) Vomiting
Correct ,,,,answer,,,: B) Change in level of consciousness
Rationale: LOC is the most sensitive indicator of neurological
deterioration. Pupillary changes (A) and seizures (C) occur later.
Vomiting (D) can occur with increased ICP but is not the earliest sign.
6. Which medication is given first for status epilepticus?
• A) Phenytoin IV
• B) Lorazepam IV
• C) Levetiracetam PO
, • D) Valproic acid IV
Correct ,,,,answer,,,: B) Lorazepam IV
Rationale: Benzodiazepines (lorazepam, diazepam) are first-line to
rapidly stop seizure activity. Phenytoin (A) is second-line for
maintenance. Levetiracetam PO (C) is not appropriate in an emergency.
7. During a generalized tonic-clonic seizure, what is the nurse’s
priority action?
• A) Insert an oral airway
• B) Restrain the patient’s arms
• C) Turn the patient to the side
• D) Give oral diazepam
Correct ,,,,answer,,,: C) Turn the patient to the side
Rationale: Side-lying position allows secretions to drain, preventing
aspiration. Never insert anything into the mouth (A) during a seizure.
Restraint (B) can cause injury. Oral meds (D) cannot be given during
seizure.
8. A patient with Parkinson’s disease has a shuffling gait and
tremors. What is the primary nursing goal?
• A) Improve memory
• B) Prevent falls
• C) Increase protein intake
• D) Reduce tremors completely
Answers| Updated
Neurological Disorders (Questions 1–40)
1. A patient is brought to the ED with sudden weakness on the right
side, slurred speech, and facial droop. What is the priority nursing
action?
• A) Obtain a CT scan of the head
• B) Check blood glucose level
• C) Assess airway, breathing, and circulation
• D) Start IV fluids
Correct ,,,,answer,,,: C) Assess airway, breathing, and circulation
Rationale: ABCs always take priority in any emergency, including
suspected stroke. Airway compromise can occur due to decreased LOC
or dysphagia. After ABCs, obtaining a CT (A) is critical to rule out
hemorrhage before tPA, but airway comes first.
2. Which finding indicates a patient with a stroke is at risk for
aspiration?
• A) Right-sided weakness
, • B) Gag reflex absent
• C) Blood pressure 160/90
• D) Pupils equal and reactive
Correct ,,,,answer,,,: B) Gag reflex absent
Rationale: Absent gag reflex eliminates the protective airway reflex,
allowing food or liquid to enter the trachea. Right-sided weakness (A)
does not directly affect swallowing. Hypertension (C) is common post-
stroke but not a direct aspiration risk.
3. A patient with ischemic stroke receives tPA. What is the most
critical monitoring parameter for the first 24 hours?
• A) Blood pressure every 15 minutes
• B) Blood glucose every hour
• C) Temperature every 4 hours
• D) Urine output every shift
Correct ,,,,answer,,,: A) Blood pressure every 15 minutes
Rationale: tPA increases bleeding risk. Elevated BP can cause
intracranial hemorrhage. Strict BP monitoring (≤185/110) is required per
tPA protocols. Glucose (B) is important but not the most critical post-
tPA.
4. Which assessment finding suggests increased intracranial
pressure (ICP) in a head-injured patient?
• A) Narrowing pulse pressure
, • B) Tachycardia
• C) Widening pulse pressure with bradycardia
• D) Hypotension
Correct ,,,,answer,,,: C) Widening pulse pressure with bradycardia
Rationale: Widening pulse pressure (increasing systolic, stable or
decreasing diastolic) + bradycardia = Cushing’s triad, a late sign of
increased ICP. Narrowing pulse pressure (A) is seen in shock.
Tachycardia (B) is not typical with increased ICP.
5. What is the earliest sign of worsening neurological status in a
patient with a hemorrhagic stroke?
• A) Dilated pupils
• B) Change in level of consciousness
• C) Seizure activity
• D) Vomiting
Correct ,,,,answer,,,: B) Change in level of consciousness
Rationale: LOC is the most sensitive indicator of neurological
deterioration. Pupillary changes (A) and seizures (C) occur later.
Vomiting (D) can occur with increased ICP but is not the earliest sign.
6. Which medication is given first for status epilepticus?
• A) Phenytoin IV
• B) Lorazepam IV
• C) Levetiracetam PO
, • D) Valproic acid IV
Correct ,,,,answer,,,: B) Lorazepam IV
Rationale: Benzodiazepines (lorazepam, diazepam) are first-line to
rapidly stop seizure activity. Phenytoin (A) is second-line for
maintenance. Levetiracetam PO (C) is not appropriate in an emergency.
7. During a generalized tonic-clonic seizure, what is the nurse’s
priority action?
• A) Insert an oral airway
• B) Restrain the patient’s arms
• C) Turn the patient to the side
• D) Give oral diazepam
Correct ,,,,answer,,,: C) Turn the patient to the side
Rationale: Side-lying position allows secretions to drain, preventing
aspiration. Never insert anything into the mouth (A) during a seizure.
Restraint (B) can cause injury. Oral meds (D) cannot be given during
seizure.
8. A patient with Parkinson’s disease has a shuffling gait and
tremors. What is the primary nursing goal?
• A) Improve memory
• B) Prevent falls
• C) Increase protein intake
• D) Reduce tremors completely
