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

Question 1

A patient complains of having the "worst headache" ever. What health problem should the nurse suspect is occurring in this patient?
1) Intracranial hemorrhage
2) Ischemic stroke
3) Subarachnoid hemorrhage
4) A brain tumor

Answer 1

3
Explanation: 1. Intracranial hemorrhage is a local hematoma in the brain that is manifested by neurologic symptoms such as a change in level of consciousness and sensory and motor deficits.
2. Ischemic stroke is characterized by confusion, difficulty speaking, visual disturbances, and sensory and motor deficits. Headache does occur.
3. Subarachnoid hemorrhage is the rupture of an aneurysm that releases blood directly into the cerebrospinal fluid under arterial pressure. The blood spreads rapidly, immediately increasing intracranial pressure. If bleeding continues, deep coma or death may result. Typically, the bleeding lasts only a few seconds, but there is risk of rebleeding. The classic symptom is a sudden, severe headache that begins abruptly and is described as "the worst headache of my life."
4. The headache associated with a brain tumor is worse in the morning but improves during the day. It worsens with coughing, exercise, and changes in position. This type of headache does not respond to usual headache treatment.

Question 2

A patient with a brain tumor is prescribed an antiseizure medication. What outcome should the nurse expect to occur with this medication?
1) All seizure activity will be eliminated.
2) Focal seizures will be reduced.
3) The patient will be premedicated for status epilepticus.
4) The onset of seizure activity will be controlled.

Answer 2

4
Explanation: 1. The majority of patients with brain tumors continue with some type of seizure, most commonly a focal seizure.
2. The majority of patients with brain tumors continue with some type of seizure, most commonly a focal seizure.
3. The use of seizure medication in the patient with a brain tumor is not to premedicate for status epilepticus.
4. Seizures after craniotomy are extremely common, and the risk of seizure development is partially dependent on the type of brain tumor. Recurrent seizures post craniotomy continue to cause significant clinical problems. Antiseizure medication is used to control the onset of seizure activity.

Question 3

The nurse plans care for a patient who is recovering from a supratentorial craniotomy. What should be included in this plan of care?
1) Apply a soft cervical collar.
2) Keep the head of the bed elevated at a 30-degree angle.
3) Keep the head of the bed flat.
4) Position the patient on the side of the tumor.

Answer 3

2
Explanation: 1. This patient had surgery involving the supratentorium; therefore, a cervical collar is not necessary.
2. Postoperatively, patients are usually positioned with the head of their bed elevated 30 degrees. This facilitates venous drainage from the head and neck, preventing increases in intracranial pressure and increasing patient comfort.
3. The head of the bed needs to be elevated to 30 degrees in order to facilitate venous drainage from the operative site. This prevents increased intracranial pressure and herniation.
4. If a large tumor was resected, the patient would usually not be permitted to turn the head to the operative side because it may cause a shift in cerebral contents.

Question 4

A patient is diagnosed with a Grade II astrocytoma. What does the nurse realize is this patient's prognosis?
1) The prognosis is excellent.
2) The prognosis is good as long as the tumor is treated soon.
3) The prognosis is good because the tumor is well defined.
4) The prognosis is poor because the tumor cells are irregularly shaped.

Question 5

A patient reports an area on the arm that has been getting numb and "feels funny." Why should the nurse consider this information as being important?
1) It pinpoints the location of a brain tumor.
2) It determines the type and amount of medication to prescribe.
3) It serves as a minor symptom that is nothing for the patient to worry about.
4) It determines how long the patient has to stay in the hospital.

Question 6

During an assessment, an older patient asks if "something is burning." What should the nurse suspect is occurring with this patient?
1) Engorged nasal passages
2) A focal seizure
3) A good sense of smell
4) Increased intracranial pressure

Question 7

An older patient is not concerned about having a brain tumor because the only symptom has been a slight increase in forgetfulness, and he has had no headaches. What explanation should the nurse consider about this patient's symptoms?
1) The patient does not have a brain tumor because brain tumors are rarely present with cognitive changes.
2) The patient does not have a tumor because forgetfulness is seen in children with a brain tumor.
3) The patient could have a brain tumor even though a headache is not present.
4) The patient has the beginnings of Alzheimer's disease.

