EAQ #6 Transient Ischemic Attack (TIA) and Stroke & Neuro and M/S

Which is the standard ceiling dose of acetaminophen (per day) in the treatment of osteoarthritis (OA)? Record your answer using a whole number.

4,000 mg The standard ceiling dose of acetaminophen is 4000 mg each day. However, patients may be at risk for liver damage if they take more than 3000 mg daily, have alcoholism, or have liver disease. Older adults are particularly at risk because of normal changes of aging such as slowed excretion of drug metabolites.

The nurse provides which medication education for a patient who receives a prescription for capsaicin cream to treat osteoarthritis? A. "You may have drowsiness for a short period after applying it." B. "You may have a burning sensation for a short period after applying it." C. "You may have increased blood pressure for a short period after applying it." D. "You may have increased blood sugar levels for a short period after applying it."

B. "You may have a burning sensation for a short period after applying it." Capsaicin is an over-the-counter (OTC) medication that works by blocking pain neurotransmitters. Capsaicin may cause a burning sensation on the skin for a short time after application. Capsaicin cream does not cause drowsiness, an increase in blood pressure, or an increase in blood sugar levels.

The nurse recognizes that which patient assessment finding is consistent with a stroke in the right hemisphere? A. Slowness B. Unawareness of any deficit C. Anger and frustration D. Deficit in the right visual field

B. Unawareness of any deficit As a result of right-hemisphere lesions, the patient may be impulsive and seemingly unaware of any deficit. Deficit in the right visual field, slowness, and anger and frustration are the symptoms of a left-hemisphere stroke.

How many categories are on the National Institutes of Health Stroke Scale (NIHSS)? A. 8 B. 9 C. 10 D. 11

D. 11 There are 11 categories of the NIHSS, including level of consciousness (LOC), LOC questions, and LOC commands; best gaze; visual; facial palsy; motor (arm); motor (leg); limb ataxia; sensory; best language; dysarthria; and extinction and inattention. There are more categories in the NIHSS than 8, 9, or 10.

Which statement is true regarding the pain associated with osteoarthritis? A. It worsens after rest in early stage of the disease. B. It is caused by the nerve supply to the cartilage. C. It diminishes after activity in early stages of the disease. D. It is caused by spasms of the surrounding muscles.

D. It is caused by spasms of the surrounding muscles. Because cartilage does not have a nerve supply, the pain is caused by joint and soft tissue involvement and by spasms of the surrounding muscles. The pain diminishes after rest in the early stages of the disease. Pain will increase after activity in the early stages of the disease.

After providing education for a community group about transient ischemic attacks (TIAs), the nurse identifies that which statement by a group member indicates the need for further teaching? A. "There is a loss of central vision." B. "Symptoms last less than 24 hours." C. "A TIA is a warning sign for ischemic stroke." D. "A TIA of any kind is a medical emergency."

A. "There is a loss of central vision." A TIA leads to loss of peripheral vision, not central vision. This results in tunnel vision. A TIA lasts a few minutes to fewer than 24 hours. TIAs are warning signs for ischemic stroke. A stroke of any kind is a medical emergency. This includes TIAs, which result from a brief interruption in cerebral blood flow.

Which is a main cause of primary osteoarthritis (OA)? A. Aging B. Obesity C. Joint injury D. Heavy manual work

A. Aging Primary OA is caused by aging and genetic factors. As people age, proteoglycans, synovial fluid, and water decrease in the joint. Enzymes in the joint break down the articular matrix, and the cartilage erodes. Eventually, inflammation will continue to cause deterioration in the joint space. Obesity, joint injury, and heavy manual work are causes of secondary OA.

Which is a factor that may lead to osteoarthritis (OA)? Select all that apply. A. Aging B. Obesity C. Genetics D. Rheumatoid arthritis (RA) E. Systemic lupus erythematosus (SLE)

A. Aging B. Obesity C. Genetics OA is a common connective tissue disease characterized by progressive degradation of the cartilage in movable joints. Aging, obesity, and genetic factors are responsible for OA. Aging contributes to a decrease in bone density. Obesity can increase pressure on the joints. Recent studies support genetic changes may contribute to cartilage destruction, osteophyte formation, or the inability of cartilage to repair itself. RA and SLE do not increase the risk for OA; they are inflammatory disorders of the connective tissue.

To prevent complications, which drug needs to be discontinued before a total knee arthroplasty (TKA)? Select all that apply. A. Anticoagulant therapy B. Antidiabetic agent C. Antihypertensive medication D. Antiplatelet medication E. NSAID

A. Anticoagulant therapy D. Antiplatelet medication E. NSAID Some drugs, such as NSAIDs and anticoagulants or antiplatelets, are discontinued 5 to 10 days before surgery to prevent surgical bleeding. The nurse should ask patients to check with their surgeon about which drugs they can take the morning of surgery with a small amount of water, including antihypertensives, thyroid hormone supplements, and antidiabetic agents.

