Stroke Practice Flashcards
Which intervention is most appropriate when communicating with a patient with aphasia after a stroke?
a) Present several thoughts at once so the patient can connect the ideas.
b) Ask open-ended questions to give the patient the opportunity to speak.
c) Use simple, short sentences with visual cues to enhance comprehension.
d) Finish the patient’s sentences to minimize frustration associated with slow speech.
c
When communicating with a patient with aphasia, the nurse should present one thought or idea at a time. Ask questions that can be answered with a “yes,” “no,” or simple word. Use visual cues and allow time for the patient to comprehend and respond to conversation.
The nurse is discharging a patient admitted with a transient ischemic attack (TIA). For which medications might the nurse expect to provide discharge instructions? (Select all that apply.)
a) Ticlopidine
b) Clopidogrel
c) Enoxaparin
d) Dipyridamole
e) Enteric-coated aspirin
f) Tissue plasminogen activator (tPA)
a,b,d,e
Aspirin is the most frequently used antiplatelet agent. Other drugs to prevent clot formation include clopidogrel, dipyridamole, ticlopidine, combined dipyridamole and aspirin, and anticoagulant drugs such as oral warfarin. Tissue plasminogen activator is a fibrinolytic medication used to treat ischemic stroke, not prevent TIAs or strokes.
The nurse is teaching a senior citizen’s group about signs and symptoms of a stroke. Which statement provides the group accurate information?
a) “Take the person to the hospital if a headache lasts for more than 24 hours.”
b) “Stroke symptoms usually start when the person is awake and physically active.”
c) “A person with a transient ischemic attack has mild symptoms that will go away.”
d) “Call 911 immediately if a person develops slurred speech or difficulty speaking.”
d
Which sensory-perceptual deficit is associated with left-sided stroke (right hemiplegia)?
a) Slow, fearful performance of tasks
b) Overestimation of physical abilities
c) Difficulty judging position and distance
d) Impulsivity and impatience at performing tasks
a
Patients with a left-sided stroke (right hemiplegia) are often slower in organization and performance of tasks and may have a fearful, anxious response to a stroke. Overconfidence, spatial disorientation, and impulsivity are more commonly associated with a right-sided stroke.
The nurse is planning psychosocial support for the family of the patient who had a stroke. What factor will have the greatest impact on family coping?
a) Specific patient neurologic deficits
b )The patient’s ability to communicate
c) Rehabilitation potential of the patient
d) Presence of complications of a stroke
c
Although a patient’s neurologic deficit might initially be severe, the ability of the patient to recover is most likely to positively impact the family’s coping. Providing explanations and emotional support beginning in the acute phase through the rehabilitation phase will facilitate coping. Emphasizing successes will offer the most realistic hope for the patient’s rehabilitation and helps maintain hope for the patient’s future abilities.
A patient has left-sided hemiplegia after an ischemic stroke 4 days earlier. How should the nurse promote skin integrity?
a) Position the patient on her weak side most of the time.
b) Avoid the use of pillows to promote independence in positioning.
c) Alternate the patient’s positioning between supine and side-lying.
d) Establish a schedule for the massage of areas where skin breakdown emerges.
c
A position change schedule should be established for stroke patients. An example is side-back-side, with a maximum duration of 2 hours for any position. The patient should be positioned on the weak or paralyzed side for only 30 minutes. Pillows may be used to facilitate positioning. Areas of skin breakdown should never be massaged.
The nurse in a primary care provider’s office is assessing several patients today. Which patient is most at risk for a stroke?
a) A 92-yr-old female patient who takes warfarin for atrial fibrillation
b) A 28-yr-old male patient who uses marijuana after chemotherapy to ease nausea
c) A 72-yr-old male patient who has hypertension and diabetes and smokes tobacco.
d) A 42-yr-old female patient who takes oral contraceptives and has migraine headaches
c
Stroke risk increases after 65 years of age. Strokes are more common in men. Hypertension is the single most important modifiable risk factor for stroke. Diabetes is a significant stroke risk factor. Smoking nearly doubles the risk of a stroke. Other risk factors include drug use (especially cocaine), high-dose oral contraception use, migraine headaches, and untreated heart disease, such as atrial fibrillation.
A CT scan of a patient’s head reveals a hemorrhagic stroke. What is the priority nursing intervention in the emergency department?
