Chapter 62: Stroke Flashcards
A nurse is educating a client about stroke prevention. Which of the following statements made by the client indicates an understanding of modifiable stroke risk factors?
A. “I can’t change my family history of strokes, so there’s not much I can do to lower my risk.”
B. “Quitting smoking and managing my blood pressure can help reduce my stroke risk.”
C. “Since I am getting older, my risk of stroke is inevitable, even if I stay healthy.”
D. “My risk of stroke is the same regardless of how much I exercise.”
B. “Quitting smoking and managing my blood pressure can help reduce my stroke risk.”
Rationale: The most effective way to reduce the burden of stroke is prevention and education, especially focusing on modifiable risk factors. Modifiable risk factors include lifestyle choices and medical conditions that can be controlled or improved, such as smoking, hypertension, and physical activity.
A 58-year-old client visits the clinic for a routine check-up. The client has a history of hypertension and smokes one pack of cigarettes daily. The client is concerned about their risk of stroke due to a family history of strokes. Based on this information, what should the nurse prioritize when educating the client?
A. “Family history is a significant risk factor, and there is little you can do to change your overall risk.”
B. “Focusing on quitting smoking and controlling your blood pressure will significantly reduce your risk of stroke.”
C. “Your age is the most important risk factor, and as you grow older, prevention efforts become less effective.”
D. “Because you have a family history of strokes, your risk cannot be reduced, even with lifestyle changes.”
B. “Focusing on quitting smoking and controlling your blood pressure will significantly reduce your risk of stroke.”
Rationale: While family history is a nonmodifiable risk factor, primary prevention should focus on reducing modifiable risk factors to dramatically lower stroke risk. Hypertension and smoking are significant modifiable risk factors. Education should emphasize the importance of managing blood pressure and quitting smoking, as these changes can greatly reduce the chance of stroke.
A nurse is providing stroke education to a group of older adults. Which of the following participants has the highest nonmodifiable risk for stroke?
A. A 72-year-old Black man with hypertension.
B. A 50-year-old White woman with a family history of stroke.
C. A 68-year-old Hispanic woman with a history of diabetes.
D. A 60-year-old Asian man who smokes one pack of cigarettes daily.
A. A 72-year-old Black man with hypertension.
Rationale: Nonmodifiable risk factors include age, gender, ethnicity, and family history. The risk of stroke doubles each decade after age 55, with two-thirds of strokes occurring in persons older than 65. Blacks have twice the incidence of stroke and higher death rates compared to other ethnic groups. While hypertension is a modifiable risk factor, this patient’s age and ethnicity make him the highest risk among the options.
A 66-year-old Black woman visits the clinic for a wellness check-up. She reports that both her mother and sister had strokes. What should the nurse prioritize in the client’s care plan?
A. Screening for hypertension and diabetes.
B. Reassuring the client that her family history does not significantly increase her risk.
C. Focusing on age as the only significant risk factor for stroke.
D. Screening for cerebral vascular anomalies due to her family history.
D. Screening for cerebral vascular anomalies due to her family history.
Rationale: A family history of stroke is a significant nonmodifiable risk factor. Individuals with at least two first-degree relatives with a history of subarachnoid hemorrhage (SAH) or aneurysm should be screened for cerebral vascular anomalies. While managing hypertension and diabetes is important, this client’s family history requires targeted screening for anomalies.
Which of the following statements about gender and stroke risk is accurate?
A. Men have a higher overall incidence of stroke and higher mortality rates than women.
B. Women are less likely to die from stroke because they live longer than men.
C. Men have a higher incidence of stroke, but more women die from stroke.
D. Gender plays no significant role in stroke incidence or mortality rates.
C. Men have a higher incidence of stroke, but more women die from stroke.
While strokes are more common in men, women have a higher mortality rate from stroke. This is partly because women live longer, increasing their lifetime risk of experiencing a stroke. Gender is a significant nonmodifiable risk factor for stroke.
Which of the following are considered nonmodifiable risk factors for stroke? (SATA)
A. Obesity
B. Family history of stroke
C. Age
D. Gender
E. Hypertension
B. Family history of stroke
C. Age
D. Gender
Rationale: Nonmodifiable risk factors for stroke include age, gender, and family history or heredity. Modifiable risk factors include conditions such as obesity and hypertension that can be managed or treated to reduce stroke risk.
A 58-year-old client is concerned about their risk of stroke due to a family history of aneurysms. What action should the nurse take?
A. Recommend the client undergo a cerebral vascular screening.
B. Educate the client about the inevitability of stroke due to genetics.
C. Reassure the client that a family history of aneurysms is not a concern.
D. Emphasize managing modifiable risk factors instead of focusing on family history.
A. Recommend the client undergo a cerebral vascular screening.
A family history of aneurysms or stroke in at least two first-degree relatives increases the risk of anomalies in cerebral vasculature. Screening for vascular anomalies is an important step in identifying and potentially preventing stroke in these individuals.
A nurse is reviewing the risk factors for stroke with a group of clients. Which client is most likely to experience a stroke based on nonmodifiable factors?
A. A 75-year-old Black man with a family history of stroke.
B. A 60-year-old Hispanic woman with a BMI of 32.
C. A 55-year-old White woman with a history of migraine headaches.
D. A 45-year-old Asian man with a cholesterol level of 240 mg/dL.
A. A 75-year-old Black man with a family history of stroke.
Rationale: The client in option B has several nonmodifiable risk factors: age (risk doubles each decade after 55), ethnicity (Blacks have a higher incidence and mortality rate from stroke), and a family history of stroke. Although other clients have modifiable risk factors (e.g., BMI, cholesterol), these are not the focus of this question.
A nurse is teaching a client about modifiable risk factors for stroke. Which statement by the client indicates a correct understanding?
