Ch 15
stroke
an interruption of blood flow to the brain that results in the loss of brain function; also called cerebrovascular accident (CVA)
Which of the following MOST accurately describes the cause of an ischemic stroke?
blockage of a cerebral artery
a patient who is possibly experiencing a stroke is not eligible for thrombolytic (fibrinolytic) therapy if he or she
has bleeding within the brain
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she:
has bleeding within the brain.
ischemic stroke
occurs when blood flow to part of the brain is cut off by blockage inside a blood vessel
You are caring for a semiconscious man with left-sided paralysis. His airway is patent and his respirations are 14 breaths/min with adequate tidal volume. Treatment for this patient should include:
oxygen via a nonrebreathing mask, left lateral recumbent position, and transport.
The principal clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia:
usually have an altered mental status or decreased level of consciousness.
the principle clinical difference between a stroke and hypoglycemia is that patients with hypoglycemia
usually have an altered mental status or decreased level or consciousness
hemiparesis
weakness on one side of the body
hemorrhagic stroke
when a blood vessel ruptures, causing increased pressure in the brain and subsequent brain damage
when obtaining medical history information from the family of a suspected stroke patient, it is MOST important to determine: A) when the patient last appeared normal. B) if there is a family history of a stroke. C) if the patient has been hospitalized before. D) the patient's overall medication compliance
when the patient last appeared normal
when obtaining medical history information from the family of a suspected stroke patient, it is most important to determine
when the patient last appeared normal
cerebrovascular accident
(CVA/stroke) an interruption of blood flow to the brain that results in the loss of brain function
transient ischemic attack
(TIA) a disorder of the brain in which cells temporarily stop working because of insufficient oxygen, causing stroke like symptoms that resolve completely within 24 hours of onset
What Glasgow Coma Scale (GCS) score would you assign to a patient who responds to painful stimuli, uses inappropriate words, and maintains his or her arms in a flexed position?
8
what glascow coma scale would you assign to a patient who responds to painful stimuli, uses inappropriate words, and flexes his or her arms in response to pain?
8
which of the following medications is not used to treat patients with a history of seizures? A) Tegretol B) Dilantin C) Dilaudid D) Phenobarbital
Dilaudid
"tips on vowels"
T-trauma I-infection P-psychogenic causes S-seizure/syncope A-alcohol E-electrolytes I-insulin O-opiates U-uremia
Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?
a 17-year-old male with depression and anxiety
which of the following patients would most likely demonstrate typical signs of infection or fever? A) an 88-year-old male with chronic renal problems B) a 17-year-old male with depression and anxiety C) a 3-month-old female who was born prematurely D) a 35-year-old female in the later stages of AIDS
a 17-year-old male with depression and anxiety
Which of the following patients would MOST likely demonstrate typical signs of infection, such as a fever?
a 17-year-old male with no past medical history
embolus
a blood clot or other substance in the circulatory system that travels to a blood vessel where it causes a blockage
thrombosis
a blood clot that forms at the site of blockage
hypoglycemia
a condition characterized by a low blood glucose level
status epilepticus
a condition in which seizures recur every few minutes or last more than 30 minutes
ischemia
a lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow; potentially reversible because permanent injury has not yet occurred
postictal state
a period following a seizure lasting between 5 and 30 minutes; characterized by labored respirations and some degree of altered mental status
you are assessing a 49-year-old man who, according to his wife, experienced a sudden, severe headache and then passed out. He is unresponsive and has slow, irregular breathing. his blood pressure is 190/94 mm Hg and his pulse rate is 50 beats/min. his wife tells you that he has hypertension and diabetes. he has MOST likely experienced: A) acute hypoglycemia. B) a ruptured cerebral artery. C) a complex partial seizure. D) an occluded cerebral artery.
a ruptured cerebral artery
for:When caring for a patient with documented hypoglycemia, you should be MOST alert for?
a seizure
when caring for a child with documented hypoglycemia, you should be most alert for
a seizure
partial seizure
a seizure affecting a limited portion of the brain
generalized seizure
a seizure characterized by twitching of all of the body's muscles that may last several minutes or more; formerly known as a grand mal seizure
Which of the following MOST accurately describes a simple partial seizure?
