Chapter 62: Stroke Flashcards

Question

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

Answer 1

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.

Answer 2

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.

Answer 3

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.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

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.

Answer 10

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.

Answer 11

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.

Answer 12

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.

Answer 13

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.

Answer 14

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.

Answer 15

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.

Answer 16

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.

Answer 17

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.

Answer 18

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.

Answer 19

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.

Answer 20

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.

Answer 21

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.

Answer 22

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.

Answer 23

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.

Answer 24

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.

Answer 25

C. Hypertension Rationale: Hypertension is the most common cause of intracerebral hemorrhage, leading to vessel rupture, especially in the basal ganglia.

Answer 26

B. Decreased level of consciousness Rationale: Decreased LOC is a common manifestation due to increased pressure from the bleeding, which can affect brain function.

Answer 27

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.

Answer 28

D. Basal ganglia Rationale: The basal ganglia is the most common site for intracerebral hemorrhages, particularly in patients with hypertension.

Answer 29

D. Basal ganglia Rationale: Manifestations of basal ganglia bleeding, such as hemiplegia, slurred speech, and eye deviation, suggest hemorrhage in this area.

Answer 30

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.

Answer 31

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.

Answer 32

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.

Answer 33

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.

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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.

Answer 38

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.

Answer 39

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.

Answer 40

C. Intracerebral hemorrhagic stroke Rationale: Intracerebral hemorrhagic stroke has a slightly higher incidence in women compared to men, according to the provided information.

Answer 41

B. Intracerebral hemorrhagic stroke Rationale: A warning headache is common in 25% of cases of intracerebral hemorrhagic strokes.

Answer 42

A. Embolic stroke Rationale: Embolic stroke is more common in men than in women, according to the provided data.

Answer 43

D. Subarachnoid hemorrhagic stroke Rationale: Subarachnoid hemorrhagic stroke has the youngest median age, which is noted in the provided information.

Answer 44

D. Thrombotic ischemic stroke Rationale: Thrombotic strokes are often preceded by a TIA, which occurs in 30% to 50% of cases.

Answer 45

B. Thrombotic ischemic stroke Rationale: Thrombotic ischemic strokes are more likely to occur during or shortly after sleep.

Answer 46

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.

Answer 47

B. Thrombotic ischemic stroke Rationale: Thrombotic ischemic strokes typically progress slowly, with symptoms developing in a stepwise manner over time.

Answer 48

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.

Answer 49

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.

Answer 50

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.

Answer 51

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.

Answer 52

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.

Answer 53

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.

Answer 54

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.

Answer 55

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.

Answer 56

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.

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

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.

Answer 61

B. Receptive aphasia Rationale: Receptive aphasia, also known as Wernicke’s aphasia, is characterized by fluent speech that lacks meaningful content and impaired comprehension.

Answer 62

A. Loss of language comprehension B. Inability to produce meaningful speech D. Minimal or no speech activity E. Total inability to communicate effectively Rationale: Global aphasia is the most severe form of aphasia, involving both the inability to comprehend language and the inability to produce meaningful speech. Patients may have minimal or no speech activity, resulting in a total inability to communicate effectively.

Answer 63

A. Encourage participation in physical therapy to improve mobility. B. Provide education on the normalcy of post-stroke emotional changes. C. Refer the patient to a mental health professional if depression is suspected. E. Encourage open communication about feelings and frustrations. Rationale: Post-stroke emotional changes, including depression and emotional lability, can be addressed by improving mobility, providing education, referring to mental health professionals when necessary, and fostering open communication. Minimizing social interactions is not recommended as it may increase isolation and worsen emotional well-being

Answer 64

B. Emotional lability Rationale: Emotional lability, a common result of stroke, is characterized by exaggerated or unpredictable emotional responses, such as sudden crying or laughing, unrelated to the patient’s emotional state.

Answer 65

D. Supervise and assist the patient when moving from the wheelchair while providing verbal reminders about safety. Rationale: Patients with a right-brain stroke often exhibit impulsive behavior. Close supervision and verbal reminders are essential to prevent falls and reinforce safety precautions.

Answer 66

B. The patient may move slowly and cautiously. C. The patient may have memory problems related to language. D. The patient may struggle with judgment and decision-making. Rationale: A left-brain stroke often leads to cautious behavior, language-related memory problems, and impaired judgment. Impulsivity and overestimation of abilities are more characteristic of right-brain strokes.

