SCRN Study Questions and Answers 2023

SCRN Study Questions and Answers 2023 A 67yo man with a hx of HTN, DM, HLD, and smoking presents to the ED. CC of persistent dizziness q1week that has become so severe he now has double vision, N/V. His wife tells you she noticed a L facial droop and slurring. Pt reports weakness in L arm and leg. He denies HA or SZ. Head CT was negative for acute bleed. Upon returning to the room he has become increasingly obtunded and difficult to arouse. You notice he now has a nystagmus and slightly dysconjugate gaze. His exam appears to be worsening now with R/L extremity weakness in addition to his L hemiparesis. What type of stroke syndrome are you concerned he may be having? a. Wallenberg's stroke b. Dissection of the R internal carotid artery c. acute basilar artery occlusion d. Superior cerebellar artery stroke c You are assessing a 35yo M who has been in a motor vehicle crash, and during the exam you notice he has some abnormal eye exam findings and weakness in the R arm and leg (arm more than leg). He has droopiness of the L eyelid and his pupils are unequal. The L pupil is 3mm in diameter and the right is 5MM. Both pupils are round and reactive to light. Although it is a hot, humid day, he is not sweating from the heat. What stroke syndrome do you suspect your patient is experiencing? a. Weber's syndrome b. Amaurosis fugax c. Locked-in syndrome d. Horner's syndrome d What is a possible cause of Horner's syndrome? a. Occlusion of the MCA b. Dissection of the L ICA c. Dissection of the R ICA d. ACA stroke b a patient presents with central retinal artery occlusion. As you evaluate the neuroimaging, you recognize that the most likely etiology is artery-to-thrombosis from which artery? a. Basilar artery b. Middle cerebral artery c. Posterior inferior cerebellar artery d. Carotid artery d A patient is admitted to the emergency department with acute symptoms of hemiparesis, hemi-sensory loss, gaze preference, and aphasia. Which vessel do you suspect is involved in the stroke? a. ACA b. MCA c. PCA d. PICA b What cluster of symptoms is consistent with Weber's syndrome? a. Ipsilateral cranial nerve 3 palsy, contralateral hemiparesis b. Ipsilateral cranial nerve 4 and 6 palsy, contralateral hemiparesis c. Contralateral cranial nerve 4 and 6 palsy, ipsilateral hemiparesis d. ipsilateral cranial nerve 5 paly, ipsilateral ataxia a a patient is admitted with symptoms consistent with Weber's syndrome. If the stroke is ischemic, which arteries would you suspect might have caused the stroke? a. Carotid artery b. Middle cerebral artery c. Posterior cerebral artery d. Basilar artery c A patient presents with vertical gaze palsy, pupils mid-dilated with light dissociation, and convergence-retraction nystagmus. This cluster of symptoms is consistent with which of the following symptoms? a. Weber's syndrome b. Horner's syndrome c. Parinaud's syndrome d. Wallenberg's syndrome c Parinaud's syndrome results from which part of the brain? a. Dorsal midbrain b. Lateral medulla c. Ventral pons d. Posterior inferior cerebellum a You are caring for a pt who has had multiple small strokes in the watershed territory between the ACA and MCA. Which of the following is the most likely etiology for this type of stroke? a. Embolus of cardiac origin b. Carotid artery atherosclerosis c. Vasculitis d. Severe hypotension d Which arteries are occluded in Wallenberg's syndrome? a. MCA b. PICA c. ICA d. PCA b A patient with lacunar ischemic stroke, with a hx of HTN, CAD, and DM is being discharged from the hospital. What BP goal will you teach them to target? a. SBP 150 b. SBP 140 c. SBP 130 d. SBP 120 c A nurse is educating a patient about modifiable ischemic stroke risk factors. Select the correct answer that indicates modifiable risk factors a. HTN and DM b. Genetic factors and age c. Oral contraceptives and migraine d. A and C e. B and C d A patient is dx with an ischemic stroke, HTN, CAD, and HLD. The patient smokes but has tried to quit multiple times in the past. Select strategies the SCRN should use to assist the patient with smoking cessation a. Follow the "5 A" counseling model for treating tobacco dependence b. Assess for risk of relapse c. Review symptoms of nicotine withdrawal d. Refer the patient to smoking cessation supportive resources e. All of the above e A pt presents to the clinic with concernce about HTN. VS include BP at 150/95, HR 90, RR 16, and O2 98. According to the American College of Cardiology/American Heart Association 2017 guidelines, the patient's BP is classified as: a. Normal b. Pre-HTN c. Stage 1 HTN d. Stage 2 HTN d According to ACC/AHA guidlines, pre-hypertension has been eliminated. A BP between 120-129 is now classified as: a. normal b. elevated c. stage 1 HTN d. stage 2 HTN b A 69yo pt with a hbA1c of 6.3% and a BMI of 30 needs education before discharge. Which of the following statements by the patient needs correcting?