Deck 49: Nursing Care of Patients With Cerebrovascular Disorders

Question 1

Some patients are placed on antiplatelet agents to prevent strokes. Which agent is an example of an antiplatelet agent?

A)Acetaminophen (Tylenol)
B)Warfarin (Coumadin)
C)Aspirin
D)Tissue-type plasminogen activator (tPA)

Answer 1

Aspirin

Question 2

A patient is admitted to a medical unit with a cerebrovascular accident (stroke). The patient is flaccid on the left side and is unable to speak but seems to understand everything the nurse says. Which of the following terms would the nurse use to document the patient's communication impairment?

A)Sensory aphasia
B)Expressive aphasia
C)Motor dysphagia
D)Receptive dysphagia

Answer 2

Expressive aphasia

Question 3

A patient enters the emergency department with right-sided weakness and vision changes. What assessment finding should be communicated to the RN or physician immediately?

A)Blood pressure 148/92 mm Hg
B)Onset of symptoms occurred 90 minutes ago
C)Blood glucose 150 mg/dL
D)History of transient ischemic attack (TIA) 3 months ago

Answer 3

Onset of symptoms occurred 90 minutes ago

Question 4

The nurse is caring for a hospitalized patient who has had a stroke and is waiting to be transferred to a rehabilitation facility. What nursing action can best maximize the patient's rehabilitation potential while awaiting the transfer?

A)Teach the patient what to expect at the rehabilitation facility.
B)Keep the patient on bedrest to conserve energy for rehabilitation.
C)Turn the patient every 2 hours to prevent pressure ulcers and contractures.
D)Call the physical therapist for bedside rehabilitation until the transfer.

Question 5

The nurse is assisting with a community education program about stroke prevention. Which of the following are nonmodifiable risk factors for stroke that the nurse should include? (Select all that apply.?

A)Gender
B)Diabetes
C)Heredity
D)Elevated blood lipids
E)Smoking
F)Obesity

Question 6

The nurse is providing care for a patient with expressive aphasia. Which of the following would the nurse expect to find in the patient's plan of care? (Select all that apply.?

A)Speak loudly.
B)Gesture or pantomime the message.
C)Speak slowly and clearly.
D)Provide pencil and paper.
E)Obtain an interpreter.
F)Use a picture board.

Question 7

The nurse is providing care for a patient with symptoms of impending stroke who is scheduled to have a cerebral angiogram. Which of the following statements would the nurse include when assisting with patient teaching?

A)"This test is done to examine cerebrospinal fluid for signs of bleeding."
B)"The angiogram is done to help identify swelling in the brain."
C)"This test is designed to detect vascular lesions in the brain."
D)"We need to do this to evaluate electrical function of the brain."

Question 8

A patient presents in the emergency department with symptoms of a stroke. Which of the following medications would the nurse expect may be given to the patient if diagnostic testing confirms an ischemic stroke?

A)Heparin
B)Warfarin (Coumadin)
C)Clopidogrel (Plavix)
D)Tissue-type plasminogen activator (tPA)

Question 9

The nurse is assisting with teaching a patient who has had a transient ischemic attack (TIA). On which understanding should a nurse base teaching?

A)TIAs are not serious, and the patient should have no further problems.
B)A TIA is predictive that the patient will have a heart attack within 1 year.
C)A TIA is a forewarning that the patient is at risk for a cerebrovascular accident (stroke).
D)A TIA is a medical emergency that requires immediate surgical intervention.

Question 10

A patient experiencing bilateral hemiparesis, dysphasia, visual changes, altered level of consciousness, ataxia, and dysphagia has most likely had a stroke involving which artery?

A)Carotid
B)Vertebrobasilar/cerebellar
C)Middle cerebral
D)Posterior cerebral

Question 11

A patient is admitted to the hospital with a severe headache and photophobia. A lumbar puncture confirms a bleeding aneurysm. What nursing interventions should the nurse anticipate assisting with to prevent increased intracranial pressure (ICP) during the acute phase of illness?

A)Quiet room, head of bed up, and stool softeners
B)Morphine, dark glasses, and expectorants
C)Range of motion exercises, bedside commode, and suctioning as needed
D)Coughing and deep breathing exercises and tranquilizers

Question 12

Which of the following demographic groups are at higher than average risk of stroke? (Select all that apply.?

