252-EXM4-CVA/STROKE (PrepU Stroke Exemplar)

small, penetrating artery thrombotic strokes

Ischemic strokes are further divided into five subtypes; ____________ strokes that affect one or more vessels and cause reduced blood flow are the most common type of ischemic stroke, typically caused by longstanding hypertension, hyperlipidemia, or diabetes. -large-artery thrombotic -small, penetrating artery thrombotic -cardio embolic -cryptogenic

FALSE - cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual onset of symptoms over 2 days would suggest an alternative etiology.

T/F: A stroke can have a gradual onset of symptoms that occurs over the course of a eew days

Maintaining patent airway

The nurse is caring for a client diagnosed with a hemorrhagic stroke. The nurse recognizes that which intervention is most important? -Elevating the head of the bed to 30 degrees -Monitoring for seizure activity -Administering a stool softener -Maintaining a patent airway

Spatial-perceptual deficits

Which is indicative of a right hemisphere stroke? -Spatial-perceptual deficits -Aphasia -Slow, cautious behavior -Altered intellectual ability

Cocaine use **Risk factors of ischemic stroke - Behavioral risk factors include obesity, physical inactivity, and oral contraceptive use.21 In addition, increased risk of stroke is associated with hormone replacement therapy, heavy alcohol consumption, and drugs of abuse including cocaine, amphetamines, and heroin **Cocaine is a potent vasoconstrictor and may result in a life-threatening reaction, even with the individual's first use of the drug.

A 45-year-old client presents to the ED reporting trouble speaking and numbness of the right arm and leg. The nurse suspects an ischemic stroke. Which insult or abnormality can cause an ischemic stroke? -Trauma -Intracerebral aneurysm rupture -Cocaine use -Arteriovenous malformation

Frontal - If damage has occurred to the frontal lobe, learning capacity, memory, or other higher cortical intellectual functions may be impaired. Such dysfunction may be reflected in a limited attention span, difficulties in comprehension, forgetfulness, and a lack of motivation.

A stroke victim is experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe? -Frontal -Occipital -Parietal -Temporal

cardio embolic stroke

Ischemic strokes are further divided into five subtypes; _____________ strokes are associated with cardiac dysrhythmias, such as atrial fibrillation, but can also be associated with valvular heart disease or left ventricular thrombus. -large-artery thrombotic -small, penetrating artery thrombotic -cardio embolic -cryptogenic

False - TIA symptoms resolve spontaneously, usually within minutes.

T/F: TIA symptoms resolve spontaneously, usually within several hours, although the underlying mechanisms are the same as for stroke.

True

T/F: The term for difficulty forming words is dysarthria.

TRUE! Ch 16 PATHO

T/F: Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.

Ten percent of the calculated dose is given as IV bolus over 1 min (p. 2015 Med Surg)

The dosage for t-PA is 0.9 mg/kg, with a maximum dose of 90 mg....__________ percent of the calculated dose is given as an IV bolus over 1 minute. The remaining dose (90%) is given IV over 1 hour via an infusion pump

FALSE - Prior stroke or head injury within 3 months, a blood pressure greater than 185/110 mm Hg, or symptoms that have been present for greater than 4.5 hours exclude the client as a candidate for thrombolytic therapy. Neither age nor heart rate are part of thrombolytic therapy treatment criteria.

Thrombolytic therapy treatment criteria includes the fact that the patient has NOT had a prior stroke or head injury within the past 6 months.

The day the patient has the stroke - Although rehabilitation begins on the day the patient has the stroke, the process is intensified during convalescence and requires a coordinated team effort.

When should the nurse plan the rehabilitation of a patient who is having an ischemic stroke? - The day before the patient is discharged -After the patient has passed the acute phase of the stroke -After the nurse has received the discharge orders -The day the patient has the stroke

A subdural hematoma develops in the area between the dura and arachnoid space and is usually the result of a tear in small bridging veins that connect the surface of the cortex to dural sinuses. This is a slow source of bleeding, thus the client with a subdural hematoma is less likely to develop a rapid bleed than a client with an epidural hematoma, red stroke, and/or subarachnoid hemorrhage.

Which client is at least risk for rapid bleeding? -Client with a epidural hematoma -Client with a subdural hematoma -Client with spontaneous subarachnoid hemorrhage -Client with a red stroke

Noncontrast computed tomography (CT)

Which of the following is the initial diagnostic in suspected stroke? -Noncontrast computed tomography (CT) -CT with contrast -Magnetic resonance imaging (MRI) -Cerebral angiography

Dysarthria

A client diagnosed with a stroke is having difficulty forming words during communication. This would be appropriately documented as -dysphagia. -dysarthria. -diplopia. -receptive aphasia.

