Nursing : Stroke, Cardiac Dysrythmias, 5555555
MRA, magnetic resonance angiography, is used to identify-
the presence of a cerebral hemorrhage, abnormal vessel structures (AV malformation, aneurysm) , vessel ruptures, and regional perfusion of blood flow in the carotid arteries and brain
the glasgow coma scale score is used when
the pt has a decreased level of consciousness or orientation -the risk for increased ICP exists related to the swelling of the brain that can occur secondary to ischemic result
shoulder subluxation-
the weight of the arm is so much on affected side that is can cause a painful dislocation of the shoulder from its socket -supporting arm, can use a sling
agnosia-
unable to recognize usual objects
You should place the food on the :
unaffected side.
right cerebral hemisphere is responsible for
visual and spatial awareness and proprioception
some pts report transient sympt such as
visual disturbances, dizziness, slurred speech, and a weak extremity
A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following? a) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" b) "Hypothyroidism" c) "Beta-adrenergic blocking agents" d) "Anything that stimulates the parasympathetic nervous system (negative chronotropy)"
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Correct Explanation: Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." The nurse's correct response is which of the following? a) "Hypertension is difficult to diagnose." b) "Hypertension often causes no pain." c) "Hypertension often causes no symptoms." d) "Hypertension often kills early in the disease process."
"Hypertension often causes no symptoms." Correct Explanation: Hypertension is sometimes called the "silent killer" because people with it are often symptom free. Physical examination may reveal no abnormalities other than elevated blood pressure. People with hypertension may remain asymptomatic for many years. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision. Pain is not usually an issue, but that is not why hypertension is called the "silent killer." Hypertension is easily diagnosed by taking a series of blood pressure readings.
The nurse is caring for a motor vehicle accident client who is unresponsive on arrival to the emergency department. The client has numerous fractures, internal abdominal injuries, and large lacerations on the head and torso. The family arrives and seeks update on the client's condition. A family member asks, "What causes the body to go into shock?"Given the client's condition, which statement is most correct? a) "The client is in shock because your loved one is not responding and brain dead." b) "The client is in shock because all peripheral blood vessels have massively dilated." c) "The client is in shock because the heart is unable to circulate the body fluids." d) "The client is in shock because the blood volume has decreased in the system."
"The client is in shock because the blood volume has decreased in the system." Correct Explanation: Shock is a life-threatening condition that occurs when arterial blood flow and oxygen delivery to tissues and cells are inadequate. Hypovolemic shock, where the volume of extracellular fluid is significantly diminished due to the loss of or reduced blood or plasma, frequently occurs with accidents.
What do patients associate Subarachnoid strokes with :
"The worst Headache of my life "
if the pt has homonomous hemianopsia
(loss of visual field in both eyes) instruct the pt to use a scanning technique when eating or ambulating -turning head from the direction of the unaffected side to to affected side)
assist the pts with safe feeding-
-assess gag and swallowing reflex; speech therapy may request a study -if a swallowing deficit is identified, the clients liquids may need to be thickened to avoid aspiration -eat upright and swallow with head and neck flexed -place food in the back of the mouth on the unaffected side -have suction on stand-by -distraction free environment
sympt with R hemisphere stroke-
-altered perception of deficits (overestimation of abilities) -one sided neglect syndrome -loss of depth perception -poor impulse control and judgement -LEFT hemiplegia (paralysis) or hemiparesis (weakness) -visual changes, such as hemianopsia
meds for stroke:
-anticoagulants (heparin sodium; enoxaparin (Lovenox); warfarin (Coumadin) -anti-platelets (aspirin) -thrombolytic meds (retaplase recombinant rtPA, Retavase) -antipileptic meds (phenytoin, Dilantin; gabapentin, Neurontin)
assist the pts communication skills if his speech is impaired-
-ask pt to follow simple commands -yes/no responses in relation to close ended questions -picture board
nursing care for pts with stroke:
-assess swallowing and gag reflex -prevent complications of immobility: clients are ambulated as soon as possible -maintain skin integrity -ROM every 2 hr -elevate the affected extremities to promote venous return and reduce swelling -safe environment to reduce risk of falls -scanning technique -prevent DVT -assistance with ADL's -pt have decreased endurance and impaired balance due to paralysis on one side of the body -shoulder subluxation can occur if affected arm is not support -support pt during periods of emotional lability and depression
risk factors:
-cerebral aneurysm -arteriovenous malformation (AV) -diabetes mellitus -obesity -HTN -artherosclerosis -hyperlipidemia -hypercoagulability -A fib -use of oral contraceptives -smoking -cocaine use
sympt consistent with a L hemisphere stroke-
-expressive and receptive aphasia (inability to speak and understand) -agnosia (unable to recognize familiar objects) -alexia (reading difficulty -agraphia (writing difficulty) -right extremity hemiplegia (paralysis) or hemiparesis (weakness) -slow cautious behavior -depression, anger, and quick to become frustrated -visual changes such as hemianopsia (loss of visual field)
a nurse is planning care for a pt who has dysphagia and has a new dietary prescription. what should the nurse include in the plan of care?
-have suction equip available for use -use thickened liquids -place food on the pts unaffected side of her mouth -teach the pt to swallow with her neck flexed
a pt has a R hemispheric stroke. what are the expected findings?
-impulse control difficulty -left hemiplegia -loss of depth perception
antiplatelets use
-low dose aspirin is given within 24-48 hrs following a stroke to prevent further clot formation -other anti platelets such as plavix are NOT recommended
monitor-
-pts temp, BP -O2, greater than 92 -cardiac monitor for arrhythmias -cardiac assessment for murmurs or irregularity -LOC, increased ICP sign -electrocardiogram -HOB 30 degrees to reduce ICP and promote venous drainage -avoid extreme flexion of the head or neck, keep midline -seizure precautions
a pt has global aphasia (both receptive and expressive). what should the nurse include in the pts plan of care?