Question 8

A patient recovering from a glioma has concluded radiation therapy. What should the nurse anticipate as being the next treatment for this patient?
1) Chemotherapy
2) An additional 6 weeks of radiation
3) Nothing, unless there is evidence the tumor has returned
4) Antiseizure medication

Question 9

A patient is diagnosed with an intracerebral hemorrhage. What is the most common cause of this disorder?
1) Hypertension
2) Atrial fibrillation
3) Atherosclerosis
4) Hyperinsulinemia

Question 10

A patient recovering from a craniotomy is complaining of a headache despite having the head of the bed elevated. The nurse also sees a damp mark on the patient's pillow. What should the nurse do? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Check the drainage for the presence of glucose.
2) Alert the physician.
3) Elevate the head of the bed to 45 degrees.
4) Plan for insertion of an external ventricular drain.
5) Apply an occlusive dressing to stop the leak.

Question 11

The nurse applies pneumatic compression boots on a postoperative craniotomy patient. Which complication is the nurse attempting to avoid with this action?
1) Meningitis
2) A deep vein thromboembolism
3) A cerebrospinal fluid leak
4) Seizures

Question 12

The nurse is assessing a patient with a meningioma. What should the nurse keep in mind when planning this patient's care?
1) A hearing disorder will occur.
2) A life expectancy of about 10 months is the prognosis.
3) The patient has an excellent prognosis if the tumor is totally removed.
4) Expect metastasis to other body organs.

Question 13

The nurse prepares a medication to decrease cerebral edema caused by a brain tumor. Which medication is the nurse most likely preparing?
1) Antiseizure medication
2) Pain medication
3) Glucocorticoid
4) Antispasmodic

Question 14

A patient is recovering from transphenoidal surgery for partial resection of a pituitary adenoma. Which action should the nurse counsel the patient to avoid performing?
1) Blowing the nose or sneezing
2) Deep breathing
3) Drinking more than 2 liters of fluid a day
4) Sitting up in bed higher than 30 degrees

Question 15

A patient with a brain tumor is going to have an ablative procedure to treat the mass. What should the nurse consider as a potential reason for this procedure?
1) It's a way to preserve eloquent areas of the brain.
2) The tumor is in an easy-to-reach area of the brain.
3) The tumor is too large to resect.
4) The tumor is small and is in a hard-to-reach area of the brain.

Question 16

A patient is recovering from posterior fossa surgery. What should the nurse include in the patient's plan of care?
1) Assess vital signs and level of consciousness every hour.
2) Maintain the patient flat in bed for at least 24 hours.
3) Maintain the patient's neck in hyperextension.
4) Observe the patient for the development of diabetes insipidus.

Question 17

A patient diagnosed with an ischemic stroke developed symptoms within the last 2 hours. What should the nurse anticipate being prescribed for this patient?
1) Surgery
2) Administration of intravenous recombinant tissue-type plasminogen activator (rt-PA or alteplase)
3) Observation
4) Intravenous fluids

Question 18

A patient with increased intracranial pressure is diagnosed with a brain tumor. What should the nurse suspect that this patient is experiencing?
1) An astrocytoma
2) A meningioma
3) A tumor less than 1 mm in size
4) A tumor greater than 1 mm in size

Question 19

A patient with an embolic stroke is demonstrating urinary incontinence, contralateral weakness, and altered mental status. Where should the nurse suspect the embolism is located?
1) Middle cerebral artery
2) Anterior cerebral artery
3) Posterior cerebral artery
4) Vertebrobasilar artery

Question 20

A patient with a brain tumor is scheduled for a diagnostic test to help determine response to therapy. Which test is this patient most likely going to have?
1) CT scan
2) PET scan
3) Angiogram
4) MRI

Question 21

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Determine pupillary response.
2) Instruct to avoid flexion of the neck.
3) Assess using the Glasgow Coma Scale.
4) Monitor strength, movement, and sensory status of all extremities.
5) Encourage fluids to prevent dry mucous membranes and coughing.

