NLE Neurosensory Nursing — Cerebrovascular Disorders and Increased Intracranial PressureExam Answer Templates

Marks

1

Topic

Transient Ischemic Attack

Difficulty

easy

Template Id

T1

Examiner Tip

The most important phrase here is 'no permanent infarction' — it is what distinguishes a TIA from a completed stroke. Include all three elements: cause, resolution, and time frame in one clean sentence.

Model Answer

A Transient Ischemic Attack (TIA) is a brief episode of neurologic dysfunction caused by temporary cerebral ischemia, with symptoms that resolve completely within 24 hours and without permanent brain infarction.

Question Type

very_short_answer

Answer Structure

• One concise sentence defining TIA: cause (temporary ischemia), key feature (resolves completely), and time frame (within 24 hours, no infarction) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying symptoms resolve 'in a few minutes' without specifying the 24-hour definition limit
• Confusing TIA with a completed stroke by saying it causes permanent deficits
• Omitting that there is no permanent infarction — this is the critical distinguishing feature

Key Phrases To Include

• temporary ischemia
• resolves completely
• within 24 hours
• no permanent infarction

Marks

1

Topic

Stroke Recognition

Difficulty

easy

Template Id

T2

Examiner Tip

Spell out every letter of the acronym individually and pair each letter with its correct expansion. Examiners check all four components. A partially correct FAST answer typically earns zero for a 1-mark item.

Model Answer

FAST stands for: Face drooping, Arm weakness, Speech difficulty, and Time to call for emergency help. It is the standard tool used for rapid community recognition of stroke warning signs.

Question Type

very_short_answer

Answer Structure

• State all four components of FAST with correct expansions [1 mark]

Scoring Breakdown

Common Mark Deductions

• Getting the 'T' wrong — some students write 'Time of onset' instead of 'Time to call for emergency help'
• Partial answers listing only two or three components
• Writing 'slurred speech' instead of the exact term 'Speech difficulty'

Key Phrases To Include

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call emergency help

Marks

2

Topic

Increased Intracranial Pressure

Difficulty

medium

Template Id

T3

Examiner Tip

Examiners almost always pair this question with 'Is it early or late?' because most students get it wrong. The triad is LATE — burn this into memory. Write the contrast with decreased LOC (earliest sign) to demonstrate deeper understanding and secure full marks.

Model Answer

Cushing's triad consists of three late warning signs of critically elevated ICP: (1) rising systolic blood pressure with a widening pulse pressure, (2) bradycardia (slowed heart rate), and (3) irregular respirations. It is a LATE and ominous sign of impending brain herniation, indicating that ICP is severely elevated and the brain is being compressed. The earliest sign of increased ICP is a decreasing level of consciousness.

Question Type

short_answer

Answer Structure

• Line 1: Name all three components of Cushing's triad correctly [1 mark]
• Line 2: Identify it as a LATE sign and briefly explain its clinical significance; contrast with earliest sign (decreased LOC) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Calling Cushing's triad an 'early sign' — this is the most common error and will cost you the second mark
• Writing 'hypertension' without specifying 'widening pulse pressure' — the widened pulse pressure is clinically specific and expected
• Forgetting to mention that decreased LOC is the earliest sign when asked to contextualize the triad

Key Phrases To Include

• widening pulse pressure
• bradycardia
• irregular respirations
• late sign
• impending herniation
• decreasing level of consciousness is the earliest sign

Marks

2

Topic

Stroke Classification and Diagnostics

Difficulty

medium

Template Id

T4

Examiner Tip

The word 'priority' in the question is your cue to justify your answer. State the test AND the reason. 'Non-contrast CT is done first because treatment for ischemic and hemorrhagic stroke is opposite' — this one sentence can earn you full marks.

