Chapter 62

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

"Emotional lability is common after a stroke, and it usually improves with time."

A client recently experienced a stroke with accompanying left-sided paralysis. His family voices concerns about how to best interact with him. They report the client doesn't seem aware of their presence when they approach him on his left side. What advice should the nurse give the family? a. "This condition is temporary." b. "The client is feeling an emotional loss. He'll eventually start acknowledging you on his left side." c. "The client is unaware of his left side. You need to encourage him to interact from this side." d. "The client is unaware of his left side. You should approach him on the right side."

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

Which term refers to the failure to recognize familiar objects perceived by the senses? a. Agnosia b. Agraphia c. Perseveration d. Apraxia

Agnosia

Which of the following is the most common side effect of tissue plasminogen activator (tPA)? a. Bleeding b. Hypertension c. Headache d. Increased intracranial pressure (ICP)

Bleeding

A client is brought to the emergency department with symptoms of a cerebrovascular accident (CVA). The nurse would anticipate which diagnostic evaluation to be completed prior to initiation of treatment? a. Lumbar puncture b. Chest x-ray c. Brain CT scan or MRI d. Prothrombin level

Brain CT scan or MRI

A patient presents to the emergency room with complaints of having an "exploding headache" for the last 2 hours. The patient is immediately seen by a triage nurse who suspects the patient is experiencing a stroke. Which of the following is a possible cause based on the characteristic symptom? a. Cerebral aneurysm b. Large artery thrombosis c. Small artery thrombosis d. Cardiogenic emboli

Cerebral aneurysm

The nurse is caring for a client with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. Which postoperative finding would cause the nurse the most concern? a. Neck pain rated 3 of 10 (on a 0 to 10 pain scale) b. Difficulty swallowing c. Mild neck edema d. Blood pressure 128/86 mm Hg

Difficulty swallowing

The nurse is caring for a client with aphasia. Which strategy will the nurse use to facilitate communication with the client? a. Speaking loudly b. Avoiding the use of hand gestures c. Speaking in complete sentences d. Establishing eye contact

Establishing eye contact

How often should neurologic assessments and vital signs be taken initially for the patient receiving tissue plasminogen activator (tPA)? a. Every 45 minutes b. Every hour c. Every 30 minutes d. Every 15 minutes

Every 15 minutes

A client undergoes cerebral angiography for evaluation of a subarachnoid hemorrhage. Which findings indicate spasm or occlusion of a cerebral vessel by a clot? a. Tachycardia, tachypnea, and hypotension b. Hemiplegia, seizures, and decreased level of consciousness c. Nausea, vomiting, and profuse sweating d. Difficulty breathing or swallowing

Hemiplegia, seizures, and decreased level of consciousness

A healthcare provider orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? a. Dexamethasone b. Methyldopa c. Heparin sodium d. Phenytoin

Heparin sodium

Which is a contraindication for the administration of tissue plasminogen activator (t-PA)? a. Age 18 years or older b. Intracranial hemorrhage c. Systolic blood pressure less than or equal to 185 mm Hg d. Ischemic stroke

Intracranial hemorrhage

The nurse is caring for a client admitted with a stroke. Imaging studies indicate an embolus partially obstructing the right carotid artery. What type of stroke does the nurse know this client has? a. Ischemic b. Hemorrhagic c. Right-sided d. Left-sided

Ischemic

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings? a. Left-sided cerebrovascular accident (CVA) b. Right-sided cerebrovascular accident (CVA) c. Transient ischemic attack (TIA) d. Completed Stroke

Left-sided cerebrovascular accident (CVA)

Which of the following is the initial diagnostic in suspected stroke? a. Noncontrast computed tomography (CT) b. CT with contrast c. Magnetic resonance imaging (MRI) d. Cerebral angiography

Noncontrast computed tomography (CT)

The nurse practitioner is able to correlate a patient's neurologic deficits with the location in the brain affected by ischemia or hemorrhage. For a patient with a left hemispheric stroke, the nurse would expect to see: a. Impulsive behavior. b. Right-sided paralysis. c. Left visual field deficit. d. Spatial-perceptual deficits.

Right-sided paralysis.

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? a. Semi-Fowler's b. Supine c. High-Fowler's d. Prone

Semi-Fowler's

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are: a. Weakness on one side of the body and difficulty with speech b. Confusion or change in mental status c. Foot drop and external hip rotation d. Severe headache and early change in level of consciousness

Severe headache and early change in level of consciousness

Health promotion efforts to decrease the risk for ischemic stroke involve encouraging a healthy lifestyle including a. a low-fat, low-cholesterol diet and increased exercise. b. a high-protein diet and increased weight-bearing exercise. c. a low-cholesterol, low-protein diet and decreased aerobic exercise. d. eating fish no more than once a month.

a low-fat, low-cholesterol diet and increased exercise.