a seizure that begins in one extremity
which of the following most accurately describes a focal seizure? A) a seizure that begins in one extremity B) generalized seizures without incontinence C) a seizure that is not preceded by an aura D) a blank stare without muscle contractions
a seizure that begins in one extremity
When caring for a patient with documented hypoglycemia, you should be MOST alert for:
a seizure.
aura
a sensation experienced prior to a seizure; serves as a warning sign that a seizure is about to occur
coma
a state of profound unconsciousness from which one cannot be roused
tonic-clonic seizure
a type of seizure that features rhythmic back-and-forth motion of an extremity and body stiffness
a patient who is experiencing receptive aphasia is
able to speak clearly but has difficulty understanding
An area of swelling or enlargement in a weakened arterial wall is called:
an aneurysm.
a 58-year-old male presents with confusion, right-sided weakness, and slurred speech. as your partner is applying oxygen, it is most important for you to
ask his wife when she noticed symptoms
A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His wife is present and is very upset. As your partner is applying oxygen, it is MOST important for you to:
ask his wife when she noticed the symptoms.
when assessing arm movement of a patient with a suspected stroke, you should
ask the patient to close his or her eyes during the assessment
When assessing arm movement of a patient with a suspected stroke, you should:
ask the patient to close his or her eyes during the assessment.
Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should:
assist ventilations, perform a rapid exam, and prepare for immediate transport.
law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. she is wearing a medical alert bracelet that identifies her as an epileptic. there is an empty bottle of vodka next to the patient. you should: A) place a bite block in her mouth in case she has a seizure and transport at once. B) apply oxygen via a nonrebreathing mask, place her on her left side, and transport. C) assist ventilations, perform a rapid exam, and prepare for immediate transport. D) apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test.
assist ventilations, perform a rapid exam, and prepare for immediate transport.
which of the following most accurately describes the cause of an ischemic stoke? A) acute atherosclerotic disease B) narrowing of a carotid artery C) rupture of a cerebral artery D) blockage of a cerebral artery
blockage of a cerebral artery
the most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the
brain stem
muscle control and body coordination are controlled by the
cerebellum
Muscle control and body coordination are controlled by the:
cerebellum.
interruption of cerebral blood flow may result from all of the following, except: A) a thrombus B) cerebral vasodilation C) an acute arterial rupture D) an embolism
cerebral vasodilation
the three major parts of the brain are the
cerebrum, cerebellum, and brain stem
The three major parts of the brain are the
cerebrum, cerebellum, and brain stem.
The three major parts of the brain are the:
cerebrum, cerebellum, and brain stem.
a 35-year-old mildly obese woman is complaining of localized pain in the upper right quadrant with referred pain to the right shoulder. the most likely cause of her pain is
cholecystitis
successful treatment of a stroke depends on whether or not
clot-buster therapy is given within 2-3 hours of symptom onset
Which of the following MOST accurately describes what the patient will experience during the postictal state that follows a seizure?
confusion and fatigue
which of the following most accurately describes the postictal state that follows a seizure? A) rapidly improving level of consciousness B) dazed, confused, or combative appearance C) hyperventilation and hypersalivation D) gradually decreasing level of consciousness
dazed, confused, or combative appearance
A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. Your initial impression is that the patient is having a stroke. The patient's wife is present and she is very upset. As your partner is applying oxygen, which of the following has a direct impact on how this patient will be treated once he is taken to the ER?
determine how long this has been happening
A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min and adequate. In addition to high-flow oxygen, further treatment should include:
dimming the lights in the back of the ambulance and transporting without lights and siren.
a patient whose speech is slurred and difficult to understand is experiencing
dysarthria
A patient whose speech is slurred and difficult to understand is experiencing:
dysarthria.
the anterior aspect of the cerebrum controls
emotion
during the initial assessment of a semiconscious 70-year-old female, you should
ensure a patent airway and support ventilation as needed
During the primary assessment of a semiconscious 70-year-old female, you should:
ensure a patent airway and support ventilation as needed.
a patient without a history of seizures experiences a sudden convulsion. the least likely cause of this seizure is
epilepsy
A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is
epilepsy.