-speak at a slower rate -look directly at the pt -allow extra time for the pt to answer -DO NOT complete sentences -give instructions one step at a time
· A nurse is caring for a client who has HF and a prescription for Digoxin 125mcg PO daily. Available is Digoxin PO 0.25mg/tablet. How many tablets should the nurse administer per dose?
0.5 tablet
pt with a stroke monitor their VS every
1-2 hr
3 causes of stroke:
1. hemorrhagic 2. thrombotic 3. embolic
Symptoms with Ischemic Stroke increase in how many hours :
1st 72 HOURS.
A-Fib is responsible for :
20% of all strokes.
Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client is now receiving an I.V. infusion of heparin sodium at 1,200 units/hour. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive? mL/hour
24 Correct Explanation: First, calculate how many units are in each milliliter of the medication: 25,000 units/500 mL = 50 units/1 mL. Next, calculate how many milliliters the client receives per hour: 1,200 units/1 hour divided by 50 units/1 mL. So 1,200 units/1 hour X 1 mL/50 units = 24 mL/hour.
Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. The nurse is assessing a client who is at risk for cardiac tamponade from chest trauma sustained in a motorcycle accident. What is the client's pulse pressure if his blood pressure is 108/82 mm Hg?
26 Correct Explanation: Pulse pressure is the difference between systolic and diastolic pressures. Normally, systolic pressure exceeds diastolic pressure by approximately 40 mm Hg. Narrowed pulse pressure, a difference of less than 30 mm Hg, is a sign of cardiac tamponade.
DO NOT POSITION ON PARALYZED SIDE FOR MORE THAN:
30 Minutes. if redness develops do not massage .
How much should you elevate the HOB :
30 degrees.
· A nurse is preparing to infuse a 250ml unit of packed RBC's over 2hrs. The drop factor of the manual IV tubing is 15gtts/ml. Drops per minute?
31gtts/min
Cerebrovascular Facts:
3rd Highest cause of death in the USA, #1 cause of permanent death.
The rapid response team has been called to manage an unwitnessed cardiac arrest in a client's hospital room. The estimated maximum time a person can be without cardiopulmonary function and still not experience permanent brain damage is: a) 12 to 15 minutes. b) 4 to 6 minutes. c) 8 to 10 minutes. d) 1 to 2 minutes.
4 to 6 minutes. Correct Explanation: After a person is without cardiopulmonary function for 4 to 6 minutes, permanent brain damage is almost certain. To prevent permanent brain damage, it is important to begin CPR promptly after a cardiopulmonary arrest.
Hypertension management will decrease stroke by :
50%
Someone with Diabetes has how many times more likely to get a stroke.
5x
· A nurse is preparing to administer Digoxin to a 6-month old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?
90bpm
Automatacity
ABILITY TO DO THINGS WITH OUT NEEDING TO OCCUPY SPACE IN THE MIND, AN AUTOMATIC RESPONCE OR PATTERN
Clinical Manifestations of a stroke :
AFFECT: Difficulty with emotions, depression , loss/ changes in body image, frustration, crying spells, exaggeration , inappropriate responses.
The nurse is assessing a client who has been admitted with impaired arterial circulation in the lower extremities due to diabetes mellitus. Which of the following would be expected findings? a) Capillary refill in the toes within 3 seconds b) Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet c) Redness, inflammation, and sharp pain with calf muscle contraction d) Edema and coolness in the ankles and feet
Absence of dorsalis pedis pulse, coolness, and decreased sensation in the feet Explanation: This choice is the most accurate description of an interference with arterial circulation. The dorsalis pedis is one of the most peripheral pulses, its absence along with coolness indicates compromised arterial flow. Impaired blood flow will also affect the nervous status in the foot, resulting in decreased sensation. Capillary refill in 2 seconds is normal; edema and coolness is more an indication of venous impairment; inflammation and calf pain likely indicate a thrombophlebitis.
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, it is important for the nurse to a) Administer the prescribed enoxaparin (Lovenox). b) Monitor partial thromboplastin (PTT) time. c) Encourage a diet high in vitamin K. d) Have the client limit physical activity.
Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.
anti platelet ex:
aspirin
The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? a) Altered patterns frequently produce neurological deficits. b) Altered patterns frequently turn into life-threatening arrhythmias. c) Altered patterns frequently affect the heart's ability to pump blood effectively. d) Altered patterns frequently cause a variety of home safety issues.
Altered patterns frequently affect the heart's ability to pump blood effectively. Explanation: The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.
· Nurse is assessing an older client who is receiving Digoxin. The nurse should recognize that which of the following findings is a manifestation of Digoxin toxicity?
Anorexia
Medications you want for Stroke :
Anticoagulants, Platelet Aggregation Inhibitors.
They should be wearing a :
Antiembolic hose. TED hose
· Nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a HR?
Apex of heart
· A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which of the following actions should the nurse take?
Assess apical pulse for a full minute
A 45-year-old client had a complete abdominal hysterectomy with bilateral salpingo-oophorectomy 2 days ago. The client's abdominal dressing is dry and intact. The client is taking liquids and voiding a sufficient quantity of straw-colored urine. While sitting up in the chair, the client has severe pain and numbness in her left leg. The nurse should first: a) Assess color and temperature of the left leg. b) Encourage the client to change her position. c) Administer pain medication. d) Assess for edema in the left leg.
Assess color and temperature of the left leg. Explanation: The client is likely suffering from an embolus as a result of abdominal surgery. The nurse should inspect the left leg for color and temperature changes associated with tissue perfusion. Administering pain medication without gathering more information about the pain can mask important signs and symptoms. Although assessing for edema is important, it is not critical to this situation. Encouraging the client to change her position does not adequately address the need for gathering more data.