Model Answer

Ischemic stroke (80–85% of strokes) is caused by a thrombus or embolus that blocks a cerebral artery, cutting off blood flow. Hemorrhagic stroke (15–20%) results from rupture of a cerebral blood vessel, causing bleeding into or around the brain. The priority diagnostic procedure for both types is an emergent non-contrast CT scan of the head, which is performed first to rule out hemorrhage because treatment is opposite — thrombolytics (tPA) are used in ischemic stroke but are absolutely contraindicated in hemorrhagic stroke.

Question Type

short_answer

Answer Structure

• Sentence 1: Define and state cause of ischemic stroke (thrombus/embolus, percentage) [0.5 mark]
• Sentence 2: Define and state cause of hemorrhagic stroke (vessel rupture, percentage) [0.5 mark]
• Sentence 3: Name priority diagnostic test and explain WHY it must be done first (treatment is opposite) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Naming MRI instead of non-contrast CT as the priority — MRI is more sensitive but CT is faster and done first in acute stroke
• Failing to explain WHY CT is the priority (i.e., because treatment is opposite) — the rationale earns the mark
• Confusing thrombus (formed in situ) and embolus (travels from elsewhere) — be precise

Key Phrases To Include

• thrombus or embolus
• vessel rupture
• non-contrast CT scan
• treatment is opposite
• tPA contraindicated in hemorrhagic stroke

Marks

3

Topic

Thrombolytic Therapy

Difficulty

medium

Template Id

T5

Examiner Tip

This is a favorite NLE-style question. Memorize the phrase 'last known well' — it distinguishes a sharp student. If the patient woke up with symptoms, the onset time is unknown and tPA may not be given (beyond imaging-guided protocols). Including this nuance in your answer signals clinical excellence.

Model Answer

The drug of choice for ischemic stroke is alteplase (tissue plasminogen activator or tPA). It is classified as a thrombolytic (fibrinolytic) agent. It works by dissolving the blood clot and restoring cerebral perfusion. The treatment window is within 3 hours of symptom onset (or up to 4.5 hours in selected eligible patients), calculated from the time the patient was last known well. One absolute contraindication is the presence of hemorrhage on CT scan (i.e., hemorrhagic stroke). Other absolute contraindications include active internal bleeding, recent intracranial surgery or head trauma, and blood pressure above 185/110 mmHg prior to administration.

Question Type

short_answer

Answer Structure

• Point 1: Name the drug (alteplase/tPA) and its classification (thrombolytic) [1 mark]
• Point 2: State the time window (3 hours from onset, up to 4.5 hours for eligible patients; from 'last known well') [1 mark]
• Point 3: State one absolute contraindication with brief rationale [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'streptokinase' or 'heparin' as the drug of choice — alteplase/tPA is the specific correct answer
• Forgetting that the time window is measured from 'last known well,' not from time of hospital arrival
• Listing only the drug without the time window — the question specifically asks for both
• Saying 'ischemic stroke' itself is a contraindication — it is actually the indication

Key Phrases To Include

• alteplase
• tissue plasminogen activator
• thrombolytic
• 3 hours
• 4.5 hours
• last known well
• hemorrhage on CT
• 185/110 mmHg

Marks

3

Topic

Thrombolytic Therapy Nursing Management

Difficulty

medium

Template Id

T6

Examiner Tip

In NLE nursing action questions, always include THREE elements for each intervention: what to do, why (rationale), and what to do if it goes wrong (response). This structure guarantees full marks on nursing responsibility questions.

Model Answer

The following are priority nursing responsibilities when administering IV alteplase (tPA) for ischemic stroke: (1) Dose strictly by weight (mg/kg) and administer the correct dose — 10% as an IV bolus, the remaining 90% as an infusion over 60 minutes; avoid giving the total dose as a bolus. (2) Avoid invasive procedures during and immediately after infusion — do not insert urinary catheters, perform arterial punctures, or give IM injections, as these increase bleeding risk. (3) Monitor neurological status and vital signs frequently (every 15 minutes during infusion, then every 30 minutes) and watch for signs of intracranial hemorrhage: sudden severe headache, vomiting, rising blood pressure, or worsening neurologic deficit. If bleeding is suspected, stop the infusion immediately and notify the physician.

