Nurs 4 - Neuro & stroke - Stroke
Which modifiable risk factors for stroke would be most important for the nurse to include when planning a community education program? 1 Hypertension 2 Hyperlipidemia 3 Alcohol consumption 4 Oral contraceptive use
1 - Hypertension Hypertension is the single most important modifiable risk factor but still it is undetected often and treated inadequately. The public is often more aware of hyperlipidemia and oral contraceptive use as risk factors for stroke. Alcohol is also a modifiable risk factor.
A nurse is explaining methods to reduce the risk of stroke to a patient. What instructions should the nurse convey to the patient? Select all that apply. 1 Limit fluid and fiber intake. 2 Eat a diet low in saturated fats. 3 Decrease level of physical exercise. 4 Maintain a normal blood pressure (BP). 5 Limit consumption of alcohol to moderate levels.
2 - Eat a diet low in saturated fats. 4 - Maintain a normal blood pressure (BP). 5 - Limit consumption of alcohol to moderate levels. Alcoholics and people with hypertension are prone to strokes. Hence, alcohol consumption should be limited, a diet low in fat should be consumed, and BP should be maintained. Also, physical exercise and adequate fluid and fiber intake will decrease the risk of stroke and should be promoted.
A patient was brought to the emergency department with a sudden onset of a severe headache different from any other headache previously experienced. When considering the possibility of a stroke, which type of stroke should the nurse know most likely is occurring? 1 Embolic stroke 2 Thrombotic stroke 3 Subarachnoid hemorrhage 4 Transient ischemic attack (TIA)
3 - Subarachnoid hemorrhage Headache is common in a patient who has a subarachnoid hemorrhage or an intracerebral hemorrhage. A TIA is a transient loss of neurologic function, usually without a headache. A headache may occur with an ischemic embolic stroke, but severe neurologic deficits are the initial symptoms. The ischemic thrombotic stroke manifestations progress in the first 72 hours as infarction and cerebral edema increase.
While assessing the level of consciousness in a patient with a stroke, the nurse asks the patient the month and the patient's age. The patient knew his or her age but could not state what month it was. What score should the nurse give to the patient, using the National Institutes of Health Stroke Scale (NIHSS)? Record your answer using a whole number. ___
1 According to the NIHSS scale, when assessing the level of consciousness in a stroke patient, if the patient is able to answer one of the two questions correctly, then the score is 1.
A patient is not able to talk properly after having a stroke but is able to understand what the nurse is saying. While talking to the patient, which sentence stated by the patient will confirm Broca's aphasia? Select all that apply. 1 "Ice-cream eat." 2 "My dog is thirsty." 3 "Bird bird two tree." 4 "You are very caring." 5 "I like to go to the park."
1 - "Ice-cream eat." 3 - "Bird bird two tree." In Broca's aphasia, the patient speaks in short phrases and often omits small words such as "is," "and," and "the." Also, the Broca's aphasia patient typically understands the speech of others fairly well. "My dog is thirsty," "You are very caring," and "I like to go to the park" are complete sentences.
The nurse is preparing a patient with a stroke for diagnostic testing to determine cerebral blood flow. Which tests would be of greatest benefit to obtain this information? Select all that apply. 1 Duplex scanning 2 Electroencephalogram (EEG) 3 Digital subtraction angiography 4 Transcranial Doppler ultrasonography 5 Computed tomography perfusion and diffusion imaging
1 - Duplex scanning 3 - Digital subtraction angiography 4 - Transcranial Doppler ultrasonography Computed tomography perfusion and diffusion imaging do not indicate cerebral blood flow. They are used to diagnose stroke. Duplex scanning, digital subtraction angiography, and transcranial Doppler ultrasonography are used to assess cerebral blood flow. An EEG would determine the electrical activity of the brain, not the cerebral blood flow.
A patient has Broca's aphasia. Which lobe of the brain does the nurse anticipate to have been affected by a stroke? 1 Frontal lobe 2 Parietal lobe 3 Occipital lobe 4 Temporal lobe
1 - Frontal lobe The frontal lobe of the brain is related to reasoning, planning, parts of speech, movement, emotions, and problem solving. Broca's aphasia causes the patient to speak in short fragments and is caused by damage to the frontal lobe of the brain. The parietal lobe, occipital lobe, and temporary lobes of the brain are not associated with Broca's aphasia.
The patient is scheduled for a transcranial Doppler imaging scan. What information will this test provide? 1 It measures the velocity of blood flow. 2 It identifies red blood cells. 3 It visualizes blood vessels. 4 It measures oxygenation.
1 - It measures the velocity of blood flow. Transcranial Doppler imaging is used to measure the velocity of blood flow in the cerebral arteries. A lumbar puncture identifies red blood cells in the cerebrospinal fluid. A computed tomographic scan visualizes the cerebral blood vessels. The LICOX system is used to measure brain oxygenation and temperature.