The nurse identifies which etiologic factor when reviewing the history of a patient who is hospitalized with an embolic stroke? A. Atrial fibrillation B. Aortic aneurysm C. Diabetes mellitus D. Irritable bowel disease

A. Atrial fibrillation The source of most embolic strokes is typically the heart. Emboli occur in patients with a history of atrial fibrillation, ischemic heart disease, or myocardial infarction. Diabetes, aortic aneurysm, and irritable bowel disease are not primary risk factors.

When reviewing a postoperative plan of care for a patient who has undergone total hip arthroplasty (THA), the nurse expects to find which intervention that addresses hip dislocation? Select all that apply. A. Avoid hip flexion beyond 90 degrees. B. Use aseptic technique for wound care. C. Instruct the patient to perform leg exercises. D. Instruct the patient to wear compression stockings. E. Assess for acute pain, rotation, and extremity shortening.

A. Avoid hip flexion beyond 90 degrees. E. Assess for acute pain, rotation, and extremity shortening. Hip flexion beyond 90 degrees should be avoided because it may lead to dislocation and also causes pain in the hip. Acute pain, rotation, and extremity shortening should be assessed after a THA. Using aseptic techniques for wound care would help in preventing infections. Instructing the patient to perform leg exercises or to wear compression stockings would help prevent venous thromboembolism.

Which test is used to detect osteoarthritis (OA)? Select all that apply. A. C-reactive protein assay B. X-ray studies C. Rheumatoid factor assay D. Antinuclear antibody test E. MRI

A. C-reactive protein assay B. X-ray studies E. MRI Assessment for OA includes serologic and imaging studies. The high-sensitivity C-reactive protein (hsCRP) may be slightly elevated when synovial inflammation occurs. Imaging studies of OA include routine x-ray images and MRI to determine structural joint changes. Rheumatoid factor assay and antinuclear antibody testing are used for diagnosing rheumatoid arthritis.

Which drug is used to reduce postoperative pain in a patient after a total knee arthroplasty? A. Capsaicin B. Cefazolin C. Dalteparin D. Enoxaparin

A. Capsaicin Capsaicin is a product used for reducing postoperative pain after total knee arthroplasty. It binds to C-fiber receptors and facilitates the release of extra calcium to enter the nerve cells. Cephalosporins such as cefazolin are antibiotics given 1 hour before surgery to reduce the risk for infection. Dalteparin and enoxaparin are anticoagulants given after surgery to prevent blood clots.

Which medication does the nurse expect to find as a prescription for a patient with osteoarthritis (OA)? Select all that apply. A. Diclofenac B. Acetaminophen C. Methotrexate D. Leflunomide E. Azathioprine

A. Diclofenac B. Acetaminophen Diclofenac is an NSAID that is used for a short period for the treatment of osteoarthritis. Acetaminophen is also prescribed for patients with OA. Methotrexate and leflunomide are useful in the treatment of rheumatoid arthritis. Azathioprine is an immunosuppressant used in the treatment of rheumatoid arthritis.

When observing personnel who are providing care for a patient with a stroke, the nurse recognizes that which action warrants immediate intervention? A. Gently pulling on the patient's flaccid arm to assist the patient up in bed B. Using pictures to aid in communicating with a patient if aphasia is present C. Reminding family members that the patient may have altered emotions D. Turning the patient's plate halfway through the meal if hemianopsia is present

A. Gently pulling on the patient's flaccid arm to assist the patient up in bed Health care providers should avoid pulling on an affected or flaccid arm because it could result in subluxation or injury. Turning the patient's plate and using pictures are appropriate actions. It is appropriate (and correct) for health care personnel to tell the family that the patient may experience emotional lability after a stroke.

The nurse recalls that which medication that is used to treat osteoarthritis has side effects of black-colored stools, dyspepsia, and shortness of breath? A. Ibuprofen B. Lidocaine C. Glucosamine D. Cyclobenzaprine

A. Ibuprofen The side effects associated with ibuprofen, which is an NSAID, include dark, tarry (black-colored) stools indicative of GI bleeding; indigestion that may result in stomach upset; and renal failure associated with abnormal levels of urea and creatinine in the blood. The side effects associated with lidocaine, which is a local anesthetic agent, include metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, and seizures. The side effects associated with glucosamine include rashes, headache, and GI disturbances, especially diarrhea and drowsiness. The side effect associated with cyclobenzaprine is acute confusion.

