CH 57 EAQ Stroke

A patient has Broca's aphasia. Which lobe of the brain does the nurse anticipate to have been affected by a stroke? a. Frontal lobe b. Parietal lobe c. Occipital lobe d. Temporal lobe

ANS: A 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 nurse finds that the patient is unable to recognize familiar objects after a stroke. What term does the nurse chart in the patient's medical record? a. Alexia b. Agnosia c. Aphasia d. Agraphia

ANS: B Agnosia is the inability to recognize familiar objects. Aphasia is difficulty in speaking or understanding speech. Alexia is difficulty reading. Agraphia is difficulty writing.

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? a. Embolic stroke b. Thrombotic stroke c. Subarachnoid hemorrhage d. Transient ischemic attack (TIA)

ANS: C 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.

ANS: 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 has been admitted to the hospital with acute cerebral infarction. The patient is completely paralyzed on the left side and does not recognize the hand. Other neurologic functions are normal. According to the National Institutes of Health Stroke Scale (NIHSS), what is this patient's score? Record the answer using a whole number.

ANS: 5 According to the NIHSS, complete paralysis on either side is scored 3; if the patient does not recognize his or her own hand, the score is 2. Therefore the combined score is 5 (3 + 2).

The brain requires a continuous supply of blood and oxygen. If it is interrupted, how quickly does cellular death occur? a. 2 minutes b. 5 minutes c. 30 minutes d. 30 seconds

ANS: B Cellular death occurs within 5 minutes of a disruption in blood flow. Neurologic metabolism is altered in 30 seconds when the blood flow to the brain is interrupted. Metabolism stops in 2 minutes. Cellular death occurs much more quickly than in 30 minutes.

Which mechanism protects the brain and promotes its functioning? a. Collateral circulation b. Intracranial pressure c. Neurologic metabolism d. Cerebral autoregulation

ANS: D 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.

A patient has suffered a stroke. Which neurologic factor will the nurse assess and record? a. Speech b. Mobility c. Respiratory function d. Level of consciousness

ANS: D 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 patient has a diagnosis of stroke. What is the priority nursing diagnosis for the nurse when planning care? a. Risk for aspiration b. Impaired swallowing c. Impaired verbal communication d. Decreased intracranial adaptive capacity

ANS: D 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.

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? a. Minor stroke b. Severe stroke c. Moderate stroke d. No stroke symptoms

ANS: B 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.

The patient is recovering from a stroke and is confined to bed for most of the day. For which condition is this patient at risk? a. Fatigue b. Malnutrition c. Dehydration d. Constipation

ANS: D A patient with poor physical mobility will have problems with constipation due to immobility and weak abdominal muscles. Fatigue is related to participation in physical activity. Malnutrition and dehydration are related to access to food and the ability to feed oneself.

A patient has sustained a stroke on the right side of the brain. What clinical manifestations does the nurse determine to be associated with this type of injury? a. Impulsiveness b. Impaired speech c. Slow performance d. Paralyzed right side

ANS: A A patient who sustains a stroke on the right side of the brain shows impulsiveness. Impaired speech, slow performance, and a paralyzed right side occur when a patient has stroke on the left side of the brain.

The patient is scheduled for a transcranial Doppler imaging scan. What information will this test provide? a. It measures the velocity of blood flow. b. It identifies red blood cells. c. It visualizes blood vessels. d. It measures oxygenation.

ANS: A 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.

A nurse is screening patients who are at risk of stroke. Which tests would be appropriate to perform when screening these patients? Select all that apply. a. Blood pressure b. Routine urinalysis c. Stool examination d. Blood sugar level e. Serum cholesterol

ANS: A D E Patients with diabetes, elevated blood pressure, and/or high cholesterol are at a higher risk of stroke. The risk for stroke in people with diabetes mellitus is five times higher than in the general population; blood sugar levels should therefore be measured to screen patients for diabetes mellitus. High blood pressure is one of the most common causes of stroke; it puts unnecessary stress on blood vessel walls, causing them to thicken and deteriorate, which can eventually lead to a stroke. Many people with diabetes also have high cholesterol, increasing their risk for stroke. A buildup of low-density lipoprotein (LDL) cholesterol, sometimes called the "bad" cholesterol, can block blood vessels and reduce blood flow to the brain, increasing the risk of stroke. Routine urinalysis and stool examination may supplement other tests but are not conclusive enough to be used for screening of stroke.

