stroke nclex questions

This NCLEX-RN practice test is focused on testing the nurses’ knowledge and skills in caring for patients who have suffered from a stroke. Included in areas to be tested are assessment for neurologic functioning during and after an episode of stroke, effects of neurologic damage on patients who suffered from CVA, complications, and rehabilitative care after discharge.

 Common care for patients, including dietary and medication therapy, as well as management of stress, are also given emphasis in this practice test. There are also items that talks about psychosocial adaptation that the patient and his family go through as they adjust to life after stroke.

           In taking this practice test, it is recommended that you time yourself while answering each question, ensuring that 1 minute is allocated to answer each item. After all the questions are answered, take some time to review them and check the answers and rationales for this practice test in the next page.

Stroke NCLEX Questions

1. The nurse is caring for a patient who has just returned after having left carotid artery angioplasty and stenting. Which assessment information would be of most concern to the nurse?

A. The patient’s pulse rate is 102 beats per minute.

B. The patient has difficulty speaking.

C. The patient’s blood pressure is 144/86 mmHg.

D. There are fine crackles at the lung bases.

2. A patient in the emergency department complaining of sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider?

A. The patient’s speech is slurring and is difficult to understand.

B. The patient’s latest blood pressure reading is 140/90mm.

C. The patient takes a diuretic because of a history of hypertension.

D. The patient has atrial fibrillation and takes warfarin (Coumadin).

3. The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to use when caring for the client?

A. “We need to discourage him from wearing eyeglasses.”

B. “We need to place objects in his impaired field of vision.”

C. “We need to approach him from the impaired field of vision.”

D. “We need to remind him to turn his head to scan the lost visual field.”

4. The nurse is assessing the adaptation of a client to changes in functional status after a stroke (brain attack). Which observation indicates to the nurse that the client is adapting most successfully?

A. Gets angry with family if they interrupt a task

B. Experiences bouts of depression and irritability

C. Has difficulty with using modified feeding utensils

D. Consistently uses adaptive equipment in dressing self

5. A newly admitted patient diagnosed with right-sided brain stroke has a nursing diagnosis of disturbed visual sensory perception related to homonymous hemianopsia. Early in the care of the patient, what should the nurse do?

A. Place objects on the right side within the patient’s field of vision.

B. Approach the patient from the left side to encourage the patient to turn the head.

C. Place objects on the patient’s left side to assess the patient’s ability to compensate.

D. Patch the affected eye to encourage the patient to turn the head to scan the environment.

6. Four days following a stroke, a patient is to start oral fluids and feedings. Before feeding the patient, what should the nurse do first?

A. Check the patient’s gag reflex.

B. Order a soft diet for the patient.

C. Raise the head of the bed to a sitting position.

D. Evaluate the patient’s ability to swallow small amounts of crushed ice or ice water.

7. The rehabilitation nurse assesses the patient, caregiver, and family before planning the rehabilitation program for this patient. What needs to be included in this assessment (select all that apply)?

A. Cognitive status of the family

B. Patient resources and support

C. Rehabilitation potential of the patient

D. Body strength remaining after the stroke

E. Physical status of body systems affected by the stroke

F. Patient and caregiver expectations of the rehabilitation

8. What is an appropriate nursing intervention to promote communication during the rehabilitation of the patient with aphasia?

A. Use gestures, pictures, and music to stimulate patient responses.

B. Talk about activities of daily living (ADLs) that are familiar to the patient.

C. Structure statements so that the patient does not have to respond verbally.

D. Use flashcards with simple words and pictures to promote recall of language.

9. A female patient has left-sided hemiplegia following an ischemic stroke that she experienced four days earlier. How should the nurse best promote the health of the patient’s integumentary system?

A. Position the patient on her weak side the majority of the time.

B. Alternate the patient’s positioning between supine and side-lying. 

C. Avoid the use of pillows in order to promote independence in positioning.

D. Establish a schedule for the massage of areas where skin breakdown emerges.

10. The nurse is caring for a patient who has been experiencing stroke symptoms for 60 minutes. Which action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

A. Assess the patient’s gag and cough reflexes.

B. Determine when the stroke symptoms began.

C. Administer the prescribed short-acting insulin.

D. Infuse the prescribed IV metoprolol (Lopressor).

11. Several weeks after a stroke, a 50-year-old male patient has impaired awareness of bladder fullness, resulting in urinary incontinence. Which nursing intervention will be best to include in the initial plan for an effective bladder training program?