Question Type

short_answer

Answer Structure

• Point 1: Correct weight-based dosing and administration technique [1 mark]
• Point 2: Avoidance of invasive procedures with rationale (bleeding risk) [1 mark]
• Point 3: Frequent neurological and vital sign monitoring; recognition and response to bleeding complication [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'monitor the patient' without specifying what to monitor or how frequently
• Not mentioning the action to take when bleeding is suspected (stop infusion, notify physician)
• Listing only monitoring points without including the dosing or invasive procedure restriction

Key Phrases To Include

• weight-based dosing
• avoid invasive procedures
• arterial punctures
• IM injections
• neurological status
• intracranial hemorrhage
• stop infusion
• sudden severe headache

Marks

3

Topic

Increased Intracranial Pressure Nursing Management

Difficulty

medium

Template Id

T7

Examiner Tip

Positioning questions are very common in NLE Neurosensory questions. Always pair the position with the physiological rationale. '30-degree HOB elevation promotes jugular venous drainage' is a complete, mark-worthy statement. 'Elevate the head' alone is incomplete.

Model Answer

Priority nursing interventions for a patient with increased ICP include: (1) Maintain a patent airway and ensure adequate oxygenation — hypoxia and hypercapnia cause cerebral vasodilation, which worsens ICP. Limit suctioning to 10–15 seconds. (2) Elevate the head of the bed (HOB) to 30 degrees and keep the head and neck in neutral, midline alignment — this promotes jugular venous drainage from the brain, reducing cerebral blood volume and ICP. Avoid extreme hip flexion and neck flexion, which obstruct venous outflow and raise ICP. (3) Prevent Valsalva maneuvers — avoid straining, coughing, and constipation (use stool softeners); cluster nursing care to allow rest periods. (4) Maintain a calm, quiet, slightly cool environment and manage fever aggressively, as fever increases cerebral metabolic demand and ICP.

Question Type

short_answer

Answer Structure

• Point 1: Airway and oxygenation — rationale: hypoxia/hypercapnia worsen ICP [1 mark]
• Point 2: HOB 30 degrees, neutral head/neck alignment — rationale: promotes venous drainage; avoid hip/neck flexion [1 mark]
• Point 3: Prevent Valsalva/straining; quiet environment; fever control [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'elevate the head of the bed' without specifying the 30-degree angle
• Stating 'turn patient to the side' without mentioning the critical requirement for midline, neutral head/neck alignment
• Giving interventions without any rationale — rationale earns marks in 3-mark answers

Key Phrases To Include

• 30 degrees
• neutral midline alignment
• jugular venous drainage
• hypoxia and hypercapnia
• cerebral vasodilation
• Valsalva maneuver
• fever management
• cluster care

Marks

3

Topic

Pharmacology — Mannitol

Difficulty

medium

Template Id

T8

Examiner Tip

When asked for 'monitoring parameters,' examiners expect specific values or thresholds, not vague terms. '320 mOsm/kg serum osmolality threshold' shows clinical precision. Contrast mannitol (osmotic diuretic — for any cerebral edema) with dexamethasone (corticosteroid — for tumor edema only) since both are frequently tested together.

Model Answer

Mannitol is an osmotic diuretic used in neurological emergencies to reduce increased intracranial pressure (ICP). It works by creating an osmotic gradient that draws excess fluid from swollen brain tissue into the bloodstream, thereby reducing cerebral edema and lowering ICP. The typical IV dose range is 0.25 to 1 g/kg of body weight. Two essential nursing monitoring parameters are: (1) Serum osmolality — mannitol is held if serum osmolality exceeds approximately 320 mOsm/kg to prevent severe dehydration and rebound cerebral edema. (2) Urinary output and fluid balance — mannitol causes significant diuresis; monitor for signs of dehydration and electrolyte imbalances (especially hyponatremia and hypokalemia). The drug is administered intravenously through a filter to prevent crystal infusion.