The nurse is planning care for a group of patients on a stroke unit. What tasks can the nurse delegate to unlicensed assistive personnel? Select all that apply. a. Measuring and recording oral intake and urine/bowel output b. Screening patients for tissue plasminogen activator therapy c. Assessing neurologic status using the Glasgow Coma Scale d. Providing oral and lip care at least every 2 hours and as needed e. Placing equipment needed for seizure precautions in the patient's room f. Assisting with positioning the patient and turning the patient at least every two hours

ANS: A D E F A registered nurse can delegate unlicensed assistive personnel to place equipment needed for seizure precautions in the patient's room, to assist with positioning the patient and turning the patient at least every two hours, to provide oral and lip care at least every 2 hours and as needed, and to measure and record oral intake and urine/bowel output. Only a registered nurse can screen patients for tissue plasminogen activator therapy and assess neurologic status using the Glasgow Coma Scale.

A patient with a stroke develops aphasia. What does the nurse suspect to be the reason for the patient's condition? a. A defect in the vertebral artery b. A defect in the middle cerebral artery c. A defect in the anterior cerebral artery d. A defect in the posterior cerebral artery

ANS: B 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? a. Echocardiography b. Cerebral angiography c. Magnetic resonance angiography d. Computed tomography angiography

ANS: B 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 conducting a physical assessment for a patient in the emergency room. Which finding is consistent with a left-hemispheric stroke? a. Good impulse control and judgment b. Unilateral weakness of the left extremities c. Unilateral weakness of the right extremities d. Alert and oriented to time, place, and person

ANS: C A patient with a left-hemispheric stroke will have unilateral weakness of the right extremities. Being alert and oriented to time, place, and person is a normal assessment finding. Good impulse control and judgment are normal assessment findings. A patient with a right-hemispheric stroke will have unilateral weakness of the left extremities.

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? a. Myopathy b. Fibromyalgia c. Embolic stroke d. Carpal tunnel syndrome

ANS: C 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.

Which sensory-perceptual deficit is associated with left-hemispheric stroke (right hemiplegia)? a. Overestimation of physical abilities b. Difficulty judging position and distance c. Slow and possibly fearful performance of tasks d. Impulsivity and impatience at performing tasks

ANS: C 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.

The nurse is caring for a patient after a stroke. Which deficit associated with the anterior cerebral artery does the nurse expect to find? a. Diplopia b. Dysphagia c. Rooting reflex d. Visual hallucination

ANS: C Rooting reflex is a deficit linked with the anterior cerebral artery during stroke. Diplopia and dysphagia are deficits that are linked to the vertebral artery in the occurrence of a stroke. Visual hallucination is a deficit linked with posterior cerebral artery during stroke.

The nurse is preparing a community stroke awareness program. The nurse knows that which ethnic group has the highest incidence of stroke? a. Asians b. Mexicans c. Caucasians d. African Americans

ANS: D African Americans have twice the incidence of stroke related to hypertension, obesity, and diabetes. Caucasians, Mexicans, and Asians have a lower risk of stroke than do African Americans.

The patient is identified as having modifiable risk factors for stroke. Which of these risk factors is will the nurse include in the teaching plan? a. Age b. Gender c. Heredity d. Smoking

ANS: D Smoking is a modifiable risk factor. Age, gender, and heredity are not modifiable.

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? a. Swallowing status is mildly compromised. b. Swallowing status is severely compromised. c. Swallowing status is moderately compromised. d. Swallowing status is substantially compromised.

ANS: A 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.

The nurse assesses atrial fibrillation on the cardiac monitor. What type of stroke does the nurse anticipate for the patient to experience, if left without treatment? a. Embolic stroke b. Thrombotic stroke c. Intracerebral hemorrhage d. Subarachnoid hemorrhage

ANS: A Heart conditions such as atrial fibrillation and infective endocarditis can cause embolic stroke. A thrombotic stroke has clinical manifestations of decreased level of consciousness in the first 24 hours. Intracerebral hemorrhage has clinical manifestations such as decreased level of consciousness and hypertension. Clinical manifestations such as stiff neck and cranial nerve deficits indicate a subarachnoid hemorrhage.

Which modifiable risk factors for stroke would be most important for the nurse to include when planning a community education program? a. Hypertension b. Hyperlipidemia c. Alcohol consumption d. Oral contraceptive use

ANS: A 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. a. Limit fluid and fiber intake. b. Eat a diet low in saturated fats. c. Decrease level of physical exercise. d. Maintain a normal blood pressure (BP). e. Limit consumption of alcohol to moderate levels.

ANS: B D E 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.