3 hours

An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The treatment window for thrombolytic therapy is which of the following? -Three hours -One hour -Two hours -Six hours

True - also note - Control of hypertension, especially in individuals over 55 years of age, clearly reduces the risk for hemorrhagic stroke. Additional risk factors are increased age, male gender, and excessive alcohol intake. Another high-risk group is African Americans, where the incidence of first stroke is almost twice that in Caucasians. Modifiable risk factors for ischemic stroke include hypertension, atrial fibrillation, hyperlipidemia, obesity, smoking, and diabetes.

T/F: Uncontrolled hypertension is the primary cause of a hemorrhagic stroke.

Broca's area controls speech and is located in the frontal lobe. Inability to form speech is Broca's aphasia.

What is Broca's area? Where is it? What does it control? What is it called when Broca's area becomes damaged?

-History of stroke -Time of symptom onset -Blood pressure *Patho Ch 16

A client arrives at the emergency department with symptoms of stroke. What evidence should the nurse gather to determine if the client is a candidate for thrombolytic therapy? Select all that apply. -History of stroke -Age -Time of symptom onset -Heart rate -Blood pressure

Going to the nearest stroke center

A client begins to exhibit manifestations of a stroke while attending a community health fair. What type of emergency care should the staff at the health fair implement first? -Going to visit his or her family physician -Going to the nearest emergency room -Going to the nearest stroke center -Going to an urgent care center

Dysarthria

A client diagnosed with a stroke is having difficulty forming words during communication. This would be appropriately documented as -dysphagia. -receptive aphasia. -dysarthria. -diplopia.

Aspirin

A client diagnosed with a stroke is ordered to receive warfarin. Later, the nurse learns that the warfarin is contraindicated and the order is canceled. The nurse knows that the best alternative medication to give is -dipyridamole. -clopidogrel. -aspirin. -ticlopidine.

The modifiable risks for stroke listed above would include atrial fibrillation, which can be controlled with medications; diabetes, which can be controlled with diet, exercise, and medications; and hypertension, which can be controlled with diet, exercise, and medications. *Thrombocytopenia is not a risk factor for stroke, and age is not modifiable.

An 85-year-old client with a history of diabetes, thrombocytopenia, and hypertension develops atrial fibrillation with an irregular heart rate of 120-140 beats/min. After successful cardioversion to normal sinus rhythm, the client is preparing to be discharged when he suddenly develops right-sided hemiplegia and dysphasia. Which modifiable risk factors for stroke does this client have? Select all that apply. -Atrial fibrillation -Diabetes -Thrombocytopenia -Hypertension -Age

large-artery thrombotic strokes

Ischemic strokes are further divided into five subtypes; _________________ strokes are caused by atherosclerotic plaques in the large blood vessels of the brain. Thrombus formation and occlusion can occur at the site of the atherosclerosis and result in ischemia and infarction (tissue death) -large-artery thrombotic -small, penetrating artery thrombotic -cardio embolic -cryptogenic

Thrombolytics may cause cerebral hemorrhage. **A previous stroke occurring within 3 months of the administration of thrombolytics significantly increases the risk of intracranial hemorrhage. (Pg 429 Patho)

A client discharged from the hospital 5 days ago following a stroke has come to the emergency department with facial droop that progressed with hemiplegia and aphasia. The client's spouse is extremely upset because the physician stated that the client cannot receive thrombolytic medications to reestablish cerebral circulation and the spouse asks the nurse why. What is the nurse's most accurate response? -"All the brain tissue damage is already done." -"Thrombolytics may cause cerebral hemorrhage." -"The stroke is hemorrhagic, not thrombotic." -"The medications do not work with subsequent strokes."

Auditory agnosia **Damage to the occipital lobe can result in visual agnosia, whereas damage to the temporal lobe can cause auditory agnosia. If damage has occurred to the frontal lobe, learning capacity, memory, or other higher cortical intellectual functions may be impaired. Such dysfunction may be reflected in a limited attention span, difficulties in comprehension, forgetfulness, and lack of motivation. Damage to motor neurons may cause hemiparesis, hemiplegia, and a change in reflexes.

A client has experienced an ischemic stroke that has damaged the temporal (lateral and superior portions) lobe. Which of the following deficits would the nurse expect during assessment of this client? -Limited attention span and forgetfulness -Hemiplegia or hemiparesis -Lack of deep tendon reflexes -Auditory agnosia

-"The client is unaware of his left side. You should approach him on the right side."

