Chapter 62: Management of Patients With Cerebrovascular Dis- orders
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th Edition
MULTIPLE CHOICE
1. A nurse is assisting a client who had a recent stroke with getting dressed for physical therapy. The
client looks at each piece of clothing before putting it on the body. The client states, “This is how I
know what item I am holding.” What impairment is this client likely experiencing?
A. Homonymous hemianopsia
B. Receptive aphasia
C. Agnosia
D. Hemiplegia
ANS: C
Rationale: Agnosia is the loss of the ability to recognize objects through a particular sensory system; it
may be visual, auditory, or tactile. The client was able to see what was being held but was not
recognizing specific garments by just touching them. Because the client was able to see homonymous
hemianopsia, which is blindness in half of the visual field in one or both eyes, is unlikely. Receptive
aphasia is an inability to understand language. Hemiplegia is a motor/ambulatory dysfunction. The
presented scenario did not support these findings.
PTS: 1 REF: p. 2033
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice
2. A client with a left hemispheric stroke is having difficulty with their normal speech patterns. The nurse
is not sure whether the client has expressive aphasia or apraxia. Which statement would most likely be
reflective of apraxia?
A. The nurse gives direction to get out of bed but the client does not understand.
B. The client points and gestures to an object needed on the overhead table.
C. The client starts by saying “good morning” but finishes with saying “good day” to the
nurse.
D. The client sits up and turns to one side to see the object and states what is needed.
ANS: C
Rationale: Apraxia is an inability to perform a previously learned action as may be seen when a client
makes verbal substitutions for desired syllables or words. The client changed “good morning” to “good
day,” which is suggestive of this condition. Aphasia which can be expressive aphasia (inability to
express oneself) or receptive aphasia (inability to understand language) is more likely represented with
the client being unable to understand directions to get out of bed and by pointing and gesturing to an
object needed rather than speaking. The client turning to one side so he/she can see the object may be
more indicative of blindness to one side (homonymous hemianopsia).
PTS: 1 REF: p. 2033 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice
3. A client with a recent stroke history is admitted to a rehabilitation unit and placed on high fall risk
precautions. The client is impulsive, easily distracted, frequently forgets his/her cane when walking,
and the location of his/her room. What stroke conditions do these signs best indicate?
, A. Ischemic stroke
B. Right hemispheric stroke
C. Hemorrhagic stroke
D. Left hemispheric stroke
ANS: B
Rationale. In right hemispheric stroke, signs include a client that is easily distracted and has impulsive
behavior and poor judgment. The client can be unaware of deficits like motor weakness, as
demonstrated by the client forgetting the cane. Clients can also have spatial or perceptual deficits. This
means they can get lost in familiar and unfamiliar places. This client was unable to find his/her room.
The client who has a right hemisphere stroke demonstrates weakness on the left side of the body. The
client with left hemispheric stroke has signs such as paralysis or weakness in the right side of the body,
right-sided visual deficits, and slow cautious behaviors. Ischemic and hemorrhagic strokes describe
what caused the stroke rather than what side of the brain was affected. Signs and symptoms differ for
each type of stroke. Ischemic strokes can include numbness to one side of the face. Headache,
decreased level of consciousness, and seizures typically are signs of a hemorrhagic stroke.
PTS: 1 REF: p. 2035
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
4. A client diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy.
The nurse explains that this procedure will be done for which purpose?
A. To decrease cerebral edema
B. To prevent seizure activity that is common following a TIA
C. To remove atherosclerotic plaques blocking cerebral flow
D. To determine the cause of the TIA
ANS: C
Rationale: The main surgical procedure for select clients with TIAs is carotid endarterectomy, the
removal of an atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in clients
with occlusive disease of the extracranial arteries. An endarterectomy does not decrease cerebral
edema, prevent seizure activity, or determine the cause of a TIA.
PTS: 1 REF: p. 2040
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand
NOT: Multiple Choice
5. The nurse is discharging home a client who had a stroke. The client has a flaccid right arm and leg and
is experiencing urinary incontinence. The nurse makes a referral to a home health nurse because of an
awareness of what common client response to a change in body image?
A. Confusion
B. Uncertainty
C. Depression
D. Disassociation
ANS: C
, Rationale: Depression is a common and serious problem in the client who has had a stroke. It can
result from a profound disruption in his or her life and changes in total function, leaving the client with
a loss of independence. The nurse needs to encourage the client to verbalize feelings to assess the
effect of the stroke on self-esteem. Confusion, uncertainty, and disassociation are not the most
common client response to a change in body image, although each can occur in some clients.