The patient was exhibiting symptoms of a stroke for two hours before the symptoms resolved. Which condition may this patient have experienced? a. Embolic brain stroke b. Acute brain infarction c. Transient ischemic attack d. Subarachnoid hemorrhage

ANS: C A transient ischemic attack is a transient episode of neurologic symptoms without acute brain infarction. With acute brain infarction, cell death occurs. An embolic brain stroke is associated with a clot to the brain, which causes permanent damage. Subarachnoid hemorrhage is bleeding in the subarachnoid area.

Which medical condition places a patient at a higher risk for an embolic stroke? a. Atrial fibrillation b. Atherosclerosis c. Cancer of the brain d. Anticoagulant therapy

ANS: A Atrial fibrillation can cause a significant number of embolic strokes. Anticoagulant therapy can cause hemorrhage strokes. Cancer of the brain is related to a mass in the cranium, not the blood vessels. Atherosclerosis causes narrowing of the blood vessels and reduces cranial blood flow.

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? a. What was the time of onset of symptoms? b. How much food did the patient eat the previous night? c. What was the position of the patient when the symptoms arose? d. Was the patient wearing tight clothes at the time of the stroke?

ANS: A 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.

A patient sustained a stroke and is experiencing cranial nerve deficits. What artery does the nurse suspect to be obstructed? a. Vertebral artery b. Middle cerebral artery c. Anterior cerebral artery d. Posterior cerebral artery

ANS: A 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 patient has sustained a stroke, and the nurse is scheduling ordered diagnostic studies to assess the patient's cardiac status. Which diagnostic tests are a priority for this patient? Select all that apply. a. Chest x-ray b. Cardiac markers c. Electrocardiogram d. Computed tomography e. Complete blood count

ANS: A B C A chest x-ray can determine whether cardiac enlargement is present. Serum cardiac markers (or cardiac enzymes) are useful in determining whether cardiac function has been disrupted. Electrocardiograms are used to record the electrical activity of the heart and to detect abnormalities in conduction. Computed tomography is used to diagnose the initial stroke and to learn the extent of involvement. CT would not reveal a patient's cardiac status. A complete blood count will not give information regarding the cardiac status of a patient.

A nurse is planning a community-based stroke awareness/prevention health fair. Which activities would be most helpful to include? Select all that apply. a. Smoking cessation b. Cholesterol screening c. Blood pressure screening d. Early warning signs of a stroke e. Education on food high in vitamin K f. Importance of taking aspirin daily if history of sinus tachycardia

ANS: A B C D Smoking, high cholesterol, and hypertension are all modifiable risk factors. Smoking cessation and lowering blood pressure and cholesterol help prevent strokes and would be beneficial to include. Education on the early warning signs of stroke can help patients seek medical care early, reducing the effect of the stroke. Education on foods high in vitamin K is important for patients on anticoagulants, but does not relate to stroke awareness and prevention. Aspirin or anticoagulants often are prescribed for patients who have atrial fibrillation, not sinus tachycardia.

The patient is being transferred to a certified stroke center. What staff should be included in the care team? Select all that apply. a. Radiologist b. Neurologist c. Registered nurse d. Radiologic technician e. Emergency physician f. Patient care technician

ANS: A B C D 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.

A patient is admitted with stroke. After initial assessment, the health care provider finds that the patient has spatial-perceptual alteration. Which manifestations should the nurse expect to find in the patient? Select all that apply. a. Agnosia b. Apraxia c. Akinesia d. Expressive aphasia e. Homonymous hemianopsia

ANS: A B E Homonymous hemianopsia, agnosia, and apraxia are examples of spatial-perceptual alterations. Homonymous hemianopsia is characterized by blindness occurring in the same half of the visual fields of both eyes. Agnosia is the inability to recognize an object by sight, touch, or hearing. Apraxia is the inability to carry out learned sequential movements on command. Expressive aphasia is not a spatial-perceptual alteration and refers to the inability to produce language. Akinesia is a motor deficit characterized by loss of skilled voluntary movements.

The nurse is reviewing a patient's chart for factors that may have predisposed the patient to a recent stroke. Which factors placed this patient at risk for the stroke and should be included in the nurse's teaching plan? Select all that apply. a. Atrial fibrillation b. Walks once a week c. Quit smoking in 1984 d. History of breast cancer e. History of urinary tract infections f. Drinks three glass of red wine daily

ANS: A B F Atrial fibrillation is responsible for 25% of all strokes. The American Stroke Association recommends 40 minutes of exercise three to four times a week. Drinking more than one glass of wine daily increases the risk of stroke. After five to 10 years without tobacco use, the risk of stroke from smoking is similar to that of nonsmokers. Breast cancer and urinary tract infections are not considered risks for stroke.

