Question 1

A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which response by the nurse is accurate?

Accepted Answer

In a carotid endarterectomy,the carotid artery is incised,and the plaque is removed. The response beginning,"The diseased portion of the artery in the brain is replaced" describes an arterial graft procedure. The answer beginning,"A catheter with a deflated balloon is positioned at the narrow area" describes an angioplasty. The final response beginning,"A wire is threaded through the artery" describes the mechanical embolus removal in cerebral ischemia (MERCI)procedure.

Question 2

After a patient experienced a brief episode of tinnitus,diplopia,and dysarthria with no residual effects,the nurse anticipates teaching the patient about

Accepted Answer

The patient's symptoms are consistent with transient ischemic attack (TIA),and drugs that inhibit platelet aggregation are prescribed after a TIA to prevent a stroke. Continuous heparin infusion is not routinely used after TIA or with acute ischemic stroke. The patient's symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic stroke,not for TIA.

Question 3

When teaching about clopidogrel (Plavix),the nurse will tell the patient with cerebral atherosclerosis

Accepted Answer

Clopidogrel inhibits platelet function and increases the risk for gastrointestinal bleeding,so patients should be advised to notify the health care provider about any signs of bleeding. The medication does not lower blood pressure,decrease plaque formation,or dissolve clots.

Question 4

Several weeks after a stroke,a 50-yr-old male patient has impaired awareness of bladder fullness,resulting in urinary incontinence. Which nursing intervention should be planned to begin an effective bladder training program?

Accepted Answer

Developing a regular voiding schedule will prevent incontinence and may increase patient awareness of a full bladder. A 1200-mL fluid restriction may lead to dehydration. Intermittent catheterization and use of a condom catheter are appropriate in the acute phase of stroke,but should not be considered solutions for long-term management because of the risks for urinary tract infection and skin breakdown.

Question 5

A patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient,which clinical manifestation will the nurse expect to find?

Accepted Answer

Right-sided paralysis indicates a left-brain stroke,which will lead to difficulty with comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more likely with a right-side stroke.

Question 6

A patient who has a history of a transient ischemic attack (TIA)has an order for aspirin 160 mg daily. When the nurse is administering medications,the patient says,"I don't need the aspirin today. I don't have a fever." Which action should the nurse take?

Accepted Answer

Aspirin is ordered to prevent stroke in patients who have experienced TIAs. Documentation of the patient's refusal to take the medication is an inadequate response by the nurse. There is no need to clarify the order with the health care provider. The aspirin is not ordered to prevent aches and pains.

Question 7

A patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously,and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for

Accepted Answer

The patient's history and clinical manifestations suggest an acute ischemic stroke,and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.

Question 8

A male patient who has right-sided weakness after a stroke is making progress in learning to use the left hand for feeding and other activities. The nurse observes that when the patient's wife is visiting,she feeds and dresses him. Which nursing diagnosis is most appropriate for the patient?

Accepted Answer

The information supports the diagnosis of disabled family coping because the wife does not understand the rehabilitation program. There are no data supporting low self-esteem,and the patient is attempting independence. The data do not support an interruption in family processes because this may be a typical pattern for the couple. There is no indication that the patient has impaired nutrition.

Question 9

A patient will attempt oral feedings for the first time after having a stroke. The nurse should assess the gag reflex and then

Accepted Answer

The patient should be as upright as possible before attempting feeding to make swallowing easier and decrease aspiration risk. To assess swallowing ability,the nurse should initially offer water or ice to the patient. Pureed diets are not recommended because the texture is too smooth. The patient may have a poor appetite,but the oral feeding should be attempted.

Question 10

A patient in the clinic reports a recent episode of dysphasia and left-sided weakness at home that resolved after 2 hours. The nurse will anticipate teaching the patient about

Accepted Answer

After a transient ischemic attack,patients typically are started on medications such as aspirin to inhibit platelet function and decrease stroke risk. tPA is used for acute ischemic stroke. Coumadin is usually used for patients with atrial fibrillation. Nimodipine is used to prevent cerebral vasospasm after a subarachnoid hemorrhage.