Cerebral Vascular Disease is usually caused by :
Atherosclerosis.
What is a Major cause of a stroke :
Atherosclerosis.
An ultrasonic Doppler is used for a) Aiding palpation of diastolic blood pressure b) Auscultating a pulse that is difficult to palpate c) Aiding palpation of pulse and rhythm d) Auscultating diastolic blood pressure
Auscultating a pulse that is difficult to palpate Correct Explanation: A Doppler device can be used to detect a pulse that is not easily palpable.
· Nurse is teaching a client about following a low-cholesterol diet after coronary artery bypass grafting. Which of the following client food choices reflects the client's understanding of these dietary restrictions?
Beans
Homonymous Hemianopia:
Blindness occurs in the same half of the visual fields of both eyes.
Ischemia Stroke results from :
Blocked Blood vessel, May have partial or complete blockage,
Embolic stroke comes from :
Blood clot that was lose from somewhere else breaks loose and goes to the brain.
Brain has constant supply of :
Blood.
Initial Interventions:
Patent Airway, Remove Dentures, Pulse Oximetry, May need Heart Monitoring, IV Access,BP Control.
Embolic Ischemic Stroke is closely related into those with :
CARDIAC DISORDERS.
the left cerebral hemisphere is responsible for:
language, math skills, and analytic thinking
A client has been diagnosed with peripheral arterial occlusive disease. Which of the following instructions would be appropriate for the nurse to give the client for promoting circulation to the extremities? a) Use a heating pad to promote warmth. b) Massage calf muscles if pain occurs. c) Participate in a regular walking program. d) Keep the extremities elevated slightly.
Clients diagnosed with peripheral arterial occlusive disease should be encouraged to participate in a regular walking program to help develop collateral circulation. They should be advised to rest if pain develops and resume activity when pain subsides. With arterial disease, extremities should be kept in a dependent position to promote circulation; elevation of the extremities will decrease circulation. To avoid burns, heating pads should not be used by anyone with impaired circulation. Massaging the calf muscles will not decrease pain. Intermittent claudication subsides with rest.
Anatomy of Cerebral Circulation: (3 Parts)
Carotid Arteries ( Anterior), Vertebral Arteries (Posterior), and Circle of Willis CONNECTS THE TWO.
What site of Atherosclerosis is more scary to be at :
Carotid Arteries or up by the brain.
Possible Surgical Interventions:
Carotid Endarectomy , Hematoma, Aneurysm Clipping, AVM Repair, Other.
Which of the following is a term used to describe the splitting or separating of fused cardiac valve leaflets? a) Valvuloplasty b) Annuloplasty c) Chordoplasty d) Commissurotomy
Commissurotomy is the splitting or separating of fused cardiac valve leaflets. Annuloplasty is a repair of a cardiac valve's outer ring. Chordoplasty is repair of the stringy, tendinous fibers that connect the free edges of the atrioventricular valve leaflets to the papillary muscle. Valvuloplasty is a repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty.
The nurse identifies which of the following symptoms as a manifestation of right-sided heart failure (HF)? a) Reduction in forward flow b) Accumulation of blood in the lungs c) Reduction in cardiac output d) Congestion in the peripheral tissues
Congestion in the peripheral tissues Correct Explanation: Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues
What is the biggest problem with stroke with Elimination:
Constipation , decreased sensation , immobility, and weak muscles, dehydration.
Non-Modifiable Risk factors :
Doubles after age 55. More common in males, but more women die from it . African Americans, Genetic Risk Factors.
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take? a) Document the findings and recheck the client in 1 hour. b) Encourage the client to perform isometric leg exercise to improve circulation in his legs. c) Contact the physician and report the findings. d) Slow the I.V. fluid to prevent any more swelling at the puncture site.
Contact the physician and report the findings. Correct Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.
A nurse assessing a client who underwent cardiac catheterization finds the client lying flat on the bed. His temperature is 99.8° F (37.7° C). His blood pressure is 104/68 mm Hg. His pulse rate is 76 beats/minute. The nurse assesses the limb and detects weak pulses in the leg distal to the puncture site. Skin on the leg is cool to the touch. The puncture site is dry, but swollen. What is the most appropriate action for the nurse to take? a) Slow the I.V. fluid to prevent any more swelling at the puncture site. b) Document the findings and recheck the client in 1 hour. c) Contact the physician and report the findings. d) Encourage the client to perform isometric leg exercise to improve circulation in his legs.
Contact the physician and report the findings. Correct Explanation: The client is probably developing a hematoma at the puncture site. The decreased pulses, swelling, and cool temperature in the leg are all classic signs that blood flow to that extremity is compromised. The nurse should notify the physician immediately to preserve the blood flow in the client's leg. Documenting findings and checking the client again in 1 hour, slowing the I.V. fluid, and encouraging the client to perform isometric leg exercises aren't appropriate actions for the nurse to take at this time.
What should not be used with Intracerebral Strokes : (meds)
Coumadin, Anticoagulant.
Artherosclerosis is associated with :
Diabetes and Hypertension.
Expressive Aphasia:
Difficulty in speaking and writing. BROCAS AREA -MOTOR SPEECH
The nurse is caring for a child with hemophilia who is actively bleeding from the leg. The nurse should apply: a) Ice bag with elevation of the leg twice a day. b) Direct pressure to the injured area continuously for 10 minutes. c) Direct pressure, checking every few minutes to see if the bleeding has stopped. d) Ice to the injured leg area several times a day.