The brain must receive a constant flow of which substance for normal function? Select all that apply. A. Oxygen B. Sodium C. Glucose D. Serotonin E. Potassium F. Acetylcholine

A. Oxygen C. Glucose The brain cannot store oxygen or glucose; therefore it must receive a constant flow of blood to provide these substances to maintain normal function. Most of the body's sodium is stored in blood and in the fluid around cells, including within the brain. About 5% of the body's serotonin is synthesized and stored in the brain within serotonergic neurons. Potassium is mainly stored in body cells. However, the body only retains the amount needed to function properly at the moment. Acetylcholine is produced by cholinergic cells in several places within the brain. It is stored until the neurotransmitter needs to be released.

Which statement describes the symptoms of a transient ischemic attack (TIA)? A. They typically resolve within 30 to 60 minutes. B. They are limited to the speech area. C. They manifest in the upper extremities. D. They last longer than 24 hours but less than a week.

A. They typically resolve within 30 to 60 minutes. By definition, the symptoms of a TIA resolve typically within 30 to 60 minutes. TIA symptoms can manifest as weakness in the arms, hands, or legs, and gait disturbance is typical. Speech deficits (aphasia, dysarthria) can result from TIA, but symptoms are not limited to this area. Typically, symptoms of a TIA resolve within 30 to 60 minutes but may last as long as 24 hours; they do not usually last for more than 24 hours.

The nurse identifies which reason for prescribing tranexamic acid (TXA) for a patient before a total hip arthroplasty (THA)? A. To prevent anemia B. To prevent infection C. To prevent vomiting D. To prevent prosthetic failure

A. To prevent anemia For most patients, TXA is used to reduce blood loss during the THA surgical procedure. TXA is an antifibrinolytic agent that improves postoperative hemoglobin and hematocrit and decreases the need for blood transfusions. TXA is not prescribed to prevent infection, vomiting, or prosthetic failure.

Which type of stroke has a key feature of coma? A. Vertebrobasilar artery stroke B. Internal carotid artery stroke C. Middle cerebral artery stroke D. Anterior cerebral artery stroke

A. Vertebrobasilar artery stroke Vertebrobasilar artery strokes occur when blood flow through the vertebrobasilar region is reduced or stopped. This may lead to a coma. Internal carotid artery strokes, middle cerebral artery strokes, and anterior cerebral artery strokes may not lead to coma. The internal carotid artery supplies blood to the brain. The middle cerebral artery supplies blood to the cerebrum. The anterior cerebral artery supplies oxygenated blood to most of the portions of the frontal lobes and superior medial parietal lobes.

The nurse is caring for an older-adult patient with osteoarthritis and recognizes that which patient statement indicates that the patient is using effective coping strategies? A. "I do not know how long my spouse will be able to take care of me at home." B. "A transportation bus picks me up from the senior center three times a week so I can play cards." C. "I help with cooking, but I hurt so badly when I am performing this activity." D. "I do not know how much longer my neighbor can continue to help clean my house."

B. "A transportation bus picks me up from the senior center three times a week so I can play cards." Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support. Caregiving responsibilities can be a source of stress; the patient worrying about a spouse's caregiving abilities does not indicate that the patient is effectively coping. Routine tasks like cooking need to be reassigned, or effective pain management should be instituted before activities are undertaken to demonstrate effective coping. Neighbors are not reliable resources for in-home needs; asking a neighbor to help does not indicate that the patient is coping effectively.

After providing discharge education for the partner of a patient who experienced a stroke, the nurse identifies that which statement indicates the need for further teaching? A. "My partner may get depressed." B. "I should spend all of my time with my partner in case I'm needed." C. "My partner must take medication every day to help prevent another stroke." D. "The physical therapist will show us how to use the equipment so my partner can climb the stairs and get into and out of bed."

B. "I should spend all of my time with my partner in case I'm needed." Family members can start to feel socially isolated when caring for a loved one. The family may need to plan for regular respite care in a structured day-care respite program or through relief provided by a friend or neighbor. The life changes associated with stroke often cause a change in the patient's self-esteem. The patient who has had a stroke should maintain a regular medication regimen, such as anticoagulant therapy, to prevent another stroke. After the home health nurse has assessed the home environment, he or she will notify the health care provider of the need for ancillary services, such as a physical therapist. The physical therapist will identify adaptive equipment needs, will request them, and then will instruct the patient about their use, along with developing an exercise program.

An adult child of a patient who experienced a stroke that affected the frontal lobe tells the nurse, "My parent cries a lot and often can't state a reason for being upset." Which nursing response is best? A. "It sounds like your parent is depressed, so I will inform the health care provider." B. "When this part of the brain is affected, emotional lability may be a result." C. "A stroke in this part of the brain causes brainstem deterioration, which is the cause of this type of response." D. "Your parent is experiencing hemianopsia, which should begin to diminish over time."

