Stroke MCQ
The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient? Semi-Fowler's Supine High-Fowler's Prone
A The head of the bed is elevated 15 to 30 degrees (semi-Fowler's position) to promote venous drainage and decrease intracranial pressure.
A client on your unit is scheduled to have intracranial surgery in the morning. Which nursing intervention helps to avoid intraoperative complications, reduce cerebral edema, and prevent postoperative vomiting? Restrict fluids before surgery. Administer prescribed medications. Administer preoperative sedation. Administer an osmotic diuretic.
A Before surgery, the nurse should restrict fluids to avoid intraoperative complications, reduce cerebral edema, and prevent postoperative vomiting. The nurse administers prescribed medications such as an anticonvulsant phenytoin, like Dilantin, to reduce the risk of seizures before and after surgery, an osmotic diuretic, and corticosteroids. Preoperative sedation is omitted.
Which terms refers to blindness in the right or left half of the visual field in both eyes? Homonymous hemianopsia Scotoma Diplopia Nystagmus
A Homonymous hemianopsia occurs with occipital lobe tumors. Scotoma refers to a defect in vision in a specific area in one or both eyes. Diplopia refers to double vision or the awareness of two images of the same object occurring in one or both eyes. Nystagmus refers to rhythmic, involuntary movements or oscillations of the eyes.
Which is a modifiable risk factor for transient ischemic attacks and ischemic strokes? Smoking Thyroid disease Advanced age Social drinking
A Modifiable risk factors for TIAs and ischemic stroke include hypertension, diabetes, cardiac disease, smoking, and excessive alcohol consumption. Advanced age, gender, and race are nonmodifiable risk factors for stroke.
A client undergoes cerebral angiography for evaluation of a subarachnoid hemorrhage. Which findings indicate spasm or occlusion of a cerebral vessel by a clot? Hemiplegia, seizures, and decreased level of consciousness Difficulty breathing or swallowing Nausea, vomiting, and profuse sweating Tachycardia, tachypnea, and hypotension
A 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.
After the patient has received tPA, the nurse knows to check vital signs every 30 minutes for 6 hours. Which of the following readings would require calling the provider? Diastolic pressure of 110 mm Hg Heart rate of 100 Systolic pressure of 130 mm Hg Respiration of 22
A Systolic BP over 180 mm Hg or diastolic BP over 110 mm Hg are contraindications (BP values close to hypertensive crisis) of tPA use.
A 64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the health care provider in the emergency department. Which is the origin of the client's symptoms? impaired cerebral circulation cardiac disease diabetes insipidus hypertension
A TIAs involve the same mechanism as in the ischemic cascade, but symptoms are transient (< 24 hours) and there is no evidence of cerebral tissue infarction. Thus, a TIA results directly from impaired blood circulation in the brain. Atherosclerosis, cardiac disease, hypertension, or diabetes can be risk factors for a TIA but do not cause it.
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? "Emotional lability is common after a stroke, and it usually improves with time." "You sound stressed; maybe using some stress management techniques will help." "You seem upset, and it may be hard for you to focus on the teaching, I'll come back later." "This behavior is common in clients with stroke. Which does your spouse do more often? Laugh or cry?"
A This is the most therapeutic and informative response. 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.
Which interventions would be recommended for a client with dysphagia? Select all that apply. Test the gag reflex before offering food or fluids. Place food on the affected side of the mouth. Assist the client with meals. Allow ample time to eat.
A,B,C Interventions for dysphagia include placing food on the unaffected side of the mouth, allowing ample time to eat, assisting the client with meals, and testing the client's gag reflex before offering food or fluids.
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? Headache Alteration in level of consciousness (LOC) Shortness of breath Tonic-clonic seizures
B Alteration in LOC is the earliest sign of deterioration in a patient with a hemorrhagic stroke; these include mild drowsiness, slight slurring of speech, and sluggish papillary reaction.
Which of the following is the most common side effect of tissue plasminogen activator (tPA)? Hypertension Bleeding Increased intracranial pressure (ICP) Headache
B Bleeding is the most common side effect of tPA. The patient is closely monitored for bleeding (at IV insertion sites, gums, urine/stools, and intracranially by assessing changes in level of consciousness). Headache, increased ICP, and hypertension are not side effects of tPA.