A. Limit fluid intake to 1200 mL daily to reduce urine volume.

B. Assist the patient onto the bedside commode every 2 hours.

C. Perform intermittent catheterization after each voiding to check for residual urine.

D. Use an external “condom” catheter to protect the skin and prevent embarrassment.

12. A male patient who has a right-sided weakness after a stroke is making progress in learning to use the left hand for feeding and other activities. The nurse observes that when the patient’s wife is visiting, she feeds and dresses him. Which nursing diagnosis is most appropriate for the patient?

A. Interrupted family processes related to effects of illness of a family member

B. Situational low self-esteem related to increasing dependence on the spouse for care

C. Disabled family coping related to inadequate understanding by patient’s spouse

D. Impaired nutrition: less than body requirements related to hemiplegia and aphasia

13. A 40-year-old patient has a ruptured cerebral aneurysm and subarachnoid hemorrhage. Which intervention will be included in the care plan?

A. Apply intermittent pneumatic compression stockings.

B. Assist to dangle on the edge of the bed and assess for dizziness.

C. Encourage patient to cough and deep breathe every 4 hours.

D. Insert an oropharyngeal airway to prevent airway obstruction.

14. A 58-year-old patient with a left-brain stroke suddenly bursts into tears when family members visit. The nurse should

A. use a calm voice to ask the patient to stop the crying behavior.

B. explain to the family that depression is normal following a stroke.

C. have the family members leave the patient alone for a few minutes.

D. teach the family that emotional outbursts are common after strokes.

15. Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is a(n)

A. obese 45-year-old Native American.

B. 35-year-old Asian American woman who smokes.

C. 32-year-old white woman taking oral contraceptives.

D. 65-year-old African American man with hypertension.

16. A patient comes to the emergency department immediately after experiencing numbness of the face and an inability to speak, but while the patient awaits examination, the symptoms disappear, and the patient requests discharge. Why should the nurse emphasize that it is important for the patient to be treated before leaving?

A. The patient has probably experienced an asymptomatic lacunar stroke.

B. The symptoms are likely to return and progress to worsening neurological deficit in the next 24 hours.

C. Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off.

D. The patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease.

17. A carotid endarterectomy is being considered as a treatment for a patient who has had several TIAs. What should the nurse explain to the patient about this surgery?

A. It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery.

B. It is used to restore blood circulation to the brain following an obstruction of a cerebral artery.

C. It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke.

D. It is used to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation.

18. A thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because

A. the body can dissolve the atherosclerotic plaques as they form

B. some tissues of the brain do not require constant blood supply to prevent damage

C. circulation through the circle of Willis may provide blood supply to the affected area of the brain

D. neurologic deficits occur only when major arteries are occluded by thrombus formation around an atherosclerotic plaque

19. The neurologic functions that are affected by a stroke are primarily related to 

A. the amount of tissue area involved

B. the rapidity of onset of symptoms

C. the brain area perfused by the affected artery

D. the presence or absence of collateral circulation

20. A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a 

A. CT scan

B. lumbar puncture

C. cerebral arteriogram

D. positron emission tomography (PET)

21. The priority intervention in the emergency department for the patient with a stroke is

A. intravenous fluid replacement 

B. administration of osmotic diuretics to reduce cerebral edema

C. initiation of hypothermia to decrease the oxygen needs of the brain

D. maintenance of respiratory function with a patent airway and oxygen administration

22. An appropriate food for a patient with a stroke who has mild dysphagia is

A. fruit juices

B. pureed meat

C. scrambled eggs

D. fortified milkshakes

23. A patient’s wife asks the nurse why her husband did not receive the clot-busting medication (tPA) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What should the nurse respond?

A. He didn’t arrive within the time frame for that therapy

B. Not every is eligible for this drug. Has he had surgery lately?

C. You should discuss the treatment of your husband with your doctor 

D. The medication you are talking about dissolves clots and could cause more bleeding in your husband’s head

24. The patient is being monitored long-term with a brain tissue oxygenation catheter. What range for the pressure of oxygen in brain tissue (PbtO2) will maintain cerebral oxygen supply and demand?

