Cerebrovascular Disorders (PrepU Ch 67)

A client who has experienced an initial transient ischemic attack (TIA) states: "I'm glad it wasn't anything serious." Which is the best nursing response to this statement?

"TIA is a warning sign. Let's talk about lowering your risks."

What is the most common side effect of tissue plasminogen activator (tPA)?

Bleeding

Which of the following antiseizure medication has been found to be effective for post-stroke pain?

Lamotrigine (Lamictal)

what term refers to the failure to recognize familiar objects perceived by the senses?

agnosia

what term refers to disturbances in writing intelligible words

agraphia

A male patient with cerebrovascular accident (CVA) is prescribed medication to treat the disorder. The patient wants to know what other measures may help reduce CVA. Which of the following is an accurate suggestion for the patient?

reduce HTN and high blood cholesterol levels

Defect in vision in a specific area in one or both eyes

scotoma

A nurse is instructing the wife of a patient who suffered a stroke about the use of eating devices her husband will be using. During the teaching, the wife starts to cry and states "One minute my husband is laughing, and the next he's crying; I just don't understand what's wrong with him." The nurse's best response is which of the following?

"Following a stroke, emotional lability is common, and it usually improves with time."

A patient is admitted via ambulance to the emergency room of a stroke center at 1:30 p.m. with symptoms that the patient said began at 1:00 p.m. Within 1 hour, an ischemic stroke had been confirmed and the doctor ordered tPA. The nurse knows to give this drug no later than what time?

4:00PM

A 154-pound woman has been prescribed tPA (0.9 mg/kg) for an ischemic stroke. The nurse knows to give how many mg initially?

6.3mg A person who weighs 154 lbs weighs 70 kg. To calculate dosage, multiply 70 × 0.9 mg/kg = 63 mg. The nurse gives 10% (6.3 mg) over 1 minute.

A patient diagnosed with a stroke is ordered to receive warfarin (Coumadin). 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 which of the following?

Aspirin

A 73-year-old client is visiting the neurologist. The client reports light-headedness, speech disturbance, and left-sided weakness that have lasted for several hours. In the examination, an abnormal sound is auscultated in an artery leading to the brain. What is the term for the auscultated discovery?

Bruit abnormal sound caused by blood flowing over a rough surface within one or both carotid arteries

A patient has been diagnosed as having global aphasia. The nurse recognizes that the patient will be unable to do which of the following actions?

Form understandable words and comprehend the spoken word global= expressive+ receptive aphasia

From which direction should a nurse approach a client who is blind in the right eye?

From the left side of the client

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings?

Left-sided cerebrovascular accident (CVA)

rhythmic, involuntary movements or oscillations of the eyes

Nystagmus

A client is hospitalized when they present to the Emergency Department with right-sided weakness. Within 6 hours of being admitted, the neurologic deficits had resolved and the client was back to their presymptomatic state. The nurse caring for the client knows that the probable cause of the neurologic deficit was what?

TIA

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following?

Thrombolytic Therapy has a time window of 3 hours

A patient diagnosed with an ischemic stroke should be treated within the first 3 hours of symptom onset with which of the following?

Tissue Plasminogen activator(tPA) within first 3 hours

What is the initial diagnostic test for a stroke?

noncontrast CT Scan

How often should neurologic assessments and vital signs be taken initially for the patient receiving tissue plasminogen activator (tPA)?

q15min

The nurse is taking care of a client with a headache. In addition to administering medications, the nurse takes measures to assist the client in reducing the pain associated with his headache. Which of the following appropriate nursing interventions may be provided by the nurse to assist this client in reducing or eliminating his pain?

Apply warm or cool cloths to the forehead or back of the neck. Warmth promotes vasodilation; cool stimuli reduce blood flow.

A client undergoes cerebral angiography for evaluation after an intracranial computed tomography scan revealed a subarachnoid hemorrhage. Afterward, the nurse checks frequently for signs and symptoms of complications associated with this procedure. Which findings indicate spasm or occlusion of a cerebral vessel by a clot?

Hemiplegia Seizures decreased LOC aphasia hemiparesis increased focal symptoms

Hemorrhagic Stroke reasons for urgent treatment

ICP is increased by space-occupying bleed ruptured intracranial aneurysm must quickly be repaired a ruptured arteriovenous malformation will cause deficits until it is stopped

contributing cofactors in cause of migraine

changes in serotonin receptors which promote dilation of cerebral blood vessels and pain intensification from neurochemicals released from trigeminal nerve. medications, chemicals in certain foods, reproductive hormones

What deficits would you expect from damage to the motor neurons?

hemiparesis, hemiplegia, change in reflexes

double vision or the awareness of two images of the same object occurring in one or both eyes

Diplopia

Which of the following is accurate regarding a hemorrhagic stroke?

Main presenting symptom is an "exploding headache." Not: One of the main presenting symptoms is numbness or weakness of the face. It is caused by a large-artery thrombosis.