Direct pressure to the injured area continuously for 10 minutes. Explanation: For the child with hemophilia who is actively bleeding, the nurse should apply direct pressure to the injured area for 10 minutes continuously along with elevating the leg. The continuous application of direct pressure aids in stopping the bleeding. Elevating the leg reduces blood flow to the area, thereby minimizing the extent of blood loss. Although ice will cause local vasoconstriction and slow the bleeding, applying continuous direct pressure is essential.
Dysarthia:
Disturbance of the muscular control of speech.
_______ may be a problem with a stroke:
Elimination
Sources for Embolism with Ischemic embolic Stroke:
Endocardium : MOST COMMON, Carotid artery, Prosthetic Heart Valves ,Irregular heart rhythms, MI.
What are the four signs someone has had a stroke :
FACE , ARMS , SPEECH AND TIME.
YOU WANT TO WATCH FOR A :
GI BLEED.
A 64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the physician in the emergency department. After completing ordered diagnostic tests, the physician indicates to the client what caused the symptoms that brought him to the hospital. What is the origin of the client's symptoms? a) Cardiac disease b) Impaired cerebral circulation c) Diabetes insipidus d) Hypertension
Impaired cerebral circulation Correct Explanation: TIAs result from impaired blood circulation in the brain, which can be caused by atherosclerosis and arteriosclerosis, cardiac disease, or diabetes. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by cardiac disease. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by diabetes. The symptoms of a TIA are the result of impaired blood circulation in the brain, which may have been caused by hypertension.
You should screen for:
Glucose level and Coagulation Disorder , Recent history of GI Bleed, Stroke ,Head Trauma.
what increases risk for strokes?
HTN, smoking, diabetes mellitus -early tx of HTN, maintenance of blood glucose levels within range, and refraining from smoking will decrease this
Atherosclerosis:
Hardening and thickening of arteries. Major Cause of Stroke.
How to prevent Stroke :
Healthy Diet, Regular Exercise, No smoking, Limits on Alcohol
Which type of benign tumor of the eyelids is characterized by superficial, vascular capillary lesions that are strawberry-red in color? a) Milia b) Nevi c) Xanthelasma d) Hemangioma
Hemangioma Correct Explanation: Hemangiomas are vascular capillary tumors that may be bright, superficial, strawberry-red lesions or bluish and purplish deeper lesions. Milia are small, white, slightly elevated cysts of the eyelid that may occur in multiples. Xanthelasma are yellowish, lipoid deposits on both lids near the inner angle of the eye that commonly appear as a result of the aging of the skin or a lipid disorder. Nevi are freckles.
Hemorrhage Intracerebral stroke can occur in people with both:
Hypertension and Atherosclerosis.
Modifiable factors for Stroke:
Hypertension, Heart Disease, Diabetes Mellitus, Smoking, Alcohol, obesity, Sleep Apnea, Poor Diet.
What's the second most common kind of stroke?
Ischemic Embolic Stroke.
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? a) Atelectasis b) Urinary retention c) Osteomyelitis d) Hypovolemic shock
Hypovolemic shock Correct Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.
TIA IS NOT A STROKE BUT CAN BE:
INDICATOR OR WORSENING VASCULAR DIEASE.
You have to use Thrombolytic Therapy for :
Ischemic Stroke.
two types of strokes:
Ischemic and Hemorrhage.
Apraxia:
Inability to carry out learned sequential movements or complex commands.
Agnosia:
Inability to recognize objects.
Which of the following is the most important postoperative assessment parameter for patients undergoing cardiac surgery? a) Inadequate tissue perfusion b) Mental alertness c) Blood glucose level d) Activity intolerance
Inadequate tissue perfusion Correct Explanation: The nurse must assess the patient for signs and symptoms of inadequate tissue perfusion, such as a weak or absent pulse, cold or cyanotic extremities, or mottling of the skin. Although the nurse does assess blood sugar and mental status, tissue perfusion is the higher priority. Assessing for activity intolerance, while important later in the recovery period, is not essential in the immediate postoperative period for patients undergoing cardiac surgery.
· Nurse is providing discharge teaching to a client who has a new prescription for Verapamil for angina. Which of the following instructions should the nurse include?
Inc. your daily intake of dietary fiber
A nurse is teaching a patient newly diagnosed with arterial insufficiency. Which of the following terms should the nurse use to refer to leg pain that occurs when the patient is walking? a) Intermittent claudication b) Thromboangiitis obliterans c) Orthopnea d) Dyspnea
Intermittent claudication Correct Explanation: Intermittent claudication is leg pain that is brought on by exercise and relieved by rest. Dyspnea is the patient's subjective statement of difficulty breathing. Orthopnea is the inability of the patient to breathe except in the upright (sitting) position. Thromboangiitis obliterans is a peripheral vascular disease also known as Buerger's disease.
Which kind of stroke causes the worst prognosis :
Intracerebral hemorrhagic Stroke , 50% die in the first 48 hours.
Two types of Hemorrhage Stroke :
Intracerebral, and Subarachnoid.
Stroke is caused by :
Ischemia to part of a brain. OR Hemorrhage in the part of the brain.
A home health nurse is teaching a client with peripheral arterial disease ways to improve circulation to the lower extremities. The nurse encourages which of the following in teaching? a) Use of antiembolytic stockings b) Keeping the legs in a neutral or dependent position c) Elevation of the legs above the heart d) Application of ace wraps from the toe to below the knees
Keeping the legs in a neutral or dependent position Correct Explanation: Keeping the legs in a neutral or dependent position assists in delivery of arterial blood from the heart to the lower extremities. All the other choices will aid in venous return, but will hinder arterial supply to the lower extremities.