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? Intracranial pressure is increased by a space-occupying bleed. Thrombolytic therapy has a time window of only 3 hours. A ruptured arteriovenous malformation will cause deficits until it is stopped. A ruptured intracranial aneurysm must quickly be repaired.
B 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 provider diagnoses the patient as having had an ischemic stroke. The etiology of an ischemic stroke would include which of the following? Cerebral aneurysm Intracerebral hemorrhage Cardiogenic emboli Arteriovenous malformation
C Aneurysms, hemorrhages, and malformations are all examples of a hemorrhagic stroke. An embolism can block blood flow, leading to ischemia.
Which term refers to the failure to recognize familiar objects perceived by the senses? Apraxia Agraphia Agnosia Perseveration
C Auditory agnosia is failure to recognize significance of sounds. Agraphia refers to disturbances in writing intelligible words. Apraxia refers to an inability to perform previously learned purposeful motor acts on a voluntary basis. Perseveration is the continued and automatic repetition of an activity, word, or phrase that is no longer appropriate.
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? Large artery thrombosis Cardiogenic emboli Cerebral aneurysm Small artery thrombosis
C If a cerebral aneurysm ruptures, hemorrhagic stroke could develop. With hemorrhagic stroke, patients will often complain of exploding headache.
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 dipyridamole. clopidogrel. aspirin. ticlopidine.
C If warfarin is contraindicated, aspirin is the best option, although other medications may be used if both are contraindicated.
A client is suspected of having had a stroke. Which is the initial diagnostic test for a stroke? A. Electrocardiography B. Transcranial Doppler studies C. Noncontrast computed tomography D. Carotid Doppler
C The initial diagnostic test for a stroke is usually a noncontrast computed tomography (CT) scan to determine whether the event is ischemic or hemorrhagic (the category of stroke determines treatment). Further diagnostics include a carotid Doppler, electrocardiogram, and transcranial Doppler.
A client admitted to the emergency department is being evaluated for the possibility of a stroke. Which assessment finding would lead the nurse to suspect that the client is experiencing a hemorrhagic stroke? difficulty finding appropriate words left-sided weakness slurred speech severe exploding headache
D A hemorrhagic stroke is often characterized by a severe headache (commonly described as the "worst headache ever") or as "exploding." Weakness and speech issues are more commonly associated with an ischemic stroke.
A patient has severe shoulder pain from subluxation of the shoulder is being cared for on the unit. To prevent further injury and pain, the nurse caring for this patient is aware of what? Use of a sling should be avoided due to adduction of the affected shoulder. Elevation of the arm and hand can lead to further complications associated with edema. Passively exercising the affected extremity is avoided to minimize pain. The patient should be taught to interlace fingers, place palms together, and slowly bring scapulae forward to avoid excessive force to shoulder.
D As many as 70% of stroke patients suffer pain in the shoulder that prevents them from regaining full ROM. To prevent shoulder pain, the nurse should never lift a patient by the flaccid shoulder or pull on the affected arm or shoulder. The patient is taught how to move and exercise the affected arm/shoulder through proper movement and positioning.
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. Blood pressure 128/86 mm Hg C. Mild neck edema D. Difficulty swallowing
D Dysphagia and aspiration are complications of strokes and some surgical procedures to treat stroke/TIAs. The client's inability to swallow without difficulty would cause the nurse the most concern. Difficulty swallowing, hoarseness, or other signs of cranial nerve dysfunction must be assessed. The nurse focuses on assessment of the following cranial nerves: facial (VII), vagus (X), spinal accessory (XI), and hypoglossal (XII). Mild edema in the neck after surgery is expected; however, extensive edema and hematoma formation can obstruct the airway. Emergency airway supplies, including those needed for a tracheostomy, must be available.
Which term refers to the inability to perform previously learned purposeful motor acts on a voluntary basis? Agnosia Agraphia Perseveration Apraxia
D This describes apraxia. In particular, verbal apraxia refers to difficulty forming and organizing intelligible words although the musculature is intact
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? As soon as the patient is able to independently identify goals for rehabilitation As soon as moderate motor activity is regained on the affected side As soon as sensory ability is regained on the affected side As soon as the patient regains consciousness
D Usually an active rehabilitation program is started as soon as the patient regains consciousness. It would be erroneous to wait until the affected side recovers.