B. "When this part of the brain is affected, emotional lability may be a result." If the frontal lobe has been injured by a stroke, the patient may experience emotional lability in which the patient laughs then cries, most often for no apparent reason. It is an uncontrollable response and should be explained to the family. Crying is not a symptom of brainstem deterioration, which would include respiratory problems, and it is not an exclusive symptom of depression. Hemianopsia leads to neglect of one side of the body.

Based on the American Stroke Association, alteplase can be given within how many hours from the onset of the symptoms of stroke? A. 1.5 hours B. 4.5 hours C. 6 hours D. 12 hours

B. 4.5 hours The most important factor in whether or not to give alteplase is the time between symptom onset and time seen in the stroke center. The American Stroke Association recommends that fibrinolytic therapy is started within 4.5 hours of symptom onset for most patients. Alteplase may be given if there has been more than 1.5 hours since the onset of the symptoms of stroke. Alteplase is not recommended for patients if it has been more than 4.5 hours since the onset of the symptoms of stroke.

The nurse monitors for which complication in a patient with a stroke who experiences dysphagia? A. Choking B. Aspiration C. Vomiting D. Respiratory arrest

B. Aspiration Aspiration is a frequent complication for patients with dysphagia. Many of these aspirations are "silent" and are not recognized until pulmonary complications occur. Choking and vomiting can occur with dysphagia but are not as common as aspiration. Respiratory arrest is not a direct complication of dysphagia.

When the nurse assesses a patient with osteoarthritis, which finding indicates crepitus? A. Inflammation near the joint B. Grating heard when the joint is palpated C. Enlarged joint with bone hypertrophy D. Bony nodules at the distal interphalangeal joint

B. Grating heard when the joint is palpated Crepitus is a condition in which the cartilage disintegrates and pieces of bone and cartilage float in the diseased joint. A grating sound can be heard because of loosened bone and cartilage in the joint. Secondary synovitis occurs if inflammation is present near the joint. An enlarged joint with bone hypertrophy indicates an advanced stage of the disease. Bony nodules at the distal interphalangeal joint indicate Heberden nodes.

Which finding in a patient's physical assessment may be associated with osteoarthritis? A. Depression B. Impaired mobility C. Altered body image D. Decreased quality of life

B. Impaired mobility Impaired mobility is a clinical manifestation in a patient with osteoarthritis. It occurs because of pain and inflammation in the joints. Depression, altered body image, and decreased quality of life are psychosocial changes associated with osteoarthritis.

The nurse anticipates which outcome when a patient presents with symptoms of an embolic stroke? A. Improvement within 24 hours of onset B. Improvement over several days C. Improvement over weeks to months D. Permanent deficits are likely

B. Improvement over several days Embolic strokes have a sudden onset of symptoms that include paralysis and expressive aphasia and tend to resolve over hours to days. Transient ischemic attacks resolve quickly, within 24 hours. Thrombotic strokes have a slower onset and resolve more slowly, sometimes taking weeks to months. Permanent deficits may occur with thrombotic strokes.

Which symptoms lead the nurse to suspect that a patient has experienced a right-hemisphere stroke? A. Aphasia and cautiousness B. Impulsiveness and unaware of any deficit C. Quick anger and frustration D. Inability to discriminate words

B. Impulsiveness and unaware of any deficit As a result of right-hemisphere lesions, the patient may be impulsive and seemingly unaware of any deficit. Aphasia, cautiousness, quick anger, frustration, and the inability to discriminate words are symptoms indicative of a left-hemisphere stroke.

The nurse suspects which type of stroke when a patient presents with perpetual, spatial, and visual field deficits? A. Internal carotid artery stroke B. Middle cerebral artery stroke C. Anterior cerebral artery stroke D. Posterior cerebral artery stroke

B. Middle cerebral artery stroke Perpetual, spatial, and visual deficits are key features of middle cerebral artery strokes. Contralateral hemiparesis, hemianopsia, blurred vision, and blindness are key features of internal carotid artery strokes. Contralateral hemiparesis, aphasia, and amnesia are clinical features of anterior cerebral artery strokes. Loss of deep sensation, decreased touch sensation, aphasia, and amnesia are clinical features of posterior cerebral artery strokes.

The nurse reviews a patient's medical record and recognizes which risk factor for osteoarthritis (OA)? A. Low body mass index (BMI) B. Obesity C. Childbearing age D. Male sex

B. Obesity Secondary OA occurs less often than primary disease and can result from joint injury and obesity. OA occurs in people who are obese much more commonly than in those who are not obese; a low BMI means that a patient is underweight. For patients with primary OA, the disease is caused by aging and genetic factors. Being male is not an identified risk factor.