A client recently experienced a stroke with accompanying left-sided paralysis. His family voices concerns about how to best interact with him. They report the client doesn't seem aware of their presence when they approach him on his left side. What advice should the nurse give the family? -"The client is feeling an emotional loss. He'll eventually start acknowledging you on his left side." -"The client is unaware of his left side. You should approach him on the right side." -"The client is unaware of his left side. You need to encourage him to interact from this side." -"This condition is temporary."

cardio embolic

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? -large-artery thrombotic -small, penetrating artery thrombotic -cardio embolic -cryptogenic

Intracerebral hemorrhage **About 80% of hemorrhagic strokes are intracerebral, and they are caused primarily by uncontrolled hypertension.

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? -Hemorrhage due to an aneurysm -Intracerebral hemorrhage -Subarachnoid hemorrhage -Arteriovenous malformation

45 mg ** administer 0.9mg/kg

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? -50 mg -45 mg -85 mg -90 mg

Atherosclerotic lesions in cerebral vessels

An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? -Aneurysm leakage -Atherosclerotic lesions in cerebral vessels -Minor residual deficits -Diffuse cerebral electrical malfunctions

Thrombosis (Ch 16 Patho)

The most common cause of an ischemic stroke is which of the following? -Intracerebral arterial vasculitis -Cardiogenic embolus -Thrombosis -Vasospasm

Berry aneurysm

The nurse caring for a client with an aneurysmal subarachnoid hemorrhage understands that the most common cause of this condition is: -Subdural hematoma -Arteriovenous malformation -Hypertension -Berry aneurysm

White man, age 60 with history of uncontrolled hypertension

The nurse is performing stroke risk screenings at a hospital open house. Identification of high-risk individuals is the goal of the screenings. The nurse has identified four patients who might be at risk for a stroke. Which patient is likely at highest risk for a stroke? -white woman, age 60 with history of excessive alcohol intake -White man, age 60 with history of uncontrolled hypertension -Black man, age 60, with history of diabetes -Black man, age 50 with history of smoking

1 hr

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 -3 to 6 hours -12 hours -24 to 36 hours

Wernickes area deals with speech comprehension; it is located in the temporal lobe. Auditory agnosia results when Wernickes area is damaged

What part of the brain is Wernickes area in? What does Wernicke area control? What happens when its damaged?

has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days **A cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual onset of symptoms over 2 days would suggest an alternative etiology. Ataxia, slurred speech, and unilateral numbness are associated with stroke, with sudden vomiting and headache being particularly indicative of a hemorrhagic CVA.

Which client's signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult: -has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days. -experienced a sudden loss of balance and slurred speech. -has vomited and complained of a severe headache. -states that her left arm and leg are numb and gait is consequently unsteady.

A man who has entered cardiogenic shock following a severe myocardial infarction

Which individual would be most likely to experience global ischemia to his or her brain? -A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater -A woman who has been admitted to the emergency department with a suspected intracranial bleed -A man who has entered cardiogenic shock following a severe myocardial infarction -A male client who has just had an ischemic stroke confirmed by CT of his head

The antiseizure medication lamotrigine (Lamictal) has been found to be effective for post-stroke pain.

Which of the following antiseizure medication has been found to be effective for post-stroke pain? -Phenytoin (Dilantin) -Topiramate (Topamax) -Lamotrigine (Lamictal) -Carbamazepine (Tegretol)

-"Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation."

During a class on stroke, a junior nursing student asks what the clinical manifestations of stroke are. What would be the instructor's best answer? -"Clinical manifestations of a stroke are highly variable, depending on the cardiovascular health of the client." -"Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation." -"Clinical manifestations of a stroke generally include aphasia, one-sided flaccidity, and trouble swallowing." -"Clinical manifestations of a stroke depend on how quickly the clot can be dissolved."

-Blood pressure historically in the range of 150/90 to 160/100 mm Hg -Diagnosed with type 2 diabetes 8 years ago -Black male

A client is admitted to a rehabilitation center after hospital treatment for an ischemic stroke. What aspects of the client's history are risk factors for ischemic stroke? Select all that apply. -Blood pressure historically in the range of 150/90 to 160/100 mm Hg -Takes corticosteroids for the treatment of rheumatoid arthritis -Diagnosed with type 2 diabetes 8 years ago -Takes iron supplements for the treatment of chronic anemia -Black male

This is significant for poor neurologic outcomes.