A patient without a history of seizures experiences a sudden convulsion. The LEAST likely cause of this seizure is:
epilepsy.
The spinal cord exits the cranium through the:
foramen magnum
the spinal cord exits the cranium through the
foramen magnum
seizure
generalized, uncoordinated muscular activity associated with loss of consciousness; a convulsion
The left cerebral hemisphere controls
he right side of the body.
Which of the following medications is NOT used to treat patients with a history of
hydromorphone (Dilaudid)
Which of the following medications is NOT used to treat patients with a history of seizures?
hydromorphone (Dilaudid)
the most significant risk factor for a hemorrhagic stroke is
hypertension
The MOST significant risk factor for a hemorrhagic stroke is:
hypertension.
which of the following conditions would most likely mimic the signs and symptoms of a stroke? A) alcohol intoxication B) acute poisoning C) hypoglycemia D) high fever
hypoglycemia
which of the following conditions would be least likely to mimic the signs and symptoms of a stroke? A) postictal state B) hypoglycemia C) intracranial bleeding D) hypovolemia
hypovolemia
you are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. your initial assessment reveals that the patient is pulseless and apneic. you should
initiate CPR and attach an AED as soon as possible
you are transporting a semiconscious patient to the hospital. en route, you note that the patient's mental status is not improving, despite 100% supplemental oxygen. you should suspect that this patient
is hypoglycemic
the mental status of a patient who has experienced a typical seizure
is likely to improve over a period of 5 to 30 minutes
The mental status of a patient who has experienced a typical seizure:
is likely to improve over a period of 5 to 30 minutes.
you receive a call to a residence, where a neighbor has found the resident, a 40-year-old female, semiconscious on her living room floor. during your assessment you discover a bottle of Dilantin on a nearby table. you should be most suspicious that this patient
is postictal following a seizure
individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the
liver
Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the:
liver.
You arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. She has a small amount of vomitus draining from the side of her mouth. After protecting her from further injury, you should:
maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high- flow oxygen.
you arrive at the residence of a 33-year-old woman who is experiencing a generalized seizure. she has a small amount of vomitus draining from the side of her mouth. after protecting her from further injury, you should:
maintain her airway with manual head positioning, suction her airway to remove the vomitus, insert a nasopharyngeal airway, and administer high-flow oxygen
Which of the following is NOT an assessment parameter included in the Cincinnati Prehospital Stroke Scale?
memory
which of the following is not an assessment parameter included in the Cincinnati Stoke Scale? A) memory B) arm drift C) facial droop D) speech
memory
You arrive at a local grocery store approximately 5 minutes after a 21-year-old female stopped seizing. She is confused and disoriented; she keeps asking you what happened and tells you that she is thirsty. Her brother, who witnessed the seizure, tells you that she takes phenytoin (Dilantin) for her seizures, but has not taken it in a few days. He also tells you that she has diabetes. In addition to applying high-flow oxygen, you should: A) administer one tube of oral glucose and prepare for immediate transport. B) place her in the recovery position and transport her with lights and siren. C) monitor her airway and breathing status and assess her blood glucose level. D) give her small cups of water to drink and observe for further seizure activity.
monitor her airway and breathing status and assess her blood glucose level
You are dispatched to a residence for a 66-year-old male who, according to family members, has suffered a massive stroke. Your primary assessment reveals that the patient is unresponsive, apneic, and pulseless. You should:
nitiate cardiopulmonary resuscitation (CPR) and attach an automated external defibrillator (AED) as soon as possible.
a patient with an altered mental status is
not thinking clearly or is incapable of being aroused
A patient with an altered mental status is:
not thinking clearly or is incapable of being aroused.
