Neuro Part 2

1. In promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in which people? a. Blacks b. Women who smoke c. Persons with hypertension and diabetes d. Those who are obese with high dietary fat intake

1. c. The highest risk factors for the most common stroke, thrombotic stroke, are hypertension and diabetes. Blacks have a higher risk for stroke than do white persons, probably because they have a greater incidence of hypertension, diabetes, and obesity. Factors, such as diet high in saturated fats and cholesterol, cigarette smoking, metabolic syndrome, sedentary lifestyle, and excessive alcohol use are also risk factors but carry less risk than hypertension.

10. A carotid endarterectomy is being considered as treatment for a patient who has had several TIAs. What should the nurse explain to the patient about this surgery? a. It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery. b. It is used to restore blood circulation to the brain following an obstruction of a cerebral artery. c. It is used to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation. d. It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke.

10. d. A carotid endarterectomy is the removal of an atherosclerotic plaque in the carotid arteries that may impair circulation enough to cause a stroke. The other procedures described may also be used to prevent strokes. An extracranial-intracranial bypass involves cranial surgery to bypass a sclerotic intracranial artery. Stenting may improve circulation in the brain. A percutaneous transluminal angioplasty uses a balloon to compress stenotic areas in the carotid and vertebrobasilar arteries and often includes inserting a stent to hold the artery open.

11. The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of which medication? a. Nimodipine b. Furosemide (Lasix) c. Warfarin (Coumadin) d. Daily low-dose aspirin

11. d. Administering antiplatelet agents, such as aspirin, ticlopidine, clopidogrel (Plavix), dipyridamole (Persantine), and combined dipyridamole and aspirin (Aggrenox), reduces the incidence of stroke in those at risk. Anticoagulants are used for prevention of embolic strokes but increase the risk for hemorrhage. The calcium channel blocker, nimodipine, is used in patients with subarachnoid hemorrhage to decrease the effects of vasospasm and minimize tissue damage. Diuretics are not used for stroke prevention other than for their role in controlling BP. Warfarin, although it is an anticoagulant, is used for patients with atrial fibrillation, not TIA.

8. The patient has a lack of comprehension of both verbal and written language. Which type of communication difficulty does this patient have? a. Dysarthria b. Fluent dysphasia c. Receptive aphasia d. Expressive aphasia

8. c. Receptive aphasia is the lack of comprehension of both verbal and written language. Dysarthria is disturbance in muscular control of speech. In fluent dysphasia, speech is present but contains little meaningful communication. Expressive aphasia is the loss of the production of language.

12. Priority Decision: What is the priority intervention in the ED for the patient with a stroke? a. IV fluid replacement b. Giving osmotic diuretics to reduce cerebral edema c. Starting hypothermia to decrease the oxygen needs of the brain d. Maintaining respiratory function with a patent airway and oxygen administration

12. d. The first priority in acute management of the patient with a stroke is preservation of life. Because the patient with a stroke may be unconscious or have a reduced gag reflex, it is most important to maintain a patent airway for the patient and provide oxygen if respiratory effort is impaired. IV fluid replacement, treatment with osmotic diuretics, and avoiding hyperthermia may be used for further treatment depending on the patient's manifestations.

13. A diagnosis of a ruptured cerebral aneurysm has been made in a patient with manifestations of a stroke. The nurse anticipates which treatment option that would be considered for the patient? a. Hyperventilation therapy b. Surgical clipping of the aneurysm c. Administration of hyperosmotic agents d. Administration of thrombolytic therapy

13. b. Surgical management with clipping of an aneurysm to decrease rebleeding and vasospasm is an option for a stroke caused by rupture of a cerebral aneurysm. Placement of coils provides immediate protection against hemorrhage by reducing the blood pulsations within the aneurysm, then a thrombus forms and the aneurysm is sealed off from the parent vessel. Hyperventilation therapy would increase vasodilation and the potential for hemorrhage. Osmotic diuretics may leak into tissue, pulling fluid out of the vessel and increasing edema. Thrombolytic therapy would be absolutely contraindicated.

14. During the acute phase of a stroke, the nurse assesses the patient's vital signs and neurologic status at least every 4 hours. What is a cardiovascular sign that the nurse would see as the body attempts to increase cerebral blood flow? a. Hypertension b. Fluid overload c. Cardiac dysrhythmias d. S3 and S4 heart sounds

14. a. The body responds to the vasospasm and decreased circulation to the brain that occurs with a stroke by increasing the BP, frequently resulting in hypertension. The other options are important cardiovascular factors to assess, but they do not result from impaired cerebral blood flow.

15. During the secondary assessment of the patient with a stroke, what should be included (select all that apply)? a. Gaze b. Sensation c. Facial palsy d. Proprioception e. Current medications f. Distal motor function

15. a, b, c, d, f. The secondary assessment and ongoing neurologic monitoring include the gaze, sensation, facial palsy, proprioception, distal motor function, cognition, motor abilities, cerebellar function, and deep tendon reflexes. Current medications and history of hypertension are part of the primary assessment.

16. What is a nursing intervention that is indicated for the patient with hemiplegia? a. The use of a footboard to prevent plantar flexion b. Immobilization of the affected arm against the chest with a sling c. Positioning the patient in bed with each joint lower than the joint proximal to it d. Having the patient perform passive range of motion (ROM) of the affected limb with the unaffected limb

16. d. Active range of motion (ROM) should be started on the unaffected side as soon as possible. Passive ROM of the affected side should be started on the first day. Having the patient actively exercise the unaffected side provides the patient with active and passive ROM as needed. Use of footboards is controversial because they stimulate plantar flexion. The unaffected arm should be supported, but immobilization may precipitate a painful shoulder-hand syndrome. The patient should be positioned with each joint higher than the joint proximal to it to prevent dependent edema.

7. A newly admitted patient diagnosed with a right-sided brain stroke has homonymous hemianopsia. Early in the care of the patient, what should the nurse do? a. Place objects on the right side within the patient's field of vision. b. Approach the patient from the left side to encourage the patient to turn the head. c. Place objects on the patient's left side to assess the patient's ability to compensate. d. Patch the affected eye to encourage the patient to turn the head to scan the environment.