A. 55% to 75%

B. 20 to 40 mm Hg

C. 70 to 150 mm Hg

D. 80 to 100 mm Hg

25. An unconscious patient with an increased ICP is on ventilatory support. The nurse notifies the health care provider when arterial blood gas (ABG) measurement results reveal what?

A. pH of 7.43

B. SaO2 of 94%

C. PaO2 of 70 mm Hg

D. PaCO2 of 35 mm Hg

26. While the nurse performed a range of motion (ROM) on an unconscious patient with increased ICP and suspected to be suffering from stroke, the patient experiences severe decerebrate posturing reflexes. What should the nurse do first?

A. Use restraints to protect the patient from injury.

B. Perform the exercises less frequently because posturing can increase ICP.

C. Administer central nervous system (CNS) depressants to lightly sedate the patient.

D. Continue the exercises because they are necessary to maintain musculoskeletal function.

27. What is a nursing intervention that is indicated for the patient with hemiplegia?

A. The use of a footboard to prevent plantar flexion

B. Immobilization of the affected arm against the chest with a sling

C. Positioning the patient in bed with each joint lower than the joint proximal to it

D. Having the patient perform passive range of motion (ROM) of the affected limb with the unaffected limb

28. Regular oral hygiene is essential for the client who has had a stroke. Which of the following nursing measures is not appropriate when providing oral hygiene?

A. Placing the client on the back with a small pillow under the head.

B. Keeping portable suctioning equipment at the bedside.

C. Opening the client’s mouth with a padded tongue blade.

D. Cleaning the client’s mouth and teeth with a toothbrush.

29. In planning care for the client who has had a stroke, the nurse should obtain a history of the client’s functional status before the stroke because?

A. The rehabilitation plan will be guided by it.

B. Functional status before the stroke will help predict outcomes.

C. It will help the client recognize his physical limitations.

D. The client can be expected to regain much of his functioning.

30. A nurse is teaching a client who had a stroke about ways to adapt to a visual disability. Which does the nurse identify as the primary safety precaution to use? 

A. Wear a patch over one eye.

B. Place personal items on the sighted side.

C. Lie in bed with the unaffected side toward the door.

D. Turn the head from side to side when walking.

31. A client is experiencing mood swings after a stroke and often has episodes of tearfulness that are distressing to the family. Which is the best technique for the nurse to instruct family members to try when the client experiences a crying episode?

A. Sit quietly with the client until the episode is over.

B. Ignore the behavior.

C. Attempt to divert the client’s attention.

D. Tell the client that this behavior is unacceptable.

32. The client who has had a stroke with residual physical handicaps becomes discouraged by his physical appearance. What approach to the client is best for the nurse to use to help the client overcome his negative self-concept? Select all that apply.

A. Helpfulness.

B. Charity.

C. Firmness.

D. Encouragement.

E. Patience.

33. What is the expected outcome of thrombolytic drug therapy for stroke?

A. Increased vascular permeability.

B. Vasoconstriction.

C. Dissolved emboli.

D. Prevention of hemorrhage.

34. A nursing assistant is providing care to a client with left-sided paralysis. Which of the following actions by the nursing assistant requires the nurse to provide further instruction?

A. Providing a passive range of motion exercises to the left extremities during the bed bath.

B. Elevating the foot of the bed to reduce edema.

C. Pulling up the client under the left shoulder when getting out of bed to a chair.

D. Putting high top tennis shoes on the client after bathing.

35. The nurse can assist the patient and the family in coping with the long term effects of a stroke by

A. informing family members that the patient will need assistance with almost all ADLs

B. explaining that the patient’s pre-stroke behavior will return as improvement progresses

C. encouraging the patient and family members to seek assistance from family therapy or stroke support groups

D. helping the patient and family understand the significance of residual stroke damage to promote problem-solving and planning

Answers with Rationale

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Nhiña Sandeep de Rosas, MAN, DIH, DSHRM, RN currently works for the Department of Health CHD Mimaropa as a Training Specialist. She is also a Nurse Licensure Exam and NCLEX-RN reviewer on her free time. She has her USRN licenses in New York and Vermont, having passed the NCLEX-RN in 2007.Since 2006, she has been a nurse educator and worked as a clinical instructor and classroom lecturer for Unciano Colleges (College of Nursing) in Antipolo City. She has earned her Master’s Degree in Nursing and Diploma in International Health at the University of the Philippines Open University; and her Diploma in Strategic Human Resource Management at the Ateneo de Manila University.

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