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MS2- |! Exam |! 3- |! Stroke |! newest |! with |!
verified |! solutions |! & |! rationales
What |! topic |! should |! the |! nurse |! anticipate |! teaching |! a |! patient |! who |! had |! a |! brief |! episode |! of |! tinnitus, |! diplopia, |! dysarthria |! with |! no |! residual |! effects? A. |! Cerebral |! aneurysm |! clipping B. |! Heparin |! intravenous |! infusion C. |! Oral |! low-dose |! aspirin |! therapy D. |! Tissue |! plasminogen |! activator |! (tPA) |! - |! Correct |! answer |! ✔ANS: |! C Rationale: 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.
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 |! a |! prescribed |! dose |! of |! aspirin? A. |! The |! patient |! has |! dysphasia. |! B. |! The |! patient |! has |! atrial |! fibrillation. |! C. |! The |! patient |! reports |! that |! symptoms |! began |! with |! a |! severe |! headache. |! D. |! The |! patient |! has |! a |! history |! of |! brief |! episodes |! of |! right-sided |! hemiplegia. |! - |! Correct |! answer |! ✔ANS: |! C Rationale: 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. A |! patient |! being |! admitted |! with |! a |! stroke |! has |! right-sided |! facial |! drooping |! and |! right-sided |! arm |! and |! leg |! paralysis. |! Which |! finding |! should |! the |! nurse |! expect? A. |! Impulsive |! behavior B. |! Right-sided |! neglect
and |! changes |! in |! judgment |! are |! more |! typical |! of |! anterior |! cerebral |! artery |! occlusion. What |! will |! the |! nurse |! tell |! the |! patient |! who |! has |! cerebral |! atherosclerosis |! about |! taking |! clopidogrel |! (Plavix)? A. |! Monitor |! and |! record |! the |! blood |! pressure |! daily. B. |! Call |! the |! health |! care |! provider |! if |! stools |! are |! tarry. C. |! Clopidogrel |! will |! dissolve |! clots |! in |! the |! cerebral |! arteries. D. |! Clopidogrel |! will |! reduce |! cerebral |! artery |! plaque |! formation. |! - |! Correct |! answer |! ✔ANS: |! B Rationale: 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. A |! patient |! with |! carotid |! atherosclerosis |! asks |! the |! nurse |! to |! describe |! a |! carotid |! endarterectomy. |! Which |! response |! by |! the |! nurse |! is |! accurate? A. |! "The |! diseased |! portion |! of |! the |! artery |! is |! replaced |! with |! a |! synthetic |! graft."
B. |! "The |! obstructing |! plaque |! is |! surgically |! removed |! from |! inside |! an |! artery |! in |! the |! neck." C. |! "A |! wire |! is |! threaded |! through |! an |! artery |! in |! the |! leg |! to |! the |! clots |! in |! the |! carotid |! artery, |! and |! clots |! are |! removed." D. |! "A |! catheter |! with |! a |! deflated |! balloon |! is |! positioned |! at |! the |! narrow |! area, |! and |! the |! balloon |! flattens |! the |! plaque." |! - |! Correct |! answer |! ✔ANS: |! B Rationale: In |! a |! carotid |! endarterectomy, |! the |! carotid |! artery |! is |! incised, |! and |! the |! plaque |! is |! removed. |! The |! response |! beginning, |! "The |! diseased |! portion |! of |! the |! artery |! 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. A |! patient |! admitted |! with |! possible |! stroke |! has |! been |! aphasic |! for |! 3 |! hours |! and |! has |! a |! current |! blood |! pressure |! (BP) |! of |! 174/94 |! mm |! Hg. |! Which |! order |! by |! the |! health |! care |! provider |! should |! the |! nurse |! question? A. |! Keep |! head |! of |! bed |! elevated |! at |! least |! 30 |! degrees. B. |! Infuse |! normal |! saline |! intravenously |! at |! 75 |! mL/hr. C. |! Start |! a |! labetalol |! drip |! to |! keep |! BP |! less |! than |! 140/90 |! mm |! Hg.
Rationale: 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. A |! female |! patient |! who |! had |! a |! stroke |! 24 |! hours |! ago |! has |! expressive |! aphasia. |! What |! is |! an |! appropriate |! nursing |! intervention |! to |! help |! the |! patient |! communicate? A. |! Ask |! questions |! that |! the |! patient |! can |! answer |! with |! "yes" |! or |! "no." B. |! Develop |! a |! list |! of |! words |! that |! the |! patient |! can |! read |! and |! practice |! reciting. C. |! Have |! the |! patient |! practice |! her |! facial |! and |! tongue |! exercises |! with |! a |! mirror. D. |! Prevent |! embarrassing |! the |! patient |! by |! answering |! for |! her |! if |! she |! does |! not |! respond. |! - |! Correct |! answer |! ✔ANS: |! A Rationale: 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. What |! concern |! should |! the |! nurse |! anticipate |! for |! a |! patient |! who |! had |! a |! right |! hemisphere |! stroke? A. |! Right-sided |! hemiplegia B. |! Speech-language |! deficits C. |! Denial |! of |! deficits |! and |! impulsiveness D. |! Depression |! and |! distress |! about |! disability |! - |! Correct |! answer |! ✔ANS: |! C Rationale: 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. Which |! intervention |! should |! the |! nurse |! include |! in |! the |! plan |! of |! care |! for |! a |! patient |! with |! new |! right-sided |! homonymous |! hemianopsia |! after |! a |! stroke? A. |! Apply |! an |! eye |! patch |! to |! the |! right |! eye.