17. a. The presence of homonymous hemianopia in a patient with right hemisphere brain damage causes a loss of vision in the left field bilaterally. Early in the care of the patient, objects should be placed on the right side of the patient in the field of vision, and the nurse should approach the patient from the right side. Later in treatment, patients should be taught to turn the head and scan the environment and should be approached from the affected side to encourage head turning. Eye patches are used if patients have diplopia (double vision).

18. Four days following a stroke, a patient is to start oral fluids and feedings. Before feeding the patient, what should the nurse do first? a. Check the patient's gag reflex. b. Order a soft diet for the patient. c. Raise the head of the bed to a sitting position. d. Assess the patient's ability to swallow tiny amounts of crushed ice.

18. a. Usually the speech therapist will have completed a swallowing study before a diet is ordered. The first step in providing oral feedings for a patient with a stroke is ensuring that the patient has an intact gag reflex because oral feedings will not be provided if the gag reflex is impaired. After placing the patient in an upright position, the nurse may then evaluate the patient's ability to swallow ice chips or ice water.

19. What is an appropriate food for a patient with a stroke who has mild dysphagia? a. Fruit juices b. Pureed meat c. Scrambled eggs d. Fortified milkshakes

19. c. Soft foods that provide enough texture, flavor, and bulk to stimulate swallowing should be used for the patient with dysphagia. Thin liquids are difficult to swallow, and patients may not be able to control them in the mouth. Pureed foods are often too bland and too smooth, and milk products should be avoided because they tend to increase the viscosity of mucus and increase salivation.

2. A thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because a. the body can dissolve atherosclerotic plaques as they form. b. some tissues of the brain do not require constant blood supply to prevent damage. c. circulation via the Circle of Willis may provide blood supply to the affected area of the brain. d. neurologic deficits occur only when major arteries are occluded by thrombus formation around atherosclerotic plaque.

2. c. The communication between the anterior and posterior cerebral circulation in the circle of Willis provides a collateral circulation, which may maintain circulation to an area of the brain if its original blood supply is obstructed. Atherosclerotic plaques are not readily reversed, and all areas of the brain require constant blood supply. Neurologic deficits can result from ischemia caused by many factors.

20. A patient's wife asks the nurse why her husband did not receive the clot-busting medication (tissue plasminogen activator [tPA]) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What is the best response by the nurse to the patient's wife? a. "He didn't arrive within the time frame for that therapy." b. "Not everyone is eligible for this drug. Has he had surgery lately?" c. "You should discuss the treatment of your husband with his doctor." d. "The medication you are talking about dissolves clots and could cause more bleeding in your husband's brain."

20. d. Recombinant tissue plasminogen activator (tPA) dissolves clots and increases the risk for bleeding. It is not used with hemorrhagic strokes. If the patient had a thrombotic or embolic stroke, the timeframe of 3 to 4.5 hours after onset of clinical signs of the stroke would be important as well as a history of surgery. The nurse should answer the question as accurately as possible and then encourage the wife to talk with the HCP if she has further questions.

21. The rehabilitation nurse assesses the patient, caregiver, and family before planning the rehabilitation program for this patient. What must be included in this assessment (select all that apply)? a. Cognitive status of the family b. Patient resources and support c. Physical status of all body systems d. Rehabilitation potential of the patient e. Body strength remaining after the stroke f. Patient and caregiver expectations of the rehabilitation

21. c, d, f. The patient's rehabilitation potential, physical status of all body systems, and the expectations of the patient and caregiver related to the rehabilitation program will have a big impact on planning and carrying out the rehabilitation plan. The other things the rehabilitation nurse will assess are the presence of complications caused by the stroke or other chronic conditions, the patient's cognitive status, and the family (including the patient and caregiver) resources and support.

22. What is an appropriate nursing intervention to promote communication during rehabilitation of the patient with aphasia? a. Allow time for the individual to complete his/her thoughts. b. Use gestures, pictures, and music to stimulate patient responses. c. Structure statements so that the patient does not have to respond verbally. d. Use flashcards with simple words and pictures to promote recall of language.

22. a. During rehabilitation, the patient with aphasia needs time to process and complete thoughts for verbal response. Conversation by the nurse and family should include meaningful verbal stimulation that is relevant to the patient. Gestures, pictures, and simple statements are more appropriate in the acute phase, when patients may be overwhelmed by verbal stimuli. Not responding verbally does not promote communication. Flashcards are often perceived by the patient as childish and meaningless.

23. Patient-Centered Care: A patient with a right hemisphere stroke has unilateral neglect. During the patient's rehabilitation, what nursing intervention is important for the nurse to do? a. Avoid positioning the patient on the affected side. b. Place all objects for care on the patient's unaffected side. c. Teach the patient to care consciously for the affected side. d. Protect the affected side from injury with pillows and supports.

23. c. Unilateral neglect, or neglect syndrome, occurs when the patient with a stroke is unaware of the affected side of the body, which puts the patient at risk for injury. During the acute phase, the affected side is cared for by the nurse with positioning and support, but during rehabilitation the patient is taught to care consciously for and attend to the affected side of the body to protect it from injury. Patients may be positioned on the affected side for up to 30 minutes.

24. A patient with a stroke has a right-sided hemiplegia. What does the nurse teach the family to prepare them to cope with the behavior changes seen with this type of stroke? a. Ignore undesirable behaviors manifested by the patient. b. Provide directions to the patient verbally in small steps. c. Distract the patient from inappropriate emotional responses. d. Supervise all activities before allowing the patient to do them independently.

24. c. Patients with left-brain damage from stroke often experience emotional lability, inappropriate emotional responses, mood swings, and uncontrolled tears or laughter disproportionate to or out of context with the situation. The behavior is upsetting and embarrassing to both the patient and family, and the patient should be distracted to minimize its presence. Maintaining a calm environment and avoiding shaming or scolding the patient are important. Patients with right-brain damage often have impulsive, rapid behavior that requires supervision and direction.