When caring for a patient who is receiving IV fibrinolytic therapy to treat a stroke, the nurse recognizes that which assessment finding indicates the need to discontinue the infusion? A. Hypotension B. Report of severe headache C. Report of feeling warm D. Hyponatremia

B. Report of severe headache The nurse should discontinue the therapy and notify the health care provider if severe headache or hypertension, bleeding, nausea, or vomiting occur. The patient may feel warm as the medication enters the body. Sodium levels are unaffected during fibrinolytic therapy.

Which imaging assessment would be ordered for a patient with osteoarthritis? Select all that apply. A. Bubble study B. Routine x-ray view C. Specialized x-ray views D. Nuclear medicine studies E. MRI

B. Routine x-ray view C. Specialized x-ray views E. MRI Routine x-rays are useful in determining structural joint changes. Specialized x-ray views are obtained when the disease cannot be visualized on standard x-ray film but is suspected. MRI may be used to determine vertebral or knee involvement in patients with osteoarthritis. A bubble study is performed in an ECG to diagnose cardiac abnormalities. Nuclear medicine scans are not used for osteoarthritis; they are typically used to identify tumors or determine organ function.

Which neurologic event does the nurse suspect when the laboratory results of a patient who sustained a stroke show protein in the cerebrospinal fluid (CSF)? A. Embolic stroke B. Thrombotic stroke C. Hemorrhagic stroke D. Transient ischemic attack

B. Thrombotic stroke The presence of protein in the CSF is indicative of a thrombotic stroke. The CSF in patients experiencing an embolic stroke is normal, and protein is absent. The CSF in patients experiencing a hemorrhagic stroke is bloody, and protein is absent. The CSF is bloody and contains no protein in patients with hemorrhagic stroke. In patients experiencing a transient ischemic attack, the CSF is normal and has no protein.

The nurse questions which instruction that is listed on a patient education resource related to home care self-management of osteoarthritis? A. Do not bend at the waist. B. Turn doorknobs clockwise. C. Use a small pillow under the head. D. Use utensils with an extended handle for eating.

B. Turn doorknobs clockwise. Patients with osteoarthritis should turn doorknobs counterclockwise to avoid twisting the arm, which promotes ulnar deviation. Patients should bend at the knees and not the waist because the back should be kept straight. A small pillow should be used under the head to support the neck. Utensils with an extended handle should be used to assist with eating.

After providing discharge teaching about rehabilitation for a patient who has had a stroke, the nurse identifies that which statement demonstrates understanding of the education? A. "Rehabilitation and physical therapy mean the same thing." B. "Frequent stimulation will help with the rehabilitation process." C. "The rehabilitation therapist will help identify changes needed at home." D. "I will no longer need to take blood pressure medication."

C. "The rehabilitation therapist will help identify changes needed at home." The rehabilitation therapist and home health professionals assist the patient and family in adapting the home environment to the patient's needs and assess the patient's need for therapy. Any medication regimen for the patient must be maintained. Rehabilitation is much more comprehensive than physical therapy. The family should develop a home routine that provides structure, repetition, and consistency.

The nurse provides which discharge instruction for a patient who underwent total hip arthroplasty (THA) and is prescribed anticoagulation therapy? A. Use an abduction pillow between the legs. B. Keep heels off the bed. C. Avoid using a straight razor. D. Reorient frequently.

C. Avoid using a straight razor. The patient will be on anticoagulants for 4 to 6 weeks at home and should avoid injury to the skin, including when shaving. Using an abduction pillow between the legs is usually done immediately after surgery, especially if the patient is confused or restless and cannot maintain proper joint positioning. Keeping the heels off the bed prevents pressure ulcers during the in-hospital postoperative period. Changes in mental status can occur immediately after surgery as a result of anesthesia.

Which dietary supplement may be recommended to treat symptoms associated with osteoarthritis (OA)? Select all that apply. A. Iron B. Garlic C. Chondroitin D. Glucosamine E. Niacin

C. Chondroitin D. Glucosamine The intake of dietary supplements can replace traditional drug therapy for decreasing OA pain and repairing cartilage. Chondroitin strengthens cartilage, and glucosamine decreases inflammation. Iron, garlic, and niacin are not used specifically to manage OA.

Abuse of which substance is most likely to result in a hemorrhagic stroke? A. Heroin B. Nicotine C. Cocaine D. Marijuana

C. Cocaine Cocaine and other stimulants can cause a sharp rise in blood pressure, which can result in a stroke. Specific risk factors for stroke include substance use disorder (especially cocaine and heavy alcohol consumption). Heroin and marijuana cause a decrease in respiration and cardiac function. Although nicotine is a stimulant, it would have to be consumed in huge doses to cause a stroke.

