NU372 PrepU: Stroke
The MRA scan of a client with a suspected stroke reports ruptured berry aneurysm. The nurse plans care for a client with: a) Encephalitis b) Subarachnoid hemorrhage c) Lacunar infarct d) Thrombotic stroke
b) Subarachnoid hemorrhage - The rupture of a berry aneurysm leads to a subarachnoid hemorrhage.
The nurse is participating in a health fair for stroke prevention. Which will the nurse say is a modifiable risk factor for ischemic stroke? a) Thyroid disease b) Social drinking c) Advanced age d) Smoking
d) Smoking - Modifiable risk factors for transient ischemic attack (TIA) and ischemic stroke include hypertension, type 1 diabetes, cardiac disease, smoking, and chronic alcoholism. Advanced age, gender, and race are nonmodifiable risk factors for stroke.
A client with hypercholesterolemia is receiving Lipitor (atorvastatin) to prevent high cholesterol and stroke. The order is for Lipitor 40 mg PO daily. The medication is supplied in 80 mg tabs. How many tabs will the nurse administer to the client? Enter the correct number ONLY.
0.5 - 40 mg/80 mg = 0.5 tabs.
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 best alternative medication to give is a) dipyridamole. b) aspirin. c) clopidogrel. d) ticlopidine.
b) aspirin. - If warfarin is contraindicated, aspirin is the best option, although other medications may be used if both are contraindicated.
An older adult is brought to the emergency department after experiencing some confusion, slurred speech, and a weak arm. Now the client is back to acting normally. Suspecting a transient ischemic attack (TIA), the health care provider prescribes diagnostic testing looking for which cause of this episode? a) Aneurysm leakage b) Minor residual deficits c) Diffuse cerebral electrical malfunctions d) Atherosclerotic lesions in cerebral vessels
d) Atherosclerotic lesions in cerebral vessels - The traditional definition of TIA as a neurologic deficit resolving within 24 hours was developed before the mechanisms of ischemic cell damage and the penumbra were known and before the newer, more advanced methods of neuroimaging became available. A more accurate definition now is a transient deficit without time limits, best described as a zone of penumbra without central infarction. TIAs are important because they may provide warning of impending stroke. The causes of TIAs are the same as those of ischemic stroke, and include atherosclerotic disease of cerebral vessels and emboli. The most common predisposing factors for cerebral hemorrhage are advancing age and hypertension; other causes include aneurysm rupture. Cerebral electrical malfunctions usually occur with seizure activity.
A 154-pound woman has been prescribed tPA (0.9 mg/kg) for an ischemic stroke. The nurse knows to give how many mg initially? a) 6.3 mg b) 7.5 mg c) 8.3 mg d) 10 mg
a) 6.3 mg - A person who weighs 154 lbs weighs 70 kg. To calculate total dosage, multiply 70 × 0.9 mg/kg = 63 mg. Ten percent of the calculated dose is given as an IV bolus over 1 minute. The remaining dose (90%) is given IV over 1 hour via an infusion pump. So initially the nurse gives 10% (6.3 mg) over 1 minute.
A client is admitted for cardioembolic stroke. Which therapy to best prevent recurrence of embolic stroke should the nurse monitor for effectiveness? a) Anticoagulation therapy b) Blood pressure management c) Correction of dyslipidemia d) Antiarrhythmic therapy
a) Anticoagulation therapy - The risk of stroke recurrence is highest in the first week after stroke, and the use of anticoagulation in cardioembolic stroke is imperative. The most common dysrhythmia that leads to cardioembolic stroke is atrial fibrillation, and converting the client to a normal rhythm using antiarrhythmic therapy is not a priority in the acute stroke recovery phase. Blood pressure will be monitored to prevent complications in the acute phase, but is not directly linked to cardioembolic stroke prevention. Dyslipidemia does not play a direct role in cardioembolic stroke and response to treatment generally takes weeks to months to be apparent.
The nurse working in an emergency room is caring for a client who is exhibiting signs and symptoms of a stroke. What does the nurse anticipate that the physician's orders will include? a) CT scan b) MRI c) Intravenous antibiotics d) Pain medication
a) CT scan - The nurse should anticipate that the client will be ordered a CT scan to rule out hemorrhagic stroke that would preclude the administration of tissue plasminogen activator (tPA).
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) Cerebral aneurysm c) Cardiogenic emboli d) Small artery thrombosis
b) Cerebral aneurysm - A cerebral aneurysm is a type of hemorrhagic stroke that is characterized by an exploding headache.
