Practice Question
The nurse is assessing the client. Which findings are indicative of the need for further neurological assessment? (Select all that apply.)
Answer Choices:
Correct Answer:
Slurred speech
Rationale:
Slurred speech
🔹 Slurred speech (dysarthria) is a classic sign of possible acute neurologic impairment, including stroke or transient ischemic attack (TIA).
🔹 It indicates dysfunction in the motor control of speech muscles, often due to cranial nerve or brainstem involvement.
🔹 Sudden onset slurred speech requires immediate neurologic evaluation, as it can signal a time-sensitive stroke emergency.
🔹 Nurses should treat this as a neurologic red flag, prompting rapid communication with the provider and stroke team.
🔹 Because it reflects a potential new or worsening brain injury, it definitely warrants further neurological assessment.
Facial droop
🔹 Facial droop, especially when unilateral, is another hallmark sign of possible stroke or cranial nerve VII (facial nerve) dysfunction.
🔹 Sudden facial asymmetry can indicate acute cerebral ischemia or hemorrhage, often involving the contralateral hemisphere.
🔹 This finding is part of standard stroke screening tools such as FAST (Face, Arms, Speech, Time).
🔹 When a nurse observes facial droop, it must be documented and escalated immediately for neurological evaluation.
🔹 Therefore, facial droop clearly indicates a need for further, urgent neurologic assessment.
Decreased strength in extremities
🔹 Decreased strength in extremities, especially if unilateral or sudden, strongly suggests motor pathway involvement from a neurologic event.
🔹 Stroke often presents with hemiparesis (weakness) or hemiplegia (paralysis) on one side of the body.
🔹 This can reflect damage to the motor cortex or corticospinal tracts, requiring prompt neurologic evaluation.
🔹 Early recognition and reporting are critical to prevent further deterioration and to guide rehabilitation planning.
🔹 Thus, decreased extremity strength is another sign that clearly warrants further neurological assessment.
Chest symmetry
🔹 Chest symmetry refers to equal rise and fall of the chest during breathing and is mainly assessed in respiratory and musculoskeletal examinations.
🔹 Symmetric chest expansion is a normal finding and does not in itself suggest neurologic compromise.
🔹 Although severe neuromuscular conditions can alter breathing patterns, this option is describing normal symmetry, not an abnormal sign.
🔹 This finding would not trigger a targeted neurologic workup by itself.
🔹 Therefore, chest symmetry is not indicative of the need for further neurological assessment in this context.
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This question is from Examplify NR304 Quiz 3 BSNOL NOV25 which contains 10 questions.
More Questions from This Exam
Which of the following is not an anticipated finding for a client that experienced a stroke?
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Which outcome is most appropriate for a client being discharged to a long-term care facility after a stroke?
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Which findings in this client's health history should the nurse associate with an increased risk for neurological impairment? (Select all that apply.)
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A nurse has four clients who have all had a stroke. Which of the clients should the nurse see first?
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Which of the following assessment findings can be related to chronic stress?
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Health Assessment
- Answer Choices: 4