A. “My stroke risk is mostly determined by my age and family history.”
B. “Quitting smoking will lower my risk of both ischemic and hemorrhagic strokes.”
C. “Drinking moderate amounts of alcohol will eliminate my risk of hypertension and stroke.”
D. “Because I have diabetes, my stroke risk is the same as someone without diabetes if I manage my diet.”
B. “Quitting smoking will lower my risk of both ischemic and hemorrhagic strokes.”
Rationale: Smoking nearly doubles the risk for ischemic stroke and increases the risk for hemorrhagic stroke 4-fold. The risk decreases substantially after smoking cessation, and former smokers have the same risk as nonsmokers after 5 to 10 years. Statements A and C fail to acknowledge the importance of modifiable risk factors. Statement D is incorrect because diabetes increases stroke risk fivefold, even with good management.
A client with hypertension asks how managing their blood pressure can reduce stroke risk. What is the nurse’s best response?
A. “Treating hypertension can reduce your stroke risk by about 50%.”
B. “Hypertension increases your stroke risk by 25%, so controlling it only lowers your risk slightly.”
C. “Blood pressure has little impact on stroke risk compared to other factors.”
D. “Reducing diastolic blood pressure is more important than systolic pressure for stroke prevention.”
A. “Treating hypertension can reduce your stroke risk by about 50%.”
Rationale: Hypertension is the single most important modifiable risk factor for stroke. Increases in both systolic and diastolic BP independently increase stroke risk. Treating hypertension can reduce stroke risk by up to 50%. Statements B and C minimize the importance of hypertension management, and D is incorrect because both systolic and diastolic BP are important.
A nurse is teaching a group of clients about lifestyle changes to reduce stroke risk. Which of the following recommendations should the nurse include? (SATA)
A. Limit alcohol to one drink per day for women and two drinks per day for men.
B. Engage in at least 150 minutes of moderate-intensity exercise per week.
C. Stop smoking to reduce stroke risk to that of nonsmokers within 5-10 years.
D. Increase dietary fat intake to improve heart health.
E. Reduce waist-to-hip ratio to decrease the risk of ischemic stroke.
A. Limit alcohol to one drink per day for women and two drinks per day for men.
B. Engage in at least 150 minutes of moderate-intensity exercise per week.
C. Stop smoking to reduce stroke risk to that of nonsmokers within 5-10 years.
E. Reduce waist-to-hip ratio to decrease the risk of ischemic stroke.
Rationale: Modifiable risk factors include physical inactivity, smoking, and poor diet. Limiting alcohol, engaging in regular exercise, and achieving a healthier waist-to-hip ratio can significantly reduce stroke risk. Smoking cessation reduces stroke risk over time. Statement D is incorrect because a diet high in fat increases stroke risk.
A 52-year-old woman with migraines with aura asks about her stroke risk. She smokes and uses oral contraceptives. What is the most important advice the nurse should provide?
A. “Switch to a lower-dose oral contraceptive to reduce your stroke risk.”
B. “Migraines with aura increase your risk for stroke, but there is nothing you can do to change this.”
C. “Quitting smoking is the most important step to reduce your stroke risk.”
D. “Exercise regularly to counteract the effects of your oral contraceptive use.”
C. “Quitting smoking is the most important step to reduce your stroke risk.”
Rationale: Women who smoke and use oral contraceptives have an increased stroke risk. Smoking cessation is critical to reduce this risk, particularly in women with migraines with aura. Switching oral contraceptives may help but is secondary to quitting smoking. Statement C is incorrect because modifiable risks can reduce overall stroke risk.
Which of the following clients is at the highest risk for stroke based on modifiable factors?
A. A 45-year-old man with untreated atrial fibrillation.
B. A 60-year-old woman who exercises regularly and has a BMI of 22.
C. A 50-year-old nonsmoker with a history of migraines without aura.
D. A 30-year-old woman taking low-dose oral contraceptives.
A. A 45-year-old man with untreated atrial fibrillation.
Rationale: Atrial fibrillation causes about 25% of strokes, and individuals with atrial fibrillation are 5 times more likely to have a stroke. Regular exercise, nonsmoking, and low-dose oral contraceptive use in the absence of smoking or other risks do not confer as high a stroke risk.
A client asks about the impact of physical activity on stroke prevention. What is the nurse’s best response?
A. “Physical activity does not significantly affect stroke risk.”
B. “Exercise reduces stroke risk only if it is vigorous and done daily.”
C. “Light physical activity, such as walking, can help reduce your stroke risk.”
D. “Only individuals with obesity benefit from exercise in stroke prevention.”
C. “Light physical activity, such as walking, can help reduce your stroke risk.”
Rationale: Physical inactivity is a modifiable risk factor for stroke. Even light to moderate regular activity can reduce stroke risk. The AHA recommends 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly.
A 70-year-old client with a history of hypertension reports occasional nonadherence to their medication. Their blood pressure at the visit is 160/95 mm Hg. What is the most important action the nurse should take?
A. Discuss the importance of lifestyle changes in managing hypertension.
B. Educate the client on home blood pressure monitoring with a goal SBP <140 mm Hg.
C. Recommend increasing the dose of the client’s antihypertensive medication.
D. Explain that occasional nonadherence does not significantly impact stroke risk.
B. Educate the client on home blood pressure monitoring with a goal SBP <140 mm Hg.
Rationale: The AHA recommends home blood pressure monitoring with a goal of SBP <140 mm Hg to reduce stroke risk. Hypertension management is crucial, as it is the most important modifiable risk factor for stroke. Increasing medication may be considered but must be addressed with the provider. Nonadherence significantly impacts stroke risk and must be emphasized.
A client asks how diabetes increases the risk for stroke. Which response by the nurse is accurate?
A. “Diabetes increases stroke risk by causing changes in blood clotting and inflammation.”
B. “Diabetes increases stroke risk because it is associated with obesity and high cholesterol.”
C. “Stroke risk in people with diabetes is five times higher than in those without diabetes.”
D. “Managing blood sugar levels eliminates stroke risk in people with diabetes.”
C. “Stroke risk in people with diabetes is five times higher than in those without diabetes.”
Rationale: Diabetes is a significant risk factor for stroke, increasing the risk fivefold. This is due to changes in blood vessels, clotting, and inflammation. Although obesity and high cholesterol are related, they do not fully account for the increased risk. Managing blood sugar levels reduces but does not eliminate stroke risk.
