Question 1

A patient is recovering from supratentorial surgery to remove a primary brain tumor. Which intervention should the nurse include in this patient's plan of care? Select all that apply.

Accepted Answer

1. The care after supratentorial surgery includes assessing pupillary response.
2. Flexion of the neck does not need to be avoided with this type of surgery.
3. The care after supratentorial surgery includes assessing with the Glasgow Coma Scale.
4. The care after supratentorial surgery includes assessing strength, movement, and sensation in all extremities.
5. Increasing oral fluids does not need to be encouraged with this type of surgery.

Question 2

A patient with dysphagia after a stroke has dry oral mucous membranes and poor skin turgor. What should the nurse anticipate being prescribed for this patient? Select all that apply.

Accepted Answer

1. The American Heart Association/American Stroke Association (AHA/ASA) currently recommends that patients with acute stroke who cannot take fluids and food orally receive hydration and nutrition via an NG tube while waiting for swallowing to resume.
2. Nutritional supplementation should be provided to meet the patient's needs. Intralipid infusions would not be necessary.
3. High-volume intravenous fluid infusions will not meet nutritional needs and could cause fluid overload.
4. Total parenteral nutrition via a central line is not a recommendation to meet nutritional needs in the patient recovering from a stroke.
5. The American Heart Association/American Stroke Association (AHA/ASA) currently recommends that patients with acute stroke who cannot take fluids and food orally receive hydration and nutrition via a percutaneous endoscopic gastrostomy (PEG) tube while waiting for swallowing to resume.

Question 3

The nurse provides intravenous dexamethasone (Decadron) 10 mg to a patient with a metastatic brain tumor. What patient outcome indicates that the medication is effective? Select all that apply.

Accepted Answer

1. Administration of dexamethasone can produce a reduction in cerebral edema and an improvement in neurologic symptoms most commonly in 12 to 24 hours.
2. The decline in cerebral edema and ICP can persist for as long as 72 hours.
3. Administration of dexamethasone improves neurologic symptoms within 12 to 24 hours and not immediately.
4. Dexamethasone does not affect the respiratory rate.
5. Dexamethasone does not affect the heart rate or blood pressure.

Question 4

A spouse asks why the patient with a newly diagnosed brain tumor is so mean and doesn't seem to be "the same person." What should the nurse explain in response? Select all that apply.

Accepted Answer

1. Irritation of the brain tissue would cause seizures.
2. Mental status and/or personality changes can be caused by involvement of the parts of the brain that control personality.
3. Compression of the cranial nerves would affect much more than personality.
4. Mental status and/or personality changes can be caused by the tumor itself.
5. Mental status and/or personality changes can be caused by increased intracranial pressure.

Question 5

A patient is brought to the emergency department demonstrating signs of a stroke. What should the nurse assess when using the National Institutes of Health stroke scale? Select all that apply.

Accepted Answer

1. Horizontal eye movements, or gaze, are assessed when using the National Institutes of Health stroke scale.
2. Walking gait is not a part of the National Institutes of Health stroke scale.
3. Motor function of the arms is assessed when using the National Institutes of Health stroke scale.
4. Facial muscle response, measured by smiling, raising the eyebrows, and squeezing the eyes shut are assessed when using the National Institutes of Health stroke scale.
5. Level of consciousness is the first area to assess when using the National Institutes of Health stroke scale.

Question 6

A patient being treated with warfarin experiences an intracerebral hemorrhage. What should the nurse anticipate being prescribed for this patient?

Accepted Answer

1. Surgery is indicated only after the cause of the bleed has been identified. This management will be based on the location and type of bleed.
2. A ventriculostomy is not used as a therapy in the management of the intracerebral hematoma. This therapy is limited and is only indicated if it would be beneficial in reducing intracranial pressure by controlling cerebrospinal fluid.
3. Since the patient has been receiving the anticoagulant warfarin, the appropriate drug is the administration of vitamin K to reverse the effects of this medication.
4. Protamine sulfate is the medication used to reverse heparin-associated ICH. The dose is dependent on the time since the cessation of heparin.

Question 7

While providing oral medications to a patient recovering from a stroke, the nurse notices that the patient coughs repeatedly and has difficulty clearing the throat. What should the nurse do?