Question 22

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Nasogastric tube feedings
2) Intralipid infusions several times a day
3) High-volume intravenous fluid infusions
4) Total parenteral nutrition via a central line
5) Placement of a percutaneous endoscopic gastrostomy tube

Question 23

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Neurologic symptoms improve within 12 hours
2) Reduced intracranial pressure
3) Neurologic symptoms improve immediately
4) Reduced respiratory rate
5) Increased heart rate and blood pressure

Question 24

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) "The tumor is irritating the brain tissue."
2) "It might be because of the location of the tumor."
3) "Brain swelling is compressing the cranial nerves."
4) "The brain tumor can cause the personality to change."
5) "The pressure within the brain can cause personality changes."

Question 25

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Gaze
2) Walking gait
3) Arm function
4) Facial muscles
5) Level of consciousness

Question 26

A patient being treated with warfarin experiences an intracerebral hemorrhage. What should the nurse anticipate being prescribed for this patient?
1) Surgery
2) Ventriculostomy
3) Vitamin K
4) Protamine sulfate

Question 27

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?
1) Change the diet to full liquid.
2) Change the diet to soft.
3) Request a physical therapy consult.
4) Request a swallowing evaluation by speech therapy.

Question 28

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Assess for pain when measuring blood pressure.
2) Assess for bladder distention.
3) Assess neurologic function with every blood pressure assessment.
4) Administer medication to reduce blood pressure by 15% over 24 hours.
5) Provide antihypertensive medication to reduce pressure to normal levels.

Question 29

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?
1) Grade 1
2) Grade 2
3) Grade 3
4) Grade 4

Question 30

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Worse in the morning
2) Worse when coughing
3) Becomes severe when bending to tie shoes
4) Worse in the evening
5) Relieved by over-the-counter pain medication

Question 31

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?
1) Pulse 108 bpm
2) Temperature 99°F
3) Respiratory rate 20
4) Blood pressure 198/120 mm Hg

Question 32

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Garbled speech
2) Inability to see out of the right eye
3) Complaint of a sudden severe headache
4) New onset of left arm and leg weakness
5) Sudden onset of pain and swelling in one lower extremity limb

Question 33

A patient with an ischemic stroke has an oxygen saturation of 88%. What should be done to help this patient?
1) Position the patient on one side.
2) Elevate the head of the bed.
3) Provide low-dose oxygen.
4) Provide high-dose oxygen.

Question 34

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Apply graduated compression stockings as indicated.
2) Administer subcutaneous low-molecular-weight heparin (LMWH) 5,000 units twice a day as prescribed.
3) Administer enoxaparin 40 mg each day.
4) Position with the legs of the bed elevated.
5) Perform bedside passive range of motion exercises every 8 hours.

Question 35

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Increased lethargy
2) Elevated body temperature
3) Nuchal rigidity
4) Dysphagia
5) Ventricular dysrhythmia

Question 36

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. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Administering protamine sulfate
2) Administering vitamin K
3) Preparing for ventriculostomy placement
4) Preparing for surgery to clip the aneurysm
5) Preparing for endovascular embolization

Question 37

A patient with dysphagia after a stroke is scheduled for a barium swallow. What test results should the nurse anticipate? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) The test will identify the presence of an aspiration.
2) The test will identify the presence of abnormalities.
3) The test will visualize the sequence of events of a swallow.
4) The test will analyze muscle activities.
5) The test will correct swallowing abnormalities.

Question 38

A patient develops cerebral vasospasm after a ruptured cerebral aneurysm. On what should collaborative treatment focus?
1) Reducing blood pressure
2) Dehydrating the patient
3) Concentrating red blood cells
4) Volume expansion

Question 39

A patient recovering from a ruptured cerebral aneurysm is demonstrating signs of hydrocephalus. What should the nurse anticipate being prescribed for this patient?
1) Glucocorticoid therapy
2) External ventricular drain
3) Ventriculoperitoneal shunt
4) Fluid and sodium restriction