Question Type

short_answer

Answer Structure

• Point 1: Classification (osmotic diuretic) and mechanism (draws fluid from brain via osmosis) [1 mark]
• Point 2: Typical dose range (0.25–1 g/kg IV) [0.5 mark]
• Point 3: Two monitoring parameters — serum osmolality (hold if >320 mOsm/kg) and urine output/electrolytes [1.5 marks]

Scoring Breakdown

Common Mark Deductions

• Confusing mannitol with a loop diuretic like furosemide — the mechanism is osmotic, not loop inhibition
• Omitting the filter — this is a specific nursing consideration unique to mannitol
• Stating 'monitor urine output' without explaining what to look for (increased output indicating diuresis, or decreased output indicating dehydration)

Key Phrases To Include

• osmotic diuretic
• osmotic gradient
• cerebral edema
• 0.25 to 1 g/kg
• serum osmolality
• 320 mOsm/kg
• urine output
• filter
• rebound edema

Marks

2

Topic

Traumatic Brain Injury

Difficulty

medium

Template Id

T9

Examiner Tip

The 'lucid interval' is the most tested concept in head injury questions. Write it in capital letters or underline it in your actual exam paper to signal to the examiner that you know this key concept. Epidural = Arterial = Lucid interval — memorize this trio.

Model Answer

Epidural hematoma results from arterial bleeding (typically from the middle meningeal artery) between the skull and the dura mater, usually caused by trauma. The classic clinical presentation is a brief loss of consciousness after head injury, followed by a LUCID INTERVAL (a period of apparent recovery and alertness), then rapid and dramatic neurological deterioration as the arterial hematoma expands — this is a neurosurgical emergency. Subdural hematoma results from venous bleeding beneath the dura mater. It may be acute (rapid deterioration) or chronic (developing slowly over days to weeks), especially in elderly patients and those on anticoagulants, often with no clear trauma history.

Question Type

short_answer

Answer Structure

• Sentence 1–2: Epidural — arterial source (middle meningeal artery), skull-to-dura location, classic lucid interval presentation [1 mark]
• Sentence 3–4: Subdural — venous source, beneath the dura, acute vs. chronic, associated with elderly/anticoagulants [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the arterial/venous sources — epidural is ARTERIAL, subdural is VENOUS
• Not mentioning the lucid interval for epidural hematoma — this is the classic hallmark and examiners always expect it
• Forgetting to mention the chronic presentation of subdural hematoma in elderly or anticoagulated patients

Key Phrases To Include

• middle meningeal artery
• arterial bleeding
• lucid interval
• between skull and dura
• venous bleeding
• beneath the dura
• chronic subdural
• anticoagulants

Marks

2

Topic

Traumatic Brain Injury — Basilar Skull Fracture

Difficulty

hard

Template Id

T10

Examiner Tip

The phrase 'never pack the nose or ears and never insert an NGT nasally' in basilar skull fracture is a non-negotiable NLE answer point. Examiners frequently present it as a 'select the CONTRAINDICATED intervention' question. Knowing what NOT to do is as important as knowing what to do.

Model Answer

The clear nasal drainage should be assessed for cerebrospinal fluid (CSF) using the 'halo/ring sign' — place a drop of drainage on a white gauze; CSF will form a clear ring around a bloody center. The nursing priority is to maintain airway patency and prevent infection, while avoiding any intervention that could force contaminated material into the CNS. Procedures that must be AVOIDED include: (1) packing the nose or ears — this traps bacteria and increases infection risk; (2) nasogastric tube (NGT) insertion via the nasal route — the tube may enter the cranial vault through the fractured base; and (3) nasal suctioning, which can introduce organisms intracranially. Inform the physician immediately.