25. The nurse can best assist the patient and family in coping with the long-term effects of a stroke by doing what? a. Informing family members that the patient will need assistance with almost all activities of daily living (ADLs) b. Explaining that the patient's prestroke behavior will return as improvement progresses c. Encouraging the patient and family members to seek assistance from family therapy or stroke support groups d. Helping the patient and family understand the significance of residual stroke damage to promote problem solving and planning

25. d. The patient and family need accurate and complete information about the effects of the stroke to problem solve and make plans for chronic care of the patient. The patient's specific needs for care must be identified and rehabilitation efforts should be continued at home. It is uncommon for patients with major strokes to return completely to prestroke function, behaviors, and role. Both the patient and family will mourn these losses. Family therapy and support groups may be helpful for some patients and families.

26. Collaboration: Which intervention can the nurse delegate to the licensed practical nurse (LPN) when caring for a patient following an acute stroke? a. Assess the patient's neurologic status. b. Assess the patient's gag reflex before beginning feeding. c. Administer ordered antihypertensives and platelet inhibitors. d. Teach the patient's caregivers strategies to minimize unilateral neglect.

26. c. Medication administration is within the scope of practice for an LPN. Assessment and teaching are within the scope of practice for the RN.

During the change of shift report, a nurse is told that a patient has an occluded left posterior cerebral artery. The nurse will anticipate that the patient may have a. dysphasia. b. confusion. c. visual deficits. d. poor judgment.

ANS: C Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior cerebral artery occlusion.

3. Patient-Centered Care: A patient comes to the emergency department (ED) with numbness of the face and an inability to speak. While the patient awaits examination, the symptoms disappear and the patient requests discharge. Why should the nurse emphasize that it is important for the patient to be treated before leaving? a. The patient has probably experienced an asymptomatic lacunar stroke. b. The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours. c. Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off. d. The patient has probably had a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease.

3. d. A transient ischemic attack (TIA) is a temporary focal loss of neurologic function caused by ischemia of an area of the brain, usually lasting an hour or less. TIAs may be caused by microemboli that temporarily block blood flow and are a warning of progressive cerebrovascular disease. Evaluation is necessary to determine the cause of the neurologic deficit and provide prophylactic treatment if possible.

7. Indicate whether the following manifestations of a stroke are more likely to occur with right-brain damage (R) or left-brain damage (L). a. _______ Aphasia b. _______ Impaired judgment c. _______ Quick, impulsive behavior d. _______ Inability to remember words e. _______ Left homonymous hemianopsia f. _______ Neglect of the left side of the body g. _______ Hemiplegia of the right side of the body

7. a. L; b. R; c. R; d. L; e. R; f. R; g. L

4. Which statements describe characteristics of a stroke caused by an intracerebral hemorrhage (select all that apply)? a. Carries a poor prognosis b. Caused by rupture of a vessel c. Strong association with hypertension d. Commonly occurs during or after sleep e. Creates a mass that compresses the brain

4. a, b, c, e. Strokes from intracerebral hemorrhage have a poor prognosis, are caused by the rupture of a blood vessel, are associated with hypertension, and may create a mass that compresses the brain. Hypertension is also related to thrombotic strokes that often occur during sleep or after sleep.

5. Which type of stroke is associated with endocardial disorders, has a rapid onset, and is likely to occur during activity? a. Embolic b. Thrombotic c. Intracerebral hemorrhage d. Subarachnoid hemorrhage

5. a. Embolic strokes are associated with endocardial disorders, such as atrial fibrillation, have a rapid onset, and are likely to occur during activity. Hemorrhage also commonly occurs during activity but is unrelated to cardiac disorders.

6. What primarily determines the neurologic functions that are affected by a stroke? a. The amount of tissue area involved b. The rapidity of the onset of symptoms c. The brain area perfused by the affected artery d. The presence or absence of collateral circulation

6. c. Clinical manifestations of altered neurologic function differ, depending primarily on the specific cerebral artery involved and the area of the brain that is perfused by the artery. The prognosis is related to the amount of brain tissue area involved. The degree of impairment depends on rapidity of onset, the size of the lesion, and the presence of collateral circulation.

9. A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, what will the nurse anticipate that the health care provider (HCP) will request? a. Lumbar puncture b. Cerebral angiography c. MRI d. CT scan with contrast

9. c. MRI could be used to rapidly distinguish between ischemic and hemorrhagic stroke and determine the size and location of the lesion. A noncontrast CT scan could also be used. Lumbar punctures are not performed routinely because of the chance of increased intracranial pressure causing herniation. Cerebral arteriograms are invasive and may dislodge an embolism or cause further hemorrhage. They are performed only when no other test can provide the needed information.

Common psychosocial problems a patient may have post stroke include (select all that apply) A) depression B) disassociation C) sleep problems D) intellectualization E) denial of severity of stroke

A) depression C) sleep problems E) denial of severity of stroke Rationale: The patient with a stroke may have many losses, including sensory, intellectual, communicative, functional, role behavior, emotional, social, and vocational. Some patients have long-term depression, manifesting symptoms, including anxiety, weight loss, fatigue, poor appetite, and sleep problems. The time and energy needed to perform previously simple tasks can result in anger and frustration. Reactions vary considerably but may involve fear, apprehension, denial of the severity of stroke, depression, anger, and sorrow

5. A nurse is assessing a client. Which of the following findings indicates that the client has experienced a left‐hemispheric stroke? A. impulse control difficulty B. Poor judgment C. inability to recognize familiar objects d. Loss of depth perception

A. A client who has experienced a right‐hemispheric stroke will experience difficulty with impulse control. B. A client who has experienced a right‐hemispheric stroke will experience poor judgment. C. CORRECT: A client who experienced a left‐hemispheric stroke will demonstrate the inability to recognize familiar objects, known as agnosia. d. A client who experienced a right‐hemispheric stroke will experience a loss of depth perception.

2. A nurse is caring for a client who has left homonymous hemianopsia. Which of the following is an appropriate nursing intervention? A. Teach the client to scan to the right to see objects on the right side of the body. B. Place the bedside table on the right side of the bed. C. Orient the client to the food on the plate using the clock method. d. Place the wheelchair on the client's left side.

A. A client who has left homonymous hemianopsia has lost the left visual field of both eyes. The client should be taught to turn the head to the left to visualize the entire field of vision. B. CORRECT: The client is unable to visualize to the left midline of their body. Placing the bedside table on the right side of the client's bed will permit visualization of items on the table. C. Using the clock method of food placement will be ineffective because only half of the plate can be seen. d. The wheelchair should be placed to the client's right or unaffected side.

