1
HESI Specialty Exam Prep: Neurological
Assessment & Stroke Nursing Care
Table of Contents
Subtopic 1: Neurological Assessment – Core Clinical Examination ................................... 2
Subtopic 2: Stroke Signs, Symptoms & Early Response .................................................... 9
Subtopic 3: Stroke Emergency Management & Acute Interventions ................................. 17
Subtopic 4: Post-Stroke Rehabilitation & Recovery Planning ........................................... 25
Subtopic 5: Stroke Complications & Nursing Management ............................................. 33
Subtopic 6: Pharmacologic Management in Stroke Care ................................................ 41
Subtopic 7: Neuroimaging and Diagnostic Interpretation in Stroke .................................. 49
Subtopic 8: Stroke Prevention and Risk Reduction Strategies ......................................... 57
Subtopic 9: Post-Stroke Complications and Long-Term Rehabilitation ............................ 64
Subtopic 10: Neurological Emergency Response and Stroke Code Protocols .................. 72
, 2
Subtopic 1: Neurological Assessment – Core Clinical
Examination
Question 1
A nurse assesses a patient’s cranial nerves and asks the patient to stick out their tongue.
The tongue deviates to the right. Which cranial nerve is likely affected?
A. Hypoglossal (CN XII)
B. Vagus (CN X)
C. Trigeminal (CN V)
D. Glossopharyngeal (CN IX)
Correct Answer: A. Hypoglossal (CN XII)
Rationale: Deviation of the tongue on protrusion suggests a lesion on the same side of CN
XII. The hypoglossal nerve controls tongue movement.
Question 2
During a neurological exam, the nurse tests a patient’s deep tendon reflexes and
documents a 4+ reflex in the patellar region. How should this finding be interpreted?
A. Normal reflex
B. Hyperactive reflex with clonus
C. Diminished reflex
D. Absent reflex
Correct Answer: B. Hyperactive reflex with clonus
Rationale: A 4+ reflex indicates a very brisk, hyperactive response with intermittent or
sustained clonus, suggesting possible upper motor neuron lesion.
Question 3
Which finding during the Glasgow Coma Scale (GCS) assessment indicates the need for
immediate medical intervention?
, 3
A. GCS score of 13
B. GCS score of 8 or less
C. GCS score of 11 with eye-opening to speech
D. GCS score of 12 with verbal disorientation
Correct Answer: B. GCS score of 8 or less
Rationale: A score of 8 or below indicates coma and typically requires airway protection
and ICU-level care.
Question 4
Which assessment finding is most concerning in a patient with a head injury?
A. Complaint of headache
B. Bilateral pupil constriction
C. Fixed and dilated pupils
D. Slight dizziness
Correct Answer: C. Fixed and dilated pupils
Rationale: Fixed, dilated pupils may indicate brain herniation or increased intracranial
pressure and require immediate intervention.
Question 5
A nurse suspects increased intracranial pressure (ICP). Which vital sign change is most
indicative of this condition?
A. Increased heart rate and hypotension
B. Increased systolic pressure, bradycardia, and irregular respirations
C. Decreased diastolic pressure and tachypnea
D. Orthostatic hypotension and tachycardia
Correct Answer: B. Increased systolic pressure, bradycardia, and irregular respirations
Rationale: This is known as Cushing’s triad and is a classic sign of increased ICP.
, 4
Question 6
What does a positive Romberg test indicate in a neurological exam?
A. Visual field defect
B. Loss of proprioception
C. Cranial nerve III palsy
D. Vestibular dysfunction
Correct Answer: B. Loss of proprioception
Rationale: A positive Romberg sign (swaying or falling when eyes are closed) suggests a
problem with proprioception or dorsal column dysfunction.
Question 7
Which response is abnormal during a Babinski reflex test in an adult patient?
A. No movement
B. Toe flexion
C. No response
D. Great toe dorsiflexion and fanning of toes
Correct Answer: D. Great toe dorsiflexion and fanning of toes
Rationale: In adults, a positive Babinski sign is abnormal and may indicate upper motor
neuron damage.
