Chapter 67 Quiz

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Question #1

The nurse practitioner is able to correlate a patient’s neurologic deficits with the location in the brain affected by ischemia or hemorrhage. For a patient with a left hemispheric stroke, the nurse would expect to see:

A Right-sided paralysis.

B Spatial-perceptual deficits.

C Left visual field deficit.

D Impulsive behavior.

Question #2

The provider diagnoses the patient as having had an ischemic stroke. The etiology of an ischemic stroke would include which of the following?

A Cerebral aneurysm

B Intracerebral hemorrhage

C Arteriovenous malformation

D Cardiogenic emboli

Question #3

The nurse is caring for a client following an aneurysm coiling procedure. The nurse documents that the client is experiencing Korsakoff syndrome. Which set of symptoms characterizes Korsakoff syndrome?

A Severe dementia and myoclonus

B Tremor, rigidity, and bradykinesia

C Psychosis, disorientation, delirium, insomnia, and hallucinations

D Choreiform movement and dementia

Question #4

The nurse is providing information about strokes to a community group. Which of the following would the nurse identify as the primary initial symptoms of an ischemic stroke?

A Severe headache and early change in level of consciousness

B Weakness on one side of the body and difficulty with speech

C Vomiting and seizures

D Footdrop and external hip rotation

Question #5

A nurse is caring for a client who has returned to his room after a carotid endarterectomy. Which action should the nurse take first?

A Ask the client if he has trouble breathing.

B Place antiembolism stockings on the client.

C Ask the client if he has a headache.

D Take the client’s blood pressure.

Question #6

Which of the following, if left untreated, can lead to an ischemic stroke?

A Atrial fibrillation

B Ruptured cerebral arteries

C Arteriovenous malformation (AVM)

D Cerebral aneurysm

Question #7

A client on your unit is scheduled to have intracranial surgery in the morning. Which nursing intervention helps to avoid intraoperative complications, reduce cerebral edema, and prevent postoperative vomiting?

A Administer prescribed medications.

B Restrict fluids before surgery.

C Administer preoperative sedation.

D Administer an osmotic diuretic.

Question #8

A client has experienced an ischemic stroke that has damaged the temporal (lateral and superior portions) lobe. Which of the following deficits would the nurse expect during assessment of this client?

A Hemiplegia or hemiparesis

B Limited attention span and forgetfulness

C Lack of deep tendon reflexes

D Auditory agnosia

Question #9

A nurse is reading a journal article about stroke and the underlying causes associated with this condition. The nurse demonstrates understanding of the information when identifying which subtype of stroke as being due to atrial fibrillation?

A large-artery thrombotic

B cryptogenic

C cardio embolic

D small, penetrating artery thrombotic

Question #10

The nurse practitioner advises a patient who is at high risk for a stroke to be vigilant in his medication regimen, to maintain a healthy weight, and to adopt a reasonable exercise program. This advice is based on research data that shows the most important risk factor for stroke is:

A Obesity

B Dyslipidemia

C Smoking

D Hypertension

Question #11

A nurse practitioner is presenting health information about strokes at a clinic. She mentions that there are five categories of strokes based on their origin. Which of the following is the category that has the highest incidence of strokes (30%)?

A Cardiogenic embolic

B Small artery thrombotic

C Large artery thrombotic

D Cryptogenic

Question #12

When should the nurse plan the rehabilitation of a patient who is having an ischemic stroke?

A The day the patient has the stroke

B After the nurse has received the discharge orders

C The day before the patient is discharged

D After the patient has passed the acute phase of the stroke

Question #13

A diagnostic test has determined that the appropriate diet for the client with a left cerebrovascular accident (CVA) should include honey thickened liquids. Which of the following is the priority nursing diagnosis for this client?

A Risk forElectrolyte Imbalance

B Impaired Swallowing

C Risk for Fluid Volume Deficit

D Altered Nutrition:Less Than Body Requirements

Question #14

A nurse is assisting with a community screening for people at high risk for stroke. To which of the following clients would the nurse pay most attention?

A A 28-year-old pregnant African-American woman

B A 62-year-old Caucasian woman

C A 60-year-old African-American man

D A 40-year-old Caucasian woman

Question #15

The nurse is caring for a patient having a hemorrhagic stroke. What position in the bed will the nurse maintain this patient?