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. a. "Ice-cream eat." b. "My dog is thirsty." c. "Bird bird two tree." d. "You are very caring." e. "I like to go to the park."

ANS: A C 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. a. Duplex scanning b. Electroencephalogram (EEG) c. Digital subtraction angiography d. Transcranial Doppler ultrasonography e. Computed tomography perfusion and diffusion imaging

ANS: A C D 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 is suspected of having a subarachnoid hemorrhage. For which diagnostic test will the nurse prepare the patient, as the most reliable diagnostic study to identify the source of subarachnoid hemorrhage? a. Cardiac imaging b. Cerebral angiography c. Magnetic resonance angiography d. Computed tomography angiography

ANS: B Cerebral angiography is the most reliable diagnostic study to identify the source of subarachnoid hemorrhage. This test helps identify cervical and cerebrovascular occlusions. Cardiac imaging, magnetic resonance angiography, and computed tomography angiography are not as definitive for identifying the source of subarachnoid hemorrhage.

The nurse would expect to find what clinical manifestation in a patient admitted with a left-hemispheric stroke? a. Impulsivity b. Impaired speech c. Left-side neglect d. Short attention span

ANS: B 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.

The nurse is teaching a patient about the onset of embolic stroke. What information does the nurse include in the teaching plan? a. Embolic stroke rarely recurs. b. Embolic stroke occurs rapidly. c. Embolic stroke renders the patient unconscious. d. Embolic stroke is marked by a surge of blood supply to the brain tissues.

ANS: B 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.

A patient sustained an ischemic stroke and is given an intravenous (IV) solution with glucose and water. What is the expected change that the nurse monitors in the patient? a. A decrease in urine output b. An increase in cerebral edema c. A decrease in intracranial pressure d. A maintained balance of fluids and electrolytes

ANS: B IV solutions with glucose and water are hypotonic. Therefore they will increase cerebral edema. Because IV solutions with glucose and water increase cerebral edema, changes will also include an increase in urine output and intracranial pressure in the patient. IV solutions with glucose and water will also alter the fluid and electrolyte balance and must be controlled carefully.

A nurse is explaining the National Institutes of Health Stroke Scale (NIHSS) to a graduate nurse. Which statement best indicates that the graduate nurse understands the purpose of performing the NIHSS? a. "The NIHSS helps prevent a second stroke." b. "The NIHSS evaluates the effects of a stroke." c. "The NIHSS is used primarily for research data collection." d. "The NIHSS is an invasive procedure that measures stroke severity."

ANS: B The NIHSS is an assessment tool that evaluates the effects of a stroke in the areas of level of consciousness (LOC) and motor/sensory function, and measures stroke severity. It is not an invasive procedure, but an assessment that the health care team member performs. It has no effect on preventing a second stroke. Although the data gained from the NIHSS assessment may be used in research, the primary purpose is for the assessment of the patient experiencing the stroke.

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. a. It is an invasive procedure. b. It is effective in detecting microemboli. c. It requires a small dose of contrast media. d. It provides visualization of cerebral blood vessels. e. It measures the velocity of blood flowing through major vessels.

ANS: B E 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.

A patient has sustained a head injury and is suspected to have increased intracranial pressure. Which factor does the nurse recognize will improve cerebral blood flow? a. An increase in blood viscosity b. A decrease in carbon dioxide levels c. An increase in hydrogen ion concentration d. A high partial pressure of arterial oxygen

ANS: C An increase in hydrogen ion concentration results in increased cerebral blood flow. A decrease in blood viscosity will increase cerebral blood flow. An increase in carbon dioxide levels results in increased cerebral blood flow. A partial pressure of oxygen in arterial blood (PaO 2) less than 50 mm Hg increases the cerebral blood flow.

The patient is scheduled for transluminal angioplasty and stenting. Which drug does the nurse anticipate will be prescribed? a. Apixaban b. Metoprolol c. Clopidogrel d. Simvastatin

ANS: C Antiplatelet drugs, such as clopidogrel, are used to prevent clotting of the stent. Simvastatin is a statin and is useful in reducing the risk of stroke. Apixaban is an anticoagulation drug and is not primarily used to prevent clots in stents. Metoprolol is a beta blocker used to treat hypertension.

What rate should blood flow in the brain in order to maintain normal function? a. 15 mL/100 g b. 25 mL/100 g c. 55 mL/100 g d. 70 mL/100 g

ANS: C 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.