Answer 67

C. Abstract reasoning Rationale: Difficulty with generalizations suggests a deficit in abstract reasoning, which may impair the patient’s ability to learn and apply concepts during rehabilitation. Both right- and left-brain strokes can lead to this impairment.

Answer 68

C. Spatial neglect Rationale: Spatial neglect involves a lack of awareness or attention to the affected side of the body, commonly occurring after right-brain strokes. This condition often results in difficulties with spatial orientation.

Answer 69

A. Inability to recognize a comb when shown it. B. Denial of having a stroke or recognizing affected body parts. C. Difficulty following sequential movements on command. D. Trouble judging distances while reaching for objects. Rationale: Spatial-perceptual problems include agnosia (inability to recognize objects), incorrect perception of self and illness, apraxia (difficulty with sequential movements), and spatial neglect (difficulty judging distances). Difficulty expressing words fluently is associated with aphasia, not spatial-perceptual deficits.

Answer 70

C. Apraxia Rationale: Apraxia is the inability to carry out learned, sequential movements on command despite having the physical ability to do so. This condition can significantly affect rehabilitation and daily activities.

Answer 71

A. Agnosia Rationale: Agnosia refers to the inability to recognize objects by sight, touch, or hearing. In this case, the patient can recognize the pen by touch, indicating visual agnosia.

Answer 72

C. They are likely to regain normal bladder function over time. Rationale: When a stroke affects one hemisphere of the brain, partial sensation for bladder filling and voluntary urination often remain intact. This leads to an excellent prognosis for regaining bladder control with appropriate interventions.

Answer 73

A. Encourage regular physical activity. B. Increase dietary fiber intake. D. Establish a regular toileting schedule. Rationale: Constipation after a stroke is often due to immobility, weak abdominal muscles, and decreased hydration or defecation reflexes. Physical activity, dietary fiber, and a regular toileting schedule support bowel health. Limiting fluids can worsen constipation, and daily laxative use is not recommended unless prescribed.

Answer 74

B. Provide scheduled toileting and adaptive clothing. Rationale: Scheduled toileting helps establish a routine, and adaptive clothing promotes independence in managing elimination needs. These strategies address the patient’s communication difficulties and clothing management without resorting to invasive measures like a catheter.

Answer 75

C. Broca’s aphasia Rationale: Broca’s aphasia is characterized by nonfluent speech with short phrases that make sense but require great effort. Patients typically understand speech and are aware of their difficulties, leading to frustration.

Answer 76

A. Fluent speech with long, nonsensical sentences. B. Difficulty understanding spoken language. D. Use of made-up words in conversation. Rationale: Wernicke’s aphasia is a type of fluent aphasia where patients may speak in long, nonsensical sentences, create made-up words, and have difficulty understanding language. They are often unaware of their language deficits.

Answer 77

C. Left temporal lobe Rationale: Wernicke’s aphasia is caused by damage to the left temporal lobe, which is responsible for understanding language and speech.

Answer 78

C. Extensive damage to the brain’s language areas Rationale:Global aphasia results from widespread damage to multiple language centers in the brain, severely affecting both expression and comprehension of language.

Answer 79

A. Severe difficulty in both speaking and understanding language. C. Damage to extensive portions of the language areas of the brain. D. Limited ability to repeat words or sentences. Rationale: Global aphasia involves severe communication difficulties due to widespread brain damage, limiting the ability to speak, understand, or repeat language. Patients may or may not be aware of their deficits, but awareness is not a hallmark feature.

Answer 80

D. Other types of aphasia Rationale: These symptoms suggest damage to specific language areas in the brain other than Broca’s or Wernicke’s areas, resulting in trouble naming objects or repeating words despite preserved understanding.

Answer 81

B. Fluent speech with long, nonsensical sentences and made-up words. Rationale: Wernicke’s aphasia is characterized by fluent speech that lacks meaning and often includes made-up words, with significant difficulty understanding language.

Answer 82

D. Specific language areas Rationale: These symptoms indicate damage to specific language areas in the brain that affect repetition and naming without completely disrupting speech or comprehension.

Answer 83

C. Broca’s aphasia is nonfluent and effortful, while Wernicke’s aphasia is fluent but nonsensical. Rationale: Broca’s aphasia results in nonfluent, effortful speech with retained comprehension, while Wernicke’s aphasia produces fluent but nonsensical speech with poor comprehension.