The nurse is counseling a client about reducing modifiable stroke risk factors. Which recommendations should the nurse include? (SATA)
A. Adhere to a diet high in fruits and vegetables.
B. Engage in at least 75 minutes of vigorous-intensity exercise per week.
C. Monitor blood pressure regularly and maintain SBP <140 mm Hg.
D. Avoid all forms of physical activity if you have heart disease.
E. Stop illicit drug use, including cocaine.
A. Adhere to a diet high in fruits and vegetables.
B. Engage in at least 75 minutes of vigorous-intensity exercise per week.
C. Monitor blood pressure regularly and maintain SBP <140 mm Hg.
E. Stop illicit drug use, including cocaine.
Rationale: A healthy diet, regular physical activity, and blood pressure control are important for reducing stroke risk. Illicit drug use, especially cocaine, is a significant modifiable risk factor for stroke. Avoiding physical activity is not appropriate, even for clients with heart disease, as light exercise can be beneficial.
A 62-year-old woman with a history of smoking and obesity is concerned about her stroke risk. She asks how smoking impacts her health. What is the nurse’s best response?
A. “Smokers are four times as likely to have a hemorrhagic stroke compared to nonsmokers.”
B. “Smoking only increases stroke risk if combined with other risk factors, such as obesity.”
C. “The effects of smoking on stroke risk are irreversible even if you quit.”
D. “Smoking primarily increases the risk of ischemic stroke, not hemorrhagic stroke.”
A. “Smokers are four times as likely to have a hemorrhagic stroke compared to nonsmokers.”
Rationale: Smoking nearly doubles the risk for ischemic stroke and increases the risk of hemorrhagic stroke fourfold. The risk of stroke decreases substantially after quitting, with former smokers having the same risk as nonsmokers after 5–10 years. Smoking is a significant independent risk factor for stroke, regardless of other factors.
A nurse is educating a client with atrial fibrillation about their stroke risk. Which statement indicates the client understands the teaching?
A. “Atrial fibrillation does not increase my stroke risk if I take blood pressure medications.”
B. “I am five times more likely to have a stroke than someone with a regular heart rhythm.”
C. “The risk of stroke with atrial fibrillation only increases if I develop heart disease.”
D. “Taking blood thinners occasionally is enough to prevent stroke.”
B. “I am five times more likely to have a stroke than someone with a regular heart rhythm.”
Rationale: Atrial fibrillation increases stroke risk fivefold due to irregular heart rhythm leading to blood pooling and clot formation. Consistent use of oral anticoagulants is critical for prevention. Stroke risk remains elevated even without concurrent heart disease or controlled blood pressure.
Which statement about alcohol consumption and stroke risk requires correction during a client education session?
A. “Moderate alcohol consumption has no impact on stroke risk.”
B. “Women should limit alcohol intake to one drink per day.”
C. “Excessive alcohol consumption increases the risk of hypertension and stroke.”
D. “Alcohol-related stroke risk depends on the amount consumed.”
A. “Moderate alcohol consumption has no impact on stroke risk.”
Rationale: The relationship between alcohol and stroke risk depends on the amount consumed. Excessive drinking increases stroke risk, especially due to hypertension. Moderate consumption should not exceed one drink per day for women and two drinks per day for men.
Which client is at the lowest risk for stroke based on modifiable factors?
A. A 68-year-old woman with controlled diabetes who exercises regularly.
B. A 55-year-old man with untreated hypertension and a diet high in sodium.
C. A 45-year-old woman who smokes and uses estrogen-based oral contraceptives.
D. A 72-year-old man with atrial fibrillation who inconsistently takes anticoagulants.
A. A 68-year-old woman with controlled diabetes who exercises regularly.
Rationale: Controlled diabetes and regular exercise reduce stroke risk. In contrast, untreated hypertension, smoking, oral contraceptive use, and inconsistent anticoagulant therapy significantly increase stroke risk.
Which statement about transient ischemic attacks (TIAs) is accurate and should be included in patient teaching?
A. “Symptoms of a TIA typically resolve within 24 hours.”
B. “TIAs are caused by brain infarction and result in permanent damage.”
C. “A TIA is a warning sign of progressive cerebrovascular disease.”
D. “If TIA symptoms resolve, medical treatment is unnecessary.”
C. “A TIA is a warning sign of progressive cerebrovascular disease.”
Rationale: A TIA is a transient episode of neurologic dysfunction without acute brain infarction. It is caused by temporary ischemia, often due to microemboli, and is a warning sign of cerebrovascular disease. Symptoms typically last less than one hour, not 24 hours. Prompt medical evaluation is critical even if symptoms resolve.
Which clinical manifestations may indicate a TIA involving the vertebrobasilar system? (SATA)
A. Tinnitus
B. Temporary loss of vision in one eye
C. Dysarthria
D. Dysphagia
E. Transient hemiparesis
A. Tinnitus
C. Dysarthria
D. Dysphagia
Rationale: A TIA involving the vertebrobasilar system can cause symptoms such as tinnitus, dysarthria, dysphagia, vertigo, and ataxia. In contrast, transient hemiparesis and temporary vision loss in one eye (amaurosis fugax) are typically associated with a TIA involving the carotid system.
A 72-year-old patient reports sudden blurred vision, vertigo, and difficulty speaking that lasted for 45 minutes. The nurse suspects a TIA. What is the priority teaching point for this patient?
A. “Avoid strenuous activity for the next 24 hours to prevent another TIA.”
B. “You should monitor your symptoms at home since they resolved.”
C. “You need immediate medical evaluation because a TIA is a medical emergency.”
D. “Your symptoms are unlikely to recur, so no further action is needed.”
C. “You need immediate medical evaluation because a TIA is a medical emergency.”
Rationale: A TIA is a warning sign of potential stroke and requires prompt evaluation to determine the cause and begin preventive treatment. Stroke risk is higher after a TIA, and time-sensitive interventions may prevent progression. Symptoms should never be ignored, even if they resolve.
What is the primary purpose of the ABCD2 score in TIA management?