Rationale: 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. A |! patient |! has |! a |! ruptured |! cerebral |! aneurysm |! and |! subarachnoid |! hemorrhage. |! Which |! intervention |! will |! the |! nurse |! include |! in |! the |! plan |! of |! care? A. |! Apply |! intermittent |! pneumatic |! compression |! stockings. B. |! Assist |! to |! dangle |! on |! edge |! of |! bed |! and |! assess |! for |! dizziness. C. |! Encourage |! patient |! to |! cough |! and |! deep |! breathe |! every |! 4 |! hours. D. |! Insert |! an |! oropharyngeal |! airway |! to |! prevent |! airway |! obstruction. |! - |! Correct |! answer |! ✔ANS: |! A Rationale: 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.
A |! patient |! will |! attempt |! oral |! feedings |! for |! the |! first |! time |! after |! having |! a |! stroke. |! After |! assessing |! the |! gag |! reflex, |! what |! action |! should |! the |! nurse |! take? A. |! Order |! a |! varied |! pureed |! diet. |! B. |! Assess |! the |! patient's |! appetite. C. |! Assist |! the |! patient |! into |! a |! chair D. |! Offer |! the |! patient |! a |! sip |! of |! juice. |! - |! Correct |! answer |! ✔ANS: |! C Rationale: The |! patient |! should |! be |! as |! upright |! as |! possible |! before |! attempting |! to |! feed |! 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. A |! 70-yr-old |! female |! patient |! with |! left-sided |! hemiparesis |! arrives |! by |! ambulance |! to |! the |! emergency |! department. |! Which |! action |! should |! the |! nurse |! take |! first? A. |! Take |! the |! patient's |! blood |! pressure. B. |! Check |! the |! respiratory |! rate |! and |! effort.
Rationale: 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. 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? A. |! Document |! that |! the |! patient |! refused |! the |! aspirin. B. |! Tell |! the |! patient |! that |! the |! aspirin |! is |! used |! to |! prevent |! a |! fever. |! C. |! Explain |! that |! the |! aspiring |! is |! ordered |! to |! decrease |! stroke |! risk. |! D. |! Call |! the |! health |! care |! provider |! to |! clarify |! the |! medication |! order. |! - |! Correct |! answer |! ✔ANS: |! C Rationale: 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. A |! patient |! in |! the |! clinic |! reports |! a |! recent |! episode |! of |! dysphasia |! and |! left-sided |! weakness |! at |! home |! that |! resolved |! after |! 2 |! hours. |! What |! topic |! should |! the |! nurse |! anticipate |! teaching |! the |! patient? A. |! tPA B. |! Aspirin C. |! Warfarin D. |! Nimodipine |! - |! Correct |! answer |! ✔ANS: |! B Rationale: 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. |! Warfarin |! is |! usually |! used |! for |! patients |! with |! atrial |! fibrillation. |! Nimodipine |! is |! used |! to |! prevent |! cerebral |! vasospasm |! after |! a |! subarachnoid |! hemorrhage. A |! patient |! with |! a |! left-brain |! stroke |! suddenly |! bursts |! into |! tears |! when |! family |! members |! visit. |! How |! should |! the |! nurse |! respond? A. |! Use |! a |! calm |! voice |! to |! ask |! the |! patient |! to |! stop |! the |! crying |! behavior.
D. |! The |! patient |! works |! at |! a |! desk |! and |! relaxes |! by |! watching |! television. |! - |! Correct |! answer |! ✔ANS: |! C Rationale: 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. A |! patient |! in |! the |! emergency |! department |! with |! sudden-onset |! right-sided |! weakness |! is |! diagnosed |! with |! an |! intracerebral |! hemorrhage. |! Which |! information |! about |! the |! patient |! is |! most |! important |! to |! communicate |! to |! the |! health |! care |! provider? A. |! The |! patient's |! speech |! is |! difficult |! to |! understand. B. |! The |! patient's |! blood |! pressure |! (BP) |! is |! 144/90 |! mm |! Hg. C. |! The |! patient |! takes |! a |! diuretic |! because |! of |! a |! history |! of |! hypertension. D. |! The |! patient |! has |! atrial |! fibrillation |! and |! takes |! warfarin |! (Coumadin). |! - |! Correct |! answer |! ✔ANS: |! D Rationale: The |! use |! of |! warfarin |! probably |! contributed |! to |! the |! intracerebral |! bleeding |! and |! remains |! a |! risk |! factor |! for |! further |! bleeding. |! Administration |! of |! vitamin |! K |! is |!
