Ischemic stroke

Question 1

**Which of the following clients has experienced a thrombotic stroke? **
* Client with atherosclerotic disease develops a blockage in an artery within the brain
* Client with atrial fibrillation has a blood clot that travels to the brain, lodges in an artery, and blocks blood flow
* Client with hypertension has a ruptured artery within the brain, putting pressure on brain tissue and
reducing blood flow
* Client with head trauma has a ruptured vein within the brain, putting pressure on brain tissue and
reducing blood flow

Answer 1

Client with atherosclerotic disease develops a blockage in an artery within the brain

Question 2

What is a stroke or (cerebrovascular accident)

Answer 2

when there is inadequate blood flow and oxygen supply ot an area of the brain, resulting in the death of the brain cells

Question 3

blocked blood flow in a cerebral artery would be classified as?

Answer 3

A ischemic stroke

or thrombotic stroke

Question 4

What is a embolic stroke

Answer 4

caused by a clot that forms elsewhere in the body and then travels to the brain, lodges in a blood vessel, and blocks blood flow.

Question 5

What is a stroke caused by a rupture of a blood vessel in the brain

Answer 5

Hemorrhagic stroke

Question 6

what is an infarct

Answer 6

area of cell death

Question 7

What is a penumbra

Answer 7

when there is reduced, but not completely blocked blood flow

May be able to save these cells

Question 8

what does FAST- VAN stand for

Answer 8

face, arm, speech, time
Vision, Aphasia (difficult naming things), neglect

Question 9

What should be done prior to FAST-VAN as per the IH protocol

Answer 9

Check for a blood glucose below 4mmol/L as hypoglycemia symptoms mimic those of a stroke

Question 10

what is pronator drift

Answer 10

When one of a person arms start to drift while their eyes are closed.

Question 10

If any of the FAST-VAN symptoms are positive, what does the HCP need to do

Answer 10

establish when the symptoms first started as this will impact the type of tmt that is recieved.

Question 11

When doing a Stroke assessment, the patient does not demonstrate any pronator drift, what does this mean.

Answer 11

They are automatically VAN -

Question 12

What is a “hot stroke”

Answer 12

when a patient has at least one positive FAST sign and symptoms started within the past 6 hours

indicates pt is in the midst of having a stroke

Question 13

**What should a nurse tell a client with a history of multiple TIAs who reports a new onset of left-sided weakness and difficulty speaking that developed about an hour ago? **
* “We’ll wait a few hours to see if the symptoms get better”
* “I’ll get you some water to sip on, so that you don’t get dehydrated”
* “We’re going to send you for a CT scan to get a picture of your brain”
* “The doctor will give you a prescription for some clopidogrel, to prevent this from happening again”

Answer 13

• “We’re going to send you for a CT scan to get a picture of your brain”

Question 14

What is a transient ischemic attack (TIA)

Answer 14

• temporary blockage in the cerebral blood flow, causing neurological symptoms.
• usually last less than a hour and the symptoms don’t last longer than 24 hours.
• common symptom is temporary blindness of one eye.

Question 15

**If blood tests show that a client with an acute stroke has severe liver disease, and the client will be receiving a thrombolytic drug, such as t-PA, there is an: **

• Increased risk of thromboembolism during treatment
• Increased risk of bleeding during treatment
• Increased risk for infection during treatment
• Increased risk of anaphylaxis during treatment

Answer 15

• Increased risk of bleeding during treatment

Question 16

What is non-contrast CT scan most commonly used to get images of

Answer 16

the brain in a client who is thought to be having a stroke

Question 17

What does t-PA (alteplase) do

tissue-plasminogen activator

Answer 17

converts plasminogen to plasmin as plasmin is an enzyme that breaks down clots

Question 18

How long does fibrinolytic activity persist after administration

Answer 18

up to 1 hour after infusion is complete

Question 19

**Which of the following conditions would PREVENT a client from receiving a thrombolytic drug? **
* Intracranial hemorrhage
* Reduced kidney function with GFR = 32
* Blood glucose = 17.9 mmol/L
* Active respiratory infection with pseudomonas

Answer 19

• Intracranial hemorrhage

Question 20

What is the door-to-needle time frame

Answer 20

thrombolytic used be administered within 60 mins or less of patients entry to ED…. ideally tmt would be started within 30 mins!