A. To assess the severity of neurologic deficits caused by a TIA
B. To predict the risk of stroke following a TIA
C. To determine the type of blood vessel involved in a TIA
D. To evaluate whether anticoagulation therapy is necessary
B. To predict the risk of stroke following a TIA
Rationale: The ABCD2 score evaluates stroke risk after a TIA by considering factors such as age, blood pressure, clinical features, duration of symptoms, and the presence of diabetes. It does not assess neurologic severity, vessel type, or directly guide anticoagulation therapy.
A patient presents with transient unilateral numbness, difficulty speaking, and a loss of sensation that lasted 30 minutes. The nurse suspects a TIA. What is the most appropriate action?
A. Perform a detailed neurologic assessment and discharge the patient if symptoms resolve.
B. Initiate stroke protocol and document the time of symptom onset.
C. Schedule the patient for an outpatient follow-up in one week.
D. Reassure the patient that there is no cause for concern since symptoms resolved.
B. Initiate stroke protocol and document the time of symptom onset.
Rationale: A TIA is a medical emergency that requires immediate evaluation and treatment to prevent progression to stroke. Documenting the time of symptom onset is critical for determining eligibility for interventions. Discharging or delaying care increases stroke risk.
Which of the following are common causes of a TIA? (SATA)
A. Microemboli blocking blood flow temporarily
B. Acute brain infarction
C. Hypertension-induced ischemia
D. Inflammatory conditions affecting blood vessels
E. Congenital heart defects
A. Microemboli blocking blood flow temporarily
D. Inflammatory conditions affecting blood vessels
E. Congenital heart defects
Rationale: TIAs often result from microemboli temporarily blocking blood flow, as well as conditions like inflammation or congenital heart defects that increase the risk of ischemia. TIAs are distinct from acute infarctions and are not solely caused by hypertension, although it is a significant risk factor for stroke.
A patient presents to the emergency department with left-sided weakness and slurred speech. Imaging confirms brain infarction. How would this event be classified?
A. Transient ischemic attack (TIA)
B. Ischemic stroke
C. Hemorrhagic stroke
D. Subarachnoid hemorrhage
B. Ischemic stroke
Rationale: A stroke involving brain infarction is classified as ischemic if it is caused by an obstruction to blood flow, such as a thrombus or embolus. A TIA does not involve infarction, while a hemorrhagic stroke results from bleeding in the brain. Subarachnoid hemorrhage is a specific type of hemorrhagic stroke caused by bleeding into the subarachnoid space.
What is the primary difference between a transient ischemic attack (TIA) and a stroke?
A. A stroke results in cell death, whereas a TIA does not cause permanent damage.
B. A stroke occurs only in the brain, while a TIA affects the spinal cord or retina.
C. A stroke lasts less than one hour, whereas a TIA persists for 24 hours or longer.
D. A TIA is caused by hemorrhage, whereas a stroke is caused by ischemia.
A. A stroke results in cell death, whereas a TIA does not cause permanent damage.
Rationale: A TIA is a transient episode of ischemia that does not lead to infarction or permanent damage. In contrast, a stroke involves infarction (cell death) due to prolonged ischemia or hemorrhage. Both TIAs and strokes can affect the brain, spinal cord, or retina.
Which statement best describes the pathophysiology of an ischemic stroke?
A. It results from a rupture of an artery, causing bleeding in the brain.
B. It is caused by a lack of blood flow due to partial or complete artery occlusion.
C. It occurs due to a sudden and severe drop in blood pressure.
D. It is the result of an aneurysm leading to compression of brain tissue.
B. It is caused by a lack of blood flow due to partial or complete artery occlusion.
Rationale: An ischemic stroke occurs when blood flow to the brain is disrupted by a thrombus (localized clot formation) or embolus (traveling clot or debris), leading to partial or complete occlusion of a cerebral artery. This inadequate blood flow causes brain tissue ischemia and infarction. Hemorrhagic strokes involve artery rupture and bleeding, not occlusion.
Which of the following is true regarding thrombotic and embolic strokes?
A. Embolic strokes are caused by plaques forming within cerebral arteries.
B. Thrombotic strokes occur suddenly without any warning signs.
C. Both thrombotic and embolic strokes involve inadequate blood flow due to artery occlusion.
D. Embolic strokes are always preceded by transient ischemic attacks (TIAs).
C. Both thrombotic and embolic strokes involve inadequate blood flow due to artery occlusion.
Rationale: Thrombotic and embolic strokes are both subtypes of ischemic stroke caused by obstruction to blood flow. Thrombotic strokes typically result from plaque buildup and clot formation in a cerebral artery, often with warning signs like TIAs. Embolic strokes occur when an embolus from another part of the body (e.g., the heart) travels to and occludes a cerebral artery. TIAs are common precursors to thrombotic strokes but do not always precede embolic strokes.
A 68-year-old patient with a history of hypertension and high cholesterol presents with slurred speech and right-sided weakness. Imaging confirms a thrombotic stroke. The patient’s LOC is stable. What does this indicate about the stroke?
A. The stroke likely occurred in the brainstem.
B. The stroke has likely caused a hemorrhage.
C. The infarction is in an area with adequate collateral circulation.
D. The patient has a high risk of seizure activity.
C. The infarction is in an area with adequate collateral circulation.
Rationale: Thrombotic strokes typically do not cause a decreased LOC in the first 24 hours unless specific complications arise, such as brainstem involvement or increased ICP. Adequate collateral circulation may preserve neurological function despite infarction.
What is the primary pathophysiological mechanism leading to a thrombotic stroke?
A. Rupture of an aneurysm causing bleeding into the brain
B. Dislodgement of an embolus from the heart or other source
C. Injury to a blood vessel wall resulting in clot formation and vessel occlusion
D. Sudden arterial spasm leading to loss of blood flow
C. Injury to a blood vessel wall resulting in clot formation and vessel occlusion
Rationale: A thrombotic stroke occurs due to damage to the blood vessel wall, leading to clot formation. This narrows the vessel lumen, and if occlusion occurs, infarction follows. This process often occurs at sites of atherosclerotic plaque buildup.
Which patient is at the highest risk of developing a thrombotic stroke?