Maintaining the patient’s airway
Positioning to promote cerebral perfusion
Controlling fluid and electrolyte imbalances
Administering tissue plasminogen activator (tPA)
Maintaining a patent airway is the priority in the acute care of a patient with a hemorrhagic stroke. It supersedes the importance of fluid and electrolyte imbalance and positioning. tPA is contraindicated in hemorrhagic stroke.
A 74-yr-old man who has right-sided extremity paralysis related to a thrombotic stroke develops constipation. Which action should the nurse take first?
a) Assist the patient to the bathroom every 2 hours.
b) Provide incontinence briefs to wear during the day.
c) Give a bisacodyl (Dulcolax) rectal suppository every day.
d) Provide several servings daily of cooked fruits and vegetables.
c
Patients after a stroke often have constipation. Dietary management includes the following: fluid intake of 2500 to 3000 mL daily, prune juice (120 mL) or stewed prunes daily, cooked fruit 3 times daily, cooked vegetables 3 times daily, and whole-grain cereal or bread 3 to 5 times daily. Patients with urinary incontinence should be assisted to the bathroom every 2 hours. Suppositories may be ordered for short-term management if the patient does not respond to increased fluid and fiber. Incontinence briefs are indicated as a short-term intervention for urinary incontinence.
Which modifiable risk factor for stroke would be most important for the nurse to include when planning a community education program?
a) Alcohol use
b) Hypertension
c) Hyperlipidemia
d) Oral contraceptive use
b
Hypertension is the single most important modifiable risk factor, but it is still often undetected and inadequately treated. The public is often more aware of hyperlipidemia and oral contraceptive use as risk factors for stroke. Alcohol is also a modifiable risk factor.
The nurse would expect what assessment finding in a patient admitted with a left-sided stroke?
a) Impulsivity
b) Impaired speech
c) Left-side neglect
d) Short attention span
Manifestations of left-sided brain damage include right hemiplegia, impaired speech/language, impaired right/left discrimination, and slow and cautious performance. Impulsivity, left-sided neglect, and short attention span are all manifestations of right-sided brain damage.
The patient with diabetes had a right-sided stroke. Which nursing intervention should the nurse plan to provide for this patient?
a) Safety measures
b) Patience with communication
c) Mobility assistance on the right side
d) Place food in the left side of patient’s mouth.
a
A patient with a right-sided stroke has spatial-perceptual deficits, tends to minimize problems, has a short attention span, is impulsive, and may have impaired judgment. Safety is the biggest concern for this patient. Hemiplegia occurs on the left side of this patient’s body.
The nurse observes a student nurse assigned to start oral feedings for a patient with an ischemic stroke. Which action by the student will require the nurse to intervene?
a) Giving the patient 1 ounce of water to swallow
b) Telling the patient to perform a chin tuck before swallowing
c) Assisting the patient to sit in a chair before feeding the patient
d) Assessing cranial nerves III, IV, and VI before attempting feeding
d
Many patients after a stroke have dysphagia. The gag reflex and swallowing ability (cranial nerves IX and X) should be assessed before the first oral feeding. Cranial nerves III, IV, and VI are responsible for ocular movements. To assess swallowing ability, the nurse should elevate the head of the bed to an upright position (unless contraindicated) and give the patient a small amount of crushed ice or ice water to swallow. The patient should remain in a high Fowler’s position, preferably in a chair with the head flexed forward, for the feeding and for 30 minutes following.
A female patient presents to the emergency department reporting the most severe headache of her life. Which type of stroke should the nurse anticipate?
a) TIA
b) Embolic stroke
c) Thrombotic stroke
d) Subarachnoid hemorrhage
d
Headache is common in a patient who has a subarachnoid hemorrhage or an intracerebral hemorrhage. A TIA is a transient loss of neurologic function usually without a headache. A headache may occur with an ischemic embolic stroke, but severe neurologic deficits are the initial symptoms. The ischemic thrombotic stroke manifestations progress in the first 72 hours as infarction and cerebral edema increase.
The factor related to cerebral blood flow morst often determines the extent of cerebral damage feom a store is the
a) O2 content of the blood
b) amount of cardiac output
c) level of CO2 in the blood
d) degree of collateral circulation
d
