Question 1

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 gold standard diagnostic test for cavernous malformations. It can provide detailed images of vascular lesions and is more sensitive than CT scans or angiography. A patient with a family history of cavernous malformation who presents with a seizure is at high risk for having a cerebral cavernous malformation and should undergo an MRI scan.

Question 2

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 assess for subarachnoid hemorrhage or other contraindications to the procedure. This is because lumbar puncture can cause herniation of the brain if there is increased intracranial pressure, which can be caused by a mass lesion or bleeding in the brain. A CT scan can identify these conditions and help determine if a lumbar puncture is safe to perform. Serum glucose and BUN levels are not typically checked prior to a lumbar puncture for subarachnoid hemorrhage, and a chest X-ray would not be relevant in this situation.

Question 3

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 4

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

It is possible for a CT scan to be normal in the early stages of a stroke, and a repeat CT scan may show damage as the stroke progresses. Therefore, a second CT done later may show damage. Option A is incorrect because intracranial aneurysm does not always cause stroke. Option B is inappropriate because it suggests that the patient is not experiencing stroke signs, which contradicts the initial assessment findings. Option D is not the next step in the evaluation of a possible stroke.

Question 5

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 decrease the pain associated with central pain syndrome. Cold temperatures may exacerbate the pain, so staying warm can be helpful. Walking and taking an ACE inhibitor are not proven home management techniques for central pain syndrome, and ice massage may actually worsen the pain.

Question 6

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 can save cells in the penumbra. The penumbra is a region of brain tissue surrounding the area of infarction that is not yet irreversibly damaged but is vulnerable to further ischemic injury. Early intervention can salvage these cells and minimize the extent of brain damage.

Question 7

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 do occur in small arteries, but they can have significant motor and sensory effects because they often occur in areas where important tracts are located.

Question 8

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?. 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 9

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 for a patient undergoing diagnostic evaluation for presence of an intracranial bleed is Risk for Altered Cerebral Tissue Perfusion. This is the most critical concern as decreased perfusion to the brain can lead to permanent damage or death. Impaired Verbal Communication and Altered Coping may be appropriate diagnoses but are not as critical as Risk for Altered Cerebral Tissue Perfusion. Potential for Aspiration may also be a concern, but is secondary to ensuring adequate cerebral tissue perfusion.

Question 10

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 11

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

The Fisher score is used to assess the severity of subarachnoid hemorrhage and ranges from 1 to 4. A score of 1 indicates no blood detected on the CT scan. Therefore, the nurse can evaluate this information as indicating that there is no evidence of bleeding in the brain.

Question 12

A patient has had successful treatment for a leaking arteriovenous malformation and is being discharged to home. The patient's Barthel Index score is

Accepted Answer

The answer of A patient has had successful treatment for...

Question 13

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 14

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?. Select all that apply.

Accepted Answer

Seizures, increased difficulty in talking, and a sudden decrease in level of consciousness are critical findings that may indicate worsening of the AVM or increased intracranial pressure, and should be reported to the surgeon immediately.

Question 15

Results of diagnostic procedures reveal that a patient's cerebral arteriovenous malformation (AVM) is Spetzler-Martin grade 1. The nurse anticipates which most common treatment for this patient?

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.

Quiz 22: Caring for the Patient With Cerebral Vascular Disorders