A. A 45-year-old with no prior medical history
B. A 70-year-old with diabetes and hypertension
C. A 30-year-old with a history of migraines
D. A 55-year-old with an active lifestyle and no comorbidities
B. A 70-year-old with diabetes and hypertension
Rationale: Thrombotic strokes are more common in older adults and are often associated with comorbid conditions such as diabetes and hypertension, which accelerate atherosclerosis.
What factors influence the extent of damage caused by a thrombotic stroke? (SATA)
A. Rapidity of onset
B. Size of the damaged area
C. Presence of collateral circulation
D. Severity of the headache preceding the stroke
E. Level of consciousness at stroke onset
A. Rapidity of onset
B. Size of the damaged area
C. Presence of collateral circulation
Rationale: The severity of a thrombotic stroke depends on how quickly the vessel becomes occluded (rapidity of onset), the size of the infarcted area, and whether collateral circulation can compensate for the blocked blood flow. Headache severity and initial LOC are not primary determinants of the extent of damage.
What distinguishes a thrombotic stroke from other types of ischemic strokes?
A. A thrombotic stroke is caused by an embolus traveling from the heart.
B. A thrombotic stroke occurs only in the presence of atrial fibrillation.
C. A thrombotic stroke is always preceded by a transient ischemic attack.
D. A thrombotic stroke results from vessel occlusion due to a localized clot.
D. A thrombotic stroke results from vessel occlusion due to a localized clot.
Rationale: Thrombotic strokes occur when a clot forms locally at the site of atherosclerotic plaque and narrows or occludes the vessel. This distinguishes it from embolic strokes, which are caused by clots that travel from another location.
A patient with a thrombotic stroke is being monitored for worsening symptoms over the first 72 hours. What is the most likely cause of this progression?
A. Recurrent TIAs
B. Increased intracranial pressure (ICP) and cerebral edema
C. Formation of new thrombi in adjacent vessels
D. Gradual dissolution of the clot
B. Increased intracranial pressure (ICP) and cerebral edema
Rationale: Thrombotic stroke symptoms may worsen in the first 72 hours due to cerebral edema and increased ICP, which occur as a result of the infarction.
A 75-year-old patient with diabetes and hypertension experienced a TIA last week. Today, they are admitted with left-sided weakness and dysarthria. Imaging confirms a thrombotic stroke. What could have been done to reduce the risk of this event?
A. Increase physical activity and improve diet
B. Perform carotid endarterectomy immediately after the TIA
C. Use thrombolytic therapy prophylactically
D. Prescribe anticoagulants to prevent clot formation
A. Increase physical activity and improve diet
Rationale: Lifestyle modifications, including increased physical activity and dietary changes, play a crucial role in managing hypertension and diabetes, both of which are major risk factors for thrombotic stroke. While anticoagulants may help in certain cases, they are typically used for embolic rather than thrombotic stroke prevention.
What is the most common origin of emboli that cause an embolic stroke?
A. Atherosclerotic plaques in the carotid arteries
B. A clot in the right atrium from atrial fibrillation
C. Fat embolism from a long bone fracture
D. Air embolism from surgery
B. A clot in the right atrium from atrial fibrillation
Rationale: Most emboli that cause embolic strokes originate from the heart, particularly in individuals with atrial fibrillation, myocardial infarction (MI), or other heart conditions. These emboli travel upward to the cerebral circulation.
A patient with a history of atrial fibrillation suddenly develops weakness on one side of the body and difficulty speaking. What is the most likely cause of their stroke?
A. Thrombotic stroke due to atherosclerosis
B. Hemorrhagic stroke caused by a ruptured aneurysm
C. Embolic stroke due to a clot originating from the heart
D. Transient ischemic attack (TIA)
C. Embolic stroke due to a clot originating from the heart
Rationale: In patients with atrial fibrillation, clots can form in the heart and travel to the brain, causing an embolic stroke. This condition is common in those with atrial fibrillation.
Which of the following are common causes of embolic stroke? (SATA)
A. Infective endocarditis
B. Carotid artery atherosclerosis
C. Valvular heart prostheses
D. Rheumatic heart disease
E. Diabetes mellitus
A. Infective endocarditis
B. Carotid artery atherosclerosis
C. Valvular heart prostheses
D. Rheumatic heart disease
Rationale: Common causes of embolic stroke include heart conditions such as infective endocarditis, valvular heart prostheses, and rheumatic heart disease. Atherosclerosis in the carotid arteries typically causes thrombotic stroke, not embolic stroke.
A 60-year-old patient with a history of myocardial infarction presents with sudden onset of right-sided weakness and slurred speech. The patient is conscious and aware of their symptoms. What is the most likely cause of their stroke?
A. Embolic stroke due to an embolus from the heart
B. Thrombotic stroke due to atherosclerosis
C. Hemorrhagic stroke caused by hypertension
D. Transient ischemic attack (TIA)
A. Embolic stroke due to an embolus from the heart
Rationale: Patients with a history of myocardial infarction are at increased risk of embolic stroke, as a clot may form in the heart and travel to the brain.
Why do embolic strokes often cause severe neurological deficits initially?
A. The clot causes a complete and sudden blockage of blood flow, with little time for collateral circulation to develop.
B. The clot fragments into smaller emboli, causing multiple small strokes in different areas of the brain.
C. The affected vessel can quickly form new connections to restore blood flow.
D. The embolus is small and has less impact on brain tissue.
A. The clot causes a complete and sudden blockage of blood flow, with little time for collateral circulation to develop.
Rationale: Embolic strokes occur rapidly and give little time for the brain to develop collateral circulation, leading to severe neurologic deficits.
Which of the following are less common causes of embolic stroke? (SATA)
A. Air embolism from surgery
B. Fat embolism from a long bone fracture
C. Atherosclerotic plaques in the carotid arteries
D. Atrial septal defects
E. Arterial hypertension
A. Air embolism from surgery
B. Fat embolism from a long bone fracture
D. Atrial septal defects
Rationale: Air embolism, fat embolism (especially from fractures), and atrial septal defects are less common causes of embolic stroke. Atherosclerotic plaques are more commonly associated with thrombotic stroke.
What is the main factor influencing the prognosis of a patient with an embolic stroke?
