Stroke and Neurologic Emergencies Practice Questions
20 free Stroke and Neurologic Emergencies practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
What is the nurse's first action when a patient arrives in the ED with sudden right facial droop, right arm weakness, and speech difficulty?
- A Wait two hours to see whether the symptoms resolve on their own
- B Start the FAST assessment and notify the stroke team immediately
- C Give aspirin right away without any diagnostic testing first
- D Send the patient for an MRI before any nursing assessment
Correct answer: Start the FAST assessment and notify the stroke team immediately
Rapid recognition of stroke signs using FAST and immediate activation of stroke protocol is critical as each minute of brain ischemia increases damage.
What assessment should NOT delay imaging in the initial evaluation of a suspected acute stroke patient?
- A Point-of-care blood glucose
- B Non-contrast CT scan for haemorrhage
- C Full neurological exam including NIH Stroke Scale (NIHSS)
- D Waiting for coagulation results before CT scan
Correct answer: Waiting for coagulation results before CT scan
Guidelines state that timely imaging (non-contrast CT) must not be delayed by lab results such as coagulation to improve outcomes.
For an ischemic stroke patient eligible for thrombolysis, what is a key early nursing intervention?
- A Elevate head of bed to 45 degrees and defer all vital sign monitoring until stable
- B Maintain airway, give oxygen if hypoxic, monitor neuro status every 15 minutes
- C Start full-dose anticoagulants immediately without a physician order
- D Allow unrestricted oral intake before a swallow screen is performed
Correct answer: Maintain airway, give oxygen if hypoxic, monitor neuro status every 15 minutes
Early care includes airway/oxygen support and frequent neuro and vital sign monitoring for quick recognition and stabilization.
Which finding is most likely indicated by a haemorrhagic stroke (intracerebral hemorrhage)?
- A Sudden worst headache of life with vomiting and focal deficit
- B Gradual onset of mild symptoms developing over several days
- C Isolated mild dizziness with no focal neurologic deficits
- D Spontaneous full improvement of symptoms within about 10 minutes
Correct answer: Sudden worst headache of life with vomiting and focal deficit
Sudden onset severe headache, vomiting and focal deficits suggest intracerebral haemorrhage, a neurologic emergency requiring rapid management.
What principle does the nurse monitor for in stroke care, reflecting that "time is brain"?
- A Delayed therapy is acceptable whenever imaging is not yet ready
- B Every minute counts and earlier reperfusion improves outcomes
- C Therapy can safely wait until morning for staffing convenience
- D A longer time to treatment generally yields a better outcome
Correct answer: Every minute counts and earlier reperfusion improves outcomes
The “time is brain” concept means that faster identification and treatment of stroke leads to less brain tissue loss and better outcomes.
What is the correct statement about the NIH Stroke Scale (NIHSS)?
- A The NIHSS is used only after the patient has been discharged home
- B The NIHSS quantifies stroke severity and helps guide treatment
- C The NIHSS is irrelevant for assessment in the acute care setting
- D The NIHSS evaluates only the patient's ability to swallow safely
Correct answer: The NIHSS quantifies stroke severity and helps guide treatment
The NIHSS is a validated tool quantifying neurological impairment in stroke and is part of initial assessment protocols.
Which vital sign change in a stroke patient should raise immediate concern for neurologic deterioration?
- A Stable blood pressure and heart rate with no new findings
- B Bradycardia, hypertension and widening pulse pressure (Cushing triad)
- C Mild tachycardia with an otherwise normal neurological exam
- D A slight isolated drop in body temperature without other change
Correct answer: Bradycardia, hypertension and widening pulse pressure (Cushing triad)
The Cushing triad suggests increased intracranial pressure and possible herniation, indicating neurologic deterioration.
To prevent aspiration pneumonia in a stroke patient, what is a vital nursing intervention?
- A Allow unrestricted oral feeding immediately on admission
- B Perform a swallowing screen before any oral intake
- C Offer thickened beverages only at the time of discharge
- D Stop monitoring the patient's cough and gag reflexes
Correct answer: Perform a swallowing screen before any oral intake
Performing a swallowing screen before oral intake reduces the risk of aspiration pneumonia in stroke patients.
In the initial evaluation of a suspected acute ischemic stroke patient, which lab test is anticipated as part of the evaluation?
- A Only a lipid profile is needed in the initial workup
- B CBC, coagulation profile (INR/aPTT), glucose and creatinine
- C Genetic testing for inherited clotting disorders is ordered first
- D All labs are deferred until 24 hours after the patient arrives
Correct answer: CBC, coagulation profile (INR/aPTT), glucose and creatinine
Initial evaluation for stroke includes labs such as CBC, INR/aPTT, glucose and creatinine, which must not delay imaging.
For a patient with atrial fibrillation post-stroke, which treatment may be indicated for future stroke prevention?
- A Long-term anticoagulation if there are no contraindications
- B Stop all of the patient's current cardiac medications
- C Treat only the hypertension and address nothing else
- D Leave the atrial fibrillation untreated and unmonitored
Correct answer: Long-term anticoagulation if there are no contraindications
Atrial fibrillation is a major risk factor for ischemic stroke; anticoagulation is standard for secondary prevention barring contraindications.
