A & P
What is an excitatory response?
stimulate agonist muscles
How does alteplase work? (mechanism of action)
directly converts plasminogen to plasmin, which then degrades clot-bound fibrin. causes lysis of thrombi causing ischemic stroke.
Who conducts a swallowing assessment?
Speech-Language Pathologist or Occupational Therapist
A 63-year-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol?
a. Obtain computed tomography (CT) scan without contrast.
b. Infuse tissue plasminogen activator (tPA).
c. Administer oxygen to keep O2 saturation >95%.
d. Use National Institute of Health Stroke Scale to assess patient.
C, D, A, B
The nurse is assessing the client's gait and notes it is unsteady and staggering. Which description should the nurse use when documenting the assessment finding?
Ataxic
What does the hypothalamus regulate?
thirst and appetite
thermoregulation
water balance
sleep and wake cycles
Which class of pharmaceuticals may be used with extreme caution alongside tissue plasminogen activator due to the increased risk of intracranial bleeding?
anticoagulants
How long does dysphagia last after a stroke?
Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months.
After receiving change-of-shift report on the following four patients, which patient should the nurse see first?
a. A 60-year-old patient with right-sided weakness who has an infusion of tPA prescribed
b. A 50-year-old patient who has atrial fibrillation and a new order for warfarin (Coumadin)
c. A 40-year-old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due
d. A 30-year-old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine (Nimotop) scheduled
A
The nurse is caring for a client diagnosed with trigeminal neuralgia. The client asks the nurse, "Why do I have so much pain?" Which is the appropriate response by the nurse?
"Pain is due to stimulation of the affected nerve by pressure and temperature."
What is the function of the frontal lobe?
voluntary motor function
planning and decision making
memory
motivation
mood
aggression
personality
smell
speech
What cardiac side effect can be contributed to the use of thrombolytic therapy?
Coronary Thrombosis
What are the three most common speech disorders presented after a stroke?
Aphasia, Dysarthria, and Apraxia
A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?
noncontrast CT scan
A client has a neurological deficit involving the limbic system. On assessment, which finding is specific to this type of deficit?
Affect is flat, with periods of emotional lability
**Limbic system affects emotions and feelings (affect). Any answer pertaining to that is correct
Where is the medulla oblongata and what structures does it connect?
most inferior part of brain, connects brain to spinal cord
Your patient has been prescribed Apixaban (Eliquis) post-stroke to prevent the formation of further clots. You come into their room during rounds and your patient complains of feeling dizzy and weak. You look into the commode and note hematochezia, then you determine that your patient is bleeding. What is the reversal agent for Apixaban and what actions do you take?
There is no reversal agent. Effects persist for 24h. Oral activated charcoal decreases apixaban absorption. Notify MD.
How do the hemispheres differ in speech interpretation?
The left hemisphere is used to understand and generate speech. The right hemisphere is used in dealing with speech patterns and emotional content in speech
Describe a carotid endarterectomy.
carotid artery is incised and the plaque is removed
A client has dysfunction of the cochlear division of the vestibulocochlear nerve (cranial nerve VIII). The nurse should determine that the client is adequately adapting to this problem if he or she states a plan to obtain which item?
A hearing aid
How much electricity does the brain use? (state in appropriate unit)
20 watts (enough to light a light bulb!)
Your patient has recently begun Warfarin Therapy post stroke. They come into the clinic a few weeks later complaining that their toes "look purple" and on assessment, you find bilateral, painful, purple lesions on the toes and sides of the feet that blanch with pressure. What do you suspect has occurred and what is the cause of this?
Purple toes syndrome. Occurs due to the microembolization of cholesterol.
You are caring for a patient who had a stroke 2 days ago. When speaking to your patient, you notice the following patterns. What area of the brain do you suspect has been affected?
Posterior superior areas of the language dominant temporal lobe (Wernicke’s area)
Several weeks after a stroke, a 50-year-old male patient has impaired awareness of bladder fullness, resulting in urinary incontinence. Which nursing intervention will be best to include in the initial plan for an effective bladder training program?
a. Limit fluid intake to 1200 mL daily to reduce urine volume.
b. Assist the patient onto the bedside commode every 2 hours.
c. Perform intermittent catheterization after each voiding to check for residual urine.
d. Use an external "condom" catheter to protect the skin
B
The nurse is caring for a client with a head injury. The client's intracranial pressure reading is 8 mm Hg. Which condition should the nurse document?