A. The speed at which the embolus dislodges
B. The amount of brain tissue deprived of blood supply
C. The age of the patient at the time of the stroke
D. The presence of comorbid conditions such as hypertension
B. The amount of brain tissue deprived of blood supply
Rationale: The prognosis of embolic stroke depends on how much brain tissue is deprived of blood supply. Larger areas of brain tissue affected by the embolus can result in more significant and long-lasting deficits.
Which of the following is true regarding embolic stroke?
A. The stroke often occurs gradually, with warning signs present for hours.
B. Recurrence of embolic stroke is rare if the underlying cause is not treated.
C. The neurological deficits from an embolic stroke may resolve if the embolus breaks up and blood flow is restored.
D. Embolic strokes are more common in patients with low cholesterol levels.
C. The neurological deficits from an embolic stroke may resolve if the embolus breaks up and blood flow is restored.
Rationale: In some cases, an embolus may break up, and blood flow may be restored, leading to resolution of neurological deficits. However, recurrence of embolic stroke is common unless the underlying cause is effectively treated.
Which of the following is a characteristic of hemorrhagic stroke?
A. It is caused by a blockage of a blood vessel in the brain.
B. It results from bleeding into the brain tissue, subarachnoid space, or ventricles.
C. It occurs due to the formation of a blood clot in the heart.
D. It is more commonly associated with atherosclerosis than ischemic stroke.
B. It results from bleeding into the brain tissue, subarachnoid space, or ventricles.
Rationale: Hemorrhagic strokes occur due to bleeding into brain tissue (intracerebral hemorrhage), subarachnoid space, or ventricles, which distinguishes them from ischemic strokes caused by blockages.
Which of the following is a common cause of hemorrhagic stroke?
A. Atherosclerotic plaque rupture
B. Hypertension
C. Atrial fibrillation
D. Carotid artery stenosis
B. Hypertension
Rationale: Hypertension is the most common cause of hemorrhagic stroke, as it can lead to the rupture of weakened blood vessels in the brain, resulting in bleeding.
Which is the most common cause of intracerebral hemorrhage?
A. Brain tumor
B. Ruptured aneurysm
C. Hypertension
D. Coagulation disorders
C. Hypertension
Rationale: Hypertension is the most common cause of intracerebral hemorrhage, leading to vessel rupture, especially in the basal ganglia.
Which of the following is a common manifestation of intracerebral hemorrhage?
A. Hyperthermia
B. Decreased level of consciousness
C. Bradycardia
D. Skin rashes
B. Decreased level of consciousness
Rationale: Decreased LOC is a common manifestation due to increased pressure from the bleeding, which can affect brain function.
What is the most severe manifestation of a hemorrhage in the pons?
A. Hemiplegia
B. Respiratory failure
C. Dysphagia
D. Sensory loss
B. Respiratory failure
Rationale: Hemorrhage in the pons is the most serious because it rapidly affects basic life functions, including respiration, which can lead to death.
Which area of the brain is most commonly affected by intracerebral hemorrhage?
A. Cerebellum
B. Pons
C. Thalamus
D. Basal ganglia
D. Basal ganglia
Rationale: The basal ganglia is the most common site for intracerebral hemorrhages, particularly in patients with hypertension.
A patient presents with hemiplegia, slurred speech, and deviation of the eyes. Which area of the brain is most likely affected by the hemorrhage?
A. Pons
B. Thalamus
C. Cerebellum
D. Basal ganglia
D. Basal ganglia
Rationale: Manifestations of basal ganglia bleeding, such as hemiplegia, slurred speech, and eye deviation, suggest hemorrhage in this area.
Which of the following is the most common cause of death in patients with subarachnoid hemorrhage (SAH)?
A. Cerebral vasospasm
B. Intracranial pressure increase
C. Hemorrhagic shock
D. Rupture of the aneurysm
D. Rupture of the aneurysm
Rationale: The most common cause of death in patients with subarachnoid hemorrhage is the rupture of the aneurysm itself, leading to immediate and severe bleeding. This can result in rapid deterioration and death, particularly if not promptly treated.
A patient with subarachnoid hemorrhage (SAH) caused by an aneurysm rupture is being closely monitored for cerebral vasospasm. Which of the following is an important aspect of care for these patients?
A. Administering high-dose steroids
B. Frequent monitoring of vital signs and neurological status
C. Limiting fluid intake to prevent cerebral edema
D. Promoting early ambulation to reduce complications
B. Frequent monitoring of vital signs and neurological status
Rationale: Patients with SAH are at high risk for complications like cerebral vasospasm, which can lead to ischemic damage. Frequent monitoring of neurological status and vital signs helps detect early changes and interventions.
Which of the following is the most likely outcome for patients with a ruptured cerebral aneurysm causing subarachnoid hemorrhage?
A. Full recovery with no long-term effects
B. Mild cognitive impairment only
C. Sudden death or subsequent bleeding
D. Chronic headaches for the remainder of life
C. Sudden death or subsequent bleeding
Rationale: Rupture of a cerebral aneurysm can cause sudden death, particularly if the rupture is large. Even with medical intervention, subsequent bleeding is a significant risk. Survivors often face long-term cognitive deficits.
Which of the following factors contributes to cerebral vasospasm after subarachnoid hemorrhage (SAH)?
A. Blood clot breakdown releasing metabolites
B. Increased cerebral blood flow
C. Decreased intracranial pressure
D. Low sodium levels
A. Blood clot breakdown releasing metabolites
Rationale: Cerebral vasospasm occurs as a result of metabolites released during the breakdown of blood clots in the subarachnoid space. These metabolites, such as endothelin, can induce vasoconstriction, leading to further brain ischemia.
Which of the following is a common symptom of a ruptured aneurysm causing a subarachnoid hemorrhage (SAH)?
A. Sudden loss of consciousness
B. Progressive weakness in limbs
C. Paresthesia in the face
D. Numbness in the fingers
A. Sudden loss of consciousness
Rationale: A ruptured cerebral aneurysm causing a subarachnoid hemorrhage can lead to sudden loss of consciousness. Other symptoms may include nausea, vomiting, and cranial nerve deficits, but a rapid decline in consciousness is a key feature.