Which metabolic disorder may be responsible for the development of joint degeneration in a patient with osteoarthritis? A. Aging B. Hemophilia C. Diabetes mellitus D. Sickle cell disease

C. Diabetes mellitus Certain metabolic diseases (e.g., diabetes mellitus, Paget disease of the bone) and blood disorders (e.g., hemophilia, sickle cell disease) can also cause joint degeneration. Aging is not a metabolic disorder. Hemophilia and sickle cell disease are blood disorders that may also cause joint degeneration.

Which organ is the usual source of emboli in an embolic stroke? A. Lung B. Liver C. Heart D. Spleen

C. Heart Embolic strokes are caused by a thrombus or group of thrombi that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system. The usual source of an emboli is the heart. Emboli that occur in the lungs can cause a pulmonary embolism. The liver and spleen are not typical sources of emboli.

The nurse reviews the medication profile of a patient with osteoarthritis (OA) and suspects that which drug is the cause of the patient's dark tarry stools and indigestion? A. Cortisone B. Lidoderm C. Ibuprofen D. Hyaluronate

C. Ibuprofen Ibuprofen is an NSAID that sometimes causes dark tarry stools and indigestion related to bleeding of the GI tract. Cortisone is a steroid; overuse can cause osteonecrosis. Lidoderm is a topical medication used to control pain; side effects are skin irritation. Hyaluronate is used to relieve knee and hip pain associated with OA. This medication may cause tingling and skin irritation around the knee.

Which primary deficit does the nurse expect to find in a patient who is diagnosed with a stroke in the right cerebral hemisphere? A. Worsening aphasia B. Agraphia C. Impaired proprioception D. Alexia

C. Impaired proprioception Strokes that occur in the right hemisphere affect proprioception, visual, and spatial awareness. The patient may also be disoriented to place and time. Agraphia (difficulty writing), aphasia (inability to use or comprehend language), and alexia (reading problems) are deficits associated with strokes that occur in the left hemisphere.

The nurse suspects a stroke in which area of the brain when a patient presents to the emergency department with aphasia and right-sided hemiplegia? A. Brainstem B. Cerebellum C. Left cerebral hemisphere D. Right cerebral hemisphere

C. Left cerebral hemisphere The left cerebral hemisphere is the center for language and analytical thinking and also controls motor nerves on the right side of the body. A patient with deficits in these areas most likely has left cerebral involvement. Patients with brainstem or cerebellum involvement will have ataxia and may experience hemiparesis or quadriparesis. The right cerebral hemisphere is involved with visual and spatial awareness.

Which tool does the nurse use to facilitate a focused neurologic assessment of a patient who presents to the emergency department with symptoms of a stroke? A. Reflex hammer B. Intracranial pressure monitor C. National Institutes of Health Stroke Scale (NIHSS) D. Mini-Mental State Examination (MMSE; mini-mental status exam)

C. National Institutes of Health Stroke Scale (NIHSS) Health care providers and nurses at primary stroke centers use a specialized stroke scale such as the NIHSS to assess patients. A reflex hammer is used to assess deep tendon reflex response. An intracranial pressure monitor would be requested by the health care specialist if signs and symptoms indicated increased intracranial pressure. The MMSE is used primarily to differentiate patients with dementia, psychosis, and affective disorders.

Which risk factor for stroke is modifiable? A. Age B. Sex C. Obesity D. Family history of hypertension

C. Obesity Obesity is a modifiable risk factor for stroke; a patient can lose weight with certain lifestyle changes. Age, sex, and family history of hypertension are risk factors for stroke, but they are not modifiable.

The nurse recognizes which condition when a patient experiences difficulty understanding spoken and written words and uses language that is meaningless? A. Mixed aphasia B. Global aphasia C. Receptive aphasia D. Expressive aphasia

C. Receptive aphasia Receptive aphasia occurs because of injury in the Wernicke area in the temporoparietal area. This leads to the patient having difficulty understanding spoken and written words, creating made-up words, and using meaningless speech. Mixed aphasia is difficulty in expression and reception, which includes difficulty speaking and writing. Global aphasia occurs because of severe damage in the receptive and expressive skills. Expressive aphasia occurs due to difficulty speaking and writing.

Which resource does the nurse recommend when the family member of a patient who has had a stroke asks for information about how to care for the patient? A. Hospice B. Internet search engines C. The National Stroke Association website D. The nursing team leader

C. The National Stroke Association website The National Stroke Association is a specific and reliable resource that can be recommended. Hospice applies to a patient who will be requiring palliative end-of-life care. Recommending Internet search engines is too broad; unless the nurse recommends a specific website, the patient's family member may not find quality information. The nurse caring for the patient is responsible for obtaining information that is readily available or for procuring a request from the health care provider for a consultation with the social worker.

