Chapter 28

An adult client has sought care for the treatment of headaches that have become increasingly severe and frequent over the past several months. Which of the following questions addresses potential etiologic factors? Select all that apply?

"Are you exposed to any toxins or chemicals at work?" "How would you describe your ability to cope with stress?" "What medications are you currently taking?" "Does anyone else in your family struggle with headaches?"

A nurse is helping a client understand the cause of ischemic stroke. Which statements might be included in this discussion? Select all that apply.

"Your stroke occurred because a blood clot got lodged in an artery that carries blood to your brain." The type of stroke you had occurs in 80% of the people who have a stroke."

cerebrovascular accident (CVA)

(also known as stroke) can occur in the near future; one-third of people who experience a TIA subsequently develop a stroke.

The nurse knows that symptoms associated with a TIA, usually a precursor of a future stroke, usually subside in what period of time?

1 hour

Which of the following, if left untreated, can lead to an ischemic stroke?

Atrial fibrillation

Substances That Trigger Migraine Headaches drugs

Drugs Analgesic overuse Benzodiazepine withdrawal Cimetidine Decongestant overuse Estrogen replacement Fenfluramine Indomethacin Nifedipine Nitrates Oral contraceptives Reserpine Theophylline

Which of the following statements reflects nursing management of the patient with expressive aphasia?

Encourage the patient to repeat sounds of the alphabet.

Substances That Trigger Migraine Headaches Events

Events Stress Menstruation; menopause Sleep changes; excess or loss Overexertion Hunger or fasting Odors, smoke, or perfume Strong glare or flashing lights

What should be included in the client's care plan when establishing an exercise program for a client affected by a stroke?

Exercise the affected extremities passively four or five times a day.

FAST (stroke)

F - Face drooping especially on one side; A - Arm weakness; S - Slurred speech; T - Time to call 911.

A client who has experienced an ischemic stroke has been admitted to the medical unit. The client's family is adamant that she remain on bed rest to hasten her recovery and to conserve energy. What principle of care should inform the nurse's response to the family?

The client should mobilize as soon as she is physically able.

Which of the following psychotropic drug classifications is often prescribed for neuropathic pain?

Tricyclic antidepressants

A client reports light-headedness, speech disturbance, and left-sided weakness lasting for several hours. The neurologist diagnosed a transient ischemic attack, which caused the client great concern. What would the nurse include during client education?

When symptoms cease, the client will return to presymptomatic state.

Hemianopia

ability to see only half of the normal visual field

bruit

abnormal blowing or swishing sound heard during auscultation of an artery or organ

cephalalgia

aching pain in the head; headache

The nurse is caring for a client recovering from an ischemic stroke. What intervention best addresses a potential complication after an ischemic stroke?

cough and breathing excerices

cerebral infarction

death of brain tissue

A nurse is providing care to a client who has had a stroke. Which symptoms are consistent with right-sided stroke?

impulsive behavior, poor judgment, deficits in left visual fields

Expressive aphasia

inability to speak

receptive aphasia

inability to understand spoken or written words (wernickes area)

aneurysm

is a weakening in the wall of a blood vessel

hemiplegia

paralysis of one side of the body

A client has a 12-year history of migraine headaches and is frustrated over how these headaches impact lifestyle. The nurse discusses the potential triggers of the client's migraines. Which is not a potential trigger to migraines?

seasonal changes

carotid endarterectomy

surgical removal of atherosclerotic plaque from the carotid artery.

Medical management of a client with a cerebral aneurysm does not include:

thrombolytic therapy.

An emergency department nurse understands that a 110-lb (50-kg) recent stroke victim will receive at least the minimum dose of recombinant tissue plasminogen activator (t-PA). What minimum dose will the client receive?

45 mg

Transient Ischemic Attack (TIA)

brief episode of neurologic impairment caused by a temporary interruption in cerebral blood flow. Symptoms may disappear within 1 hour; some continue for as long as 1 day.

A patient has had a large ischemic stroke and is hospitalized in the neurologic intensive care unit. What interventions will be provided for this patient to decrease intracranial pressure? Select all that apply.

Administering mannitol Maintaining the partial pressure of carbon dioxide (PaCO2) within a range of 30 to 35 mm Hg Elevating the head of the bed 30 degrees

Substances That Trigger Migraine Headaches Food

Foods Aged cheese Alcohol Bananas, figs, raisins Caffeine Citrus fruits Chocolate Dairy products Fermented or pickled food Nuts Onions Pea or lima bean pods Processed foods containing nitrites, sulfites, or monosodium glutamate (MSG) Saccharin or aspartame Yeast-containing products

A client has recently begun mobilizing during the recovery from an ischemic stroke. To protect the client's safety during mobilization, the nurse should perform what action?

Have a colleague follow the client closely with a wheelchair.

A client who had a cerebrovascular accident has dysphagia related to hemiplegia and has a history of aspiration. Which nursing interventions would be contraindicated for this client?

Have the client tilt their head back to facilitate swallowing.

A client has had an ischemic stroke and has been admitted to the medical unit. What action should the nurse perform to best prevent joint deformities?

Place a pillow in the axilla when there is limited external rotation.

A nurse practitioner provides health teaching to a patient who has difficulty managing hypertension. This patient is at an increased risk of which type of stroke? q

Intracerebral hemorrhage

A transcranial Doppler ultrasonography detects cerebral vasospasms in a client experiencing lethargy 8 days following a subarachnoid hemorrhage. The nurse anticipates which therapeutic intervention? q

Nimodipine PO

Nursing care during the immediate recovery period from an ischemic stroke should include which of the following?

Positioning to avoid hypoxia

A nurse is planning care for a client who experienced a stroke in the right hemisphere of his brain. What should the nurse do?

Provide close supervision because of the client's impulsiveness and poor judgment.

As a member of the stroke team, the nurse knows that thrombolytic therapy carries the potential for benefit and for harm. The nurse should be cognizant of what contraindications for thrombolytic therapy? Select all that apply.

Recent intracranial pathology Current anticoagulation therapy Symptom onset greater than 3 hours prior to admission

A nurse is caring for a client with a cerebral aneurysm. Which nursing interventions would be most useful to the nurse to avoid bleeding in the brain? Select all that apply.

Report changes in neurologic status as soon as a worsening trend is identified. Maintain the head of the bed at 30 degrees. Avoid any activities that cause a Valsalva maneuver.

A nurse is reading a journal article about stroke and the underlying causes associated with this condition. The nurse demonstrates understanding of the information when identifying which subtype of stroke as being due to atrial fibrillation?

cardio embolic