A Prone

B High-Fowler’s

C Supine

D Semi-Fowler’s

Question #16

A nurse is instructing the spouse of a client who suffered a stroke about the use of eating devices the client will be using. During the teaching, the spouse starts to cry and states, “One minute he is laughing, and the next he’s crying; I just don’t understand what’s wrong with him.” Which statement is the best response by the nurse?

A Emotional lability is common after a stroke, and it usually improves with time.”

B This behavior is common in clients with stroke. Which does your spouse do more often? Laugh or cry?”

C You sound stressed; maybe using some stress management techniques will help.”

D You seem upset, and it may be hard for you to focus on the teaching, I’ll come back later.”

Question #17

The nurse is caring for a client diagnosed with a subarachnoid hemorrhage resulting from a leaking aneurysm. The client is awaiting surgery. Which nursing interventions would be appropriate for the nurse to implement? Select all that apply.,,

A Ambulate the client every hour.

B Provide a dimly lit environment.

C Permit friends to visit often.

D Administer docusate per order.

E Elevate the head of bed 30 degrees.

Question #18

A client with a cerebrovascular accident (CVA) is having difficulty with eating food on the plate. Which is the best priority nursing action to be taken?

A Perform a vision field assessment.

B Assist the client with feeding.

C Reposition the tray and plate.

D Know this is a normal finding for CVA.

Question #19

A client who complains of recurring headaches, accompanied by increased irritability, photophobia, and fatigue is asked to track the headache symptoms and occurrence on a calendar log. Which is the best nursing rationale for this action?

A Tension headaches are easier to treat.

B Cluster headaches can cause severe debilitating pain.

C Headaches are the most common type of reported pain.

D Migraines often coincide with menstrual cycle.

Question #20

A 64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the physician in the emergency department. What is the origin of the client’s symptoms?

A hypertension

B impaired cerebral circulation

C diabetes insipidus

D cardiac disease

Question #21

A client has experienced an ischemic stroke that has damaged the lower motor neurons of the brain. Which of the following deficits would the nurse expect during assessment?

A Limited attention span and forgetfulness

B Visual agnosia

C Lack of deep tendon reflexes

D Auditory agnosia

Question #22

Which term refers to the inability to perform previously learned purposeful motor acts on a voluntary basis?

A Agraphia

B Apraxia

C Agnosia

D Perseveration

Question #23

A nurse knows that, for a patient with an ischemic stroke, tPA is contraindicated if the blood pressure reading is:

A 175 mm Hg/100 mm Hg

B 185 mm Hg/110 mm Hg

C 190 mm Hg/120 mm Hg

D 170 mm Hg/105 mm Hg

Question #24

The nurse knows that symptoms associated with a TIA, usually a precursor of a future stroke, usually subside in what period of time?

A 12 hours

B 3 to 6 hours

C 1 hour

D 24 to 36 hours

Question #25

The nurse is caring for a client diagnosed with a hemorrhagic stroke. The nurse recognizes that which intervention is most important?

A Administering a stool softener

B Monitoring for seizure activity

C Maintaining a patent airway

D Elevating the head of the bed to 30 degrees

Question #26

A client diagnosed with a stroke is ordered to receive warfarin. Later, the nurse learns that the warfarin is contraindicated and the order is canceled. The nurse knows that the best alternative medication to give is

A ticlodipine.

B clopidogrel.

C dipyridamole.

D aspirin.

Question #27

The nurse is participating in a health fair for stroke prevention. Which will the nurse say is a modifiable risk factor for ischemic stroke?

A Smoking

B Social drinking

C Thyroid disease

D Advanced age

Question #28

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings?

A Left-sided cerebrovascular accident (CVA)

B Completed Stroke

C Right-sided cerebrovascular accident (CVA)

D Transient ischemic attack (TIA)

Question #29

Which of the following is the most common side effect of tissue plasminogen activator (tPA)?

A Hypertension

B Headache

C Bleeding

D Increased intracranial pressure (ICP)

Question #30

A client has experienced an ischemic stroke that has damaged the frontal lobe of his brain. Which of the following deficits does the nurse expect to observe during assessment?

A Hemiplegia or hemiparesis

B Limited attention span and forgetfulness

C Lack of deep tendon reflexes

D Visual and auditory agnosia

Question #31

While providing information to a community group, the nurse tells them the primary initial symptoms of a hemorrhagic stroke are:

A Severe headache and early change in level of consciousness

B Weakness on one side of the body and difficulty with speech

C Footdrop and external hip rotation

D Confusion or change in mental status

Question #32

A patient presents to the emergency room with complaints of having an “exploding headache” for the last 2 hours. The patient is immediately seen by a triage nurse who suspects the patient is experiencing a stroke. Which of the following is a possible cause based on the characteristic symptom?