1. A nurse is caring for a client who has experienced a right‐hemispheric stroke. The nurse should expect the client to have difficulty with which of the following? (select all that apply.) A. impulse control B. Moving the left side C. depth perception d. speaking e. situationalawareness

A. CORRECT: A client who has experienced a right‐hemispheric stroke can exhibit impulse control difficulty, suchas the urgency to use the restroom. B. CORRECT: A client who has experienced a right‐hemispheric stroke can exhibit left‐sided hemiplegia. C. CORRECT: A client who has experienced a right‐hemispheric stroke can experience a loss in depth perception. d. A client who has experienced a left‐hemispheric stroke can experience aphasia. e. CORRECT: A client who has experienced a right‐hemispheric stroke can demonstrate a lack of awareness of surroundings.

4. A nurse is caring for a client who has global aphasia (both receptive and expressive). Which of the following should the nurse include in the client's plan of care? (select all that apply.) A. speak to the client at a slower rate. B. Assist the client to use cards with pictures. C. speak to the client in a loud voice. d. Complete sentences that the client cannot finish. e. Give instructions one step at a time.

A. CORRECT: Clients who have global aphasia have difficulty with speaking and understanding speech. One strategy that can enhance client understanding is speaking to the client at a slower rate. B. CORRECT: One strategy that can enhance understanding is the use of alternative forms of communication,such as cards with pictures or a computer. C. For the client who has aphasia, speaking in a loud voice is unnecessary and can be interpreted as patronizing. d. Allow the client adequate time to finish sentences and not complete the sentences for them. e. CORRECT: One strategy that can enhance understanding is giving instructions one step at a time.

3. A nurse is planning care for a client who has dysphagia and a new dietary prescription. Which of the following should the nurse include in the plan of care? (select all that apply.) A. Have suction equipment available for use. B. Feed the client thickened liquids. C. Place food on the unaffected side of the client's mouth. d. Assign an assistive personnel to feed the client slowly. e. Teach the client to swallow with the neck flexed.

A. CORRECT: suction equipment should be available in case of choking and aspiration. B. CORRECT: The client should be given liquids that are thicker than water to prevent aspiration. C. CORRECT: Placing food on the unaffected side of the client's mouth will allow them to have better control of the food and reduce the risk of aspiration. d. due to the risk of aspiration, assistive personnel should not be assigned to feed the client because the client's swallowing ability should be assessed, and suctioning can be needed if choking occurs. e. CORRECT: The client should be taught to flex the neck, tucking the chin down and under to close the epiglottis during swallowing.

A 63-yr-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol? (Put a comma and a space between each answer choice [A, B, C, D].) a. Obtain CT scan without contrast. b. Infuse tissue plasminogen activator (tPA). c. Administer oxygen to keep O2 saturation >95%. d. Use National Institute of Health Stroke Scale to assess patient.

ANS: C, D, A, B The initial actions should be those that help with airway, breathing, and circulation. Baseline neurologic assessments should be done next. A CT scan will be needed to rule out hemorrhagic stroke before tPA can be administered.

A female patient who had a stroke 24 hours ago has expressive aphasia. An appropriate nursing intervention to help the patient communicate is to a. ask questions that the patient can answer with "yes" or "no." b. develop a list of words that the patient can read and practice reciting. c. have the patient practice her facial and tongue exercises with a mirror. d. prevent embarrassing the patient by answering for her if she does not respond.

ANS: A Communication will be facilitated and less frustrating to the patient when questions that require a "yes" or "no" response are used. When the language areas of the brain are injured, the patient might not be able to read or recite words, which will frustrate the patient without improving communication. Expressive aphasia is caused by damage to the language areas of the brain, not by the areas that control the motor aspects of speech. The nurse should allow time for the patient to respond.

A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which response by the nurse is accurate? a. "The obstructing plaque is surgically removed from inside an artery in the neck." b. "The diseased portion of the artery in the brain is replaced with a synthetic graft." c. "A wire is threaded through an artery in the leg to the clots in the carotid artery, and the clots are removed." d. "A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque."

ANS: A In a carotid endarterectomy, the carotid artery is incised, and the plaque is removed. The response beginning, "The diseased portion of the artery in the brain is replaced" describes an arterial graft procedure. The answer beginning, "A catheter with a deflated balloon is positioned at the narrow area" describes an angioplasty. The final response beginning, "A wire is threaded through the artery" describes the mechanical embolus removal in cerebral ischemia (MERCI) procedure.

A patient has a ruptured cerebral aneurysm and subarachnoid hemorrhage. Which intervention will the nurse include in the plan of care? a. Apply intermittent pneumatic compression stockings. b. Assist to dangle on edge of bed and assess for dizziness. c. Encourage patient to cough and deep breathe every 4 hours. d. Insert an oropharyngeal airway to prevent airway obstruction.

ANS: A The patient with a subarachnoid hemorrhage usually has minimal activity to prevent cerebral vasospasm or further bleeding and is at risk for venous thromboembolism. Activities such as coughing and sitting up that might increase intracranial pressure or decrease cerebral blood flow are avoided. Because there is no indication that the patient is unconscious, an oropharyngeal airway is inappropriate.

After receiving change-of-shift report on the following four patients, which patient should the nurse see first? a. A 60-yr-old patient with right-sided weakness who has an infusion of tPA prescribed b. A 50-yr-old patient who has atrial fibrillation and a new order for warfarin (Coumadin) c. A 30-yr-old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine scheduled d. A 40-yr-old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due

ANS: A tPA needs to be infused within the first few hours after stroke symptoms start in order to be effective in minimizing brain injury. The other medications should also be given as quickly as possible, but timing of the medications is not as critical.

A patient in the clinic reports a recent episode of dysphasia and left-sided weakness at home that resolved after 2 hours. The nurse will anticipate teaching the patient about a. tPA. b. aspirin c. warfarin (Coumadin) d. nimodipine

ANS: B After a transient ischemic attack, patients typically are started on medications such as aspirin to inhibit platelet function and decrease stroke risk. tPA is used for acute ischemic stroke. Coumadin is usually used for patients with atrial fibrillation. Nimodipine is used to prevent cerebral vasospasm after a subarachnoid hemorrhage.