The nurse practitioner is able to correlate a patient's neurologic deficits with the location in the brain affected by ischemia or hemorrhage. For a patient with a left hemispheric stroke, the nurse would expect to see:

Right-sided weakness or paralysis

Clinical manifestations of a stroke depend on: (4)

area of the cerebral cortex, the affected hemisphere, the degree of blockage, and the presence or absence of collateral circulation.

What deficit would you expect from damage to the temporal lobe?

auditory agnosia

what term refers to the failure to recognize significance of sounds

auditory agnosia

A client has experienced an ischemic stroke that has damaged the frontal lobe of his brain. What deficits does the nurse expect to observe during assessment?

limited attention span, difficulties in comprehension, forgetfulness, lack of motivation

The nurse is caring for a patient with dysphagia. Which of the following interventions would be contraindicated while caring for this patient?

placing food on the affected side of mouth

what is the term for when patient is unable to comprehend the spoken word

receptive aphasia

Karen Nichols, a 32-year-old concert promoter, has a 12-year history of migraine headaches. As she discusses her most recent headaches, she voices frustration over how her life is at the mercy of these headaches. As she describes the characteristics of her head pain, you begin to discuss the potential triggers of her migraines. Which of the following is not a potential trigger to migraines?

seasonal changes Are triggers: specific food chemicals reproductive hormone fluctuations medications

A patient is exhibiting classic signs of a hemorrhagic stroke. What complaint from the patient would be an indicator of this type of stroke?

severe headache

You are caring for a client with chronic migraines who is prescribed medication. What drug-related instructions should the nurse give the client?

take medication as soon as symptoms of the migraine begin; take before going to bed or in the morning

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

What deficit would you expect from damage to the occipital lobe?

visual agnosia

The nurse is providing information about strokes to a community group. What would the nurse identify as the primary initial symptoms of an ischemic stroke? (3)

weakness on one side of the body, difficulty with speech, change in mental status

The nurse is providing diet-related advice to a male patient following a cerebrovascular accident (CVA). The patient wants to minimize the volume of food and yet meet all nutritional elements. Which of the following suggestions should the nurse give to the patient about controlling the volume of food intake?

provide thickened commercial beverages and fortified cooked cereals, scrambled eggs avoid high-fat foods (pt should lose weight) avoid peanut butter, bread, tart foods, dry or crisp foods, chewy meats because they cause choking

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are (4)

severe headache, early change in level of consciousness, vomiting, seizures

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?

Lioresal (Baclofen) Botulinum toxin type A IM into wrist and finger

what term refers to inability to perform previously learned purposeful motor acts on a voluntary basis

apraxia

The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regime, 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:

HTN

Which of the following terms refers to blindness in the right or left halves of the visual fields of both eyes?

Homonymous hemianopsia

A client is receiving an I.V. infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant?

Increased Urine Output (therapeutic level of mannitol is diuresis)

Immediate complications of hemorrhagic stroke

cerebral hypoxia, decreased cerebral blood flow, extension in the area of the injury

The nurse is caring for a patient with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. Which of the following postoperative findings would cause the nurse the most concern?

difficulty swallowing, hoarseness, other signs of cranial nervedysfunction

what is the term for when patient is unable to form words that are understandable

expressive aphasia

A nurse is communicating with a client who has aphasia after having a stroke. Which action should the nurse take?

face the client and establish eye contact; use short sentences; give the client time between phrases to understand; keep extraneous and background noise to a minimum; not necessary to speak in louder or softer voice than normal

The nurse is caring for a patient with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. The nurse focuses on assessment of which cranial nerves? (4)

facial (VII) vagus (X) spinal accessory(XI) hypoglossal(XII)

The nurse is caring for a patient diagnosed with a hemorrhagic stroke. The nurse recognizes that which of the following interventions is most important?

maintaining a patent airway

A patient is brought to the emergency department with a possible stroke. What initial diagnostic test for a stroke, usually performed in the emergency department, would the nurse prepare the patient for?

noncontrast computed tomogram (CT Scan) should be performed within 25 minutes of time pt presents in ED to determine if event is ischemic or hemorrhagic

A white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for stroke?

obesity

Risk factors for stroke(13)

obesity history of ischemic episodes cardiovascular disease diabetes mellitus atherosclerosis of the cranial vessels hypertension polycythemia smoking hypercholesterolemia hormonal contraceptive use emotional stress family history of stroke advancing age.

what term refers to the continued and automatic repetition of an activity, word, or phrase that is no longer appropriate

perseveration

The nurse is caring for a patient diagnosed with a subarachnoid hemorrhage resulting from a leaking aneurysm. The patient is awaiting surgery. What nursing interventions would be appropriate for the nurse to implement? (5)

provide dimly light environment administer Colace per order (no enemas) elevate HOB 15-30 degrees absolute bed rest restrict visitors to family

A client has tension headaches. The nurse recommends massage as a treatment for tension headaches. How does massage help clients with tension headaches?

relaxes muscles causes local dilation of blood vessels, and relieves HA, does not likely help client with migraine of cluster HA

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 unaware of his left side. You should approach him on the right side."