A patient is admitted to the intensive care unit (ICU) with a diagnosis of hypertension emergency/crisis. The patient's blood pressure (BP) is 200/130 mm Hg. The nurse is preparing to administer IV Nitropress (nitroprusside). Upon assessment, which of the following patient findings requires immediate intervention by the nurse? a) Urine output of 40 cc/mL over the last hour b) Nausea and severe headache c) Left arm numbness and weakness d) Chest pain score of 3/10 (on a scale of 1 to 10)
Left arm numbness and weakness Explanation: Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. The finding of left arm numbness and weakness may indicate the patient is experiencing neurological symptoms associated with an ischemic stroke because of the severely elevated BP and requires immediate interventions. A urine output of 40 mL/h is within normal limits. The other findings are likely caused by the hypertension and require intervention, but they do not require action as urgently as the neurologic changes.
Language skills are usually on what side of the brain:
Left.
Infarction:
Local area of obstruction of blood flow leading to Necrosis.
Left side of the Brain deals with:
Logic, Math, Language, Reading, Writing, Analysis.
What does a stroke result in :
Loss of function controlled by the part of brain affected. How much depends on severity.
Aphasia:
Loss of the power of expression.
With a TIA ; Amaurosis Fugax occurs :
Loss of vision, numbness or loss of sensation, inability to speak.
· A nurse is caring for a client who recently had surgery for insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify?
MRI of chest
diagnostic procedures:
MRI, CT or CAT scan MRA lumbar puncture glasgow coma scale
Diagnostic Studies of a Stroke:
MRI, CT, CEREBRAL ANGIOGRAM, TRANSCRANIAL DOPPLER, EKG,CHEST X RAY, ABGS.
GOALS OF RESPIRATORY CARE:
Maintain Airway , Suctioing :effects on Intracranial Pressure. Position : Side Lying. Assess Swallowing, Keep 02 sat 95%
A 12-year-old client fractured her right leg while skiing and is undergoing an open reduction of the femur fracture. She returns to the orthopedic unit where you practice nursing with a cast in place. What is the rationale for frequently assessing her pedal pulses? a) Ensuring there wasn't nerve damage during surgery b) Making sure surgery was successful c) Maintaining adequate circulation d) Typical postoperative nursing management
Maintaining adequate circulation Correct Explanation: Circulation, sensation, and mobility of exposed fingers or toes must be assessed every 1 to 2 hours to ensure neurovascular status is not compromised.
Elimation can be a problem :
May not be able to tell you, or decreased sensation for Elimination. cannot get undressed fast enough
· Nurse is measuring a client for knee-high anti-embolic stockings to help prevent venous stasis. Which of the following actions should the nurse take?
Measure from heel to popliteal space
Clinical Manifestations with Intellect :
Memory and Judgment are impaired, Difficulty learning concepts. (ABSTRACT THINKING)
Manifestations of a stroke with Motor Function:
Mobility, Respiratory , Swallowing and Speech, Gag Reflex, Self-care Abilities.
Which positioning strategy should be used for the patient diagnosed with hypovolemic shock? a) Prone b) Supine c) Modified Trendelenburg d) Semi-Fowler's
Modified Trendelenburg Correct Explanation: A modified Trendelenburg position is recommended in hypovolemic shock. Elevation of the legs promotes the return of venous blood.
antipileptic meds are
NOT commonly given following a stroke unless the pt develops seizures
Plaque formation in the Veins leads to :
Narrowing of arteries.
What happens when blow flow is halted to the brain:
Neurological Metabolism is altered in = 30 seconds. Neurological Metabolism stops in 2 minutes. Cellular Death in 5 Minutes.
Symptoms for a TIA:
Occur rapidly and last short time.
The Blood to the brain is made up of :
Oxygen and Glucose.
TIA FACTS:
PERIOD OF TIME that blood flow is not too the brain. NOT A STROKE ,BLOOD FLOW IS JUST HINDERED.
· A nurse is caring for a client who is prescribed Warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of Warfarin?
PT
Assessment of the pulse amplitude is accomplished by which of the following? a) Palpating the flow of blood through an artery b) Auscultating the flow of blood through an artery c) Palpating the area of the left ventricle d) Auscultating the area of the left ventricle
Palpating the flow of blood through an artery Correct Explanation: The pulse amplitude describes the quality of the pulse in terms of its fullness and reflects the strength of left ventricular contraction. It is assessed by the feel of the blood flowing through an artery.
Left Brain Damage :
Paralyzed on Right side, Impaired speech and Language Impaired left/right discrimination Slow performance, Cautious Aware of deficits, Depression, Anxiety Impaired Comprehension to language and math.
Right Brain Damage :
Paralyzed on left side , Left-sided Neglect Spatial - Perceptual Deficits Tends to deny or minimize problems Short Attention span Impulsive.
Goals of Musculoskeletal:
Passive Rom, Maximize muscle Function, Prevent Deformity . USE TROCHANTER ROLL . EACH JOINT SHOULD BE POSITIONED HIGHER THAN WHATS NEXT TO IT.
The nurse is assisting the physician with placing a ventricular assist device (VAD). Which assessment finding would confirm the successful implementation? a) Temperature within normal limits b) Pedal pulse stronger c) Respiratory rate decreased d) Heart rate increased
Pedal pulse stronger Correct Explanation: The ventricular assist device (VAD) is a medical mechanical device used to improve cardiac output and redistribute blood. The best evidence to confirm successful implementation is by identifying a strong pedal pulse in a lower extremity. Respiratory rate decreases as a client rests. Heart rate decreases when the tissues obtain the needed oxygen. The temperature within normal limits does not confirm successful implementation
Right side of the Brain deals with :
Personality, Creativity, Intuition, Music , Art, Spatial Abilities.
To eat what position should they be in:
Place in High Fowlers position, Head flexed, Forward for feeding, and 30 min .after.