Answer 84

A. Difficulty forming complete sentences. B. Limited speech output. D. Awareness of their language deficits. Rationale: Broca’s aphasia is marked by limited, effortful speech and an awareness of deficits. Patients typically retain comprehension, differentiating it from Wernicke’s aphasia.

Answer 85

C. Wernicke’s aphasia Rationale: Wernicke’s aphasia involves fluent but nonsensical speech, difficulty understanding language, and lack of awareness of language deficits.

Answer 86

B. Use yes/no questions and gestures. Rationale: Using simple yes/no questions and gestures helps patients with Broca’s aphasia express themselves more easily and reduces frustration.

Answer 87

A. Severe difficulty with both speech and comprehension. C. Limited speech output. D. Inability to understand written language. E. Difficulty naming objects or repeating sentences. Rationale: Global aphasia results in severe communication deficits, affecting both expression and comprehension, including written language. Patients may have limited speech and struggle to name objects or repeat sentences.

Answer 88

D. Other aphasia Rationale: These symptoms suggest damage to specific brain areas affecting naming, repetition, or task sequencing, not fitting the classic patterns of Broca’s, Wernicke’s, or global aphasia.

Answer 89

B. MRI Rationale: MRI is more effective than CT scans in identifying ischemic strokes due to its higher sensitivity for detecting changes in brain tissue.

Answer 90

B. Noncontrast head CT Rationale: A noncontrast head CT is the fastest and most widely available method to differentiate between ischemic and hemorrhagic stroke, guiding initial treatment decisions.

Answer 91

A. Vasospasm B. Dislodging an embolus C. Allergic reaction to contrast media E. Further hemorrhage Rationale: Cerebral angiography carries risks such as vasospasm, embolus dislodgement, allergic reactions to contrast media, and further hemorrhage. Hypotension is not a common complication.

Answer 92

A. CT angiography (CTA) and cardiac imaging Rationale: Cardiac imaging is essential to evaluate emboli originating from the heart, and CTA can detect perfusion issues and filling defects in cerebral arteries.

Answer 93

B. It is a rapid diagnostic tool to rule out hemorrhage. C. It can guide treatment decisions by determining stroke size and location. E. Serial scans may be used to assess recovery. Rationale: Noncontrast head CT is primarily used to rule out hemorrhage, guide treatment decisions, and assess recovery through serial scans. MRI is more sensitive for detecting ischemic stroke in its early stages.

Answer 94

C. Magnetic resonance angiography (MRA) Rationale: MRA is effective for detecting vascular lesions and blockages, providing similar information to CTA without requiring exposure to ionizing radiation.

Answer 95

C. Cerebral angiography Rationale: Cerebral angiography is the gold standard for identifying the source of subarachnoid hemorrhage, including vascular malformations and aneurysms.

Answer 96

A. CT angiography (CTA) C. Magnetic resonance angiography (MRA) E. Cerebral angiography Rationale: CTA, MRA, and cerebral angiography are commonly used to evaluate blood vessels for occlusions, lesions, or malformations in stroke patients. Noncontrast CT and MRI diffusion imaging are used to assess brain tissue, not vessels.

Answer 97

A. Troponin levels B. ECG C. Transthoracic echocardiography Rationale: Cardiac assessments for stroke include troponin levels, ECG to identify arrhythmias like atrial fibrillation, and transthoracic echocardiography to detect embolic sources. Lipid profiles are part of additional lab studies, and CT angiography evaluates cerebral vessels.

Answer 98

D. CT scan Rationale: A CT scan is a standard and rapid diagnostic tool to determine the extent of stroke involvement and differentiate between ischemic and hemorrhagic strokes.

Answer 99

B. Carotid duplex scanning Rationale: Carotid duplex scanning is a noninvasive diagnostic test that evaluates blood flow through the carotid arteries and is commonly used to detect stenosis.

Answer 100

C. Echocardiography Rationale: Echocardiography, including transthoracic and transesophageal techniques, evaluates the heart for potential embolic sources, such as atrial fibrillation or thrombi.

Answer 101

A. Coagulation studies C. Electrolyte panel with blood glucose D. Lipid profile Rationale: Additional studies include coagulation studies, electrolyte panels with blood glucose, and lipid profiles to evaluate risk factors and underlying conditions contributing to stroke. Cardiac markers assess cardiac function, while MRI is used for stroke localization.