The patient is being transferred to a certified stroke center. What staff should be included in the care team? Select all that apply. 1 Radiologist 2 Neurologist 3 Registered nurse 4 Radiologic technician 5 Emergency physician 6 Patient care technician
1 - Radiologist 2 - Neurologist 3 - Registered nurse 4 - Radiologic technician The American Heart Association recommends that acute care facilities have the following members on their stroke team: registered nurse, neurologist, radiologist, and radiologic technician. The emergency physician will activate the stroke team but not be a part of it. A patient care technician can be delegated tasks by the registered nurse but only if needed.
The nurse is caring for a patient who sustained a stroke and who is having difficulty swallowing. The nurse recorded the patient's swallowing status score as 4. What does this score indicate? 1 Swallowing status is mildly compromised. 2 Swallowing status is severely compromised. 3 Swallowing status is moderately compromised. 4 Swallowing status is substantially compromised.
1 - Swallowing status is mildly compromised. According to the measurement scale, the patient has a mildly compromised swallowing status. A score of 1 indicates a severely compromised swallowing status. A score of 2 indicates that the patient has a substantially compromised swallowing status. A score of 3 indicates a moderately compromised swallowing status.
A patient sustained a stroke and is experiencing cranial nerve deficits. What artery does the nurse suspect to be obstructed? 1 Vertebral artery 2 Middle cerebral artery 3 Anterior cerebral artery 4 Posterior cerebral artery
1 - Vertebral artery The vertebral artery supplies blood to the posterior part of the circle of Willis. Any impairment in the vertebral artery leads to cranial nerve deficits. The middle cerebral artery supplies blood to the cerebrum and is not associated with cranial nerve deficits. The anterior cerebral artery supplies blood to the middle portions of the frontal lobes and superior medial parietal lobes and is not associated with cranial nerve deficits. The posterior cerebral artery supplies blood to the occipital lobe and is not a cause of cranial nerve deficits.
A nurse is updating the health history of a patient who has been admitted to the hospital with a stroke. What question should the nurse ask the patient's support person? 1 What was the time of onset of symptoms? 2 How much food did the patient eat the previous night? 3 What was the position of the patient when the symptoms arose? 4 Was the patient wearing tight clothes at the time of the stroke?
1 - What was the time of onset of symptoms? The time of onset of stroke is important for all types of stroke since it can affect the treatment decisions. Other questions are not relevant. The quantity of food that the person had in the previous night does not contribute to diagnosis or treatment of stroke. Strokes do not happen in a particular position; therefore, questions about the patient's position are not relevant. Wearing tight clothes does not increase the risk of stroke; therefore, the question is not relevant.
The nurse is planning self-care priorities with a patient after a stroke. Rank these goals from highest to lowest priority. 1. Maintain adequate nutrition. 2. Maintain stable body functions. 3. Attain maximum physical functioning. 4. Avoid complications of stroke. 5. Attain maximum self-care abilities.
1. - Attain maximum physical functioning. 2. - Attain maximum self-care abilities. 3. - Maintain stable body functions. 4. - Maintain adequate nutrition. 5. - Avoid complications of stroke. The priority goal for a patient following a stroke is to attain maximum physical functioning (get out of bed), then to attain maximum self-care abilities (going to the bathroom, feeding oneself), maintain stable body functions (bladder/bowel control), maintain adequate nutrition (adequate intake of nutrients), and avoid complications (malnutrition, prevention of falls).
A patient with a stroke develops aphasia. What does the nurse suspect to be the reason for the patient's condition? 1 A defect in the vertebral artery 2 A defect in the middle cerebral artery 3 A defect in the anterior cerebral artery 4 A defect in the posterior cerebral artery
2 - A defect in the middle cerebral artery Aphasia is caused by a defect in the middle cerebral artery. A defect in the vertebral artery may lead to cranial nerve deficits or coma. Defects in the anterior cerebral artery may cause motor or sensory deficits. A defect in the posterior cerebral artery may result in visual hallucinations or motor deficits.
A patient who sustained a stroke is to have a diagnostic test to determine cerebral blood flow. For what diagnostic test does the nurse prepare the patient? 1 Echocardiography 2 Cerebral angiography 3 Magnetic resonance angiography 4 Computed tomography angiography
2 - Cerebral angiography Cerebral angiography is performed to assess cerebral blood flow. Cerebral angiography helps find blood vessel blockages present in the head and neck. Echocardiography is performed for cardiac assessment. Magnetic resonance angiography and computed tomography angiography are performed for the diagnosis of a stroke and to assess the extent of involvement.
The nurse is teaching a patient about the onset of embolic stroke. What information does the nurse include in the teaching plan? 1 Embolic stroke rarely recurs. 2 Embolic stroke occurs rapidly. 3 Embolic stroke renders the patient unconscious. 4 Embolic stroke is marked by a surge of blood supply to the brain tissues.