A)African Americans
B)American Indians
C)Men and women 75 years old or older
D)Asian Americans
E)Pregnant women
F)Individuals who have had a transient ischemic attack (TIA)

Question 13

Which area of the brain is affected in a patient who has right-sided weakness and aphasia due to a transient ischemic attack (TIA)?

A)Right hemisphere
B)Left hemisphere
C)Occipital lobe
D)Medulla

Question 14

The nurse is caring for a patient admitted to the intensive care unit with a subarachnoid bleed. Vital signs are as follows: blood pressure (BP) 120/74 mm Hg, pulse 70 beats/min, and respirations 16 breaths/min. Several hours later, the patient requests help to have a bowel movement. The patient refuses a bedpan and asks to use a bathroom. When told that this is not possible, the patient becomes angry and belligerent and starts yelling at the nurse. Vital signs are now BP 160/60 mm Hg, pulse 48 beats/min, and respirations 12 breaths/min. The neurosurgeon has been paged but has not yet responded. With which of the following actions should the LPN anticipate assisting the RN?

A)Waiting for the neurosurgeon to call back with orders
B)Administering an as-needed dose of a sedative that is ordered
C)Helping the patient to get up on a bedside commode
D)Paging security to restrain the patient from harming the nurse

Question 15

The nurse is assisting in preparing a patient for transfer to a rehabilitation facility after a stroke. What is most likely the goal for rehabilitation?

A)To cure any effects of the stroke
B)To maximize remaining abilities
C)To monitor neurological status
D)To determine the extent of neurological deficits

Question 16

The nurse is involved in a blood pressure clinic in the community, and an individual with possible stroke symptoms is brought for evaluation. Which of the following findings in the F.A.S.T. assessment indicate the need to call emergency personnel? (Select all that apply.?

A)When asked to close the eyes and hold arms straight in front, one arm drifts downward.
B)The patient sways when asked to stand still with eyes closed.
C)The patient is unable to repeat a stated phrase exactly as it was stated.
D)The patient's face shows signs of uneven symmetry when asked to smile.
E)The patient is unable to follow directions during the assessment.

Question 17

Which term describes left-sided flaccidity in a patient who has had a stroke?

A)Ipsilateral paraplegia
B)Contralateral quadriparesis
C)Contralateral hemiplegia
D)Ipsilateral hemiparesis

Question 18

Which type of cerebrovascular accident has the slowest rate of recovery and the highest probability of causing extensive neurological deficits?

A)Reversible ischemic neurological deficit (RIND)
B)Cerebral aneurysm
C)Subarachnoid hemorrhage (SAH)
D)Thrombotic stroke

Question 19

The nurse is caring for a patient admitted to the emergency department with right-sided weakness and difficulty speaking. Within an hour, the symptoms have subsided, and the patient receives a diagnosis of transient ischemic attack (TIA). The patient asks, "What is a TIA?" What information should be included when assisting with teaching the patient about TIA?

A)"Your brain was temporarily deprived of oxygen."
B)"You had a small hemorrhage in your brain."
C)"You have a vessel that is occluded, blocking the blood supply to your brain."
D)"The neurons in your brain are tangled, so messages get mixed up."

Question 20

The nurse is providing care for a patient recently admitted with transient ischemic attack (TIA). Which of the following statements indicates that further teaching is required??

A)"My risk for Alzheimer's disease is increased now, so I'll have to stop driving."
B)"The risk factors and symptoms of a TIA are just like those of a stroke."
C)"I recognize how important it is to take my anti-hypertension medications regularly."
D)"I need to stop smoking to help lower my chances of this happening again."

Question 21

For thrombolytic medications to be effective in reversing stroke symptoms, they must be administered within ________________hour(s) of onset of symptoms.

Question 22

A patient has been prescribed pravastatin (Pravachol) to reduce cholesterol level after having a transient ischemic attack (TIA). What possible side effects should the nurse include in teaching the patient about this drug? (Select all that apply.?

A)Muscle aches
B)Confusion
C)Purple toe
D)Diarrhea
E)Irritability
F)Heartburn

Question 23

The LPN has been asked to help a patient eat who has impaired swallowing due to a stroke. What should be included in the plan of care? (Select all that apply.?

A)Place the patient in high Fowler's position or in a chair for meals.
B)Offer the patient a straw for liquids.
C)Stay with the patient during meals.
D)Instruct the patient to try to chew on both sides of the mouth.
E)Have suction equipment available.
F)Encourage the patient to eat slowly.