Question 11

A female patient who had a stroke 24 hours ago has expressive aphasia. An appropriate nursing intervention to help the patient communicate is to

Accepted Answer

Communication will be facilitated and less frustrating to the patient when questions that require a "yes" or "no" response are used. When the language areas of the brain are injured,the patient might not be able to read or recite words,which will frustrate the patient without improving communication. Expressive aphasia is caused by damage to the language areas of the brain,not by the areas that control the motor aspects of speech. The nurse should allow time for the patient to respond.

Question 12

A patient with a left-brain stroke suddenly bursts into tears when family members visit. The nurse should

Accepted Answer

Patients who have left-sided brain stroke are prone to emotional outbursts that are not necessarily related to the emotional state of the patient. Depression after a stroke is common,but the suddenness of the patient's outburst suggests that depression is not the major cause of the behavior. The family should stay with the patient. The crying is not within the patient's control,and asking the patient to stop will lead to embarrassment.

Question 13

When caring for a patient with a new right-sided homonymous hemianopsia resulting from a stroke,which intervention should the nurse include in the plan of care?

Accepted Answer

During the acute period,the nurse should place objects on the patient's unaffected side. Because there is a visual defect in the right half of each eye,an eye patch is not appropriate. The patient should be approached from the left side. The visual deficit may not resolve,although the patient can learn to compensate for the defect.

Question 14

A patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin?

Accepted Answer

A sudden onset headache is typical of a subarachnoid hemorrhage,and aspirin is contraindicated. Atrial fibrillation,dysphasia,and transient ischemic attack are not contraindications to aspirin use.

Question 15

A left-handed patient with left-sided hemiplegia has difficulty feeding himself. Which intervention should the nurse include in the plan of care?

Accepted Answer

Because the patient has difficulty feeding himself,the appropriate interventions will focus on teaching the patient to use the right hand for self-feeding. The other interventions are appropriate for patients with other etiologies for the imbalanced nutrition.

Question 16

A patient has a ruptured cerebral aneurysm and subarachnoid hemorrhage. Which intervention will the nurse include in the plan of care?

Accepted Answer

The patient with a subarachnoid hemorrhage usually has minimal activity to prevent cerebral vasospasm or further bleeding and is at risk for venous thromboembolism. Activities such as coughing and sitting up that might increase intracranial pressure or decrease cerebral blood flow are avoided. Because there is no indication that the patient is unconscious,an oropharyngeal airway is inappropriate.

Question 17

A patient admitted with possible stroke has been aphasic for 3 hours,and his current blood pressure (BP)is 174/94 mm Hg. Which order by the health care provider should the nurse question?

Accepted Answer

Because elevated BP may be a protective response to maintain cerebral perfusion,antihypertensive therapy is recommended only if mean arterial pressure (MAP)is greater than130 mm Hg or systolic pressure is greater than 220 mm Hg. Fluid intake should be 1500 to 2000 mL/day to maintain cerebral blood flow. The head of the bed should be elevated to at least 30 degrees unless the patient has symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for tPA use.

Question 18

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the nurse to address?

Accepted Answer

Hypertension is the single most important modifiable risk factor. People who drink more than 1 (for women)or 2 (for men)alcoholic beverages a day may increase their risk for hypertension. Physical inactivity and obesity contribute to stroke risk but not as much as hypertension.

Question 19

For a patient who had a right hemisphere stroke,the nurse anticipates planning interventions to manage

Accepted Answer

The patient with right-sided brain damage typically denies any deficits and has poor impulse control,leading to risk for injury when the patient attempts activities such as transferring from a bed to a chair. Right-sided brain damage causes left hemiplegia. Left-sided brain damage typically causes language deficits. Left-sided brain damage is associated with depression and distress about the disability.

Question 20

During the change of shift report,a nurse is told that a patient has an occluded left posterior cerebral artery. The nurse will anticipate that the patient may have

Accepted Answer

Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with middle cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior cerebral artery occlusion.

Quiz 57: Stroke