Question 8
A nurse tests the patient’s ability to identify an object by feel with eyes closed. This test is
known as:
A. Graphesthesia
B. Stereognosis
C. Proprioception
HESI Specialty Exam Prep: Neurological
Assessment & Stroke Nursing Care
Table of Contents
Subtopic 1: Neurological Assessment – Core Clinical Examination ................................... 2
Subtopic 2: Stroke Signs, Symptoms & Early Response .................................................... 9
Subtopic 3: Stroke Emergency Management & Acute Interventions ................................. 17
Subtopic 4: Post-Stroke Rehabilitation & Recovery Planning ........................................... 25
Subtopic 5: Stroke Complications & Nursing Management ............................................. 33
Subtopic 6: Pharmacologic Management in Stroke Care ................................................ 41
Subtopic 7: Neuroimaging and Diagnostic Interpretation in Stroke .................................. 49
Subtopic 8: Stroke Prevention and Risk Reduction Strategies ......................................... 57
Subtopic 9: Post-Stroke Complications and Long-Term Rehabilitation ............................ 64
Subtopic 10: Neurological Emergency Response and Stroke Code Protocols .................. 72
, 2
Subtopic 1: Neurological Assessment – Core Clinical
Examination
Question 1
A nurse assesses a patient’s cranial nerves and asks the patient to stick out their tongue.
The tongue deviates to the right. Which cranial nerve is likely affected?
A. Hypoglossal (CN XII)
B. Vagus (CN X)
C. Trigeminal (CN V)
D. Glossopharyngeal (CN IX)
Correct Answer: A. Hypoglossal (CN XII)
Rationale: Deviation of the tongue on protrusion suggests a lesion on the same side of CN
XII. The hypoglossal nerve controls tongue movement.
Question 2
During a neurological exam, the nurse tests a patient’s deep tendon reflexes and
documents a 4+ reflex in the patellar region. How should this finding be interpreted?
A. Normal reflex
B. Hyperactive reflex with clonus
C. Diminished reflex
D. Absent reflex
Correct Answer: B. Hyperactive reflex with clonus
Rationale: A 4+ reflex indicates a very brisk, hyperactive response with intermittent or
sustained clonus, suggesting possible upper motor neuron lesion.
Question 3
Which finding during the Glasgow Coma Scale (GCS) assessment indicates the need for
immediate medical intervention?
, 3
A. GCS score of 13
B. GCS score of 8 or less
C. GCS score of 11 with eye-opening to speech
D. GCS score of 12 with verbal disorientation
Correct Answer: B. GCS score of 8 or less
Rationale: A score of 8 or below indicates coma and typically requires airway protection
and ICU-level care.
Question 4
Which assessment finding is most concerning in a patient with a head injury?
A. Complaint of headache
B. Bilateral pupil constriction
C. Fixed and dilated pupils
D. Slight dizziness
Correct Answer: C. Fixed and dilated pupils
Rationale: Fixed, dilated pupils may indicate brain herniation or increased intracranial
pressure and require immediate intervention.
Question 5
A nurse suspects increased intracranial pressure (ICP). Which vital sign change is most
indicative of this condition?
A. Increased heart rate and hypotension
B. Increased systolic pressure, bradycardia, and irregular respirations
C. Decreased diastolic pressure and tachypnea
D. Orthostatic hypotension and tachycardia
Correct Answer: B. Increased systolic pressure, bradycardia, and irregular respirations
Rationale: This is known as Cushing’s triad and is a classic sign of increased ICP.
, 4
Question 6
What does a positive Romberg test indicate in a neurological exam?
A. Visual field defect
B. Loss of proprioception
C. Cranial nerve III palsy
D. Vestibular dysfunction
Correct Answer: B. Loss of proprioception
Rationale: A positive Romberg sign (swaying or falling when eyes are closed) suggests a
problem with proprioception or dorsal column dysfunction.
Question 7
Which response is abnormal during a Babinski reflex test in an adult patient?
A. No movement
B. Toe flexion
C. No response
D. Great toe dorsiflexion and fanning of toes
Correct Answer: D. Great toe dorsiflexion and fanning of toes
Rationale: In adults, a positive Babinski sign is abnormal and may indicate upper motor
neuron damage.
Question 8
A nurse tests the patient’s ability to identify an object by feel with eyes closed. This test is
known as:
A. Graphesthesia
B. Stereognosis
C. Proprioception