Answer 102

B. MRI diffusion and perfusion imaging Rationale: MRI diffusion and perfusion imaging evaluates both brain tissue and blood flow, providing critical information on ischemic areas and perfusion deficits.

Answer 103

B. Adoption of a healthy lifestyle Rationale: Primary prevention for stroke focuses on adopting a healthy lifestyle, including managing modifiable risk factors such as diet, exercise, and weight control.

Answer 104

C. To decrease morbidity and mortality Rationale: The primary goal of health promotion in stroke prevention is to decrease morbidity and mortality by encouraging lifestyle changes and managing risk factors.

Answer 105

D. No need for close monitoring or dosage adjustments Rationale: The primary advantage of direct factor Xa inhibitors (such as rivaroxaban, dabigatran, and apixaban) over warfarin is that they do not require close monitoring or dosage adjustments.

Answer 106

B. Warfarin (Coumadin) C. Rivaroxaban (Xarelto) E. Apixaban (Eliquis) Rationale: For patients with atrial fibrillation, oral anticoagulation agents such as warfarin, rivaroxaban, and apixaban are commonly used to prevent stroke. Statins, while used for high cholesterol, are not used primarily for atrial fibrillation-related stroke prevention.

Answer 107

C. Aspirin Rationale: Aspirin, at a dose of 81 mg/day, is the most commonly used antiplatelet agent for preventing stroke in patients who have had a transient ischemic attack (TIA).

Answer 108

A. They clamp the LAA to prevent blood flow into and out of it Rationale: LAA occlusion devices such as AtriClip and Watchman are used to close off the LAA by clamping it, which prevents blood from entering and exiting the LAA, thereby reducing the risk of emboli formation.

Answer 109

D. To reduce the risk of stroke by preventing clot formation Rationale: LAA occlusion is used to prevent stroke in patients with atrial fibrillation by decreasing the risk of emboli formation, which typically originate in the LAA.

Answer 110

B. Passage of blood clots from the right atrium to the brain, leading to ischemia Rationale: A patent foramen ovale allows blood clots to pass from the right atrium to the left atrium and into the brain, potentially leading to ischemia and stroke.

Answer 111

A. Anticoagulation therapy B. Implantation of an occlusion device in the foramen ovale Rationale: Anticoagulation therapy and implantation of an occlusion device are common interventions to prevent blood clots from passing through the patent foramen ovale. Surgical repair may be considered in some cases, but occlusion devices are a more common solution.

Answer 112

A. To remove atherosclerotic plaque and improve blood flow to the brain Rationale: The main purpose of carotid endarterectomy is to remove atheromatous lesions from the carotid artery to restore proper blood flow to the brain and prevent stroke.

Answer 113

A. To remove atherosclerotic plaque and improve blood flow to the brain Rationale: The main purpose of carotid endarterectomy is to remove atheromatous lesions from the carotid artery to restore proper blood flow to the brain and prevent stroke.

Answer 114

A. Neurovascular assessment B. Monitoring for stent occlusion C. Maintaining the leg straight at the insertion site E. Blood pressure management Rationale: After stenting or angioplasty, essential care includes neurovascular assessment, monitoring for stent occlusion, managing blood pressure, and ensuring that the patient’s leg remains straight at the insertion site to minimize bleeding risks.

Answer 115

B. Time of onset of symptoms Rationale: The time of symptom onset is the most important factor in acute stroke care, as it guides treatment decisions, particularly for fibrinolytic therapy.

Answer 116

A. Preserving life C. Preventing further brain damage D. Reducing disability Rationale: The primary care goals in the acute phase of ischemic stroke management are to preserve life, prevent further brain damage, and reduce disability. Immediate rehabilitation is important but typically starts after stabilization.

Answer 117

B. If SBP is greater than 220 mm Hg or diastolic BP (DBP) is greater than 120 mm Hg Rationale: Blood pressure-lowering drugs should be used if BP is markedly elevated, specifically if SBP is greater than 220 mm Hg or DBP exceeds 120 mm Hg, to prevent further complications.

Answer 118

A. Elevating the head of the bed C. Keeping the head and neck aligned E. Administering anticonvulsants to prevent seizures Rationale: To manage increased ICP, the head of the bed should be elevated, the head and neck should be kept in alignment, and anticonvulsants should be administered if needed. IV glucose and water solutions should be avoided because they can worsen cerebral edema. Fever management should aim for a target temperature of 96.8°F to 98.6°F.