Accepted Answer

1. This patient needs to be made NPO immediately. A nutritional consult needs to be done in order to determine an alternative means of providing nutrition for this patient, such as enteral or parenteral routes.
2. This patient needs to be made NPO immediately. A nutritional consult needs to be done in order to determine an alternative means of providing nutrition for this patient.
3. A PT consult would be done, but it would be for promoting mobility and preventing muscle atrophy.
4. Dysphagia, or difficulty swallowing, is very common post stroke and is a major risk factor for developing aspiration pneumonia. The nurse should keep the patient NPO and ask for a speech therapy order for a swallowing evaluation.

Question 8

A patient is admitted with symptoms of an ischemic stroke. After further evaluation, it is determined that the patient is not a candidate for thrombolytic therapy. Which intervention would be appropriate to reduce the patient's blood pressure? Select all that apply.

Accepted Answer

1. When blood pressure is elevated, the nurse should assess for factors such as pain that can contribute to the patient's hypertension.
2. When blood pressure is elevated, the nurse should assess for factors such as bladder distention that can contribute to the patient's hypertension.
3. While treating the elevated blood pressure, continual reassessment of neurologic function is recommended.
4. When treatment is needed, blood pressure should be lowered by about 15% over the first 24 hours.
5. Blood pressure should be lowered by about 15% over the first 24 hours and not to normal levels since this could cause cerebral hypoperfusion.

Question 9

A patient with a ruptured cerebral aneurysm is demonstrating drowsiness and confusion. Using the Hunt and Hess scale, how should the nurse rate this patient?

Accepted Answer

1. A Grade 1 is asymptomatic or is evidenced by minimal headache and slight nuchal rigidity.
2. A Grade 2 is evidenced by moderate-to-severe headache, nuchal rigidity, and no neurologic deficit other than cranial nerve palsy.
3. A Grade 3 is evidenced by drowsiness, confusion, or mild focal deficit.
4. In Grade 4 there is stupor, moderate-to-severe hemiparesis, possible early decerebrate rigidity, and vegetative disturbances.

Question 10

While conducting a health history, the nurse suspects a patient with headaches is demonstrating signs of a brain tumor. How did the patient most likely describe the headaches to the nurse? Select all that apply.

Accepted Answer

1. The headache associated with a brain tumor is typically worse in the morning.
2. The headache associated with a brain tumor will worsen with coughing.
3. The headache associated with a brain tumor will worsen with a position change, such as bending over.
4. The headache associated with a brain tumor is not worse in the evening.
5. The headache associated with a brain tumor will not respond to usual headache remedies.

Question 11

A patient experiencing an ischemic stroke is being considered for thrombolytic therapy. Which finding needs to be addressed before preparing the patient for this treatment?

Accepted Answer

1. Although the pulse is slightly elevated, this pulse would not be a contraindication for thrombolytic therapy.
2. Temperature is not a contraindication for thrombolytic therapy.
3. This is a normal respiratory rate.
4. Before lytic therapy is started, it is suggested that SBP be less than or equal to 185 mm Hg and DBP be less than or equal to 110 mm Hg. To accomplish this, the nurse might administer labetalol (Normodyne) 10 to 20 mg IV over 1 to 2 minutes. The dose may be repeated once. The goal is to maintain the BP below 180/105 for a minimum of 24 hours after intravenous tPA treatment. If the blood pressure does not drop to an appropriate level, the patient will usually be excluded as a candidate for thrombolytic therapy.

Question 12

A patient being treated for a cardiac dysrhythmia demonstrates signs of an ischemic stroke. What assessment finding alerted the nurse to the development of this complication? Select all that apply.

Accepted Answer

1. Difficulty understanding speech or speaking is a symptom of an ischemic stroke.
2. The inability to see out of one eye is a symptom of an ischemic stroke.
3. A new onset of a sudden severe headache is a symptom of an ischemic stroke.
4. The onset of weakness on one side of the body is a symptom of an ischemic stroke.
5. The sudden onset of pain and swelling in one lower extremity limb is not a symptom of ischemic stroke but rather a venous thromboembolism.

Question 13

A patient with an ischemic stroke has an oxygen saturation of 88%. What should be done to help this patient?

