Med Surg: Chapter 47: Nursing Management: Patients With Cerebrovascular Disorders: PREPU
The nurse is caring for a client with dysphagia. Which intervention would be contraindicated while caring for this client? A Testing the gag reflex before offering food or fluids B Placing food on the affected side of the mouth C Assisting the client with meals D Allowing ample time to eat
B
Which is a contraindication for the administration of tissue plasminogen activator (t-PA)? A Systolic blood pressure less than or equal to 185 mm Hg B Intracranial hemorrhage C Ischemic stroke D Age 18 years or older
B
Which disturbance results in loss of half of the visual field? A Anisocoria B Homonymous hemianopsia C Nystagmus D Diplopia
B Homonymous hemianopsia (loss of half of the visual field) may occur from stroke and may be temporary or permanent. Double vision is documented as diplopia. Nystagmus is ocular bobbing and may be seen in multiple sclerosis. Anisocoria is unequal pupils.
The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke? A. Severe headache and early change in level of consciousness B Weakness on one side of the body and difficulty with speech C. Footdrop D. external hip rotation
B The main presenting symptoms for an ischemic stroke are numbness or weakness of the face, arm, or leg, especially on one side of the body; confusion or change in mental status; and trouble speaking or understanding speech. Severe headache, vomiting, early change in level of consciousness, and seizures are early signs of a hemorrhagic stroke. Footdrop and external hip rotation are things that can occur if a stroke victim is not turned or positioned correctly.
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. Right sided B. Left sided C. Ischemia D. Hemorrhaging.
C Explanation: Ischemic strokes occur when a thrombus or embolus obstructs an artery carrying blood to the brain; about 80% of strokes are the ischemic variety.
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 Large artery thrombosis B Small artery thrombosis C Cardiogenic emboli D Cerebral aneurysm
D
Question 3 of 5 The nurse is caring for a client with chronic migraines who is prescribed medication. What drug-related instructions should the nurse give the client? A Take medication just before going to bed at night. B Take medication only during the morning when it's calm and quiet. C Take medication only when migraine is intense. D Take medication as soon as symptoms of the migraine begin.
D
A client has been diagnosed as having global aphasia. The nurse recognizes that the client will be unable to do perform which action? A Form understandable words and comprehend spoken words B Speak at all C Comprehend spoken words D Form understandable words
A
A nurse is completing discharge teaching for the client who has left-sided hemiparesis following a stroke. When investigating the client's home environment, the nurse should focus on which nursing diagnosis? A Risk for injury B Noncompliance C Ineffective coping D Diarrhea
A
Aneurysm rebleeding occurs most frequently during which time frame after the initial hemorrhage? A First 2 to 12 hours B First 48 hours C First week D First 2 weeks
A
A patient diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy. The nurse explains that this procedure will be done for what purpose? A To determine the cause of the TIA B To prevent seizure activity that is common following a TIA C To prevent a stroke by removing atherosclerotic plaques blocking cerebral flow D To decrease cerebral edema
C
The nurse is preparing discharge teaching for a patient who is being discharged after hospitalization for a hemorrhagic stroke. What should be included in the discharge teaching for this patient? A Take ibuprofen for complaints of a serious headache. B Intermittent seizures can be expected. C Take antihypertensive medication as ordered. D Drowsiness is normal for the first week after discharge.
C
From which direction should a nurse approach a client who is blind in the right eye? A From the right side of the client B From directly in front of the client C From directly behind the client D From the left side of the client
D
Agnosia means
the inability to recognize familiar objects.
Which term refers to the failure to recognize familiar objects perceived by the senses? A Apraxia B Agnosia C Agraphia D Perseveration
A
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 Spatial-perceptual deficits. B Right-sided paralysis. C Impulsive behavior. D Left visual field deficit.
B A left hemispheric stroke will cause right-sided weakness or paralysis. Because upper motor neurons decussate, a disturbance on one side of the body can cause damage on the opposite side of the brain
A patient had a carotid endarterectomy yesterday and when the nurse arrived in the room to perform an assessment, the patient states, "All of a sudden, I am having trouble moving my right side." What concern should the nurse have about this complaint? A This is a normal occurrence after an endarterectomy and would not be a concern. B A thrombus formation at the site of the endarterectomy C Surgical wound infection D Bleeding from the endarterectomy site
B Formation of a thrombus at the site of the endarterectomy is suspected if there is a sudden new onset of neurologic deficits, such as weakness on one side of the body.
Which of the following is the initial diagnostic in suspected stroke? A Noncontrast computed tomography (CT) B Magnetic resonance imaging (MRI) C Cerebral angiography D CT with contrast
A An initial head CT scan will determine whether or not the patient is experiencing a hemorrhagic stroke. An ischemic infarction will not be readily visible on initial CT scan if it is performed within the first few hours after symptoms onset; however, evidence of bleeding will almost always be visible.
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 Thrombolytic therapy has a time window of only 3 hours. B Intracranial pressure is increased by a space-occupying bleed. C A ruptured intracranial aneurysm must quickly be repaired. D A ruptured arteriovenous malformation will cause deficits until it is stopped.
A Currently approved thrombolytic therapy for ischemic strokes has a treatment window of only 3 hours after the onset of symptoms. Urgency is needed on the part of the public for rapid entry into the medical system. The other three choices are related to hemorrhagic strokes.
When caring for a patient who has had a hemorrhagic stroke, close monitoring of vital signs and neurological status is imperative. What is the earliest sign of deterioration in a patient with a hemorrhagic stroke? A Alteration in level of consciousness (LOC) B Headache C Shortness of breath D Tonic-clonic seizures
A
A nurse is assisting with a community screening for people at high risk for stroke. To which of the following clients would the nurse pay most attention? A A 28-year-old pregnant African-American woman B A 60-year-old African-American man C A 62-year-old Caucasian woman D A 40-year-old Caucasian woman
B
A physician orders several drugs for a client with hemorrhagic stroke. Which drug order should the nurse question? A Methyldopa (Aldomet) B Heparin sodium C Phenytoin (Dilantin) D Dexamethasone (Decadron)
B
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 Blood pressure 128/86 mm Hg D Mild neck edema
B
A female patient who is recovering from a stroke has begun eating a minced and pureed diet after passing the speech pathologist's swallowing assessment. This morning, the nurse set up the patient with her breakfast tray and later noticed that the woman was swallowing her food well but dribbling small amounts of food out of affected side of her mouth. How should the nurse follow up this observation? A Provide oral suctioning after each bite that the patient swallows. B Remove the patient's tray because of the risk of aspiration. C Cue the patient to the fact that she is dribbling food while commending her for eating. Make the patient D NPO and encourage the care provider to consider enteral nutrition.
C
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 Severe headache and early change in level of consciousness D Footdrop and external hip rotation
C
A patient has been admitted to a unit at a primary stroke center after experiencing an ischemic stroke. The nurse on the unit is aware of the vital importance of rehabilitative efforts and knows that an active rehabilitation program should begin at what point? A As soon as the patient is able to independently identify goals for rehabilitation B As soon as moderate motor activity is regained on the affected side C As soon as sensory ability is regained on the affected side D As soon as the patient regains consciousness
D