A patient with a recent subarachnoid hemorrhage (SAH) is at increased risk for which complication, particularly in the 6 to 10 days following the event?
A. Brain tumor formation
B. Cerebral vasospasm
C. Cardiac arrhythmia
D. Seizures
B. Cerebral vasospasm
Rationale: Cerebral vasospasm, a narrowing of blood vessels, is a serious complication of SAH and most commonly occurs between 6 to 10 days after the initial bleed, increasing the risk of cerebral infarction.
Which of the following is a key characteristic of a “silent killer” cerebral aneurysm?
A. Noticeable, persistent headaches
B. Sudden rupture with no prior symptoms
C. Severe seizures before rupture
D. Gradual development of visual disturbances
B. Sudden rupture with no prior symptoms
Rationale: Cerebral aneurysms are often referred to as a “silent killer” because many people do not experience warning symptoms until the aneurysm ruptures, at which point sudden and severe neurological deficits occur.
Which location in the brain is most commonly affected by cerebral aneurysms that lead to subarachnoid hemorrhage?
A. Temporal lobe
B. Basal ganglia
C. Medulla oblongata
D. Circle of Willis
D. Circle of Willis
Rationale: The majority of cerebral aneurysms that cause subarachnoid hemorrhage are located in the Circle of Willis, an area at the base of the brain where several arteries converge.
Which of the following is the most common cause of subarachnoid hemorrhage (SAH)?
A. Trauma
B. Cocaine use
C. Cerebral aneurysm rupture
D. Arteriovenous malformation
C. Cerebral aneurysm rupture
Rationale: Subarachnoid hemorrhage (SAH) is most commonly caused by the rupture of a cerebral aneurysm, which can be congenital or acquired. Other causes include trauma and cocaine use, but aneurysms are the primary cause.
Which type of stroke is most commonly associated with a sudden onset during physical activity?
A. Ischemic stroke (Embolic)
B. Thrombotic stroke
C. Hemorrhagic stroke (Intracerebral)
D. Subarachnoid hemorrhagic stroke
A. Ischemic stroke (Embolic)
Rationale: Embolic ischemic strokes typically occur suddenly during physical activity and are associated with emboli originating from the heart or other vascular sources.
Which type of stroke has a slightly higher incidence in women?
A. Thrombotic stroke
B. Subarachnoid hemorrhagic stroke
C. Intracerebral hemorrhagic stroke
D. Embolic stroke
C. Intracerebral hemorrhagic stroke
Rationale: Intracerebral hemorrhagic stroke has a slightly higher incidence in women compared to men, according to the provided information.
Which type of stroke is most likely to have a warning sign of a headache in 25% of cases?
A. Ischemic stroke (Thrombotic)
B. Intracerebral hemorrhagic stroke
C. Subarachnoid hemorrhagic stroke
D. Embolic stroke
B. Intracerebral hemorrhagic stroke
Rationale: A warning headache is common in 25% of cases of intracerebral hemorrhagic strokes.
Which type of stroke has a higher incidence in men than in women?
A. Embolic stroke
B. Subarachnoid hemorrhagic stroke
C. Intracerebral hemorrhagic stroke
D. Thrombotic stroke
A. Embolic stroke
Rationale: Embolic stroke is more common in men than in women, according to the provided data.
Which type of stroke has a median age of occurrence that is the youngest among all stroke types?
A. Ischemic stroke (Embolic)
B. Intracerebral hemorrhagic stroke
C. Thrombotic stroke
D. Subarachnoid hemorrhagic stroke
D. Subarachnoid hemorrhagic stroke
Rationale: Subarachnoid hemorrhagic stroke has the youngest median age, which is noted in the provided information.
Which type of stroke is most likely to be preceded by a transient ischemic attack (TIA)?
A. Embolic ischemic stroke
B. Subarachnoid hemorrhagic stroke
C. Intracerebral hemorrhagic stroke
D. Thrombotic ischemic stroke
D. Thrombotic ischemic stroke
Rationale: Thrombotic strokes are often preceded by a TIA, which occurs in 30% to 50% of cases.
Which type of stroke is more likely to occur during sleep or shortly after waking up?
A. Ischemic stroke (Embolic)
B. Thrombotic ischemic stroke
C. Subarachnoid hemorrhagic stroke
D. Intracerebral hemorrhagic stroke
B. Thrombotic ischemic stroke
Rationale: Thrombotic ischemic strokes are more likely to occur during or shortly after sleep.
Which type of stroke is most commonly associated with a fatality if coma is present?
A. Ischemic stroke (Thrombotic)
B. Intracerebral hemorrhagic stroke
C. Subarachnoid hemorrhagic stroke
D. Embolic stroke
C. Subarachnoid hemorrhagic stroke
Rationale: Subarachnoid hemorrhagic strokes are more likely to result in fatality when coma is present, as the severity of the stroke and the risk of complications are high.
Which stroke type has a stepwise progression with slow development of symptoms?
A. Ischemic stroke (Embolic)
B. Thrombotic ischemic stroke
C. Subarachnoid hemorrhagic stroke
D. Intracerebral hemorrhagic stroke
B. Thrombotic ischemic stroke
Rationale: Thrombotic ischemic strokes typically progress slowly, with symptoms developing in a stepwise manner over time.
Why do neurologic manifestations not significantly differ between ischemic and hemorrhagic strokes?
A. Both types of stroke involve the same artery.
B. Neural tissue destruction is the basis of dysfunction in both types.
C. The effects are primarily caused by hemorrhage.
D. Ischemic strokes are less severe than hemorrhagic strokes.
B. Neural tissue destruction is the basis of dysfunction in both types.
Rationale: Neurologic dysfunction in both ischemic and hemorrhagic strokes results from the destruction of neural tissue, regardless of the underlying cause.
Which body functions can be affected by a stroke?
A. Motor activity, bladder function, and swallowing
B. Bladder function, hearing, and vision
C. Vision, swallowing, and digestion
D. Coordination, hearing, and blood pressure regulation
A. Motor activity, bladder function, and swallowing
Rationale: A stroke can impair motor activity, bladder and bowel function, intellect, spatial perception, personality, affect, sensation, swallowing, and communication.