The nurse suspects which cause of pain in the vertebral column and hips of a construction worker who is diagnosed with secondary osteoarthritis (OA)? A. Aging B. Genetic changes C. Trauma D. Obesity

C. Trauma Injury to the joints from excessive use, trauma, or other joint disease (e.g., rheumatoid arthritis) predisposes a person to OA. Heavy manual occupations (e.g., carpet laying, construction, farming) cause high-intensity or repetitive stress to the joints. Primary OA may be triggered by aging, genetic changes, or obesity.

After providing a patient with education about the differences between rheumatoid arthritis (RA) and osteoarthritis (OA), the nurse identifies that which statement indicates the need for further teaching? A. "RA is inflammatory. OA is degenerative." B. "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." C. "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in patients older than 60 years." D. "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric and is noted in multiple joints."

D. "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric and is noted in multiple joints." OA is unilateral and usually affects a single joint, whereas RA is bilateral and affects multiple joints; this statement by the patient indicates the need for further teaching. RA is indeed an inflammatory process, while OA is a degenerative process. Research is being done to find a possible genetic cause for OA, but age, trauma, obesity, and occupation are the main causes of degeneration. RA occurs most often in women, usually between 35 and 45 years of age, whereas older age is a cause of OA.

According to the Centers for Disease Control and Prevention (CDC), which group is at the highest risk for stroke? A. White men B. Latino men C. Black women D. Alaskan Native men

D. Alaskan Native men Alaskan-Native and American Indian patients are at the highest risk for stroke. Black men and women are at a higher risk than their white counterparts, and Latino men are at a higher risk than their non-Hispanic counterparts, but these groups are all at a lower risk than Alaskan-Native men and women.

Which nursing intervention is important while caring for a patient who has experienced a right-hemisphere stroke? A. Allow independent ambulation to facilitate self-care. B. Encourage family members to provide total care to maintain safety. C. Wash the patient's affected side, and have the patient wash the other. D. Approach the patient from the unaffected side.

D. Approach the patient from the unaffected side. Patients with right-hemisphere involvement often have an inability to recognize physical impairment and will exhibit neglect of the left visual field. The nurse should always approach the patient from the unaffected side, which should face the door of the room. Independent ambulation should be discouraged; it may be a safety risk because these patients often have poor judgment. Patients should be encouraged to wash and dress themselves with instructions to care for the affected side first to improve independence.

Which cause of stroke is an abnormality that occurs during embryonic development? A. Aneurysm B. Vasospasm C. Atherosclerosis D. Arteriovenous malformation

D. Arteriovenous malformation Arteriovenous malformation is very rare and occurs during embryonic development. Aneurysm occurs because of a condition that leads to weakening of artery walls such as atherosclerosis and hypertension. Vasospasm happens when bleeding occurs because of aneurysm or arteriovenous malformation. Atherosclerosis occurs because of a decrease in blood supply resulting from thrombosis. These abnormalities are not limited to the embryonic development stage.

Which action does the nurse take first when a patient who is hospitalized for hypertension experiences a new onset of slurred speech and right-sided weakness? A. Contact the health care provider. B. Perform a neurologic assessment. C. Instruct the patient to take some deep breaths to reduce anxiety. D. Assess airway, breathing, and circulation.

D. Assess airway, breathing, and circulation. The patient must be evaluated within 10 minutes of having a stroke. The priority is assessment of ABCs: airway, breathing, and circulation. Contacting the health care provider after assessing ABCs would be appropriate. A neurologic check may be performed later, but it is not the priority in this situation. Instructing the patient to take deep breaths is often helpful but is not the priority.

Which is the characteristic feature of Bouchard nodes? A. Excess fluid in the joint B. Atrophy of the skeletal muscle C. Bony nodules at the distal interphalangeal joints D. Bony nodules at the proximal interphalangeal joints

D. Bony nodules at the proximal interphalangeal joints Bouchard nodes are nodes at the proximal interphalangeal joints caused by bony hypertrophy. Excess fluid in the joint indicates joint effusion. Heberden nodes are bony nodules at the distal interphalangeal joints. Skeletal muscle atrophy occurs with muscle disuse related to pain and stiffness associated with osteoarthritis.

The nurse expects a patient to experience which phenomenon as a result of a stroke that caused damage to the Broca area of the frontal lobe? A. Stuttering B. Dysarthria C. Receptive aphasia D. Expressive aphasia

D. Expressive aphasia The patient with damage to the Broca area will experience expressive aphasia; it is a motor speech problem in which the patient generally understands what is being said but cannot communicate verbally. Writing skills are also affected. Rote speech and automatic speech such as responses to a greeting are often intact. Receptive aphasia is due to injury involving the Wernicke area in the temporoparietal area; patients cannot understand the spoken, and often the written, word, and language is often meaningless. Dysarthria is due to a loss of motor function to the tongue or to the muscles of speech, causing facial weakness and slurred speech. Patients with damage to the Broca area will not experience stuttering.

