Multiple Choice Questions
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
B. Impaired Speech
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.
What causes an ischemic stroke?
What causes an Hemorrhagic stroke?
Ischemic: brain attack where there is decreased cerebral blood flow due to obstruction of the blood vessel. causes deficient blood and oxygen supple to the brain
Hemorrhagic: a sudden bleed from a blood vessel inside the brain or in the spaces around the brain. causes: Head injuries, cerebral aneurysm
How soon does the healthcare provider want to initiate treatment for a stroke?
<45 minutes door to treatment
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. Slow, fearful performance of tasks
Rationale:
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.
What the differences between Hemiplegia and Hemiparesis?
Hemiplegia : Paralysis of one side of the body or part of it which is caused by a lesion of the opposite side of the brain
Hemiparesis: Weakness of one side of the body
Bonus Information: Flaccid Paralysis is an early sign of a stoke which is sagging of the face
What diagnosis confirm a stroke?
noncontract CT scan (quick, rule out intracranial hemorrhage) or MRI (more specific)
The nurse observes a student nurse assigned to start oral feedings for a patient with an ischemia 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
C. Assessing cranial nerves III, IV, and VI before attempting feeding
Rationale:
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.
The nurse in a primary care provider’s office is assessing several patients. 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
Correct Answer:
A 72-yr-old male patient who has hypertension and diabetes and smokes tobacco
Rationale:
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.
What is Homonymous hemianopsia? What Hemisphere is involved? Nursing Interventions?
Is blindness in half of the visual field in one or both eyes which could be temporary or permanent. It involves the right side, Nursing interventions: place objects within an intact field of vision. Remind the patient to turn their head.
What does the National Institute of Health Stroke Scale (NIHSS) tell us?
This tells us the severity of the stroke and greater than 6 can receive IV t-PA
A patient presents to the emergency department reporting the most severe headache of their life. Which type of stroke would the nurse anticipate?
A. Transient ischemic attack (TIA)
B. Embolic stroke
C. Thrombotic stroke
D. Subarachnoid hemorrhage
D. Subarachnoid hemorrhage
Rationale:
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.
What are the difference between Left and Right Hemispheric Stroke.
Left: Paralysis or weakness on the right side of the body, right visual field deficit, Aphasia, altered intellectual ability, slow, cautious behavior
Right: Paralysis or weakness of the left side of the body, left visual field deficit, spatial-perceptual deficit, increased distractibility, impulsive behavior and poor judgement, lack of awareness of deficit
What is the treatment for patients with ischemic stoke who are not candidates for t-PA?
IV heparin or low molecular weight heparin and osmotic diuretic
What is a TIA?
Transient Ischemic Attack
this is a neurologic deficit that completely resolves in 24 hours but most last for 1 hour. Manifested by sudden loss of motor, sensory, or visual function, patient couldn't talk and slumps to one side, neuro assessment is normal.
What is Tissue Plasminogen Activator (t-PA)? How would you administer this medication?
Lowers the risk of intracranial hemorrhage, It is a plasminogen converted to plasmin whose enzymatic action then digest fibrin and fibrogen thus breaking down the clot
needs to be administered within 3-4 1/2 hours of onset symptoms.
needs two IV sites (IV t-PA and IV fluids)
max dosage: 0.9mg/kg=90mg 10% of calculated dose is given IV bolus over 1 minute and remaining dose is 90% is given over 1 hour via infusion pump
Freq cardiac, neurologic, vital monitoring
Side Effect: Bleeding