Chapter 57: Stroke
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no
residual effects, the nurse anticipates teaching the patient about
a. cerebral aneurysm clipping. c. oral low-dose aspi...
1. After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no
residual effects, the nurse anticipates teaching the patient about
a. cerebral aneurysm clipping. c. oral low-dose aspirin therapy.
b. heparin intravenous infusion. d. tissue plasminogen activator (tPA).
ANS: C
The patient’s symptoms are consistent with transient ischemic attack (TIA), and drugs that
inhibit platelet aggregation are prescribed after a TIA to prevent a stroke. Continuous heparin
infusion is not routinely used after TIA or with acute ischemic stroke. The patient’s symptoms
are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic stroke, not for
TIA.
2. A patient is being admitted with a possible stroke. Which information from the assessment
indicates that the nurse should consult with the health care provider before giving the
prescribed aspirin?
a. The patient has dysphasia.
b. The patient has atrial fibrillation.
c. The patient reports that symptoms began with a severe headache.
d. The patient has a history of brief episodes of right-sided hemiplegia.
ANS: C
A sudden onset headache is typical of a subarachnoid hemorrhage, and aspirin is
contraindicated. Atrial fibrillation, dysphasia, and transient ischemic attack are not
contraindications to aspirin use.
3. A patient with a stroke experiences facial drooping on the right side and right-sided arm and
leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to
find?
a. Impulsive behavior
b. Right-sided neglect
c. Hyperactive left-sided tendon reflexes
d. Difficulty comprehending instructions
ANS: D
Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with
comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive
behavior and neglect are more likely with a right-side stroke.
, 4. During the change of shift report, a nurse is told that a patient has an occluded left posterior
cerebral artery. The nurse will anticipate that the patient may have
a. dysphasia. c. visual deficits.
b. confusion. d. poor judgment.
ANS: C
Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs with
middle cerebral artery involvement. Cognitive deficits and changes in judgment are more
typical of anterior cerebral artery occlusion.
5. When teaching about clopidogrel (Plavix), the nurse will tell the patient with cerebral
atherosclerosis
a. to monitor and record the blood pressure daily.
b. to call the health care provider if stools are tarry.
c. that clopidogrel will dissolve clots in the cerebral arteries.
d. that clopidogrel will reduce cerebral artery plaque formation.
ANS: B
Clopidogrel inhibits platelet function and increases the risk for gastrointestinal bleeding, so
patients should be advised to notify the health care provider about any signs of bleeding. The
medication does not lower blood pressure, decrease plaque formation, or dissolve clots.
6. A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy.
Which response by the nurse is accurate?
a. “The obstructing plaque is surgically removed from inside an artery in the neck.”
b. “The diseased portion of the artery in the brain is replaced with a synthetic graft.”
c. “A wire is threaded through an artery in the leg to the clots in the carotid artery,
and the clots are removed.”
d. “A catheter with a deflated balloon is positioned at the narrow area, and the
balloon is inflated to flatten the plaque.”
ANS: A
In a carotid endarterectomy, the carotid artery is incised, and the plaque is removed. The
response beginning, “The diseased portion of the artery in the brain is replaced” describes an
arterial graft procedure. The answer beginning, “A catheter with a deflated balloon is
positioned at the narrow area” describes an angioplasty. The final response beginning, “A wire
is threaded through the artery” describes the mechanical embolus removal in cerebral
ischemia (MERCI) procedure.
7. A patient admitted with possible stroke has been aphasic for 3 hours, and his current blood
pressure (BP) is 174/94 mm Hg. Which order by the health care provider should the nurse
question?
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