What determines the specific neurologic manifestations of a stroke?
A. The type of stroke and the patient’s age
B. The presence of preexisting conditions
C. The size of the brain affected
D. The location of the stroke and the artery involved
D. The location of the stroke and the artery involved
Rationale: Neurologic manifestations are directly related to the artery involved and the area of the brain it supplies.
How do manifestations of right- and left-brain damage differ?
A. They do not differ significantly.
B. Right-brain damage affects intellect more than left-brain damage.
C. They differ slightly based on the affected hemisphere.
D. Left-brain damage affects perception more than right-brain damage.
C. They differ slightly based on the affected hemisphere.
Rationale: The specific manifestations of right- and left-brain damage differ somewhat due to the distinct functions controlled by each hemisphere.
Which of the following is a general manifestation of stroke?
A. Hyperthermia
B. Impaired spatial perception
C. Increased heart rate
D. Fluctuating blood pressure
B. Impaired spatial perception
Rationale: General manifestations of stroke include impaired motor activity, intellect, spatial perception, swallowing, and communication. These effects depend on the stroke’s location.
A 65-year-old patient is admitted with right-sided hemiparesis and slurred speech following a stroke. A CT scan reveals a lesion on the left side of the brain affecting the middle cerebral artery. Which motor deficit is the patient most likely to experience?
A. Greater weakness in the lower extremity than the upper extremity
B. Equal weakness in both upper and lower extremities
C. Greater weakness in the upper extremity than the lower extremity
D. Flaccidity lasting indefinitely with no progression
C. Greater weakness in the upper extremity than the lower extremity
Rationale: A stroke involving the middle cerebral artery typically results in greater weakness in the upper extremity compared to the lower extremity. The motor deficits occur contralaterally to the lesion.
A nurse is assessing a patient recovering from a stroke with motor deficits. Which findings are consistent with the progression of motor deficits in stroke patients? (SATA)
A. Loss of skilled voluntary movement (akinesia)
B. Initial flaccidity of muscles
C. Persistent hyporeflexia without progression
D. Spasticity during later recovery stages
E. Impaired integration of movements
A. Loss of skilled voluntary movement (akinesia)
B. Initial flaccidity of muscles
D. Spasticity during later recovery stages
E. Impaired integration of movements
Rationale: Motor deficits in stroke patients typically include loss of skilled voluntary movement, initial flaccidity followed by spasticity, and impaired integration of movements. Hyporeflexia progresses to hyperreflexia over time, not remaining static.
A 72-year-old patient presents with weakness on the left side of the body after a stroke. The patient exhibits increased muscle tone and hyperactive reflexes in the left upper and lower extremities. What does this finding indicate?
A. The patient is in the initial stage of motor recovery.
B. The patient is experiencing muscle flaccidity due to nerve damage.
C. The patient has progressed to the stage of spasticity.
D. The patient’s motor deficits are resolving completely.
C. The patient has progressed to the stage of spasticity.
Rationale: Muscle spasticity, characterized by increased muscle tone and hyperreflexia, occurs after the initial flaccid stage as the upper motor neuron influence is interrupted.
Which statement best explains why motor deficits in stroke patients occur on the side of the body opposite the brain lesion?
A. Reflex arcs are disrupted on the affected side.
B. The pyramidal pathway crosses at the level of the medulla.
C. The stroke causes global neurologic dysfunction.
D. Brain swelling compresses motor neurons bilaterally.
B. The pyramidal pathway crosses at the level of the medulla.
Rationale: The pyramidal pathway, responsible for voluntary motor control, decussates (crosses) at the medulla, causing motor deficits to appear on the side opposite the brain lesion.
A nurse is teaching a family about motor deficits in their loved one recovering from a stroke. What key points should the nurse include? (SATA)
A. The affected shoulder may rotate internally.
B. Muscle flaccidity can last for several weeks.
C. Reflexes will remain depressed permanently.
D. Spasticity may develop after the flaccid stage.
E. Motor function recovery depends on the extent of brain damage.
A. The affected shoulder may rotate internally.
B. Muscle flaccidity can last for several weeks.
D. Spasticity may develop after the flaccid stage.
E. Motor function recovery depends on the extent of brain damage.
Rationale: Motor deficits can cause internal rotation of the shoulder, prolonged flaccidity, and later spasticity. Recovery of motor function depends on the extent of damage and rehabilitation efforts. Reflexes typically progress from hyporeflexia to hyperreflexia.
A 58-year-old patient presents with difficulty speaking after a stroke. Upon assessment, the patient can comprehend language but struggles to produce speech, requiring significant effort. Which condition best describes the patient’s communication deficit?
A. Receptive aphasia
B. Global aphasia
C. Dysarthria
D. Expressive aphasia
D. Expressive aphasia
Rationale: Expressive aphasia involves difficulty producing language, despite the ability to comprehend it. This condition often results in slow and effortful speech.
A nurse is caring for a patient with dysarthria following a stroke. Which characteristics are associated with this condition? (SATA)
A. Difficulty with articulation
B. Impaired comprehension of spoken words
C. Problems with phonation
D. Issues with pronunciation
E. Loss of written language skills
A. Difficulty with articulation
C. Problems with phonation
D. Issues with pronunciation
Rationale: Dysarthria refers to impaired muscular control of speech, affecting articulation, phonation, and pronunciation. It does not affect comprehension of language or written language skills.
A nurse is educating a family about the difference between aphasia and dysarthria. Which statement by the family indicates a correct understanding?
A. “Aphasia is a speech problem caused by weakened muscles.”
B. “Dysarthria affects the meaning of words, while aphasia does not.”
C. “Aphasia involves difficulty with language comprehension or expression, while dysarthria involves speech mechanics.”
D. “Both aphasia and dysarthria affect written communication in the same way.”
C. “Aphasia involves difficulty with language comprehension or expression, while dysarthria involves speech mechanics.”
Rationale: Aphasia is a language disorder affecting comprehension or expression of language, while dysarthria is related to the physical mechanics of speech.