Question Type

short_answer

Answer Structure

• Sentence 1: Assess drainage for CSF using halo/ring sign [0.5 mark]
• Sentence 2–3: State nursing priority (prevent infection, maintain airway) and list three specific procedures to avoid with rationale [1.5 marks]

Scoring Breakdown

Common Mark Deductions

• Recommending nasal packing as a nursing action — this is explicitly contraindicated
• Not mentioning the NGT restriction — this is the most clinically dangerous omission
• Describing only the halo sign without identifying the priority interventions

Key Phrases To Include

• halo/ring sign
• CSF rhinorrhea
• do not pack the nose
• no nasogastric tube via nasal route
• no nasal suctioning
• meningitis risk
• basilar skull fracture

Marks

1

Topic

Hemorrhagic Stroke — Subarachnoid Hemorrhage

Difficulty

easy

Template Id

T11

Examiner Tip

The phrase 'worst headache of my life' in quotes is the exact clinical red flag taught in all neurosensory nursing textbooks and is directly lifted from standard NLE review materials. Including this exact phrase signals that you know the high-yield material.

Model Answer

A ruptured cerebral aneurysm causing subarachnoid hemorrhage classically presents with a sudden, severe headache described by the patient as the 'worst headache of my life,' accompanied by neck stiffness (nuchal rigidity from meningeal irritation) and rapid neurological deterioration.

Question Type

very_short_answer

Answer Structure

• One or two sentences identifying the classic 'thunderclap' headache, neck stiffness, and rapid decline [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing gradual onset headache — the hallmark is sudden, explosive onset
• Omitting neck stiffness/nuchal rigidity — this is the second key hallmark
• Confusing subarachnoid hemorrhage presentation with ischemic stroke (no motor weakness as the primary complaint)

Key Phrases To Include

• worst headache of my life
• sudden severe headache
• nuchal rigidity
• subarachnoid hemorrhage
• meningeal irritation

Marks

2

Topic

Stroke — Hemisphere Differentiation

Difficulty

medium

Template Id

T12

Examiner Tip

A quick memory trick: LEFT brain = LANGUAGE (aphasia) + RIGHT body weakness. RIGHT brain = spatial/peRceptual + LEFT body weakness. The contralateral rule is tested every exam cycle — state it explicitly in your answer.

Model Answer

Left hemisphere stroke (dominant hemisphere in most people) causes right-sided hemiplegia or hemiparesis and aphasia (expressive, receptive, or global), because language centers (Broca's and Wernicke's areas) are located in the left hemisphere. The patient tends to be slow, cautious, and anxious about deficits. Right hemisphere stroke causes left-sided hemiplegia or hemiparesis with spatial-perceptual deficits, unilateral neglect (ignoring the left side of the body and environment), and impulsive or poor safety judgment. Note: Stroke deficits are CONTRALATERAL — the side of the body affected is opposite to the side of the brain lesion.

Question Type

short_answer

Answer Structure

• Sentence 1–2: Left hemisphere stroke — right-sided weakness, aphasia, language deficits, cautious behavior [1 mark]
• Sentence 3–4: Right hemisphere stroke — left-sided weakness, spatial/perceptual deficits, unilateral neglect, impulsive behavior; contralateral rule stated [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that left hemisphere stroke causes left-sided weakness — this is the most common confusion; deficits are always CONTRALATERAL
• Omitting aphasia as the key deficit of left hemisphere stroke
• Not mentioning unilateral neglect for right hemisphere stroke — it is a classic and frequently tested finding

Key Phrases To Include

• contralateral deficits
• aphasia
• Broca's area
• Wernicke's area
• unilateral neglect
• spatial-perceptual deficits
• right-sided hemiplegia
• left-sided hemiplegia

Marks

5

Topic

Stroke Nursing Management — Nursing Process Application

Difficulty

hard

Template Id

T13

Examiner Tip

For 5-mark nursing process questions, use the five-step nursing process as your paragraph headings (Assessment, Diagnosis, Planning/Goals, Implementation, Evaluation) to ensure you do not miss a step. Each step earns approximately 1 mark. A full nursing process answer will always outperform a bulleted list of interventions alone. Use Maslow's hierarchy explicitly when prioritizing diagnoses to demonstrate theoretical grounding.