needed |! to |! reverse |! the |! effects |! of |! the |! warfarin, |! especially |! if |! the |! patient |! is |! to |! have |! surgery |! to |! correct |! the |! bleeding. |! The |! history |! of |! hypertension |! is |! a |! risk |! factor |! for |! the |! patient |! but |! has |! no |! immediate |! effect |! on |! the |! patient's |! care. |! The |! BP |! of |! 144/90 |! indicates |! the |! need |! for |! ongoing |! monitoring |! but |! not |! for |! any |! immediate |! change |! in |! therapy. |! Slurred |! speech |! is |! consistent |! with |! a |! left- sided |! stroke, |! and |! no |! change |! in |! therapy |! is |! indicated. A |! patient |! with |! left-sided |! weakness |! that |! started |! 60 |! minutes |! earlier |! is |! admitted |! to |! the |! emergency |! department |! and |! diagnostic |! tests |! are |! ordered. |! Which |! test |! should |! be |! done |! first? A. |! Complete |! blood |! count |! (CBC) B. |! Chest |! radiograph |! (chest |! x-ray) C. |! Computed |! tomography |! (CT) |! scan D. |! 12-Lead |! electrocardiogram |! (ECG) |! - |! Correct |! answer |! ✔ANS: |! C Rationale: Rapid |! screening |! with |! a |! noncontrast |! CT |! scan |! is |! needed |! before |! administration |! of |! tissue |! plasminogen |! activator |! (tPA), |! which |! must |! be |! given |! within |! 4.5 |! hours |! of |! the |! onset |! of |! clinical |! manifestations |! of |! the |! stroke. |! The |! sooner |! the |! tPA |! is |! given, |! the |! less |! brain |! injury. |! The |! other |! diagnostic |! tests |! give |! information |! about |! possible |! causes |! of |! the |! stroke |! and |! do |! not |! need |! to |! be |! completed |! as |! urgently |! as |! the |! CT |! scan.
C. |! The |! patient |! reports |! a |! severe |! and |! unrelenting |! headache. |! D. |! The |! cerebrospinal |! fluid |! (CSF) |! report |! shows |! red |! blood |! cells |! (RBCs). |! - |! Correct |! answer |! ✔ANS: |! B Rationale: To |! prevent |! cerebral |! vasospasm |! and |! maintain |! cerebral |! perfusion, |! BP |! needs |! to |! be |! maintained |! at |! a |! level |! higher |! than |! 90 |! mm |! Hg |! systolic |! after |! a |! subarachnoid |! hemorrhage. |! A |! low |! BP |! or |! drop |! in |! BP |! indicates |! a |! need |! to |! administer |! fluids |! and/or |! vasopressors |! to |! increase |! the |! BP. |! An |! ongoing |! headache, |! RBCs |! in |! the |! CSF, |! and |! a |! stiff |! neck |! are |! all |! typical |! clinical |! manifestations |! of |! a |! subarachnoid |! hemorrhage |! and |! do |! not |! need |! to |! be |! rapidly |! communicated |! to |! the |! health |! care |! provider. The |! nurse |! is |! caring |! for |! a |! patient |! who |! has |! been |! experiencing |! stroke |! symptoms |! for |! 60 |! minutes. |! Which |! action |! can |! the |! nurse |! delegate |! to |! a |! licensed |! practical/vocational |! nurse |! (LPN/VN)? A. |! Assess |! the |! patient's |! gag |! and |! cough |! reflexes. B. |! Determine |! when |! the |! stroke |! symptoms |! began. C. |! Administer |! the |! prescribed |! short-acting |! insulin. D. |! Infuse |! the |! prescribed |! IV |! metoprolol |! (Lopressor). |! - |! Correct |! answer |! ✔ANS: |! C
Rationale: Administration |! of |! subcutaneous |! medications |! is |! included |! in |! LPN/VN |! education |! and |! scope |! of |! practice. |! The |! other |! actions |! require |! more |! education |! and |! scope |! of |! practice |! and |! should |! be |! done |! by |! the |! registered |! nurse |! (RN). After |! receiving |! change-of-shift |! report |! on |! the |! following |! four |! patients, |! which |! patient |! should |! the |! nurse |! see |! first? A. |! A |! 60-yr-old |! patient |! with |! right-sided |! weakness |! who |! has |! an |! infusion |! of |! tPA |! prescribed B. |! A |! 50-yr-old |! patient |! who |! has |! atrial |! fibrillation |! and |! a |! new |! order |! for |! warfarin |! (Coumadin) C. |! A |! 30-yr-old |! patient |! with |! a |! subarachnoid |! hemorrhage |! 2 |! days |! ago |! who |! has |! nimodipine |! scheduled D. |! A |! 40-yr-old |! patient |! who |! had |! a |! transient |! ischemic |! attack |! yesterday |! and |! has |! a |! dose |! of |! aspirin |! due |! - |! Correct |! answer |! ✔ANS: |! A Rationale: tPA |! needs |! to |! be |! infused |! within |! the |! first |! few |! hours |! after |! stroke |! symptoms |! start |! to |! be |! effective |! in |! minimizing |! brain |! injury. |! The |! other |! medications |! should |! also |! be |! given |! as |! quickly |! as |! possible, |! but |! timing |! of |! the |! medications |! is |! not |! as |! critical.