A Small artery thrombosis

B Large artery thrombosis

C Cerebral aneurysm

D Cardiogenic emboli

Question #33

A patient is brought to the emergency department with a possible stroke. What initial diagnostic test for a stroke, usually performed in the emergency department, would the nurse prepare the patient for?

A Transcranial Doppler flow study

B 12-lead electrocardiogram

C Noncontrast computed tomogram

D Carotid ultrasound study

Question #34

A client with a history of atrial fibrillation has experienced a TIA. In an effort to reduce the risk of cerebrovascular accident (CVA), the nurse anticipates the priority medical treatment to include which of the following?

A Anticoagulant therapy

B Monthly prothrombin levels

C Carotid endarterectomy

D Cholesterol-lowering drugs

Question #35

When providing teaching to a client who reports tension headaches, which of the following instructions would be most beneficial to prevent onset of symptoms?

A Apply cool or warm cloth to head or eyes.

B Avoid certain foods.

C Perform stretching exercises and frequent position change.

D Eliminate use of bright lights when working.

Question #36

The geriatric advanced practice nurse (APN) is doing client teaching with a client who has had a cerebrovascular accident (CVA) and the client’s family. One concern the APN addresses is a potential for falls related to the CVA and resulting muscle weakness. What would be most important for the APN to include in teaching related to this concern?

A Use of tripod cane.

B Remove throw rugs and electrical cords from home environment.

C Leg exercises to strengthen muscle weakness.

D Need for support group due to decreased self image related to restricted mobility.

Question #37

A nurse is teaching a community class that those experiencing symptoms of ischemic stroke need to enter the medical system early. The primary reason for this is which of the following?

A A ruptured arteriovenous malformation will cause deficits until it is stopped.

B A ruptured intracranial aneurysm must quickly be repaired.

C Thrombolytic therapy has a time window of only 3 hours.

D Intracranial pressure is increased by a space-occupying bleed.

Question #38

Which term refers to the failure to recognize familiar objects perceived by the senses?

A Agraphia

B Apraxia

C Perseveration

D Agnosia

Question #39

A client has been diagnosed as having global aphasia. The nurse recognizes that the client will be unable to perform which action?

A Form words that are understandable or comprehend spoken words

B Comprehend spoken words

C Form words that are understandable

D Speak at all

Question #40

A nurse is planning discharge for a client who experienced right-sided weakness caused by a stroke. During his hospitalization, the client has been receiving physical therapy, occupational therapy, and speech therapy daily. The family voices concern about rehabilitation after discharge. How should the nurse intervene?

A Contact the appropriate agencies so that they can provide care after discharge.

B Suggest that the family members speak with the physician about their concerns.

C Inform the case manager of the family’s concern and provide information about the client’s current clinical status so appropriate resources can be provided after discharge.

D The nurse should do nothing because she is responsible only for inpatient care

Question #41

A client is receiving an IV infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To determine whether this drug is producing its therapeutic effect, the nurse should consider which finding most significant?

A Increased urine output

B Elevated blood pressure

C Decreased heart rate

D Decreased level of consciousness (LOC)

Question #42

Which interventions would be recommended for a client with dysphagia? Select all that apply.,,

A Allow ample time to eat.

B Place food on the affected side of the mouth

C Assist the client with meals.

D Test the gag reflex before offering food or fluids

Question #43

A patient who has suffered a stroke begins having complications regarding spasticity in the lower extremity. What ordered medication does the nurse administer to help alleviate this problem?

A Heparin

B Pregabalin (Lyrica)

C Diphenhydramine (Benadryl)

D Lioresal (Baclofen)

Question #44

A client reports light-headedness, speech disturbance, and left-sided weakness that have lasted for several hours. In the examination, an abnormal sound is auscultated in an artery leading to the brain. What is the term for the auscultated discovery?

A diplopia

B TIA

C atherosclerotic plaque

D bruit

Question #45

Which of the following is accurate regarding a hemorrhagic stroke?

A Main presenting symptom is an “exploding headache.”

B One of the main presenting symptoms is numbness or weakness of the face

C It is caused by a large-artery thrombosis.

D Functional recovery usually plateaus at 6 months.

