Prep-U Neuro

A healthcare provider orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? A) Heparin sodium B) Dexamethasone C) Methyldopa D) Phenytoin

Heparin sodium Explanation: Administering heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain. In a client with hemorrhagic stroke, the healthcare provider may use dexamethasone (Decadron) to decrease cerebral edema and pressure, methyldopa (Aldomet) to reduce blood pressure, and phenytoin (Dilantin) to prevent seizures.

A nurse practitioner provides health teaching to a patient who has difficulty managing hypertension. This patient is at an increased risk of which type of stroke? A) Intracerebral hemorrhage B) Subarachnoid hemorrhage C) Hemorrhage due to an aneurysm D) Arteriovenous malformation

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

Which is the initial diagnostic test for a stroke? A) Carotid Doppler B) Electrocardiography C) Transcranial Doppler studies D) Noncontrast computed tomography

Noncontrast computed tomography Explanation: The initial diagnostic test for a stroke is nonconstrast computed tomography performed emergently to determine whether the event is ischemic or hemorrhagic. Further diagnostics include a carotid Doppler, electrocardiogram, and transcranial Doppler.

A patient is exhibiting classic signs of a hemorrhagic stroke. What complaint from the patient would be an indicator of this type of stroke? A) Numbness of an arm or leg B) Double vision C) Severe headache D) Dizziness and tinnitus

Severe headache Explanation: The patient with a hemorrhagic stroke can present with a wide variety of neurologic deficits, similar to the patient with ischemic stroke. The conscious patient most commonly reports a severe headache.

The nurse is caring for a client with chronic migraines who is prescribed medication. What drug-related instructions should the nurse give the client? A) Take medication just before going to bed at night. B) Take medication only when migraine is intense. C) Take medication as soon as symptoms of the migraine begin. D) Take medication only during the morning when it's calm and quiet.

Take medication as soon as symptoms of the migraine begin. Explanation: The nurse reinforces the drug therapy regimen and instructs the client on self-administration of medications. To stop the migraine headache, the nurse stresses the importance of taking medication as soon as symptoms of the migraine begin and not when the migraine intensifies.

Which of the following is the chief cause of intracerebral hemorrhage (ICH)? A) Uncontrolled hypertension B) Diabetes C) Hypercholesterolemia D) Migraine headaches

Uncontrolled hypertension Explanation: Primary intracerebral hemorrhage (ICH) from a spontaneous rupture of small arteries or arterioles accounts for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled hypertension. Diabetes, hypercholesterolemia, and migraine headaches are not a chief cause of ICH.

A 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? A) bruit B) diplopia C) atherosclerotic plaque D) TIA

bruit Explanation: A neurologic examination during an attack reveals neurologic deficits. Auscultation of the artery may reveal a bruit (abnormal sound caused by blood flowing over a rough surface within one or both carotid arteries). The term for the auscultated discovery is "bruit."

A client admitted to the emergency department is being evaluated for the possibility of a stroke. Which assessment finding would lead the nurse to suspect that the client is experiencing a hemorrhagic stroke? A) severe exploding headache B) left-sided weakness C) slurred speech D) difficulty finding appropriate words

severe exploding headache Explanation: A hemorrhagic stroke is often characterized by a severe headache (commonly described as the "worst headache ever") or as "exploding." Weakness and speech issues are more commonly associated with an ischemic stroke.

A nurse is instructing the spouse of a client who suffered a stroke about the use of eating devices the client will be using. During the teaching, the spouse starts to cry and states, "One minute he is laughing, and the next he's crying; I just don't understand what's wrong with him." Which statement is the best response by the nurse? A) "Emotional lability is common after a stroke, and it usually improves with time." B) "You sound stressed; maybe using some stress management techniques will help." C) "You seem upset, and it may be hard for you to focus on the teaching, I'll come back later." D) "This behavior is common in clients with stroke. Which does your spouse do more often? Laugh or cry?"

"Emotional lability is common after a stroke, and it usually improves with time." Explanation: This is the most therapeutic and informative response. Often, most relatives of clients with stroke handle the physical changes better than the emotional aspects of care. The family should be prepared to expect occasional episodes of emotional lability. The client may laugh or cry easily and may be irritable and demanding or depressed and confused. The nurse can explain to the family that the client's laughter does not necessarily connote happiness, nor does crying reflect sadness, and that emotional lability usually improves with time. The remaining responses are nontherapeutic and do not address the spouse's concerns.

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

Maintaining a patent airway Explanation: Maintaining the airway is the most important nursing intervention. Immediate complications of a hemorrhagic stroke include cerebral hypoxia, decreased cerebral blood flow, and extension of the area of injury. Providing adequate oxygenation of blood to the brain minimizes cerebral hypoxia. Brain function depends on delivery of oxygen to the tissues. Administering supplemental oxygen and maintaining hemoglobin and hematocrit at acceptable levels will assist in maintaining tissue oxygenation. All other interventions are appropriate, but the airway takes priority. The head of the bed should be elevated to 30 degrees, monitoring the client because of the risk for seizures, and stool softeners are recommended to prevent constipation and straining, but these are not the most important interventions.