Model Answer

ASSESSMENT: The patient is a 68-year-old male with left hemisphere ischemic stroke presenting with right-sided hemiplegia (motor deficit), expressive aphasia (communication deficit — inability to produce speech, though comprehension may be intact), and dysphagia (swallowing difficulty — a major aspiration risk). Glasgow Coma Scale and neurological baseline must be established. Dysphagia must be confirmed before oral intake is initiated. PRIORITY NURSING DIAGNOSES (NANDA, Maslow-prioritized): 1. Risk for Aspiration related to impaired swallowing (dysphagia) secondary to stroke — HIGHEST PRIORITY (physiological safety need, Maslow Level 1) 2. Impaired Physical Mobility related to right-sided hemiplegia secondary to left hemisphere ischemic stroke 3. Impaired Verbal Communication related to expressive aphasia secondary to left hemisphere stroke 4. Risk for Impaired Skin Integrity related to immobility and inability to reposition self GOALS / EXPECTED OUTCOMES: - Patient will not exhibit signs or symptoms of aspiration pneumonia during hospitalization. - Patient will be repositioned every 2 hours using a turning schedule. - Patient will demonstrate use of an alternative communication method (e.g., picture board or writing) by discharge. NURSING INTERVENTIONS: 1. For Risk for Aspiration: Perform a bedside swallowing screen before initiating any oral intake; maintain NPO status until a formal swallowing evaluation by speech therapy is completed. Position the patient in a high Fowler's (90 degrees) during meals. Offer thickened liquids and soft foods as prescribed. Keep suction equipment at the bedside. Approach the patient from the unaffected (left) side when feeding. 2. For Impaired Physical Mobility: Reposition every 2 hours; use positioning devices (pillows, foot drop splints) to maintain correct anatomical alignment. Implement passive range-of-motion (PROM) exercises for the affected right side at least twice daily. Collaborate with physical therapy. Apply antiembolic stockings or sequential compression devices to prevent DVT. 3. For Impaired Verbal Communication: Use simple, short questions answerable with yes/no. Speak slowly, use gestures and visual aids (picture boards). Allow extra time for response. Do NOT complete the patient's sentences or pretend to understand — this discourages communication. Refer to speech therapy for aphasia rehabilitation. 4. For Skin Integrity: Inspect skin over bony prominences every 2 hours. Use a pressure-relief mattress. Keep skin clean and dry. EVALUATION: Reassess for aspiration (lung sounds, oxygen saturation, signs of pneumonia). Evaluate mobility progress weekly. Assess communication adaptation. Document response to all interventions.

Question Type

long_answer

Answer Structure

• Paragraph 1: Assessment — identify three main clinical problems from the case (right hemiplegia, expressive aphasia, dysphagia); establish clinical priority [1 mark]
• Paragraph 2: At least 2–3 NANDA nursing diagnoses written in correct format, prioritized using Maslow's hierarchy [1 mark]
• Paragraph 3: Goals/expected outcomes — at least 2 SMART goals relevant to the priority diagnoses [0.5 mark]
• Paragraph 4: Nursing interventions — at least 3 specific, correctly justified interventions covering aspiration prevention, mobility, and communication [2 marks]
• Paragraph 5: Evaluation — brief statement of how to evaluate outcomes [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Writing nursing diagnoses without the correct NANDA three-part format (problem + related to + as evidenced by)
• Prioritizing mobility or communication over aspiration/airway — a physiological safety need always takes priority over psychosocial needs (Maslow)
• Saying 'monitor patient' without specifying what to monitor and what findings to report
• Omitting the speech therapy referral — dysphagia and aphasia both require speech therapy, and collaborative care is expected in 5-mark answers
• Not addressing evaluation — incomplete nursing process format costs marks in long-answer questions

Key Phrases To Include

• Risk for Aspiration
• dysphagia
• NPO until swallowing evaluation
• speech therapy
• expressive aphasia
• approach from unaffected side
• PROM exercises
• pressure injury prevention
• Maslow physiological priority
• NANDA nursing diagnosis format
• high Fowler's position

Marks

2

Topic

Brain Tumors — Pharmacology

Difficulty

hard

Template Id

T14

Examiner Tip

The vasogenic vs. cytotoxic edema distinction is a high-yield pharmacology concept tested across both Neurosensory and Medical-Surgical Nursing. Vasogenic = blood-brain barrier breakdown = responds to steroids. Cytotoxic = cell death/swelling = does NOT respond to steroids. Mastering this distinction answers multiple question types.

