Chapter 62

Question 1

What impairment is a client experiencing if they cannot recognize objects through visual, auditory, or tactile means?

Answer 1

Agnosia

Question 2

What condition of a stroke involves blindness in half the visual field of one or both eyes?

Answer 2

Homonymous hemianopsia.

Question 3

What condition of stroke involves an inability to understand language?

Answer 3

Receptive aphasia.

Question 4

What condition of stroke manifests as motor or ambulatory dysfunction on one side?

Answer 4

Hemiplegia.

Question 5

A condition of stroke that manifests as verbal substitutions for syllables or previously known words?

Answer 5

Apraxia of speech.

Question 6

What is a condition of stroke that manifests as an inability to perform a task that was previously learned, as in combing their own hair or other ADLs?

Answer 6

Apraxia.

Question 7

A condition of stroke that manifests as an inability to express oneself verbally - “word salad” or pointing to objects instead of naming them?

Answer 7

Aphasia.

Question 8

What kind of stroke is indicated by impulsivity, being easily distracted, poor judgment due to unawareness of new deficits, and getting lost in familiar places?

Answer 8

Right hemispheric stroke.

Question 9

What kind of stroke is indicated by left-sided weakness or paralysis and left-sided visual deficits?

Answer 9

Right hemispheric stroke.

Question 10

What kind of stroke is indicated by slow and cautious behaviors as well as right-sided weakness or paralysis and right-sided vision loss?

Answer 10

Left hemispheric stroke.

Question 11

Severe headache, decreased LOC, and seizures are typically indicative of what kind of stroke?

Answer 11

Hemorrhagic stroke.

Question 12

Numbness and droopiness to one side of the face is typically indicative of what kind of stroke?

Answer 12

Ischemic stroke.

Question 13

What is the purpose of a carotid endarterectomy in a client who has had a transient ischemic attack?

Answer 13

Prevent a future stroke by removing an atherosclerotic plaque or thrombus blocking flow to the brain.

Question 14

What is a common response to changes in body image and ability after a stroke?

Answer 14

Depression.

Question 15

What assessment finding indicates an early sign of deterioration in a client having a hemorrhagic stroke?

Answer 15

LOC changes like drowsiness, speech slurring, and sluggish pupillary reaction.

Question 16

In an ischemic stroke, what is the area of low cerebral blood flow surrounding tissue infarction during early ischemic cascade?

Answer 16

The Penumbra region, which can be salvaged if intervention is timely.

Question 17

What are priority interventions for a client with increased ICP to prevent increased blood pressure due to anxiety and/or activity?

Answer 17

Place in a quiet, dark, nonstimulating environment, elevate the HOB to 30 degrees, and keep the head neutral. Avoid flexion, extension, and turning the head from side to side.

Question 18

What effective positioning is needed after an ischemic stroke to promote hyperextension of the hip joints to normalize gait and prevent knee and hip flexion contractures?

Answer 18

In a prone position for 150-30 minutes several times a day, place a pillow under the pelvis from the umbilicus to the upper third of the thigh.

Question 19

What are some risks for a client experiencing increased ICP?

Answer 19

Seizures and HYPOnatremia.

Question 20

A priority goal for a client experiencing a stroke?

Answer 20

Maintain and improve cerebral tissue perfusion.

Question 21

What is the most serious risk factor for a repeat hemorrhagic stroke?

Answer 21

Hypertension: educate the patient on taking antihypertensives as prescribed.

Question 22

What is the main contraindicated treatment for someone with a hemorrhagic stroke, and why?

Answer 22

Thrombolytic therapy because it increases bleeding.

Question 23

From what side should you approach a stroke client if they have vision loss, and where should you place items they may need?

Answer 23

The unaffected visual and physical side.

Question 24

What education is needed for a client experiencing one-sided visual loss?

Answer 24

To compensate, turn the head toward the direction of the vision loss and remind the client regularly of the other side of the body.

Question 25

What kind of exercise is needed for a client who has recently had a stroke?

Answer 25

Passive range of motion of affected extremities four or five times daily to prevent contracture and deterioration of the neuromuscular system.

Question 26

A client has homonymous hemianopsia after a stroke. What is it called when the client neglects the side of the body they can no longer see, and what are the nurse’s interventions?

Answer 26

This is called amorphosynthesis. The nurse should continually remind the patient about the affected side and place extremities where the client can see them.

Question 27

What are potential interventions and treatments for muscle spasms after a stroke?

Answer 27

Stretching and medication such as baclofen and tizanidine. A temporary fix of 2-4 months may be reached through a botulism A injection.

Question 28

What medication is best for post-stroke pain and depression?

Answer 28

Amitriptyline.

Question 29

What are the best interventions for shoulder pain after a stroke?

Answer 29

Corticosteroids, heat therapy, acupuncture, and forward shoulder stretch with hands interlaced.

Question 30

When should ambulation occur after an ischemic stroke?

Answer 30

As soon as physically possible.

Question 31

Where do hemorrhagic strokes take place?

Answer 31

In the brain or subarachnoid space.

Question 32

Where do ischemic strokes take place?

Answer 32

Vascular occlusion.

Question 33

Other names for an ischemic stroke?

Answer 33

Thrombotic or lacunar.

Question 34

COVID-19 increases the risk for what type of stroke?

Answer 34

Ischemic stroke due to increased risk for blood clotting abnormalities.

Question 35

What arrhythmia is most commonly responsible for cardiogenic embolic strokes?

Answer 35

Atrial fibrillation.

Question 36

List the steps of an ischemic cascade in order.

Answer 36

1. Central blood flow decreases to less than 25mL per 100g blood per minute.
2. Mitochondria lose energy and switch to anaerobic respiration.
3. Lactic acid is then generated
4. This leads to Ph changes
5. Membrane pumps controlling electrolytes fail.
6. Cells cease to function.

Question 37

What are nursing interventions immediately after an ischemic stroke?

Answer 37

Reduce ICP by administering an osmotic diuretic like mannitol and positioning the patient’s HOB at 30 degrees. Handle the patient’s secretions to avoid aspiration. Keep PaCO2 in an acceptable range. Do not start mobilization until after ICP threat has passed.

Question 38

What are the most important things to monitor in a patient receiving t-PA therapy?

Answer 38

Bleeding, cardiac status, and neurological status.

Question 39

What are necessary interventions for a patient experiencing dysphagia after a stroke?

Answer 39

A swallowing assessment should be performed within 4-24 hours after a stroke. Educate the client to take smaller boluses of food and eat food that is easier to swallow. They may be started on thick liquids or a pureed diet. Have the client sit upright, preferably in a chair, and instruct them to tuck the chin forward when swallowing.

Question 40

What is a potential complication of stroke due to dysphagia, and possible interventions?

Answer 40

Aspiration leading to pneumonia. Deep breathing and coughing, small and frequent meals, and ambulate asap.

Question 41

What are the best predictors of outcome during a stroke?

Answer 41

NIHSS score, LOC at the time of admission, and the patient’s age.