2 - Embolic stroke occurs rapidly. Embolic stroke often occurs rapidly, whereby accommodation toward developing collateral circulation becomes difficult. It is not uncommon for embolic stroke to recur, unless the underlying causes are treated aggressively. During an embolic stroke the patient may experience a headache but does not lose consciousness. The prognosis of embolic stroke is related to the deprivation of blood supply to the brain tissues.
The nurse would expect to find what clinical manifestation in a patient admitted with a left-hemispheric stroke? 1 Impulsivity 2 Impaired speech 3 Left-side neglect 4 Short attention span
2 - Impaired speech Clinical manifestations of left-hemispheric stroke damage include right hemiplegia, impaired speech/language, impaired right/left discrimination, and slow and cautious performance. Impulsivity, left-sided neglect, and short attention span are all manifestations of right-sided brain damage.
A patient suspected of having a subarachnoid hemorrhage is scheduled to undergo transcranial Doppler (TCD). What information about this procedure should the nurse provide the patient and the patient's family? Select all that apply. 1 It is an invasive procedure. 2 It is effective in detecting microemboli. 3 It requires a small dose of contrast media. 4 It provides visualization of cerebral blood vessels. 5 It measures the velocity of blood flowing through major vessels.
2 - It is effective in detecting microemboli. 5 - It measures the velocity of blood flowing through major vessels. TCD ultrasonography is a noninvasive study that measures the velocity of blood flow in the major cerebral arteries. It is effective in detecting microemboli and vasospasm and is ideal for the patient suspected of having a subarachnoid hemorrhage. The procedure is noninvasive. TCD does not provide visualization of cerebral blood vessels; a computed tomography angiogram may provide visualization of cerebral blood vessels. The procedure does not include injection of contrast medium.
While doing a neurologic assessment of a patient who sustained a thrombotic stroke, the nurse records the score of a patient as 40 on a National Institutes of Health Stroke Scale (NIHSS). What does this score indicate? 1 Minor stroke 2 Severe stroke 3 Moderate stroke 4 No stroke symptoms
2 - Severe stroke According to the NIHSS scale, a score of 40 indicates severe stroke. Minor and moderate strokes have scores below 40. A score of 0 indicates the patient has no stroke symptoms.
A patient discharged from the hospital after a stroke looks at an old photograph and breaks down, crying inconsolably. What should the nurse tell the patient and the family? Select all that apply. 1 "Leave the patient alone for some time." 2 "Try to find out why the patient is crying." 3 "Frustration and depression are common during the first year after stroke." 4 "Do not communicate with the patient on topics that make the patient cry." 5 "Be patient during recovery and do not complain about these involuntary behaviors."
3 - "Frustration and depression are common during the first year after stroke." 5 - "Be patient during recovery and do not complain about these involuntary behaviors." Because of the disabilities secondary to stroke, it is common for the patient to get frustrated, and an unpredictable mood is common for stroke patients. Patients who may have previously been emotionally strong may suddenly show a change in behavior after a stroke. Therefore it is necessary to be patient with them and show them more compassion, care, and encouragement. Leaving the patient alone may make the patient more isolated. Trying to find out the reason for patient's behavior may make the patient embarrassed and depressed. The family members should not stop communicating with the patient; instead, more opportunities for communication would help the patient to express his or her frustration.
The registered nurse is teaching a novice nurse about interventions for a patient with a stroke on the left side of the brain. Which statement by the novice nurse indicates a need for further teaching? 1 "I should maintain a calm and relaxing environment." 2 "I should refrain from scolding the patient during an emotional outburst." 3 "I should refrain from distracting the patient during a sudden emotional outburst." 4 "I should educate the patient and the family about emotional outbursts after stroke."
3 - "I should refrain from distracting the patient during a sudden emotional outburst." Distraction during emotional outbursts is important to help the patient overcome the situation. A calm and relaxing environment should be maintained to prevent any atypical behavior. Scolding during emotional outbursts should be avoided because the patient is unable to control the feelings. After a stroke, it is important to educate the patient and the family members about emotional outbursts.
What rate should blood flow in the brain in order to maintain normal function? 1 15 mL/100 g 2 25 mL/100 g 3 55 mL/100 g 4 70 mL/100 g
3 - 55 mL/100 g Blood flow must be maintained at 55 mL/100 g for optimal brain functioning. Blood flow of 15 mL/100 g or 25 mL/100 g is not sufficient for optimal brain functioning. Blood flow of 70 mL/100 g indicates an increased rate.