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) Transient ischemic attack (TIA) b) Left-sided cerebrovascular accident (CVA) c) Right-sided cerebrovascular accident (CVA) d) Completed Stroke
b) Left-sided cerebrovascular accident (CVA) - When the infarct is on the left side of the brain, the symptoms are likely to be on the right, and the speech is more likely to be involved. If the MRI reveals an infarct, TIA is no longer the diagnosis. There is not enough information to determine if the stroke is still evolving or is complete.
A patient having an acute stroke with no other significant medical disorders has a blood glucose level of 420 mg/dL. What significance does the hyperglycemia have for this patient? a) The patient has new onset diabetes. b) This is significant for poor neurologic outcomes. c) The patient has developed diabetes insipidus due to the location of the stroke. d) The patient has liver failure.
b) This is significant for poor neurologic outcomes. - Hyperglycemia has been associated with poor neurologic outcomes in acute stroke and should be treated if the blood glucose is above 140 mg/dL (Summers et al., 2009).
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.
c) 4:00 p.m. - Tissue plasminogen activator (tPA) must be given within 3 hours after symptom onset. Therefore, since symptom onset was 1:00 pm, the window of opportunity ends at 4:00 pm.
A white female client is admitted to an acute care facility with a diagnosis of stroke. Her history reveals bronchial asthma, exogenous obesity, and iron-deficiency anemia. Which history finding is a risk factor for stroke? a) Being white b) Being female c) Being obese d) Having bronchial asthma
c) Being obese - Obesity is a risk factor for stroke. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, hormonal contraceptive use, emotional stress, family history of stroke, and advancing age. The client's race, gender, and bronchial asthma aren't risk factors for stroke.
The most common cause of an ischemic stroke is which of the following? a) Intracerebral arterial vasculitis b) Cardiogenic embolus c) Thrombosis d) Vasospasm
c) Thrombosis - Thrombi are the most common cause of ischemic strokes, usually occurring in atherosclerotic blood vessels.
The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is: a) Obesity b) Dyslipidemia c) Smoking d) Hypertension
d) Hypertension - Hypertension is the most modifiable risk factor for either ischemic or hemorrhagic stroke. Unfortunately, it remains under-recognized and undertreated in most communities.
The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? a) High-Fowler's b) Prone c) Supine d) Semi-Fowler's
d) Semi-Fowler's - The head of the bed is elevated 15 to 30 degrees (semi-Fowler's position) to promote venous drainage and decrease intracranial pressure.
A stroke victim is experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe? a) Frontal b) Occipital c) Parietal d) Temporal
a) Frontal - If damage has occurred to the frontal lobe, learning capacity, memory, or other higher cortical intellectual functions may be impaired. Such dysfunction may be reflected in a limited attention span, difficulties in comprehension, forgetfulness, and a lack of motivation.
A patient who has suffered a stroke begins having complications regarding spasticity in the lower extremity. What ordered medication does the nurse administer to help alleviate this problem? a) Diphenhydramine (Benadryl) b) Lioresal (Baclofen) c) Heparin d) Pregabalin (Lyrica)
b) Lioresal (Baclofen) - Spasticity, particularly in the hand, can be a disabling complication after stroke. Botulinum toxin type A injected intramuscularly into wrist and finger muscles has been shown to be effective in reducing this spasticity (although the effect is temporary, typically lasting 2 to 4 months) (Teasell, Foley, Pereira, et al., 2012). Other treatments for spasticity may include stretching, splinting, and oral medications such as baclofen (Lioresal).
The nurse is caring for a client who has received tissue plasminogen activator (tPA). The nurse's discharge planning should include education related to which interventions to prevent recurrent stroke? Select all that apply. a) Antiplatelet agents like warfarin therapy b) Aspirin (ASA) therapy twice per day c) Reduction of risk factors by controlling hypertension or diabetes d) Monitoring for signs and symptoms of recurrence
a) Antiplatelet agents like warfarin therapy c) Reduction of risk factors by controlling hypertension or diabetes d) Monitoring for signs and symptoms of recurrence - Clients receive tPA as treatment for ischemic stroke. In her plan of care the nurse should include education related to warfarin therapy, signs and symptoms of stroke recurrence (most likely in first week post-tPA administration), and ways for the client to reduce risk factors for another stroke like controlling hypertension, diabetes, high lipid levels, and smoking cessation.
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) "Emotional lability is common after a stroke, and it usually improves with time." b) "You sound stressed; maybe using some stress management techniques will help." 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?"
a) "Emotional lability is common after a stroke, and it usually improves with time." - This is the most therapeutic and informative response. Often, most relatives of clients with stroke handle the physical changes better than the emotional aspects of care. The family should be prepared to expect occasional episodes of emotional lability. The client may laugh or cry easily and may be irritable and demanding or depressed and confused. The nurse can explain to the family that the client's laughter does not necessarily connote happiness, nor does crying reflect sadness, and that emotional lability usually improves with time. The remaining responses are nontherapeutic and do not address the spouse's concerns.