Answer 119

A. BP less than 185/110 mm Hg Rationale: Before fibrinolytic therapy, the BP must be less than 185/110 mm Hg, and it should be maintained at or below 180/105 mm Hg for at least 24 hours after treatment.

Answer 120

B. Increased intracranial pressure D. Hypertension E. Seizures Rationale: In the acute phase, complications such as increased intracranial pressure, hypertension, and seizures must be monitored closely. Dehydration and hypoglycemia are less common in the acute phase but should still be managed.

Answer 121

D. To ensure adequate hydration for brain perfusion Rationale: The goal is to maintain adequate hydration to promote brain perfusion and reduce brain injury. Overhydration should be avoided to prevent complications like increased intracranial pressure (ICP).

Answer 122

D. To reduce elevated blood pressure that could worsen stroke Rationale: In ischemic stroke, elevated blood pressure may initially be a protective response but can be detrimental. Antihypertensive drugs are used to reduce BP if it is excessively high to prevent further brain damage.

Answer 123

A. Central venous pressure levels B. Serum sodium levels C. Blood glucose levels D. Fluid intake and output Rationale: Monitoring central venous pressure levels, serum sodium, blood glucose, and fluid intake/output is essential to guide fluid and electrolyte management, particularly in the acute phase of ischemic stroke.

Answer 124

A. Administering hypertonic saline B. Ensuring the head of the bed is elevated D. Providing adequate pain management Rationale: Managing increased ICP involves elevating the head of the bed to improve venous drainage, administering hypertonic saline to reduce ICP, and providing pain management to prevent increases in ICP. IV fluids with glucose should be avoided.

Answer 125

C. Insertion of an artificial airway Rationale: If a stroke patient is unresponsive and at risk of airway obstruction, the priority is to maintain an open airway, which may require the insertion of an artificial airway.

Answer 126

A. Administering supplemental oxygen B. Inserting an endotracheal tube D. Using mechanical ventilation as necessary Rationale: Maintaining adequate oxygenation may involve administering supplemental oxygen, inserting an endotracheal tube if needed, and using mechanical ventilation for patients who cannot maintain oxygenation independently.

Answer 127

B) Time of onset of symptoms Rationale: The time of onset of symptoms is the most critical factor in determining whether tPA can be administered, as it must be given within 3 to 4½ hours of the onset of ischemic stroke symptoms to be effective.

Answer 128

A) Noncontrast CT scan or MRI Rationale: A noncontrast CT scan or MRI is needed to rule out hemorrhagic stroke before tPA administration.

Answer 129

C. It promotes fibrinolysis to break down clots. Rationale: tPA promotes fibrinolysis by converting plasminogen to plasmin, which breaks down fibrin and fibrinogen, dissolving the clot.

Answer 130

D) 6 hours Rationale: Intraarterial tPA should be administered within 6 hours of symptom onset to be effective.

Answer 131

B) SBP less than 185 mm Hg Rationale: BP must be controlled to maintain SBP less than 185 mm Hg during tPA infusion to reduce the risk of hemorrhagic transformation.

Answer 132

C) It increases the risk of intracranial hemorrhage. Rationale: Anticoagulants are avoided in the acute phase of ischemic stroke due to the risk of causing or worsening intracranial hemorrhage.

Answer 133

B) High-dose aspirin Rationale: High-dose aspirin may be started within 24 to 48 hours to prevent further clot formation after ischemic stroke.

Answer 134

A) GI bleeding Rationale: High-dose aspirin can lead to gastrointestinal bleeding, which is a common complication after ischemic stroke treatment.

Answer 135

B) Warfarin and direct factor Xa inhibitors Rationale: Patients with ischemic stroke caused by atrial fibrillation may be treated with oral anticoagulants such as warfarin or direct factor Xa inhibitors (e.g., rivaroxaban, apixaban) to prevent further clot formation.

Answer 136

A) To expand the artery and allow blood flow to the brain Rationale: The primary function of a stent retriever is to expand the artery’s interior walls and restore blood flow to the brain by removing the clot.

Answer 137

B) Femoral or radial arteries Rationale: The catheter used for stent retriever procedures is typically inserted into the femoral or radial artery to access the blocked brain artery.

Answer 138

C) They allow for immediate restoration of blood flow to the brain Rationale: Stent retrievers are considered one of the most effective methods because they allow for immediate restoration of blood flow to the brain, minimizing brain damage during ischemic stroke.