In a hemorrhagic stroke patient, which complications are directly related to increased intracranial pressure?
- A An episode of profound hypoglycaemia of the blood
- B Seizures, decreased level of consciousness and vomiting
- C Marked improvement of gait within the first few hours
- D Isolated acute urinary retention without other findings
Correct answer: Seizures, decreased level of consciousness and vomiting
Hemorrhagic strokes often produce edema and increased ICP, leading to seizures, altered consciousness, and vomiting—monitoring is essential.
What positioning strategy is recommended to prevent shoulder subluxation in a post-stroke patient with right-sided hemiplegia?
- A Pull on the flaccid arm during every patient transfer
- B Support the affected arm with pillows and avoid shoulder traction
- C Leave the affected arm unsupported, hanging off the bed
- D Force active movement of the arm within the first hour only
Correct answer: Support the affected arm with pillows and avoid shoulder traction
Proper positioning using pillows and avoiding pulling helps prevent shoulder pain and subluxation in stroke patients.
Which sign alerts the nurse to acute spinal cord compression as a neurologic emergency besides stroke?
- A Back pain that slowly worsens gradually over many months
- B Sudden back pain with motor weakness and bladder/bowel dysfunction
- C An isolated mild headache with no other associated symptoms
- D Gradual onset of aching joint pain felt in both of the knees
Correct answer: Sudden back pain with motor weakness and bladder/bowel dysfunction
Acute spinal cord compression presents with rapid neurologic changes, motor/sensory loss, and autonomic dysfunction requiring urgent intervention.
Why is it important to monitor and treat fever aggressively in the acute phase of stroke nursing care?
- A Fever has no measurable effect on the patient's outcome
- B Fever raises metabolic demand in ischemic brain and worsens outcomes
- C Fever in this setting always indicates an underlying infection
- D Fever is beneficial and actually aids the recovery of the brain
Correct answer: Fever raises metabolic demand in ischemic brain and worsens outcomes
Fever in acute stroke increases cerebral metabolic demands and exacerbates injury, so aggressive treatment is indicated.
Why should mobilization and rehabilitation begin as soon as feasible in stroke care?
- A Early rehabilitation does not matter to recovery at all
- B Early mobilization improves outcomes and reduces DVT and pneumonia
- C Mobilization should be delayed for several weeks after the stroke
- D Only physical therapy, not nursing, should decide mobilization timing
Correct answer: Early mobilization improves outcomes and reduces DVT and pneumonia
Early rehabilitation, including mobilization, reduces complications and improves functional recovery in stroke patients.
When a patient with suspected stroke has a blood glucose of 42 mg/dL on arrival, what should the nurse recognize?
- A Hypoglycaemia may mimic stroke and must be corrected at once
- B This low glucose value is irrelevant to the presentation
- C Treat the glucose only if other new signs appear later on
- D Send the patient for a CT scan before any glucose correction
Correct answer: Hypoglycaemia may mimic stroke and must be corrected at once
Hypoglycaemia can cause neurologic deficits mimicking stroke and must be promptly corrected to avoid misdiagnosis and further damage.
What is an essential nursing action post-administration of thrombolytic therapy (tPA) in a patient undergoing acute ischemic stroke?
- A There is no need to monitor vital signs once tPA is started
- B Monitor for intracranial hemorrhage and vital signs every 15 minutes
- C Start therapeutic anticoagulants immediately once tPA is given
- D Allow the patient unrestricted activity and unrestricted oral intake
Correct answer: Monitor for intracranial hemorrhage and vital signs every 15 minutes
After tPA administration, the nurse must monitor closely for hemorrhagic conversion, neurologic changes, and vital sign instability.
What is a common nursing diagnosis for the stroke patient related to impaired communication?
- A Impaired skin integrity related to prolonged immobility
- B Impaired verbal communication related to expressive or receptive aphasia
- C Risk for infection related to an invasive indwelling catheter
- D Anxiety related to a sudden change in functional ability
Correct answer: Impaired verbal communication related to expressive or receptive aphasia
Aphasia or dysarthria are common in stroke; nursing diagnosis of impaired verbal communication guides appropriate interventions and outcomes.
What is a key nursing intervention for a patient in the ICU with left-sided neglect post-stroke?
- A Place all objects only on the right (unaffected) side of the bed
- B Encourage environmental scanning and place items on the neglected side
- C Ignore the neglect since it will resolve without any intervention
- D Avoid all rehabilitation activities directed at the neglected side
Correct answer: Encourage environmental scanning and place items on the neglected side
Spatial neglect after stroke requires interventions such as placing stimuli on the neglected side and encouraging scanning to improve awareness and safe function.
For a patient with a large vessel occlusion stroke beyond the thrombolysis window but within 24 hours of last known well, what advanced treatment can the ED nurse anticipate?
- A No further treatment, only supportive care
- B Endovascular thrombectomy (EVT) if eligible
- C Only daily aspirin and no imaging
- D Wait another 24 hours before decision
Correct answer: Endovascular thrombectomy (EVT) if eligible
Many stroke guidelines support endovascular thrombectomy up to 24 hours in selected patients with large vessel occlusion, requiring neurointerventional evaluation.