A patient with a history of rheumatic heart disease arrives in the emergency room and informs the nurse of sudden loss of strength in the left arm without pain. The patient is unable to lift the arm and says that it "just fell." What condition should the nurse suspect? 1 Myopathy 2 Fibromyalgia 3 Embolic stroke 4 Carpal tunnel syndrome
3 - Embolic stroke Embolic stroke occurs when an embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel. Rheumatic heart disease is one cause of embolic stroke in young to middle-aged adults. Fibromyalgia presents as stiffness and pain in a particular part of the body. If there is no stiffness and pain, myopathy can be ruled out. The most common symptoms of carpal tunnel syndrome are tingling, numbness, weakness, or pain felt in the fingers or, less commonly, in the palm. Symptoms most often occur in the parts of the hand supplied by the median nerve: the thumb, index finger, middle finger, and half of the ring finger.
A patient who sustained a stroke is having a severe headache, vomiting, dysphagia, dysarthria, and eye movement disturbances. What type of stroke does the nurse determine to correlate with these clinical manifestations? 1 Embolic stroke 2 Thrombotic stroke 3 Intracerebral hemorrhage 4 Subarachnoid hemorrhage
3 - Intracerebral hemorrhage Symptoms such as headaches, vomiting, dysphagia, dysarthria, and eye movement disturbances indicate intracerebral hemorrhage. An embolic stroke is mostly related to heart conditions such as atrial fibrillation, myocardial infarction, and infective endocarditis. A thrombotic stroke has the clinical manifestation of decreased level of consciousness in the first 24 hours. Clinical manifestations such as stiff neck and cranial nerve deficits indicate a subarachnoid hemorrhage.
The nurse provides care for a patient who has had a transient ischemic attack (TIA). The patient's spouse asks about the significance of the condition. How should the nurse explain a TIA? 1 It is usually neurologically damaging. 2 It is a signal of progressive brain damage. 3 It can be a warning of an impending stroke. 4 It is nothing to be concerned about because it is not a stroke.
3 - It can be a warning of an impending stroke. Transient ischemic attacks (TIAs) can be a warning of an impending stroke or cerebrovascular accident. They may occur hours or days before. TIAs are usually not neurologically damaging or a sign of progressive brain damage. Patients should be instructed to report TIAs to the health care provider and not ignore them.
Which sensory-perceptual deficit is associated with left-hemispheric stroke (right hemiplegia)? 1 Overestimation of physical abilities 2 Difficulty judging position and distance 3 Slow and possibly fearful performance of tasks 4 Impulsivity and impatience at performing tasks
3 - Slow and possibly fearful performance of tasks Patients with a left-hemispheric stroke (right hemiplegia) commonly are slower in organization and performance of tasks and may have a fearful, anxious response to a stroke. Overconfidence, spatial disorientation, and impulsivity more commonly are associated with a right-hemispheric stroke.
Which mechanism protects the brain and promotes its functioning? 1 Collateral circulation 2 Intracranial pressure 3 Neurologic metabolism 4 Cerebral autoregulation
4 - Cerebral autoregulation The brain is well protected and functions best with cerebral autoregulation. Collateral circulation, or alternative routes of blood flow, may develop over time to compensate for a decrease in cerebral blood flow. The neurologic metabolism is a continuous supply of oxygen and glucose for neurons to function. Intracranial pressure influences cerebral blood flow and is affected by volume and pressure changes in the brain.
The patient has a diagnosis of stroke. What is the priority nursing diagnosis for the nurse when planning care? 1 Risk for aspiration 2 Impaired swallowing 3 Impaired verbal communication 4 Decreased intracranial adaptive capacity
4 - Decreased intracranial adaptive capacity The priority nursing diagnosis for a patient after a stroke is decreased intracranial adaptive capacity related to decreased cerebral perfusion. The reduction in cerebral perfusion places the patient at risk for airway problems related to aspiration and swallowing. Impaired verbal communication may be a result of impaired cerebral perfusion.
A patient has suffered a stroke. Which neurologic factor will the nurse assess and record? 1 Speech 2 Mobility 3 Respiratory function 4 Level of consciousness
4 - Level of consciousness The nurse will assess the patient's level of consciousness and record it as a neurologic finding. Though related to neurologic functioning, speech, mobility, and respiratory function are motor function assessments.
The nurse assesses a stiff neck and cranial nerve deficits in a patient with head trauma. What does the nurse suspect has occurred with this patient? 1 Embolic stroke 2 Thrombotic stroke 3 Intracerebral hemorrhage 4 Subarachnoid hemorrhage
4 - Subarachnoid hemorrhage Findings such as a stiff neck and cranial nerve deficits indicate subarachnoid hemorrhage. A thrombotic stroke has a clinical manifestation of a decreased level of consciousness in the first 24 hours. An embolic stroke is mostly related to heart conditions such as atrial fibrillation, myocardial infarction, and infective endocarditis. An intracerebral hemorrhage has clinical manifestations of decreased level of consciousness and hypertension.