Answer 139

A) They can increase the risk of further bleeding Rationale: Anticoagulants and platelet inhibitors are contraindicated because they can increase the risk of further bleeding in patients with hemorrhagic strokes.

Answer 140

B) Managing hypertension Rationale: The primary focus of drug therapy for hemorrhagic stroke is managing hypertension to maintain blood pressure within a normal to high-normal range to prevent further bleeding.

Answer 141

C) To maintain SBP less than 160 mm Hg Rationale: The goal of using oral and IV agents in hemorrhagic stroke is to maintain systolic blood pressure (SBP) less than 160 mm Hg to prevent further bleeding and reduce intracranial pressure.

Answer 142

A) To remove the hematoma and prevent further pressure on the brain Rationale: The purpose of surgical evacuation is to remove the hematoma and prevent further pressure on the brain, which can lead to additional brain damage.

Answer 143

C) To block blood flow and prevent rebleeding Rationale: Clipping an aneurysm involves placing a metallic clip on the neck of the aneurysm to block blood flow and prevent rebleeding, which is a common cause of further hemorrhage.

Answer 144

A) By blocking CSF circulation, leading to increased pressure on the brain Rationale: Blood in the subarachnoid space can block CSF circulation, leading to increased pressure on the brain and the enlargement of ventricles, resulting in hydrocephalus.

Answer 145

B) By dilating blood vessels to improve blood flow to the brain Rationale: Nimodipine is a calcium channel blocker that dilates narrowed blood vessels around the area of bleeding, improving blood flow and minimizing cerebral damage from vasospasms.

Answer 146

B) Obtain a detailed history of the current illness and risk factors Rationale: The priority is to obtain a detailed history of the current illness, including symptom onset, duration, and nature, as well as any history of similar symptoms and risk factors, to determine the severity and potential cause of the stroke.

Answer 147

B) Assessing cranial nerve function Rationale: The NIHSS is the primary tool for evaluating stroke severity and predicting both short- and long-term outcomes. It is essential for ongoing patient care and communication among healthcare providers.

Answer 148

C) Monitoring the patient’s blood pressure Rationale: Monitoring blood pressure is critical in patients receiving fibrinolytic therapy as uncontrolled hypertension can lead to bleeding complications.

Answer 149

A) The importance of adhering to prescribed antihypertensive therapy Rationale: Managing hypertension is the primary preventive measure for stroke, as uncontrolled hypertension is the leading risk factor for stroke. Anticoagulant therapy may help prevent stroke recurrence but controlling blood pressure is crucial.

Answer 150

B) Smoking Rationale: Smoking is a major modifiable risk factor for stroke, and smoking cessation is a key focus of stroke prevention.

Answer 151

C) Elevate the head of the bed to 30 degrees to reduce ICP Rationale: Elevating the head of the bed helps reduce ICP, which is critical in patients with increased intracranial pressure. Other interventions like seizure precautions may be necessary but reducing ICP is the priority.

Answer 152

C) To predict long-term outcomes and guide treatment planning Rationale: The NIHSS helps to predict both short-term and long-term outcomes and is essential for planning patient care, as well as for communicating the severity of the stroke with other healthcare providers.

Answer 153

C) Left-sided weakness and spatial-perceptual deficits Rationale: A stroke in the right hemisphere often leads to left-sided weakness and spatial-perceptual deficits, such as difficulty judging distances or recognizing familiar objects.

Answer 154

B) Notify the healthcare provider of the elevated blood pressure Rationale: Notifying the healthcare provider is important, as elevated blood pressure can exacerbate stroke symptoms and complicate treatment. The provider will determine if antihypertensive therapy is needed.

Answer 155

D) Refer the patient to a smoking cessation program Rationale: Referring the patient to a formal smoking cessation program is likely to provide the best support and resources for long-term success in quitting smoking.

Answer 156

A) Provide thickened liquids and soft foods Rationale: Thickened liquids and soft foods help prevent aspiration by making swallowing easier for patients with difficulty swallowing after a stroke.

Answer 157

B) The patient’s ability to communicate using simple words or gestures Rationale: Assessing the patient’s ability to communicate is essential, as difficulty speaking is a common symptom of stroke and may require alternative methods of communication.

Answer 158

a. O2 content of the blood.

Answer 159

d. sudden onset of severe headache.

Answer 160

c. Left middle cerebral artery

Answer 161

c. Left middle cerebral artery

Answer 162

a. Noncontrast head CT

Answer 163

c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow.