When teaching about clopidogrel (Plavix), the nurse will tell the patient with cerebral atherosclerosis a. to monitor and record the blood pressure daily. b. to call the health care provider if stools are tarry. c. that clopidogrel will dissolve clots in the cerebral arteries. d. that clopidogrel will reduce cerebral artery plaque formation.

ANS: B Clopidogrel inhibits platelet function and increases the risk for gastrointestinal bleeding, so patients should be advised to notify the health care provider about any signs of bleeding. The medication does not lower blood pressure, decrease plaque formation, or dissolve clots.

Several weeks after a stroke, a 50-yr-old male patient has impaired awareness of bladder fullness, resulting in urinary incontinence. Which nursing intervention should be planned to begin an effective bladder training program? a. Limit fluid intake to 1200 mL daily to reduce urine volume. b. Assist the patient onto the bedside commode every 2 hours. c. Perform intermittent catheterization after each voiding to check for residual urine. d. Use an external "condom" catheter to protect the skin and prevent embarrassment.

ANS: B Developing a regular voiding schedule will prevent incontinence and may increase patient awareness of a full bladder. A 1200-mL fluid restriction may lead to dehydration. Intermittent catheterization and use of a condom catheter are appropriate in the acute phase of stroke, but should not be considered solutions for long-term management because of the risks for urinary tract infection and skin breakdown.

The nurse is caring for a patient who has just returned after having left carotid artery angioplasty and stenting. Which assessment information is of most concern to the nurse? a. The pulse rate is 102 beats/min. b. The patient has difficulty speaking. c. The blood pressure is 144/86 mm Hg. d. There are fine crackles at the lung bases.

ANS: B Small emboli can occur during carotid artery angioplasty and stenting, and the aphasia indicates a possible stroke during the procedure. Slightly elevated pulse rate and blood pressure are not unusual because of anxiety associated with the procedure. Fine crackles at the lung bases may indicate atelectasis caused by immobility during the procedure. The nurse should have the patient take some deep breaths.

A 70-yr-old female patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first? a. Take the patient's blood pressure. b. Check the respiratory rate and effort. c. Assess the Glasgow Coma Scale score. d. Send the patient for a computed tomography (CT) scan.

ANS: B The initial nursing action should be to assess the airway and take any needed actions to ensure a patent airway. The other activities should take place quickly after the ABCs (airway, breathing, and circulation) are completed.

For a patient who had a right hemisphere stroke, the nurse anticipates planning interventions to manage a. impaired physical mobility related to right-sided hemiplegia. b. risk for injury related to denial of deficits and impulsiveness. c. impaired verbal communication related to speech-language deficits. d. ineffective coping related to depression and distress about disability.

ANS: B The patient with right-sided brain damage typically denies any deficits and has poor impulse control, leading to risk for injury when the patient attempts activities such as transferring from a bed to a chair. Right-sided brain damage causes left hemiplegia. Left-sided brain damage typically causes language deficits. Left-sided brain damage is associated with depression and distress about the disability.

Which information about the patient who has had a subarachnoid hemorrhage is most important to communicate to the health care provider? a. The patient complains of having a stiff neck. b. The patient's blood pressure (BP) is 90/50 mm Hg. c. The patient reports a severe and unrelenting headache. d. The cerebrospinal fluid (CSF) report shows red blood cells (RBCs).

ANS: B To prevent cerebral vasospasm and maintain cerebral perfusion, BP needs to be maintained at a level higher than 90 mm Hg systolic after a subarachnoid hemorrhage. A low BP or drop in BP indicates a need to administer fluids and/or vasopressors to increase the BP. An ongoing headache, RBCs in the CSF, and a stiff neck are all typical clinical manifestations of a subarachnoid hemorrhage and do not need to be rapidly communicated to the health care provider.

A patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin? a. The patient has dysphasia. b. The patient has atrial fibrillation. c. The patient reports that symptoms began with a severe headache. d. The patient has a history of brief episodes of right-sided hemiplegia.

ANS: C A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is contraindicated. Atrial fibrillation, dysphasia, and transient ischemic attack are not contraindications to aspirin use.

The nurse is caring for a patient who has been experiencing stroke symptoms for 60 minutes. Which action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)? a. Assess the patient's gag and cough reflexes. b. Determine when the stroke symptoms began. c. Administer the prescribed short-acting insulin. d. Infuse the prescribed IV metoprolol (Lopressor).

ANS: C Administration of subcutaneous medications is included in LPN/LVN education and scope of practice. The other actions require more education and scope of practice and should be done by the registered nurse (RN).

A patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need the aspirin today. I don't have a fever." Which action should the nurse take? a. Document that the aspirin was refused by the patient. b. Tell the patient that the aspirin is used to prevent a fever. c. Explain that the aspirin is ordered to decrease stroke risk. d. Call the health care provider to clarify the medication order.

ANS: C Aspirin is ordered to prevent stroke in patients who have experienced TIAs. Documentation of the patient's refusal to take the medication is an inadequate response by the nurse. There is no need to clarify the order with the health care provider. The aspirin is not ordered to prevent aches and pains.

A patient admitted with possible stroke has been aphasic for 3 hours, and his current blood pressure (BP) is 174/94 mm Hg. Which order by the health care provider should the nurse question? a. Keep head of bed elevated at least 30 degrees. b. Infuse normal saline intravenously at 75 mL/hr. c. Start a labetalol drip to keep BP less than 140/90 mm Hg. d. Administer tissue plasminogen activator (tPA) intravenously per protocol.

ANS: C Because elevated BP may be a protective response to maintain cerebral perfusion, antihypertensive therapy is recommended only if mean arterial pressure (MAP) is greater than130 mm Hg or systolic pressure is greater than 220 mm Hg. Fluid intake should be 1500 to 2000 mL/day to maintain cerebral blood flow. The head of the bed should be elevated to at least 30 degrees unless the patient has symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for tPA use.

A left-handed patient with left-sided hemiplegia has difficulty feeding himself. Which intervention should the nurse include in the plan of care? a. Provide a wide variety of food choices. b. Provide oral care before and after meals. c. Assist the patient to eat with the right hand. d. Teach the patient the "chin-tuck" technique.