Accepted Answer

1. Positioning the patient on one side does not improve O₂ saturation. 2. Raising the head of the bed assists in keeping the airway open as well as facilitating lung expansion to prevent atelectasis but will not improve oxygen saturation. 3. Low-dose oxygen does not provide adequate supplementation to maintain oxygen saturation, especially when it falls below 90%. It is helpful as an adjunct, when the saturation is 90%, in order to raise saturation to more appropriate levels. 4. High-flow oxygen therapy is indicated when arterial blood gases or O₂ saturation is less than 92%. Hypoventilation may cause an elevation in carbon dioxide, which could lead to cerebral vasodilation and further increase ICP.

Question 14

The nurse is concerned that a patient recovering from a craniotomy for a malignant brain tumor is at risk for developing a deep vein thrombosis. Which interventions would be appropriate for the patient at this time? Select all that apply.

Accepted Answer

1. Graduated compression stockings have been shown to decrease the occurrence of venous thrombosis without increasing intracranial pressure.
2. The use of low-molecular-weight heparin is an alternative to the use of compression boots to reduce the risk for venous thrombosis.
3. The use of enoxaparin 40 mg each day is an alterative to the use of compression boots to reduce the risk for venous thrombosis.
4. Elevating the legs of the bed will not reduce the development of venous thrombosis in this patient.
5. Passive range of motion exercises every 8 hours will not reduce the development of venous thrombosis.

Question 15

The nurse is concerned that the patient recovering from surgery to repair an aneurysm is experiencing vasospasm. What did the nurse assess in the patient? Select all that apply.

Accepted Answer

1. A change in mental status, such as lethargy, is a symptom associated with vasospasm.
2. Elevated body temperature is a symptom associated with vasospasm.
3. Neck stiffness is a symptom associated with vasospasm.
4. Dysphagia is a symptom associated with vasospasm.
5. Ventricular dysrhythmia is not a symptom associated with vasospasm.

Question 16

A patient receiving an infusion of heparin for treatment of a venous thromboembolism is diagnosed with an intracerebral hemorrhage. What intervention should the nurse anticipate for this patient? Select all that apply.

Accepted Answer

1. Protamine sulfate is used to reverse heparin-associated intracerebral hemorrhage.
2. Vitamin K is used to reverse the effects of warfarin (Coumadin).
3. A ventriculostomy may need to be performed and an external ventricular drain inserted to drain CSF.
4. Aneurysms are associated with subarachnoid hemorrhages.
5. This is a treatment for an aneurysm.

Question 17

A patient with dysphagia after a stroke is scheduled for a barium swallow. What test results should the nurse anticipate? Select all that apply.

Accepted Answer

1. A barium swallow may identify the presence of an aspiration.
2. A barium swallow may identify subtle anatomic abnormalities. This test is especially useful if more than one abnormality is discovered.
3. Videofluoroscopy visualizes the sequence of events of a swallow.
4. Videofluoroscopy analyzes muscle activities.
5. The barium swallow does not correct swallowing abnormalities.

Question 18

A patient develops cerebral vasospasm after a ruptured cerebral aneurysm. On what should collaborative treatment focus?

Accepted Answer

1. Blood pressure needs to be maintained 10-60 mm Hg above baseline and/or kept between 150-200 mm Hg systolic blood pressure.
2. Dehydration is not desirable as it will increase blood viscosity and increase the risk of clot formation.
3. Keeping the RBCs concentrated is not desirable as this can lead to the formation of blood clots.
4. Vasospasm management is hypertensive, hypervolemic, and hemodilution (HHH) therapy. Volume expansion raises the blood pressure and decreases blood viscosity.

Question 19

A patient recovering from a ruptured cerebral aneurysm is demonstrating signs of hydrocephalus. What should the nurse anticipate being prescribed for this patient?

Accepted Answer

1. Glucocorticoid therapy is not indicated for this health problem.
2. If hydrocephalus leads to an increase in ICP and deterioration of the patient's neurological status, an external ventricular drain might be emergently placed for CSF diversion.
3. If the hydrocephalus is persistent, the patient may require a ventriculoperitoneal shunt.
4. Fluid and sodium restriction is not indicated for this health problem.

Quiz 11: Care of the Patient With a Cerebral or Cerbrovascular Disorder