Question 1

A patient will have either endovascular coiling or neurosurgical clipping as treatment for an intracranial aneurysm. How would the nurse describe the benefits and risks of each form of treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The nurse would describe the benefits of coiling as being generally less invasive than surgery and potentially requiring the placement of a stent. The nurse would also explain that the decision between coiling and surgery depends on factors such as the size and location of the aneurysm, but not on the patient's preference. The nurse would not describe surgery as the most reliable method of treating aneurysms or suggest that coiling is only successful in very small aneurysms.

Question 2

Diagnostic testing has revealed that the patient has an arteriovenous malformation AVM). Surgical treatment is scheduled for tomorrow. Which critical assessment findings should the nurse report to the surgeon? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

Accepted Answer

The answer of Diagnostic testing has revealed that the patient...

Question 3

A patient is admitted to the emergency department after complaining of a headache and having a seizure. On CT examination the patient is assigned a Fisher score of 1. How does the nurse evaluate this information?

Accepted Answer

Fisher score is a grading system used to classify the amount of blood detected on a CT scan in patients with subarachnoid hemorrhage (SAH). A Fisher score of 1 indicates no blood detected on the CT scan. Therefore, option A is the correct answer.

Question 4

A patient with a family history of cavernous malformation presents to the emergency department following a seizure. The nurse anticipates which diagnostic testing?

Accepted Answer

MRI scan is the best choice because it is the most sensitive imaging modality for detecting cavernous malformations, especially in patients with a family history. It can also help assess the location and size of the malformation in order to guide treatment decisions. Angiography may be used for further evaluation if necessary, but it is not typically the first-line imaging test for cavernous malformations. CT scan and skull series X-ray are less sensitive and specific than MRI for detecting cavernous malformations.

Question 5

A patient experienced onset of weakness, left-sided facial drooping, and difficulty talking 2 hours before presenting in the emergency department. The patient has been in the ED for 30 minutes, and the nurse is aware that t-PA treatment for stroke must be administered within the next _______ hours to be effective.

Accepted Answer

The answer of A patient experienced onset of weakness, left-sided...

Question 6

Results of diagnostic procedures reveal that a patient's cerebral arteriovenous malformation AVM) is Spetzler-Martin grade
1) Surgical resection
1) The nurse anticipates which most common treatment for this patient?
2) Endovascular coiling
3) Radiosurgery
4) Watchful waiting

Accepted Answer

Spetzler-Martin grade 1 AVMs are the smallest and the least complex. Surgical resection is the most common and effective treatment for grade 1 AVMs. Endovascular coiling and radiosurgery are options for larger, more complex AVMs. Watchful waiting is not a treatment option for AVMs as they can lead to serious complications such as hemorrhages.

Question 7

The nurse is monitoring a patient who has had a subarachnoid bleed. The nurse plans care based on the knowledge that the risk for cerebral vasospasm is highest in Fisher grade _______ aneurysms.

Accepted Answer

The answer of The nurse is monitoring a patient who...

Question 8

The nurse is presenting a community health program regarding stroke. The nurse emphasizes the importance of early transport to the emergency department. What is the primary rationale for this recommendation?

Accepted Answer

Prompt treatment of a stroke can save cells in the penumbra, which refers to the area of the brain surrounding the ischemic core that is at risk of infarction but may still be salvaged with timely intervention. Early transport to the emergency department is critical in order to receive time-sensitive interventions such as intravenous thrombolysis or mechanical thrombectomy.

Question 9

A patient is diagnosed with a lacunar stroke. The patient's daughter says, "If this is a stroke in a small artery, why is my dad's movement so affected?" Which nursing response is indicated?

Accepted Answer

Lacunar strokes may occur in smaller or deeper penetrating arteries, but they can still cause significant neurological effects depending on the location of the stroke. In particular, lacunar strokes often occur in areas where lots of motor and sensory tracts are located, leading to movement or sensory deficits. Option A is incorrect because lacunar strokes actually occur in smaller arteries. Option C is incorrect because while sensory effects can occur with lacunar strokes, motor deficits are also common. Option D is incorrect because the damage seen on scans may be small, but still impact the patient significantly depending on the location of the stroke.

Question 10

After a stroke, a patient was left with painful feet and hands. The physician diagnoses central pain syndrome. Which home management technique should the nurse teach this patient?

Accepted Answer

Keeping the feet and hands warm may help alleviate the pain associated with central pain syndrome. Other techniques that may be helpful include physical therapy and medication management. Walking may not necessarily improve comfort and ice massage may exacerbate the pain. Taking an ACE inhibitor may be helpful for other conditions but is not typically used in the management of central pain syndrome.

Question 11

A patient is scheduled for a lumbar puncture to assess for subarachnoid hemorrhage. The nurse should check to see if which test has been performed prior to the procedure?

Accepted Answer

A CT scan of the head should be performed prior to a lumbar puncture to rule out the presence of a mass or other lesions that may increase the risk of brain herniation during the procedure. The other tests listed are not directly related to assessing for subarachnoid hemorrhage.

Question 12

A patient has been admitted with stroke-like symptoms. The nurse would report a serum potassium level of less than _____mEq/L as below the desired level.

Accepted Answer

The answer of A patient has been admitted with stroke-like...

Question 13

The nurse is planning care for a patient undergoing diagnostic evaluation for presence of an intracranial bleed. Which nursing diagnosis NDX) would the nurse set as the first priority?

Accepted Answer

The priority nursing diagnosis would be Risk for Altered Cerebral Tissue Perfusion. This is because an intracranial bleed can lead to increased intracranial pressure, which can result in further injury and damage to cerebral tissue. Therefore, ensuring adequate cerebral tissue perfusion is crucial in preventing further injury and promoting patient outcomes.

Question 14

A patient has had successful treatment for a leaking arteriovenous malformation and is being discharged to home. The patient's Barthel Index score is 48. The nurse anticipates that the patient will require which assistance?

Accepted Answer

A Barthel Index score of 48 indicates partial assistance with daily care activities.

Question 15

The patient with assessment findings of stroke has a normal CT scan upon admission to the emergency department. How should the nurse evaluate this information?

Accepted Answer

A normal CT scan upon admission does not rule out a stroke, as it may take time for damage to appear on the scan. A second CT done later may show evidence of damage. Intracranial aneurysm and psychosomatic illness are not necessarily more likely diagnoses with a normal CT scan, and an electroencephalogram is not typically used to diagnose a stroke.

Quiz 22: Caring for the Patient With Cerebral Vascular Disorders