When the nurse observes that the patient's systolic blood pressure is less than 80 to 90 mm Hg, respirations are rapid and shallow, heart rate is over 150 beats per minute, and urine output is less than 30 cc per hour, the nurse recognizes that the patient is demonstrating which stage of shock? a) Compensatory b) Irreversible c) Refractory d) Progressive
Progressive Correct Explanation: In compensatory shock, the patient's blood pressure is normal, respirations are above 20, and heart rate is above 100 but below 150. In progressive shock, the patient's skin appears mottled and mentation demonstrates lethargy. In refractory or irreversible shock, the patient requires complete mechanical and pharmacologic support.
A patient has been diagnosed with congestive heart failure. Which of the following is a cause of crackles heard in the bases of the lungs? a) Pulmonary congestion b) Mitral valve stenosis c) Heart palpitations d) Pulmonary hypertension
Pulmonary congestion Correct Explanation: Crackles heard in the bases of the lungs are a sign of pulmonary congestion. Heart palpitations are caused by tachydysrhythmias. Crackles heard in the bases of the lungs are not signs of pulmonary hypertension and mitral valve stenosis.
A nurse is assessing the pulse volume of a client with influenza. The nurse notes that the client has a thready pulse. Which of the following is a description of a thready pulse? a) Pulse is strong and remains despite moderate pressure. b) Pulse is strong, and light pressure causes it to disappear. c) Pulse is felt with difficulty and disappears with slight pressure. d) Pulse is felt easily, and moderate pressure causes it to disappear.
Pulse is felt with difficulty and disappears with slight pressure. Correct Explanation: Thready pulse is felt with difficulty or not easily felt, and slight pressure causes it to disappear. A weak pulse is stronger than a thready pulse, and light pressure causes it to disappear. A normal pulse is felt easily, and moderate pressure causes it to disappear. A bounding pulse is strong and does not disappear with moderate pressure.
A nurse palpates the pulse of a patient and documents the following: 6/6/12 pulse 85 and regular, 3+, and equal in radial, popliteal, and dorsalis pedis. What does the number 3+ represent? a) Pulse rhythm b) Pulse rate c) Pulse deficit d) Pulse quality (amplitude)
Pulse quality (amplitude) Correct Explanation: Pulse quality/amplitude describes the quality of the pulse in terms of its fullness, ranging from absent (0) to bounding (4+). Pulse rates are measured in beats per minute. Pulse rhythm is the pattern of the pulsations and the pauses between them. The pulse deficit is the difference between the apical and radial pulse rates.
Onset of the Embolic Stroke :
Rapid Onset, maybe headache. less likely to have a warning.
Which of the following is the most common symptom of a polyp? a) Diarrhea b) Rectal bleeding c) Abdominal pain d) Anorexia
Rectal bleeding Correct Explanation: The most common symptom is rectal bleeding. Lower abdominal pain may also occur. Diarrhea and anorexia are clinical manifestations of ulcerative colitis.
You should not swallow until :
Reflex is evaluated
Hemorrhagic Stroke : Subarachnoid.
Results form bleeding into the cerebrospinal fluid - filled space between arachnoid and pia matter on the surface of the brain.
Hemorrhage Stroke :
Results from spontaneous bleeding in brain, subarachnoid, and ventricles.
Hemorrhagic Stroke :Intracerebral
Results when Blood vessel in the Brain Ruptures.
Embolic Ischemic Stroke :
Results when an Embolus lodge in and occludes a cerebral artery, resulting in Infarction and Edema.
Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: a) Control chest pain. b) Reduce coronary artery vasospasm. c) Control the arrhythmias associated with MI. d) Revascularize the blocked coronary artery.
Revascularize the blocked coronary artery. Correct Explanation: The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and reestablish a blood supply to the area.
Spatial Perceptual Alterations affects mostly the :
Right side stroke.
Homonymous Hemianopsia lets you see the :
Right side.
Narrowing of Arteries can also cause :
Rupture of Clot , Blood Clot.
Warning signs of a stroke :
Sudden Severe Headache, Unexplained Dizziness, Sudden Difficulty Speaking, Sudden Dimness of loss of vision, Sudden weakness or numbness.
Factors affecting Blood Flow to the brain:
Systemic Blood Pressure, Cardiac Output, Blood Viscosity , Intracranial Pressure.
1/3 of all strokes are followed by :
TIA
An elderly male client has been taking doxazosin (Cardura) 2 mg daily for 4 weeks for treatment of benign prostatic hypertrophy. The client reports feeling dizzy. The nurse should first: a) Take his blood pressure lying, standing, and sitting. b) Report the symptoms to the physician. c) Review his other medications. d) Test his urine for ketones.
Take his blood pressure lying, standing, and sitting. Explanation: Doxazosin is also used as an antihypertensive agent; the client may be experiencing orthostatic hypotension. Testing the urine for ketones would be appropriate if the client had diabetes mellitus. Because an adverse effect of doxazosin is orthostatic hypotension, the nurse should first take the client's blood pressure; later, she can review other mediations. The client's report of symptoms should be reported to the physician with the blood pressure readings.
· A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide?
Take medication with orange juice to enhance absorption
Patients should do what to the environment with their eyes :
Teach patients to scan the environment.
Elimination can be :
Temporary or Permanent
Conductivity
The ability of an object to transfer heat or electricity to another object.
A client arrives in the emergency department reporting intense pain in the abdomen and tells the nurse that it feels like a heartbeat in the abdomen. Which nursing assessment would indicate potential rupture of an aortic aneurysm? a) The blood pressure and pulse are within normal limits, but the client's skin color is pale and slightly diaphoretic. b) The client has been taking an antihypertensive for the past 3 years but forgot to take it today. c) The client reports feeling nauseated. d) The client reports increasing severe back pain.