Answer 164

b. time at which stroke symptoms first appeared.

Answer 165

b. helping the patient to stand to void.

Answer 166

c. Oral low-dose aspirin therapy 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.

Answer 167

d. The patient reports that the symptoms began with a severe headache. Rationale: A sudden onset headache is typical of a subarachnoid hemorrhage. Atrial fibrillation and infective endocarditis are a risk factors for thrombotic or embolic stroke. Brief episodes of right-sided hemiplegia are consistent with transient ischemic attack and risk for embolic stroke.

Answer 168

Right-sided paralysis indicates a left-brain stroke, which is also associated with difficulty in comprehension and use of language: the left hemisphere is dominant for language skills in right-handed persons and in most left-handed persons. Impulsive behavior and neglect are more likely with a right-side stroke. The left-side reflexes are likely to be intact. Rationale: Right-sided paralysis indicates a left-brain stroke, which is also associated with difficulty in comprehension and use of language: the left hemisphere is dominant for language skills in right-handed persons and in most left-handed persons. Impulsive behavior and neglect are more likely with a right-side stroke. The left-side reflexes are likely to be intact.

Answer 169

c. Visual deficits

Answer 170

c. Start a labetalol drip to keep BP less than 140/90 mm Hg. Rationale: Because elevated BP may be a protective response to maintain cerebral perfusion, antihypertensive therapy is recommended only if mean arterial pressure (MAP) is greater than 130 mm Hg or systolic pressure is greater than 220 mm Hg. Fluid intake should be 1500 to 2000 mL/day to maintain cerebral blood flow. The head of the bed should be elevated to at least 30 degrees unless the patient has symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for tPA use.

Answer 171

d. Tissue plasminogen activator (tPa) infusion 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.

Answer 172

a. Ask questions that the patient can answer with “yes” or “no.” 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.

Answer 173

c. Denial of deficits and impulsiveness 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.

Answer 174

c. Place needed objects on the patient‘s left side. Rationale: During the acute period, the nurse would place objects on the patient‘s unaffected side. Because there is a visual defect in the right half of each eye, an eye patch is not appropriate. The patient would be approached from the left side. The visual deficit may not resolve, although the patient can learn to compensate for the defect.

Answer 175

c. Assist the patient to eat with the right hand. 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.

Answer 176

a. Apply intermittent pneumatic compression stockings. 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.

Answer 177

c. Assist the patient into a chair. 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.

Answer 178

b. Check the respiratory rate and effort. Rationale: The initial nursing action should be to assess the airway and take any needed actions to ensure a patent airway. The other activities should take place quickly after the ABCs (airway, breathing, and circulation) are completed.

Answer 179

b. Assist the patient onto the bedside commode every 2 hours. 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 an external 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.

Answer 180

c. Explain that the aspirin is ordered to decrease stroke risk. Rationale: Aspirin is ordered to prevent stroke in patients who have experienced TIAs. Documentation of the patient‘s refusal to take the medication without providing more information 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.

Answer 181

b. Aspirin 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.

Answer 182

d. Teach the family that emotional outbursts are common after strokes. Rationale: Patients who have left-sided brain stroke are prone to emotional outbursts that are not necessarily related to the emotional state of the patient. Depression after a stroke is common, but the suddenness of the patient‘s outburst suggests that depression is not the major cause of the behavior. The family should stay with the patient. The crying is not within the patient‘s control. Asking the patient to stop will lead to embarrassment.

Answer 183

c. The patient‘s usual blood pressure (BP) is 170/94 mm Hg. 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 stroke. Physical inactivity and obesity contribute to stroke risk but not as much as hypertension.

Answer 184

d. The patient has atrial fibrillation and takes warfarin (Coumadin). Rationale: The use of warfarin may have 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.

Answer 185

c. Computed tomography (CT) scan 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.

Answer 186

b. Risk for aspiration Rationale: Protection of the airway is the priority of nursing care for a patient having an acute stroke. The other diagnoses are also appropriate, but interventions to prevent aspiration are the priority at this time.

Answer 187

b. The patient‘s blood pressure (BP) is 90/50 mm Hg. 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 Oral and IV agents may be used to maintain BP within a normal to high-normal range (SBP less than 160 mm Hg). 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.

Answer 188

a. A 60-yr-old patient with right-sided weakness who has an infusion of tPA prescribed 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.