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 60-year-old Black man b) A 40-year-old White woman c) A 62-year-old White woman d) A 28-year-old pregnant Black woman
a) A 60-year-old Black man - The 60-year-old Black man has three risk factors: gender, age, and race. Black people have almost twice the incidence of first stroke compared with White people.
A client has experienced an ischemic stroke that has damaged the frontal lobe of his brain. Which of the following deficits does the nurse expect to observe during assessment? a) Limited attention span and forgetfulness b) Hemiplegia or hemiparesis c) Lack of deep tendon reflexes d) Visual and auditory agnosia
a) Limited attention span and forgetfulness - Damage to the frontal lobe may impair learning capacity, memory, or other higher cortical intellectual functions. Such dysfunction may be reflected in a limited attention span, difficulties in comprehension, forgetfulness, and a lack of motivation. Damage to the motor neurons may cause hemiparesis, hemiplegia, and a change in reflexes. Damage to the occipital lobe can result in visual agnosia, whereas damage to the temporal lobe can cause auditory agnosia.
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.
a) Main presenting symptom is an "exploding headache." - One of hemorrhagic stroke's main presenting symptom is an "exploding headache." In ischemic stroke, functional recovery usually plateaus at 6 months; it may be caused by a large artery thrombosis and may have a presenting symptoms of numbness or weakness of the face.
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
a) Noncontrast computed tomography (CT) - 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 client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: a) Transient ischemic attack (TIA) b) Cardiogenic embolic stroke c) Thrombotic stroke d) Lacunar infarct
a) Transient ischemic attack (TIA) - Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.
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) "The client is feeling an emotional loss. He'll eventually start acknowledging you on his left side." b) "The client is unaware of his left side. You should approach him on the right side." c) "The client is unaware of his left side. You need to encourage him to interact from this side." d) "This condition is temporary."
b) "The client is unaware of his left side. You should approach him on the right side." - The client is experiencing unilateral neglect and is unaware of his left side. The nurse should advise the family to approach him on his unaffected (right) side. Approaching the client on the affected side would be counterproductive. It's too premature to make the determination whether this condition will be permanent.
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) Nausea, vomiting, and profuse sweating b) Hemiplegia, seizures, and decreased level of consciousness c) Difficulty breathing or swallowing d) Tachycardia, tachypnea, and hypotension
b) Hemiplegia, seizures, and decreased level of consciousness - Spasm or occlusion of a cerebral vessel by a clot causes signs and symptoms similar to those of a stroke: hemiplegia, seizures, decreased level of consciousness, aphasia, hemiparesis, and increased focal symptoms. Nausea, vomiting, and profuse sweating suggest a delayed reaction to the contrast medium used in cerebral angiography. Difficulty breathing or swallowing may signal a hematoma in the neck. Tachycardia, tachypnea, and hypotension suggest internal hemorrhage.
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) Severe headache and early change in level of consciousness c) Foot drop and external hip rotation d) Confusion or change in mental status
b) Severe headache and early change in level of consciousness - The main presenting symptoms for 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. Foot drop and external hip rotation can occur if a stroke victim is not turned or positioned correctly.
The nurse recognizes health promotion efforts to decrease the risk for ischemic stroke involve encouraging a healthy lifestyle, including a) eating fish no more than once a month. b) a low-fat, low-cholesterol diet and increased exercise. c) a high-protein diet and increased weight-bearing exercise. d) a low-cholesterol, low-protein diet and decreased aerobic exercise.
b) a low-fat, low-cholesterol diet and increased exercise. - Health promotion efforts to decrease the risk for ischemic stroke involve encouraging a healthy lifestyle, including a low-fat, low-cholesterol diet and increased exercise. Recent evidence suggests that eating fish two or more times per week reduces the risk of thrombotic stroke for women.
A client has suffered a stroke that has affected his speech. The physician has identified the client as having expressive aphasia. Later in the day, the family asks the nurse to explain what this means. The most accurate response would be aphasia that is: a) characterized by an inability to comprehend the speech of others or to comprehend written material. b) nearly normal speech except for difficulty with finding singular words. c) manifested as impaired repetition and speech riddled with letter substitutions, despite good comprehension, and fluency. d) characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing.
d) characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. - Expressive or nonfluent aphasia is characterized by an inability to communicate spontaneously with ease or translate thoughts or ideas into meaningful speech or writing. Conduction aphasia manifest as impaired repetition and speech riddled with letter substitutions, despite good comprehension and fluency. Anomic aphasia is speech that is nearly normal except for difficulty with finding singular words. Wernicke aphasia is characterized by an inability to comprehend the speech of others or to comprehend written material.