Question 21

**If a client has an ischemic stroke, but is not eligible to receive a thrombolytic, what other treatment might be an option? **
* Balloon angioplasty with the placement of a stent
* Carotid endarterectomy
* Continuous infusion of intravenous heparin
* Endovascular thrombectomy with a stent retriever

Answer 21

• Endovascular thrombectomy with a stent retriever

Question 22

What is intra-arteral mechanical thrombectomy or (endovascular thrombectomy [EVT])

Answer 22

• a procedure in which a catheter is used to manually remove the clot from the blood vessel.
• this is typically done for clots in large arteries.

Question 23

**After a stroke, if a client understands what the nurse is saying, and knows what he wants to say, but can’t find the right words to make a sentence, the client has: **
* Expressive aphasia
* Receptive aphasia
* Anomic aphasia
* Global aphasia

Answer 23

• Expressive aphasia or broca’s aphasia

difficulty in expressing thought through speech or writing

Question 24

What is receptive aphasia | (Wernicke’s):

Answer 24

When the client has difficulty understand spoken or written language

Question 25

What is anomic aphasia

Answer 25

When the client can;t find the correct names for specific objects, people, places or events

Question 26

What is global aphasia

Answer 26

A loss of all expressive and receptive functions

Question 27

**What does it mean if after a stroke, a client initially has flaccid muscles on the right side; but 48 hrs later, the muscles start to show spasticity with exaggerated reflexes? ** * The client’s condition is deteriorating and losing muscle function * The client’s condition is improving and beginning to regain muscle function * The client is developing thromboemboli in the affected limbs * The client is developing hypercalcemia due to prolonged immobility

Answer 27

* The client’s condition is improving and beginning to regain muscle function

Question 28

**After a stroke, a client has urinary incontinence due to an impaired awareness of bladder fullness. Which nursing intervention would be BEST to include in the plan of care? ** * Perform intermittent catheterization after each voiding to check for residual urine * Use an external ‘condom’ catheter to protect the skin and prevent embarrassment * Limit fluid intake to 1200 mL daily to reduce urine volume * Assist the client to the bedside commode every 2 hours

Answer 28

* Assist the client to the bedside commode every 2 hours

Question 29

What should the nurse assess and monitor for 24 hours post stroke

Answer 29

resp assessment and temp as the risk for respiratory failure and pneumonia are greater

Question 30

A client develops homonymous hemianopia after an acute ischemic stroke. What knowledge will guide the nurse’s care for this client? * The client will probably have a preference for foods high in salt * The client will probably forget the names of foods * The client will probably only eat the food on half of the plate * The client will probably be unable to swallow liquids

Answer 30

* The client will probably only eat the food on half of the plate

Question 31

What is homonymous hemianopia

Answer 31

blindess in half of the visual field

Question 32

What is the single, most important modifiable risk factor for stroke?

Answer 32

HTN

Question 33

In an embolic stroke, where do most emboli originate from?

Answer 33

endocardium

Question 34

What is akinesia?

Answer 34

Loss of skilled voluntary movements.

Question 35

Right sided brain stroke characterisitics

Answer 35

Reckless → impulsivity, neglect, spatial issues

Question 36

left sided brain stroke characteristics

Answer 36

Language → aphasia more common, more anxious and cautious

Question 37

What is a carotid endarterectomy, and how does it prevent stroke?

Answer 37

A tube is inserted above and below the blockage to reroute the blood flow. The plaque is removed.

Question 38

How does transluminal angioplasty and stenting used to prevent stroke?

Answer 38

Insertion of a balloon is to open a stenosed artery and improved blood flow.

Question 39

 What typically happens to a person’s blood pressure after an ischemic stroke? Why?

Answer 39

Increased to maintain cerebral perfusion.

Question 40

When should drugs be used to lower blood pressure in acute ischemic stroke?

Answer 40

IV labetalol when MAP is & greater than 130mmHg or systolic & greater than 220mmHg.

Question 41

how long max can a patient be left on their affected side post stroke

Answer 41

30 mins

Question 42

 Early in the recovery from stroke, what difference does it make, if a client has flaccid muscles vs. having spasticity?

Answer 42

Spasticity = good prognosis. Flaccid = poor prognosis.