You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:
obtain a description of how the seizure developed
you arrive at a grocery store shortly after a 35-year-old male stopped seizing. your assessment reveals that he is confused and incontinent of urine. the patient's girlfriend tells you that he had a history of seizures and takes Tegretol. when obtaining further medical history from the girlfriend, it is most important to
obtain a description of how the seizure developed
You arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:
obtain a description of how the seizure developed.
ou arrive at a grocery store shortly after a 35-year-old male stopped seizing. Your assessment reveals that he is confused and incontinent of urine. The patient's girlfriend tells you that he has a history of seizures and takes carbamazepine (Tegretol). When obtaining further medical history from the girlfriend, it is MOST important to:
obtain a description of how the seizure developed.
you are caring for a conscious, confused patient with left-sided hemiparalysis. his airway is patent and his respirations are 22 breaths/min with adequate tidal volume. treatment for this patient should include
oxygen via nonrebreathing mask, left lateral recumbent position, and transport
An absence seizure is also referred to as a
petit mal seizure.
an absence seizure is also referred to as a
petite mal seizure
which of the following is a metabolic cause of a seizure? A) brain tumor B) massive stroke C) poisoning D) head trauma
poisoning
Status epilepticus is characterized by:
prolonged seizures without a return of consciousness.
status epilepticus is characterized by
prolonged seizures without a return on consciousness
in the immediate postictal state you should anticipate
rapid, deep respirations and fast heart rate
when transporting a stable stroke patient with unilateral hemiparalysis, it is best to place the patient in a
recumbent position with the paralyzed side down
You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should
repeat the arm drift test, but move the patient's arms into position yourself.
You are assessing the arm drift component of the Cincinnati Prehospital Stroke Scale on a 60-year-old woman. When she holds both of her arms out in front of her and closes her eyes, both of her arms immediately fall to her sides. You should:
repeat the arm drift test, but move the patient's arms into position yourself.
Which of the following conditions would MOST likely affect the entire brain?
respiratory failure or cardiopulmonary arrest
which of the following conditions would most likely affect the entire brain? A) blocked cerebral artery in the frontal lobe B) respiratory failure or cardiopulmonary arrest C) reduced blood supply to the left hemisphere D) ruptured cerebral artery in the occipital lobe
respiratory failure or cardiopulmonary arrest
febrile seizures
seizures that result from sudden high fevers, particularly in children
Which of the following conditions is NOT a common cause of seizures?
severe hypovolemia
which of the following conditions is not a common cause of seizures? A) acute alcohol withdrawal B) severe hypovolemia C) acute hypoglycemia D) poisoning or overdose
severe hypovolemia
a generalized seizure is characterized by
severe twitching of all the body's muscles
A generalized seizure is characterized by
severe twitching of all the body's muscles.
dysarthria
slurred speech
you are caring for a 70-year-old female with signs and symptoms of an acute stroke. she is conscious, has secretions in her mouth, and is breathing as a normal rate with adequate depth. you should
suction her oropharynx and apply 100% oxygen
You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, and is breathing at a normal rate with adequate depth. You should:
suction her oropharynx and apply 100% oxygen.
which of the following clinical signs would be most suggestive of a ruptured cerebral artery? A) unilateral hemiparesis B) nasal discharge of blood C) confusion and weakness D) sudden, severe headache
sudden, severe headache
aneurysm
swelling or enlargement of part of a blood vessel, resulting from the weakening of the vessel wall
a patient experiencing a tonic-clonic seizure exhibits
tachycardia, hyperventilation, sweating, and intense salivation
aphasia
the inability to understand and/or produce speech
a transient ischemic attack occurs when
the normal body processes destroy a clot in a cerebral artery
A transient ischemic attack (TIA) occurs when:
the normal body processes destroy a clot in a cerebral artery.
you respond to a residence for a child who is having a seizure. upon arrival at the scene, you enter the residence and find the mother holding her child, a male 2-year-old. the child is conscious and crying. according to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. you should
transport the child to the hospital and reassure the mother en route
You respond to a residence for a child who is having a seizure. Upon arrival at the scene, you enter the residence and find the mother holding her child, a 2-year-old male. The child is conscious and crying. According to the mother, the child had been running a high fever and then experienced a seizure that lasted approximately 3 minutes. You should:
transport the child to the hospital and reassure the mother en route.
the most appropriate treatment for a patient with severe abdominal pain and signs of shock includes
transporting the patient without delay
A patient who is experiencing aphasia is:
unable to produce or understand speech.
febrile seizures are
usually benign but should be evaluated