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? a. "I should maintain a calm and relaxing environment." b. "I should refrain from scolding the patient during an emotional outburst." c. "I should refrain from distracting the patient during a sudden emotional outburst." d. "I should educate the patient and the family about emotional outbursts after stroke."

ANS: C 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.

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? a. Embolic stroke b. Thrombotic stroke c. Intracerebral hemorrhage d. Subarachnoid hemorrhage

ANS: C 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? a. It is usually neurologically damaging. b. It is a signal of progressive brain damage. c. It can be a warning of an impending stroke. d. It is nothing to be concerned about because it is not a stroke.

ANS: C 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.

The patient is being evaluated for thrombolytic therapy. Which findings support the use of thrombolytic agents? Select all that apply. a. The onset of symptoms was five hours ago. b. The patient had a hip replacement one week ago. c. There has been no head trauma for three months. d. The patient's blood pressure (BP) is 180/100 mm Hg. e. There is a recent history of gastrointestinal (GI) bleeding. f. The computed tomographic (CT) scan is clear of hemorrhage.

ANS: C D F To receive thrombolytic agents, the patient should have a CT scan clear of hemorrhage, no head trauma in the past three months, and a BP lower than 185/110 mm Hg. Five hours is too long to wait before administering the therapy; this should be done within three to four and a half hours since the onset of symptoms. There should be no recent history of GI bleeding. The patient should also not have had surgery within the last two weeks.

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. a. "Leave the patient alone for some time." b. "Try to find out why the patient is crying." c. "Frustration and depression are common during the first year after stroke." d. "Do not communicate with the patient on topics that make the patient cry." e. "Be patient during recovery and do not complain about these involuntary behaviors."

ANS: C E 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 patient has a sudden onset of symptoms including headache and vomiting. The nurse observes that the patient is also drowsy. Which condition may this patient be experiencing? a. Embolic stroke b. Brain infarction c. Cerebral edema d. Hemorrhagic stroke

ANS: D Clinical manifestations of hemorrhagic stroke include a sudden onset of symptoms like headache and vomiting with a change in mental status. Embolic stroke and brain infarction symptoms are related to a change in mental status and functional weakness or disability. Cerebral edema has a gradual onset as the brain swells.

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? a. Embolic stroke b. Thrombotic stroke c. Intracerebral hemorrhage d. Subarachnoid hemorrhage

ANS: D 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.

Which assessments would the nurse conduct that will enhance detection and responsiveness in patients experiencing a stroke? a. Foot drop, leg weakness, speech difficulties, time b. Facial drooping, leg weakness, garbled speech, time c. Facial weakness, arm weakness, states disoriented d. Facial drooping, arm weakness, speech difficulties, time

ANS: D The FAST mnemonic, a quick and easy way to remember the signs of stroke according to the American Stroke Association, includes Face drooping, Arm weakness, Speech difficulties, and Time. States disoriented, Foot drop, Legs weakness, and Garbled speech are not specific to the FAST mnemonic. (The page reference for this item in Lewis 10e is 1345; Table 57-1.)

The patient's vitals are a blood pressure (BP) of 180/100 mm Hg, a heart rate of 100 beats/minute, a respiratory rate of 22, and a body temperature of 98.9 F. The doctor has ordered labetalol by slow intravenous (IV) push. What is recommended for BP management after a stroke? a. A lower BP is a protective response to maintain cerebral perfusion. b. The BP must be lower than 180/105 mm Hg to receive fibrinolytic agents. c. Elevated BPs are expected after a stroke, and drug therapy should be initiated. d. Drugs to lower blood pressure are recommended if the BP is 220/120 mm Hg or higher.

ANS: D The use of drugs to lower blood pressure is recommended if the BP is 220/120 mm Hg or higher. An elevated BP is common after a stroke and may be a protective response to maintain cerebral perfusion. The BP must be lower than 185/110 mm Hg to receive a fibrinolytic agent and must then be maintained at or below 108/105 mm Hg for 24 hours.

A nurse is teaching a group of caregivers the warning signs of stroke. What type of assessment data obtained from the patients should the nurse teach the caregivers to consider as an emergency? Select all that apply. a. The patient is unable to sleep. b. The patient cannot hear properly. c. The patient has a loss of appetite. d. The patient suddenly has blurry vision. e. The patient suddenly has slurred speech.

ANS: D E Blood vessels carry blood throughout the body. When a blood vessel in the brain becomes blocked for a short period of time, the blood flow to that area of the brain slows or stops. This lack of blood (and oxygen) often leads to temporary symptoms such as slurred speech or blurry vision. Insomnia, deafness, and loss of appetite are not associated with stroke.