Model Answer

Dexamethasone is a corticosteroid that reduces vasogenic cerebral edema — the type caused by breakdown of the blood-brain barrier around brain tumors. It decreases the permeability of tumor-associated blood vessels, reducing fluid leakage into surrounding brain tissue and thereby lowering ICP in patients with brain tumors. It is NOT used for ischemic stroke edema because stroke causes cytotoxic edema (intracellular swelling from ischemic neuronal death), not vasogenic edema. Corticosteroids are ineffective against cytotoxic edema and may actually worsen outcomes in stroke by raising blood glucose and increasing infection risk. Similarly, dexamethasone is not effective for the cytotoxic edema of traumatic brain injury.

Question Type

short_answer

Answer Structure

• Sentence 1–2: Role of dexamethasone — reduces vasogenic edema around brain tumors by decreasing blood-brain barrier permeability [1 mark]
• Sentence 3–4: Not used in ischemic stroke — stroke causes cytotoxic (not vasogenic) edema; corticosteroids ineffective and potentially harmful [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying dexamethasone 'reduces all types of brain edema' — it is type-specific (vasogenic only)
• Not differentiating between vasogenic and cytotoxic edema — this distinction is the entire basis of the answer
• Forgetting that this same restriction applies to traumatic brain injury edema (cytotoxic)

Key Phrases To Include

• vasogenic edema
• cytotoxic edema
• blood-brain barrier
• brain tumor
• not used in ischemic stroke
• dexamethasone
• corticosteroid

Marks

3

Topic

Stroke Recognition and Emergency Response

Difficulty

medium

Template Id

T15

Examiner Tip

The phrase 'do not give any medications until hemorrhagic stroke is ruled out by CT' is a critical safety statement that differentiates an average from an excellent nursing answer. Including it demonstrates clinical reasoning beyond memorization — this is what earns bonus recognition from examiners.

Model Answer

The FAST warning signs of stroke are: F — Face drooping (one side of the face droops, especially when smiling); A — Arm weakness (one arm drifts downward when both arms are raised); S — Speech difficulty (slurred, confused, or inability to speak or understand speech); T — Time to call for emergency help (call emergency services immediately — 'time is brain'). One additional clinical warning sign not in FAST is sudden severe headache with no known cause (the 'worst headache of my life'), which may signal subarachnoid hemorrhage from a ruptured aneurysm. Other additional signs include sudden vision loss or hemianopia, and sudden severe dizziness or loss of balance. Immediate nursing action: Activate the emergency response system (call the rapid response or stroke team), ensure the patient is safe (prevent falls), establish IV access, and prepare for an emergent non-contrast CT scan of the head — do NOT give any medications until hemorrhagic stroke is ruled out.

Question Type

short_answer

Answer Structure

• Part 1: All four FAST components correctly identified with brief description [1 mark]
• Part 2: One additional clinical sign correctly identified and explained [1 mark]
• Part 3: Immediate nursing actions: activate emergency response, ensure safety, prepare for CT scan, no medications until hemorrhage ruled out [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing FAST components in vague terms without clinical detail
• Recommending antihypertensive medications or aspirin immediately without waiting for CT results — this is dangerous and incorrect
• Listing nursing actions without including CT scan preparation — this is the critical first diagnostic step

Key Phrases To Include

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call emergency
• sudden severe headache
• non-contrast CT scan
• activate emergency response
• time is brain
• no medications until hemorrhage ruled out