The client reports increasing severe back pain. Correct Explanation: Increased severe back pain and increased irritation to nerves are indicative of a potential rupture of an aneurysm. The client would be hypertensive and present with tachycardia, so the other choices are not correct. Nausea, although possible, or a missed dose of medication, do not indicate potential rupture.
TPA hits :
The clot.
A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? a) The development of right-sided heart failure b) The development of left-sided heart failure c) The development of corpulmonale d) The development of chronic obstructive pulmonary disease (COPD)
The development of left-sided heart failure Correct Explanation: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Corpulmonale is a condition in which the heart is affected secondarily by lung damage.
Ischemic Stroke is the most :
common form of a stroke. Type most often signaled by a TIA.
What might be wrong with someone's arms that just had a stroke ?
The may not be able to raise their arms and keep them there.
Why does a stroke affect the opposite side of the body:
The pathways cross at the medulla, so a stroke on one side of the brain affects motor function on the opposite side.
hemorrhagic stroke-
a ruptured artery or aneurysm
Alteplase recombinant, or tissue plasminogen activator (t-PA), a thrombolytic enzyme, is administered during the first 6 hours after onset of myocardial infarction (MI) to: a) Control chest pain. b) Revascularize the blocked coronary artery. c) Reduce coronary artery vasospasm. d) Control the arrhythmias associated with MI.
The thrombolytic agent t-PA, administered intravenously, lyses the clot blocking the coronary artery. The drug is most effective when administered within the first 6 hours after onset of MI. The drug does not reduce coronary artery vasospasm; nitrates are used to promote vasodilation. Arrhythmias are managed by antiarrhythmic drugs. Surgical approaches are used to open the coronary artery and reestablish a blood supply to the area.
Medical Interventions for Stroke Medications:
Thrombolytic Therapy : Clot Buster , drugs such as TPA.
ischemic Stroke is the result of :
Thrombosis of narrowing of the blood vessel.
What are the two types of Ischemic Strokes :
Thrombotic, and Embolic
Signs of a TIA:
Tinnitus, Vertigo, Darkened or blurred vision, diplopia, dysphagia.
Necrosis is :
Tissue Death.
TIA:
Transient Ischemic Attack.
Narrowing of Arteries causes :
Turbulent blood flow (can't get through) increased risk of clot formation.
notify the provider immediately if the pts BP exceeds
a systolic greater than 180 or diastolic greater than 110 -this can indicate an ischemic stroke
prevention of DVT-
compression socks frequent position changes mobilization
· A nurse is caring for a client who is on Warfarin therapy for A Fib. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?
Vitamin K
Symptoms of Subarachnoid Stroke:
Vomiting, stiff neck, seizures, loss of consciousness.
Receptive Aphasia:
Wernicke;s Area: Difficulty in understanding written and spoken language. WERNICKES AREA.
Clot buster Drugs should be given within :
Within 3 hours . of onset and symptoms.
an embolic stroke may be reversed with-
a thrombolytic enzyme, such as recombinant tissue plasminogen activator (rtPA, Retavase) if given within 4.5 hrs of the initial sympt
transient sympt can indicate
a transient ischemic attack (TIA) which can be a warning of an impending stroke
EXCITABILITY
ability to respond to stimuli
embolic stroke-
an embolus traveling from another part of the body to a cerebral artery -blood to the brain distal to the occlusion is immediately shut off causing neuro deficits or a loss of consciousness
what can a high BP indicate-
an ischemic stroke
a hemorrhagic stroke, if caught early enough
and evacuation of the clot can be done with cessation of the active bleed, the prognosis improves significantly
what can prevent the subsequent occurance of a stroke-
anti-thrombotic med and/or surgical removal of artherosclerotic plaques in the carotid
sympt will vary based on the
brain that is deprived of oxygenated blood
ischemic strokes-
caused by a thrombotic or embolic blockage of blood flow to the brain
systemic or catheter-directed thrombolytic therapy restores
cerebral blood flow -must be admin within 6 hr of the onset of sympt -CANT be used for a hemorrhagic stroke
strokes are known as-
cerebrovascular accidents (CVA's) or brain attacks
thrombotic stroke-
development of a blood clot on an artherosclerotic plaque in a cerebral artery that gradually shuts off the artery and causes ischemia distal to the occlusion
strokes involve a
disruption in the cerebral blood flow secondary to ischemia, hemorrhage, brain attack or embolism
sympt of a thrombotic stroke
evolve over a period of several hours to days
Give mouth care before and after :
feeding.
lumbar puncture is used to assess-
for the presence of blood in the cerebrospinal fluid; a + finding is consistent with a cerebral hemorrhage or ruptured aneurysm
what do you have to assess for before feeding!!
gag and swallowing reflexes
what can be placed on affected hand if swelling is severe
glove -massage affected hand by stroking distal to proximal
anticoagulant EX:
heparin sodium; enoxaparin (Lovenox); warfarin (Coumadin)
one sided neglect syndrome-
ignore left side of body, cannot see, feel or mover affected side, so pt unaware of its existence -can occur with L side but more common in R
a pt has L hemispheric stroke. what is an expected finding?
inability to recognize familiar objects
aphasia-
inability to speak or understand
ischemia-
inadequate blood supply to an organ
Spatial Perceptual Alterations are:
incorrect perception of self or illness, erroneous perception of self in space.
a fever can indicate-
increase in ICP
anticoagulants use
is controversial and NOT recommended due to high risk of intracerebral bleeding
MRI, CT or CAT scan may be used to identify
ischemia, edema, and necrosis
thrombotic and embolic are together-
ischemic
hemianopsia-
loss of visual field in one or both eyes
what can decrease risk of stroke?
maintaining healthy weight and regular exercise
· A nurse is providing teaching to a client about smoking cessation. Which of the following client statements indicates a need for further education?
o "I will test my ability to quit smoking by going to the bar where I used to smoke."