A client diagnosed with a stroke is ordered to receive warfarin. Later, the nurse learns that the warfarin is contraindicated and the order is canceled. The nurse knows that the bestalternative medication to give is a. dipyridamole. b. clopidogrel. c. aspirin. d. ticlopidine.

aspirin.

A nurse is providing care to a client who has had a stroke. Which symptoms are consistent with left-sided stroke? a. cautious behavior, deficits in left visual fields, misjudgment of distances b. expressive aphasia, defects in the right visual fields, problems with abstract thinking c. impulsive behavior, poor judgment, deficits in left visual fields d. problems with abstract thinking, impairment of short-term memory, poor judgment

impulsive behavior, poor judgment, deficits in left visual fields

During a class on stroke, a junior nursing student asks what the clinical manifestations of stroke are. What would be the instructor's best answer? a. "Clinical manifestations of a stroke generally include aphasia, one-sided flaccidity, and trouble swallowing." b. "Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation." c. "Clinical manifestations of a stroke depend on how quickly the clot can be dissolved." d. "Clinical manifestations of a stroke are highly variable, depending on the cardiovascular health of the client."

"Clinical manifestations of a stroke depend on the area of the cortex, the affected hemisphere, the degree of blockage, and the availability of collateral circulation."

A patient is admitted via ambulance to the emergency room of a stroke center at 1:30 p.m. with symptoms that the patient said began at 1:00 p.m. Within 1 hour, an ischemic stroke had been confirmed and the doctor ordered tPA. The nurse knows to give this drug no later than what time? a. 2:00 p.m. b. 3:00 p.m. c. 4:00 p.m. d. 7:00 p.m.

4:00 p.m.

A client has been diagnosed as having global aphasia. The nurse recognizes that the client will be unable to do perform which action? a. Comprehend spoken words b. Form understandable words c. Speak at all d. Form understandable words and comprehend spoken words

Form understandable words and comprehend spoken words

Which term will the nurse use when referring to blindness in the right or left half of the visual field in both eyes? a. Scotoma b. Diplopia c. Homonymous hemianopsia d. Nystagmus

Homonymous hemianopsia

Which of the following is accurate regarding a hemorrhagic stroke? a. Main presenting symptom is an "exploding headache." b. Functional recovery usually plateaus at 6 months. c. One of the main presenting symptoms is numbness or weakness of the face. d. It is caused by a large-artery thrombosis.

Main presenting symptom is an "exploding headache."

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

Maintaining a patent airway

Which is a modifiable risk factor for transient ischemic attacks and ischemic strokes? a. Thyroid disease b. Advanced age c. Social drinking d. Smoking

Smoking

A client reports light-headedness, speech disturbance, and left-sided weakness that have lasted for several hours. In the examination, an abnormal sound is auscultated in an artery leading to the brain. What is the term for the auscultated discovery? a. diplopia b. bruit c. atherosclerotic plaque d. TIA

bruit

A nurse is reading a journal article about stroke and the underlying causes associated with this condition. The nurse demonstrates understanding of the information when identifying which subtype of stroke as being due to atrial fibrillation? a. large-artery thrombotic b. small, penetrating artery thrombotic c. cryptogenic d. cardio embolic

cardio embolic

A nurse in a rehabilitation facility is coordinating the discharge of a client who is tetraplegic. The client, who is married and has two children in high school, is being discharged to home and will require much assistance. Who would the discharge planner recognize as being the most important member of this client's care team? a. chaplain b. physical therapist c. spouse d. home care nurse

spouse

Which interventions would be recommended for a client with dysphagia? Select all that apply. a. Place food on the affected side of the mouth. b. Test the gag reflex before offering food or fluids. c. Allow ample time to eat. d. Assist the client with meals.

-Test the gag reflex before offering food or fluids. -Allow ample time to eat. -Assist the client with meals.

The nurse is caring for a client with dysphagia. Which intervention would be contraindicated while caring for this client? a. Placing food on the affected side of the mouth b. Assisting the client with meals c. Allowing ample time to eat d. Testing the gag reflex before offering food or fluids

Placing food on the affected side of the mouth

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following? a. Intracranial pressure is increased by a space-occupying bleed. b. Thrombolytic therapy has a time window of only 3 hours. c. A ruptured intracranial aneurysm must quickly be repaired. d. A ruptured arteriovenous malformation will cause deficits until it is stopped.

Thrombolytic therapy has a time window of only 3 hours.