Which type of stroke is caused by aneurysm or hypertension? A. Embolic stroke B. Ischemic stroke C. Thrombotic stroke D. Hemorrhagic stroke

D. Hemorrhagic stroke In a hemorrhagic stroke, vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the subarachnoid space because of aneurysm or hypertension. A stroke caused by an embolus or a dislodged clot is referred to as an embolic stroke. An acute ischemic stroke is caused by the occlusion or blockage of a cerebral artery by either a thrombus or an embolus. A stroke that is caused by a thrombus (clot) is referred to as a thrombotic stroke.

Which type of stroke shows interrupted vessel integrity and bleeding that occurs into the brain tissue or into the subarachnoid space? A. Embolic stroke B. Ischemic stroke C. Thrombotic stroke D. Hemorrhagic stroke

D. Hemorrhagic stroke In a hemorrhagic stroke, vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the subarachnoid space. A stroke caused by an embolus (dislodged clot) is referred to as an embolic stroke. An acute ischemic stroke is caused by the occlusion (blockage) of a cerebral artery by either a thrombus or an embolus. A stroke that is caused by a thrombus (clot) is referred to as a thrombotic stroke.

The nurse includes which consideration of minimally invasive surgery when discussing options with a patient who requires treatment of osteoarthritis? A. It involves more scarring. B. It results in a slow recovery. C. It increases postoperative pain. D. It enables a shorter hospital stay.

D. It enables a shorter hospital stay. Minimally invasive surgery requires a shorter hospital stay because of reduced muscle cutting. Minimally invasive surgery results in less scarring, a quick recovery, and decreased postoperative pain.

Which nursing intervention takes priority in a patient with dysphagia? A. Monitor intake and output hourly. B. Keep an emergency tracheostomy kit at the bedside. C. Maintain the head of the bed elevated. D. Keep the patient on strict NPO status until the ability to swallow is verified.

D. Keep the patient on strict NPO status until the ability to swallow is verified. The nurse should ensure that the patient remains completely NPO until the speech pathologist determines the patient can safely tolerate liquids or foods without aspirating. Monitoring the intake and output, keeping an emergency tracheostomy kit at the bedside, and keeping the head of the bed elevated while the patient eats are important interventions. However, assuring no intake until the ability to swallow is verified is the priority because of safety risks.

The nurse reviews the medical record of a patient who is diagnosed with an acute ischemic stroke and identifies that which assessment finding is a contraindication for fibrinolytic therapy according to the American Stroke Association guidelines? Patient age: 70 years NIHSS score: 26 Symptom onset: 3.5 hours before evaluation INR: 1.1 A. INR result B. Time from symptom onset C. Patient's age D. NIHSS score

D. NIHSS score The American Stroke Association guidelines for treatment with fibrinolytic therapy include administering the treatment within 4.5 hours of symptom onset, unless the patient is over 80 years old or has an NIHSS score greater than 25. The patient's INR is normal.

Which clinical finding is associated with a diagnosis of early-stage osteoarthritis? A. Fissures and ulceration B. Osteophytes in joint space C. Secondary joint inflammation D. Opaque and yellowish-brown cartilage

D. Opaque and yellowish-brown cartilage In the early stage of osteoarthritis, the cartilage changes from a bluish-white translucent color to an opaque and yellowish-brown appearance. As the disease progresses, fissures and ulceration are observed. Osteophytes are formed in the later stages of osteoarthritis. Secondary joint inflammation occurs in the late stage of osteoarthritis.

The nurse recognizes that chronic use of which medication used to treat osteoarthritis (OA) puts a patient at risk for osteonecrosis? A. Capsaicin B. Chondroitin C. Glucosamine D. Steroid

D. Steroid Osteonecrosis is bone death secondary to lack of or disruption in blood supply to the affected bone, usually from trauma or chronic steroid therapy. Capsaicin causes a burning sensation on the skin for a short period. Chondroitin helps strengthen cartilage. Glucosamine may cause GI disturbances.

Which instruction does the nurse include in a teaching plan for a patient diagnosed with osteoarthritis (OA)? A. Begin a running program. B. Activities such as knitting can slow down joint degeneration. C. Eating at least two cups of yogurt per day can prevent exacerbation. D. Wear supportive shoes.

D. Wear supportive shoes. Wearing supportive shoes will help prevent falls and damage to foot joints, especially metatarsal joints. Running promotes stress on joints and should be avoided. Repetitive stress activities such as knitting or typing should be avoided for prolonged periods. No single food can prevent an exacerbation; a well-balanced diet is recommended.