ANS: C Because the patient has difficulty feeding himself, the appropriate interventions will focus on teaching the patient to use the right hand for self-feeding. The other interventions are appropriate for patients with other etiologies for the imbalanced nutrition.

When caring for a patient with a new right-sided homonymous hemianopsia resulting from a stroke, which intervention should the nurse include in the plan of care? a. Apply an eye patch to the right eye. b. Approach the patient from the right side. c. Place needed objects on the patient's left side. d. Teach the patient that the left visual deficit will resolve.

ANS: C During the acute period, the nurse should place objects on the patient's unaffected side. Because there is a visual defect in the right half of each eye, an eye patch is not appropriate. The patient should be approached from the left side. The visual deficit may not resolve, although the patient can learn to compensate for the defect.

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the nurse to address? a. The patient is 25 lb above the ideal weight. b. The patient drinks a glass of red wine with dinner daily. c. The patient's usual blood pressure (BP) is 170/94 mm Hg. d. The patient works at a desk and relaxes by watching television.

ANS: C Hypertension is the single most important modifiable risk factor. People who drink more than 1 (for women) or 2 (for men) alcoholic beverages a day may increase their risk for hypertension. Physical inactivity and obesity contribute to stroke risk but not as much as hypertension.

A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first? a. Complete blood count (CBC) b. Chest radiograph (chest x-ray) c. Computed tomography (CT) scan d. 12-Lead electrocardiogram (ECG)

ANS: C Rapid screening with a noncontrast CT scan is needed before administration of tissue plasminogen activator (tPA), which must be given within 4.5 hours of the onset of clinical manifestations of the stroke. The sooner the tPA is given, the less brain injury. The other diagnostic tests give information about possible causes of the stroke and do not need to be completed as urgently as the CT scan.

A male patient who has right-sided weakness after a stroke is making progress in learning to use the left hand for feeding and other activities. The nurse observes that when the patient's wife is visiting, she feeds and dresses him. Which nursing diagnosis is most appropriate for the patient? a. Interrupted family processes related to effects of illness of a family member b. Situational low self-esteem related to increasing dependence on spouse for care c. Disabled family coping related to inadequate understanding by patient's spouse d. Impaired nutrition: less than body requirements related to hemiplegia and aphasia

ANS: C The information supports the diagnosis of disabled family coping because the wife does not understand the rehabilitation program. There are no data supporting low self-esteem, and the patient is attempting independence. The data do not support an interruption in family processes because this may be a typical pattern for the couple. There is no indication that the patient has impaired nutrition.

A patient will attempt oral feedings for the first time after having a stroke. The nurse should assess the gag reflex and then a. order a varied pureed diet. b. assess the patient's appetite. c. assist the patient into a chair d. offer the patient a sip of juice.

ANS: C The patient should be as upright as possible before attempting feeding to make swallowing easier and decrease aspiration risk. To assess swallowing ability, the nurse should initially offer water or ice to the patient. Pureed diets are not recommended because the texture is too smooth. The patient may have a poor appetite, but the oral feeding should be attempted.

After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no residual effects, the nurse anticipates teaching the patient about a. cerebral aneurysm clipping. b. heparin intravenous infusion. c. oral low-dose aspirin therapy. d. tissue plasminogen activator (tPA).

ANS: C The patient's symptoms are consistent with transient ischemic attack (TIA), and drugs that inhibit platelet aggregation are prescribed after a TIA to prevent a stroke. Continuous heparin infusion is not routinely used after TIA or with acute ischemic stroke. The patient's symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic stroke, not for TIA.

A patient with a left-brain stroke suddenly bursts into tears when family members visit. The nurse should a. use a calm voice to ask the patient to stop the crying behavior. b. explain to the family that depression is normal following a stroke. c. have the family members leave the patient alone for a few minutes. d. teach the family that emotional outbursts are common after strokes.

ANS: D Patients who have left-sided brain stroke are prone to emotional outbursts that are not necessarily related to the emotional state of the patient. Depression after a stroke is common, but the suddenness of the patient's outburst suggests that depression is not the major cause of the behavior. The family should stay with the patient. The crying is not within the patient's control, and asking the patient to stop will lead to embarrassment.

Nurses in change-of-shift report are discussing the care of a patient with a stroke who has progressively increasing weakness and decreasing level of consciousness. Which patient problem do they determine has the highest priority for the patient? a. Impaired physical mobility related to weakness b. Disturbed sensory perception related to brain injury c. Risk for impaired skin integrity related to immobility d. Risk for aspiration related to inability to protect airway

ANS: D Protection of the airway is the priority of nursing care for a patient having an acute stroke. The other diagnoses are also appropriate, but interventions to prevent aspiration are the priority at this time.

A patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find? a. Impulsive behavior b. Right-sided neglect c. Hyperactive left-sided tendon reflexes d. Difficulty comprehending instructions

ANS: D Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more likely with a right-side stroke.

A patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for a. surgical endarterectomy. b. transluminal angioplasty. c. intravenous heparin drip administration. d. tissue plasminogen activator (tPA) infusion.

ANS: D The patient's history and clinical manifestations suggest an acute ischemic stroke, and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.

A patient in the emergency department with sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider? a. The patient's speech is difficult to understand. b. The patient's blood pressure (BP) is 144/90 mm Hg. c. The patient takes a diuretic because of a history of hypertension. d. The patient has atrial fibrillation and takes warfarin (Coumadin).

ANS: D The use of warfarin probably contributed to the intracerebral bleeding and remains a risk factor for further bleeding. Administration of vitamin K is needed to reverse the effects of the warfarin, especially if the patient is to have surgery to correct the bleeding. The history of hypertension is a risk factor for the patient but has no immediate effect on the patient's care. The BP of 144/90 indicates the need for ongoing monitoring but not for any immediate change in therapy. Slurred speech is consistent with a left-sided stroke, and no change in therapy is indicated.