· A client with a hx or MI is prescribed Aspirin 325mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?
o Antiplatelet aggregate
· A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instruction should the nurse include in the teaching?
o Apply patch in the morning
· A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? Select all that apply.
o Apply the patch to a hairless area and rotate sites o Apply a new patch each morning o Remove patch for 10-12hrs daily
· A nurse is caring for a client who just had a cardiac catheterization. Which of the following nursing interventions should the nurse include in the client's plan of care? Select all that apply.
o Check peripheral pulses in the affected extremity o Keep client's hip and leg extended o Have client remain in bed up to 6hrs post op
· A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?
o Check the PT's vital signs
· A nurse is caring for a client who had congestive heart failure and is taking Digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
o Check vital signs
· A nurse is teaching a client who is Post Op following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? Select all that apply.
o Count your pulse for 1 min. each morning o Don't wear tight clothing over insertion area
· A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?
o Crushing the medication might cause you to have a stomachache or indigestion
· A nurse finds that a client didn't receive a scheduled dose of Lasix. Which of the following should the nurse include in the incident/variance report? Select all that apply
o Date of incident o Time client was to receive the medication o The client's vital signs
· A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload.
o Dyspnea o Jugular vein distention o Confusion
· Nurse is caring for a client who has thrombophlebitis and is receiving Heparin by continuous IV infusion. The client asks the nurse how long it will take for the Heparin to dissolve the clot. Which of the following responses should the nurse give?
o Heparin does not dissolve clots. It stops new clots from forming
· A nurse is giving a presentation to a community group about preventing atherosclerosis. Which of the following should the nurse include as a modifiable risk factor for this disorder?
o Hypercholesterolemia o Hypertension o Obesity o Smoking
· A nurse is teaching a client who takes Warfarin daily. Which of the following statements by the client indicates a need for further teaching?
o I have started taking ginger root to treat my joint stiffness
· A nurse is reinforcing teaching with a client regarding reduction of risk factors for coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply.
o I must stop smoking o I need to monitor my weight o I am limiting my intake of fast foods
· A nurse is instruction a client who has a new diagnosis of Raynaud's disease about preventing the onset of manifestations. Which of the following client statements should indicate to the nurse the need for additional teaching?
o I will take my medications at the first sign of an attack
· A nurse is assessing a client who had fluid overload. Which of the following findings should the nurse expect? Select all that apply.
o Inc. HR o Inc. BP o Inc. RR
· A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching?
o Increasing my intake of foods containing trans fatty acids can lower my risk.
· A nurse is assisting with obtaining an ECG for a client who has A Fib. Which of the following actions should the nurse take? Select all that apply.
o Inspect electrode pads o Instruct the client not to talk during the test
· Nurse in an emergency dept is assessing a client who is having a suspected acute MI. Which of the following manifestations should the nurse expect to find for a client experiencing an acute MI?
o Nausea o Tachycardia o Diaphoresis
· Nurse is caring for a client who reports an area of redness, warmth, tenderness and pain in the right calf. The nurse anticipated which of the following orders when notifying the provider of this finding?
o Obtain a venous duplex ultrasound
· A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG trip should the nurse recognize as normal sinus rhythm?
o P wave falls before the QRS complex
· A nurse is caring for a male client who has peripheral vascular disease, takes dietary supplements and has a new prescription for Warfarin. The nurse should instruct the client to stop which of the following supplements prior to starting the Warfarin?
o Saw Palmetto o Glucosamine o Gingko Biloba
· A nurse is teaching a client who has a new prescription for Colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include?
o Take medication 4hrs after other medications
· A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?
o Take one tablet at the first indication of chest pain
· A nurse in an emergency department is caring for a client who reports substernal chest pain and dyspnea. The client is vomiting and diaphoretic. Which of the following lab tests are used to diagnose a MI? Select all that apply
o Troponin I o Troponin T o CPK o Myoglobin
· A nurse is planning to teach a client about a low potassium diet. Which of the following foods should the nurse instruct the client to avoid?
o Yogurt o Orange Juice
Avoid Fluid ____
overload.
hemiplegia-
paralysis
gabapentin can be given for
paresthetic pain in an affected extremity
antipileptic meds EX:
phenytoin (Dilantin); gabapentin (Neurontin)
nurse is caring for a pt who has L homonomous hemianopsia. what is the appropriate nursing interventions?
place the pts bedside table on the right side of the bed
the prognosis for a pt who has had a hemorrhagic stroke is
poor due to the amount of ischemia and increased ICP caused by the expanding collection of blood
A client with gestational hypertension is likely to exhibit: a) proteinuria, headaches, and vaginal bleeding. b) headaches, double vision, and vaginal bleeding. c) proteinuria, headaches, and double vision. d) proteinuria, double vision, and uterine contractions.
proteinuria, headaches, and double vision. Correct Explanation: A client with gestational hypertension typically complains of headache, double vision, and sudden weight gain. Additional findings include proteinuria. Vaginal bleeding and uterine contractions aren't associated with gestational hypertension.
You should toilet the patient for up to :
q 2 H.
alexia-
reading difficulty
thombolytic meds EX:
reteplase combinant rtPA (Retavase)
Subarachnoid is caused by the :
rupture of an Aneurysm (Blister on a blood vessel)
Ischemic Stroke usually occurs in _____.
sleep.
if the pt has one sided neglect:
teach him to protect and care for the affected extremity to avoid injuring
hemiparesis
weakness
agraphia
writing difficulty