Question #46

A client is hospitalized when presenting to the emergency department with right-sided weakness. Within 6 hours of being admitted, the neurologic deficits had resolved and the client was back to his presymptomatic state. The nurse caring for the client knows that the probable cause of the neurologic deficit was what?

A Cerebral aneurysm

B Transient ischemic attack

C Right-sided stroke

D Left-sided stroke

Question #47

The nurse is caring for a client with chronic migraines who is prescribed medication. What drug-related instructions should the nurse give the client?

A Take medication as soon as symptoms of the migraine begin.

B Take medication only during the morning when it’s calm and quiet.

C Take medication just before going to bed at night

D Take medication only when migraine is intense

Question #48

Which is a contraindication for the administration of tissue plasminogen activator (t-PA)?

A Intracranial hemorrhage

B Ischemic stroke

C Age 18 years or older

D Systolic blood pressure less than or equal to 185 mm Hg

Question #49

A nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?

A Call the physician immediately.

B Inform the nurse manager.

C Sit with the client for a few minutes

D Administer an analgesic.

Question #50

During assessment of cognitive impairment, post-stroke, the nurse documents that the patient was experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe?

A Temporal

B Occipital

C Frontal

D Parietal

Question #51

After the patient has received tPA, the nurse knows to check vital signs every 30 minutes for 6 hours. Which of the following readings would require calling the provider?

A Systolic pressure of 180 mm Hg

B Heart rate of 100

C Respiration of 22

D Diastolic pressure of 110 mm Hg

Question #52

A patient is exhibiting classic signs of a hemorrhagic stroke. What complaint from the patient would be an indicator of this type of stroke?

A Double vision

B Numbness of an arm or leg

C Severe headache

D Dizziness and tinnitus

Question #53

A client is suspected of having had a stroke. Which is the initial diagnostic test for a stroke?

A Noncontrast computed tomography

B Electrocardiography

C Carotid Doppler

D Transcranial Doppler studies

Question #54

A client’s spouse relates how the client reported a severe headache and then was unable to talk or move their right arm and leg. After diagnostics are completed and the client is admitted to the hospital, when would basic rehabilitation begin?

A in 2 to 3 days

B after 1 week

C upon transfer to a rehabilitation unit

D immediately

Question #55

How often should neurologic assessments and vital signs be taken initially for the patient receiving tissue plasminogen activator (tPA)?

A Every 45 minutes

B Every 15 minutes

C Every hour

D Every 30 minutes

Question #56

The nurse is providing diet-related advice to a male patient following a cerebrovascular accident (CVA). The patient wants to minimize the volume of food and yet meet all nutritional elements. Which of the following suggestions should the nurse give to the patient about controlling the volume of food intake?

A Include dry or crisp foods and chewy meats.

B Always serve hot or tepid foods.

C Provide thickened commercial beverages and fortified cooked cereals.

D Provide a high-fat diet.

Question #57

Which term refers to the inability to perform previously learned purposeful motor acts on a voluntary basis?

A Agnosia

B Agraphia

C Perseveration

D Apraxia

Question #58

A 154-pound woman has been prescribed tPA (0.9 mg/kg) for an ischemic stroke. The nurse knows to give how many mg initially?

A 7.5 mg

B 6.3 mg

C 8.3 mg

D 10 mg

Question #59

Which term will the nurse use when referring to blindness in the right or left half of the visual field in both eyes?

A Scotoma

B Nystagmus

C Diplopia

D Homonymous hemianopsia

Question #60

A client reports light-headedness, speech disturbance, and left-sided weakness lasting for several hours. The neurologist diagnosed a transient ischemic attack, which caused the client great concern. What would the nurse include during client education?

A Two thirds of people that experience a TIA will go on to develop a stroke

B When symptoms cease, the client will return to presymptomatic state.

C A TIA is an insidious, often chronic episode of neurologic impairment.

D Symptoms of a TIA may linger for up to a week.

Question #61

A nurse in a rehabilitation facility is coordinating the discharge of a client who is tetraplegic. The client, who is married and has two children in high school, is being discharged to home and will require much assistance. Who would the discharge planner recognize as being the most important member of this client’s care team?

A spouse

B chaplin

C physical therapist

D home care nurse

Question #62

A nurse is teaching a community group about modifiable and nonmodifiable risk factors for ischemic strokes. Which of the following is a risk factor that cannot be modified?

A Obesity

B Atrial fibrillation

C Advanced age

D Hypertension

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