A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient? -The patient has new onset diabetes. -This is significant for poor neurologic outcomes. -The patient has developed diabetes insipidus due to the location of the stroke. -The patient has liver failure.

-1 to 3 days

A patient is in the acute phase of an ischemic stroke. How long does the nurse know that this phase may last? -1 to 3 days -Up to 1 week -Up to 24 hours -Up to 2 weeks

Homonymous hemianopsia

Which disturbance results in loss of half of the visual field? -Homonymous hemianopsia -Diplopia -Nystagmus -Anisocoria

Neglect of objects and people on the left side Left-sided hemiplegia Tendency to distractibility

A family member comes to the clinic to talk to the nurse about a client who has had a stroke on the right side of the brain. The family member is concerned because of the deficits the client is exhibiting. The nurse knows that when a client experiences a stroke on the right side of the brain, common deficits include what? Select all that apply. -Impairment of long-term memory -Neglect of objects and people on the left side -Hyperaware of deficits -Left-sided hemiplegia -Tendency to distractibility

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

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. -A TIA is an insidious, often chronic episode of neurologic impairment. -Symptoms of a TIA may linger for up to a week. -Two thirds of people that experience a TIA will go on to develop a stroke.

TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. **TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature and their effects are not normally cumulative. They may require treatment medically or surgically.

A nurse at a long-term care facility provides care for a client who has had recent transient ischemic attacks (TIAs). What significance should the nurse attach to the client's TIAs? - TIAs result in an accumulation of small deficits that may eventually equal the effects of a CV. -TIAs are relatively benign phenomena that necessitate monitoring, but not treatment. -TIAs, by definition, resolve rapidly, but they constitute an increased risk for stroke. -The small bleeds that define TIAs can be a warning sign of an impending stroke.

HTN

The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is: -Smoking -Obesity -Hypertension -Dyslipidemia

Hemiplegia, seizures, and decreased level of consciousness

A client undergoes cerebral angiography for evaluation of a subarachnoid hemorrhage. Which findings indicate spasm or occlusion of a cerebral vessel by a clot? -Nausea, vomiting, and profuse sweating -Hemiplegia, seizures, and decreased level of consciousness -Difficulty breathing or swallowing -Tachycardia, tachypnea, and hypotension

Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored.

An older adult male client has been brought to the emergency department after experiencing stroke-like symptoms a few hours ago, and has been subsequently diagnosed with an ischemic stroke. The care team is eager to restore cerebral perfusion despite the likely death of the brain cells directly affected by the stroke. What is the rationale for the care team's emphasis on restoring circulation? -Failure to restore blood flow creates a severe risk for future transient ischemic attacks. -Necrosis will continue unabated throughout the brain unless blood flow is restored. -Cells of the penumbra may be saved from hypoxic damage if blood flow is promptly restored. -Unless blood flow is restored, the client faces the risk of progressing to hemorrhagic stroke.

Lioresal (Baclofen)

A patient who has suffered a stroke begins having complications regarding spasticity in the lower extremity. What ordered medication does the nurse administer to help alleviate this problem? -Pregabalin (Lyrica) -Heparin -Lioresal (Baclofen) -Diphenhydramine (Benadryl)

-Elevating the head of the bed to 30 degrees **Because the client's gag reflex is absent, elevating the head of the bed to 30 degrees helps minimize the client's risk of aspiration. Checking the stools, performing ROM exercises, and keeping the skin clean and dry are important, but preventing aspiration through positioning is the priority.

After a stroke, a client is admitted to the facility. The client has left-sided weakness and an absent gag reflex. He's incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g. Which nursing intervention is a priority for this client? -Checking stools for occult blood -Performing range-of-motion (ROM) exercises on the left side -Keeping skin clean and dry -Elevating the head of the bed to 30 degrees

International normalized ratio greater than 2 (Med surg book pg 2015 chart 67-3) **The client is at risk for further bleeding if the international normalized ratio is greater than 2. Thrombolytic therapy must be initiated within 3 hours in clients with ischemic stroke. The client is not eligible for thrombolytic therapy if she has had surgery within 14 days. Digoxin and labetalol do not prohibit thrombolytic therapy.

An emergency department nurse is interviewing a client who is presenting with signs of an ischemic stroke that began 2 hours ago. The client reports a history of a cholecystectomy 6 weeks ago and is taking digoxin, warfarin, and labetalol. What factor poses a threat to the client for thrombolytic therapy? -Surgery 6 weeks ago -Taking digoxin -Two hour time period of the stroke -International normalized ratio greater than 2