PTS: 1 REF: p. 2046 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Caring BLM: Cognitive Level: Understand
NOT: Multiple Choice
6. The nurse is caring for a client who had a hemorrhagic stroke. What assessment finding constitutes an
early sign of deterioration?
A. Generalized pain
B. Alteration in level of consciousness (LOC)
C. Tonic-clonic seizures
D. Shortness of breath
ANS: B
Rationale: Alteration in LOC is the earliest sign of deterioration in a client after a hemorrhagic stroke,
such as mild drowsiness, slight slurring of speech, and sluggish papillary reaction. Sudden headache
may occur, but generalized pain is less common. Seizures and shortness of breath are not identified as
early signs of hemorrhagic stroke.
PTS: 1 REF: p. 2051
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice
7. A client with an ischemic stroke has been brought to the emergency room. The health care provider
institutes measures to restore cerebral blood flow. What area of the brain would most likely benefit
from this immediate intervention?
A. Cerebral cortex
B. Temporal lobe
C. Central sulcus
D. Penumbra region
ANS: D
Rationale: In an ischemic stroke, there is disruption of the cerebral blood flow due to obstruction of a
blood vessel. This disruption in blood flow initiates a complex series of cellular metabolic events
referred to as the ischemic cascade. Early in the cascade, an area of low cerebral blood flow, referred
to as the penumbra region, exists around the area of infarction. The penumbra region is ischemic brain
tissue that may be salvaged with timely intervention. The cerebral cortex, temporal lobe, and central
sulcus are all different areas of the brain. Since the specific area was not identified in the scenario; the
area that would most benefit from immediate interventions would be the area surrounding the infarct
called the penumbra region.
PTS: 1 REF: p. 2033
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
, 8. A rapid response and stroke alert/code has been called for a client with deep vein thrombosis (DVT) of
the left leg being treated with intravenous heparin. The client’s international normalized ratio (INR) is
2.1 and vital signs are: Temperature 100.1°F (37.8°C), heart rate 102, blood pressure 190/100,
respirations 14, and saturation 89% on room air. What are priority interventions for a client who is
currently on anticoagulant therapy and having an ischemic stroke?
A. Immediate intubation and urinary catheter placement
B. Supplemental oxygen and monitoring blood glucose levels
C. Antipyretics in order to keep the client in a state of hypothermia
D. Antihypertensive medications and vital signs every two hours
ANS: B
Rationale: Careful maintenance of cerebral hemodynamics to maintain cerebral perfusion is extremely
important after a stroke. Interventions during this period include measures to reduce ICP. Other
treatment measures include: Providing supplemental oxygen if saturation is below 95% and
monitoring of blood glucose and management. Intubation is used only if necessary to establish a patent
airway. For this client, a more expedient and less invasive measure would be supplemental oxygen.
Urinary catheter placement is not a priority measure for this client. It is important to monitor for
febrile events, but there is no protocol in place to keep the client hypothermic. Antihypertensive
medication goals for blood pressure in the first 24 hours after a stroke remain controversial for a client
who has not received thrombolytic therapy; antihypertensive treatment may be given to lower the
blood pressure by 15% if the systolic blood pressure exceeds 220 mm Hg or the diastolic blood
pressure exceeds 120 mm Hg. Vital signs for this client would be monitored closely and continuously
until stable.
PTS: 1 REF: p. 2039
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice
9. A client with a cerebral aneurysm exhibits signs and symptoms of an increase in intracranial pressure
(ICP). What nursing intervention would be most appropriate for this client?
A. Passive range-of-motion exercises to prevent contractures
B. Supine positioning
C. Early initiation of physical therapy
D. Absolute bed rest in a quiet, non stimulating environment
ANS: D
Rationale: The client is placed on immediate and absolute bed rest in a quiet, nonstressful environment
because activity, pain, and anxiety elevate BP, which increases the risk for bleeding. Visitors are
restricted. The nurse administers all personal care. The client is fed and bathed to prevent any exertion
that might raise BP. Clients with increased ICP are normally positioned with the HOB elevated.
PTS: 1 REF: p. 2051
NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 62: Management of Clients With Cerebrovascular Disorders
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
10. A client recovering from a stroke has severe shoulder pain from subluxation of the shoulder. To
prevent further injury and pain, the nurse caring for this client is aware of what principle of care?
A. The client should be fitted with a cast because use of a sling should be avoided due to
adduction of the affected shoulder.
B. Elevation of the arm and hand can lead to further complications associated with edema.