Bladder training in a male patient who has urinary incontinence after a stroke includes... A) limiting fluid intake B) helping the patient to stand to void C) keeping a urinal in place at all times D) catheterizing the patient every four hours

B) helping the patient to stand to void Rationale: In the acute stage of stroke, the primary urinary problem is poor bladder control and incontinence. A bladder retraining program consists of (1) adequate fluid intake, with the greatest fluid intake between 7:00 AM and 7:00 PM; and (2) scheduled toileting every 2 hours with the use of a urinal, commode, or bathroom, (3) assisting with clothing and mobility; and (4) encouraging the usual position for urinating

For a patient who is suspected of having a stroke, the most important piece of information that the nurse can obtain is... A) time of the patient's last meal B) time at which stroke symptoms first appeared C) patient's hypertension history and management D) family history of stroke and other cardiovascular diseases

B) time at which stroke symptoms first appeared Rationale: During initial evaluation, the most crucial point in the patient's history is the time since onset of stroke symptoms. If the stroke is ischemic, recombinant tissue plasminogen activator (tPA) must be given within 3 to 4½ hours of the onset of signs of ischemic stroke; tPA reestablishes blood flow through a blocked artery and prevents brain cell death in patients with acute onset of ischemic stroke

A patient is having word finding difficulty and weakness in his right arm. What area of the brain is most likely involved? A) brainstem B) vertebral artery C) left middle cerebral artery D) right middle cerebral artery

C) left middle cerebral artery Rationale: If the middle cerebral artery is involved in a stroke, the expected manifestations include aphasia, motor and sensory deficit, and hemianopsia on the dominant side and include neglect, motor and sensory deficit, and hemianopsia on the nondominant side

The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the... A) presence of increased ICP B) site and size of the infection C) patency of the cerebral blood vessels D) presence of blood in the cerebrospinal fluid

C) patency of the cerebral blood vessels Rationale: Angiography provides visualization of cerebral blood vessels and can help estimate perfusion and detect filling defects in the cerebral arteries.

A patient having TIAs is scheduled for a carotid edarterectomy. The nurse explains that this procedure is done to... A) decrease cerebral edema B) reduce the brain damage that occurs during a stroke in evolution C) prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow D) provide a circulatory bypass around thrombotic plaques obstructing cranial circulation

C) prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow Rationale: In a carotid endarterectomy, the atheromatous lesion is removed from the carotid artery to improve blood flow

Information provided by the patient that would help distinguish a hemmorrhagic stroke from a thrombotic stroke includes... A) sensory changes B) a history of hypertension C) presence of motor weakness D) sudden onset of severe headache

D) sudden onset of severe headache Rationale: A hemorrhagic stroke usually causes a sudden onset of symptoms, which include neurologic deficits, headache, nausea, vomiting, decreased level of consciousness, and hypertension. Ischemic stroke symptoms may progress in the first 72 hours as infarction and cerebral edema increase

Which modifiable risk factor 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

a. Hypertension Hypertension is the single most important modifiable risk factor, but it is still often undetected and inadequately treated. The public is often more aware of hyperlipidemia and oral contraceptive use as risk factors for stroke. Alcohol is also a modifiable risk factor.

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

a. Impaired speech Clinical manifestations of left-sided brain damage include right hemiplegia, impaired speech/language, impaired right/left discrimination, and slow and cautious performance. Impulsivity, left-sided neglect, and short attention span are all manifestations of right-sided brain damage.

A CT scan of a 68-yr-old male patient's head reveals that he has experienced a hemorrhagic stroke. What is the priority nursing intervention in the emergency department? a. Maintenance of the patient's airway b. Positioning to promote cerebral perfusion c. Control of fluid and electrolyte imbalances d. Administration of tissue plasminogen activator (tPA)

a. Maintenance of the patient's airway Maintenance of a patent airway is the priority in the acute care of a patient with a hemorrhagic stroke. It supersedes the importance of fluid and electrolyte imbalance and positioning. tPA is contraindicated in hemorrhagic stroke.

The patient with diabetes mellitus had a right-sided stroke. Which nursing intervention should the nurse plan to provide for this patient? a. Safety measures b. Patience with communication c. Mobility assistance on the right side d. Place food in the left side of patient's mouth.

a. Safety measures A patient with a right-sided stroke has spatial-perceptual deficits, tends to minimize problems, has a short attention span, is impulsive, and may have impaired judgment. Safety is the biggest concern for this patient. Hemiplegia occurs on the left side of this patient's body. The patient with a left-sided stroke has hemiplegia on the right, is more likely to have communication problems, and needs mobility assistance on the right side with food placed on the left side if the patient needs to be fed after a swallow evaluation has taken place.

The nurse is discharging a patient admitted with a transient ischemic attack (TIA). For which medications might the nurse expect to provide discharge instructions? Select all that apply. a. Ticlopidine b. Clopidogrel c. Enoxaparin d. Dipyridamole e. Enteric-coated aspirin f. Tissue plasminogen activator (tPA)

a. Ticlopidine b. Clopidogrel d. Dipyridamole e. Enteric-coated aspirin Aspirin is the most frequently used antiplatelet agent. Other drugs to prevent clot formation include clopidogrel, dipyridamole, ticlopidine, combined dipyridamole and aspirin, and anticoagulant drugs such as oral warfarin. Tissue plasminogen activator is a fibrinolytic medication used to treat ischemic stroke, not prevent TIAs or strokes.

Which sensory-perceptual deficit is associated with left-sided 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

c. Slow and possibly fearful performance of tasks Patients with a left-sided 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 are more commonly associated with a right-sided stroke.

A female patient has left-sided hemiplegia after an ischemic stroke 4 days earlier. How should the nurse promote skin integrity? a. Position the patient on her weak side the majority of the time. b. Alternate the patient's positioning between supine and side-lying. c. Avoid the use of pillows in order to promote independence in positioning. d. Establish a schedule for the massage of areas where skin breakdown emerges.

b. Alternate the patient's positioning between supine and side-lying. A position change schedule should be established for stroke patients. An example is side-back-side, with a maximum duration of 2 hours for any position. The patient should be positioned on the weak or paralyzed side for only 30 minutes. Pillows may be used to facilitate positioning. Areas of skin breakdown should never be massaged.

When providing care to the patient with an acute stroke, which duty can be delegated to the LPN/LVN? a. Screen patient for tPA eligibility. b. Assess the patient's ability to swallow. c. Administer scheduled anticoagulant medications. d. Place equipment needed for seizure precautions in room.

c. Administer scheduled anticoagulant medications. Assessment and screening are considered part of the registered nurse scope of practice. The LPN/LVN can administer PO or subcutaneous anticoagulant medications. Anticoagulant medications are considered high risk and should be double checked with another LPN/LVN or RN. The UAP can place equipment needed for seizure precautions in the room.

The nurse is planning psychosocial support for the family of the patient who suffered a stroke. What factor will have the greatest impact on family coping? a. Specific patient neurologic deficits b. The patient's ability to communicate c. Rehabilitation potential of the patient d. Presence of complications of a stroke

c. Rehabilitation potential of the patient Although a patient's neurologic deficit might initially be severe, the ability of the patient to recover is most likely to positively impact the family's coping. Providing explanations and emotional support beginning in the acute phase through the rehabilitation phase will facilitate coping. Emphasizing successes will offer the most realistic hope for the patient's rehabilitation and helps maintain hope for the patient's future abilities.

The nurse in a primary care provider's office is assessing several patients today. Which patient is most at risk for a stroke? a. A 92-yr-old female patient who takes warfarin (Coumadin) for atrial fibrillation b. A 28-yr-old male patient who uses marijuana after chemotherapy to control nausea c. A 42-yr-old female patient who takes oral contraceptives and has migraine headaches d. A 72-yr-old male patient who has hypertension and diabetes mellitus and smokes tobacco

d. A 72-yr-old male patient who has hypertension and diabetes mellitus and smokes tobacco Stroke risk increases after 65 years of age. Strokes are more common in men. Hypertension is the single most important modifiable risk factor for stroke. Diabetes mellitus is a significant stroke risk factor, and smoking nearly doubles the risk of a stroke. Other risk factors include drug abuse (especially cocaine), high-dose oral contraception use, migraine headaches, and untreated heart disease such as atrial fibrillation.

A 74-yr-old man who has right-sided extremity paralysis related to a thrombotic stroke develops constipation. Which action should the nurse take first? a. Assist the patient to the bathroom every 2 hours. b. Provide incontinence briefs to wear during the day. c. Administer a bisacodyl (Dulcolax) rectal suppository every day. d. Arrange for several servings per day of cooked fruits and vegetables.

d. Arrange for several servings per day of cooked fruits and vegetables. Patients after a stroke frequently have constipation. Dietary management includes the following: fluid intake of 2500 to 3000 mL daily, prune juice (120 mL) or stewed prunes daily, cooked fruit three times daily, cooked vegetables three times daily, and whole-grain cereal or bread three to five times daily. Patients with urinary incontinence should be assisted to the bathroom every 2 hours. Suppositories may be ordered for short-term management if the patient does not respond to increased fluid and fiber. Incontinence briefs are indicated as a short-term intervention for urinary incontinence.

The nurse observes a student nurse assigned to initiate oral feedings for a 68-yr-old woman with an ischemic stroke. Which action by the student will require the nurse to intervene? a. Giving the patient 1 oz of water to swallow b. Telling the patient to perform a chin tuck before swallowing c. Assisting the patient to sit in a chair before feeding the patient d. Assessing cranial nerves III, IV, and VI before attempting feeding

d. Assessing cranial nerves III, IV, and VI before attempting feeding The majority of patients after a stroke have dysphagia. The gag reflex and swallowing ability (cranial nerves IX and X) should be assessed before the first oral feeding. Cranial nerves III, IV, and VI are responsible for ocular movements. To assess swallowing ability, the nurse should elevate the head of the bed to an upright position (unless contraindicated) and give the patient a small amount of crushed ice or ice water to swallow. The patient should remain in a high Fowler's position, preferably in a chair with the head flexed forward, for the feeding and for 30 minutes following.

The nurse is teaching a senior citizen's group about signs and symptoms of a stroke. Which statement by the nurse would provide accurate information? a. "Take the person to the hospital if a headache lasts for more than 24 hours." b. "Stroke symptoms usually start when the person is awake and physically active." c. "A person with a transient ischemic attack has mild symptoms that will go away." d. "Call 911 immediately if a person develops slurred speech or difficulty speaking."

d. Call 911 immediately if a person develops slurred speech or difficulty speaking." Medical assistance should be obtained immediately for someone with signs and symptoms of a stroke such as sudden numbness; weakness; paralysis of the face, arm, or leg (especially on one side of the body); sudden confusion; trouble speaking or understanding; slurred speech; sudden trouble seeing in one or both eyes; sudden trouble walking; dizziness; loss of balance or coordination; or a sudden, severe headache with no known cause. A person with signs and symptoms of a transient ischemic attack should seek medical attention immediately because it is unknown if the symptoms will resolve or persist and progress to a stroke. Onset of signs and symptoms of a stroke vary depending on the type. Onset of an ischemic thrombotic stroke usually occurs at rest. Onset of an ischemic embolic stroke is not related to rest or activity, and onset of a hemorrhagic stroke usually occurs with activity.

The female patient has been brought to the emergency department complaining of the most severe headache of her life. Which type of stroke should the nurse anticipate? a. TIA b. Embolic stroke c. Thrombotic stroke d. Subarachnoid hemorrhage

d. Subarachnoid hemorrhage Headache is common in a patient who has a subarachnoid hemorrhage or an intracerebral hemorrhage. A TIA is a transient loss of neurologic function usually without a headache. A headache may occur with an ischemic embolic stroke, but severe neurologic deficits are the initial symptoms. The ischemic thrombotic stroke manifestations progress in the first 72 hours as infarction and cerebral edema increase.

Which intervention is most appropriate when communicating with a patient with aphasia after a stroke? a. Present several thoughts at once so that the patient can connect the ideas. b. Ask open-ended questions to provide the patient the opportunity to speak. c. Finish the patient's sentences to minimize frustration associated with slow speech. d. Use simple, short sentences accompanied by visual cues to enhance comprehension.

d. Use simple, short sentences accompanied by visual cues to enhance comprehension. When communicating with a patient with aphasia, the nurse should present one thought or idea at a time. Ask questions that can be answered with a "yes," "no," or simple word. Use visual cues and allow time for the individual to comprehend and respond to conversation.