* a. "it is important for me to increase intake of fruits, veggies, and grains while limiting saturated fats, salt intake, and alcohol intake" b. "with my current BMI, I might consider cutting my caloric intake by 500-1000 cals/day" c. "my currect hbA1c classifies me as pre-diabetic" d. "if I have strict control of my bg, it will decrease my chances of having a stroke" d According to the CHADS-VASc score, a 70yo man with PMH of HTN, DM, a-fib, migraine, HLD, and vascular disease is a candidate for anticoag therapy. T or F? a. True b. False a A 53y menopausal woman presents to the clinic, informing her PCP "I prefer not to take hormone therapy. I understand it can increase my chances of having a stroke." Which life-style counseling should the nurse recommend to reduce her symptoms? a. exercise in the evening before bed b. sleep in a cooler room c. limit alcohol intake d. a and c e. b and c e A 30y woman with a PMH of DM, migraines with aura, HTN, and tobacco use wants information of birth control option. As a stroke-certified nurse, you know the safest option for the pt to use is oral contraceptives rather than non-estrogen contraceptives, such as an IUD. T or F? a. True b. False b You are teaching a patient about modifiable risk factors to decrease the risk of cariovascular disease and stroke. You ask the patient to recite "Life's Simple 7" to demonstrate understanding. Which lifestyle focus represents the AHA's goal to improve cardiovascular health? a. BP, cholesterol, bg, exercise, alcohol, diet, BMI b. BP, cholesterol, bg, stress, smoking, diet, BMI c. BP, cholesterol, bg, exercise, smoking, diet, BMI d. BP, cholesterol, bg, stress, alcohol, diet, BMI c Mr. Tucker was admitted for an ischemic stroke d/t a-fib. He has a hx of HTN, HF, and obesity. During the night, you hear him snoring. The day nurse reports he was sleeping a lot and unpleasant with staff, which is not normal behavior according to his family. As a stroke-certified nurse, you are concerned he may have OSA, a risk factor for stroke. Which tool can the nurse use to screen for OSA? a. The Patient Health Questionnaire b. STOP-BANG Questionnaire c. Health Risk Assessment Questionnaire d. Adult Physical Health Questionnaire b What strategies should the nurse teach a patient with intracerebral hemorrhage to prevent recurrence? a. BP control b. Avoiding tobacco and illicit drugs c. Treating sleep apnea d. All of the above d Your patient with aneurysmal SAH has a second aneurysm. The plan is to monitor the patient after discharge. Which risk factor that causes a 2.5-fold increase risk of aneurysm rupture should be the focus of nursing education? a. HTN b. Moderate alcohol consumption c. Smoking d. Increased caffeine intake c Which of the following information must be obtained before administering alteplase? a. Time symptoms started b. Current medication c. Noncontrast head CT results d. Sx hx e. All of the above e A patient received alteplase for a L MCA ischemic stroke. What should be included in the post-tPA care of this patient? a. VS q15 min during infusion, q15m 2h post infusion, q30m for 6h, q1h for 16h b. Neuro assessment q15m for 8h, q30m for 12h, and q1h for 16h c. VS and Neuro checks q15m for 8h, q30min for 12h, and q1h for 16h d. VS and Neruo checks q30 min until symptoms resolve a Which position sould be avoided when caring for a pt with ICH? a. Trendelenburg b. Reverse trendelenburg c. Left lateral position d. Supine with HOB elevated a What imaging must be completed before administering tPA? a. Noncontrast heast CT b. CT angiogram c. MRI of the brain d. CT perfusion a Which of the following describes the region of the penumbra? a. Hypoperfused tissue surrounding the ischemic core in which blood flow is too low to maintain electrical activity b. The boundary zone between dead and healthy tissue c. It is not potentially salvageable d. Occurs when blood flow drops below 12ml/100g/min b Which of the following tests provides the physician with the mean transit time for blood flow in the brain? a. Magnetic resonance spectroscopy b. Magnetic resonance venogram c. CT perfusion study d. CT arteriogram study c A patient is scheduled for a transesophageal echocardiogram. In preparing for this test, what should the nurse tell the patient? a. You will be able to have breakfast before the test b. You will receive sedation before the test starts to make you comfortable c. This test will show exactly where your stroke came from d. This test will take 3 hours to complete b A patient presents to the ED complaining of a 4d hx of "the worst HA of my life." Neuro exam is normal. Head CT is normal. What is the next test that the nurse should anticipate? a. An MRI of the brain b. A cerebral arteriogram c. A lumbar puncture d. A CT perfusion study c A pt with a confirmed SAH from a ruptured anterior communicating artery aneurysm asks why they are undergoing daily transcranial doppler (TCD) ultrasounds. The nurse's best response is: a. The TCD can provide info as to whether any of the vessels in your brain are in spasm b. If we do not do a TCD, we will have to send you for a cerebral angiogram c. The TCD can tell us whether there has been further bleeding in your brain d. We need to do the TCD to determine how well your brain is healing a A patient has evidence of a SAH on a nonenhanced head CT scan. The pt is being taken back for a CT angiogram. What lab results should the nurse check before this scan? a. CBC b. Electrolytes c. BUN and Cr d. PTT c In a young pt (40yo), what is the most common cause of spontaneous intraparenchymal hemorrhage? a. cerebral aneurysm rupture b. coagulopathy c. amyloid angiopathy d. arteriovenous malformation d The gold standard for diagnosing a cerebrovascular lesion is: a. CT angiogram b. Magnetic resonance angiogram c. Digital subtraction angiography (aka cerebral angiogram) d. Lumbar puncture c A pt who has undergone an interventional procedure is complaining of swelling and pain to the groin. Upon assessment, a pulsatile mass that has a bruit is found. Which of the following is the most likely cause? a. Hematoma b. Inguinal hernia c. Pseudoaneurysm d. Arterial thrombosis c A pt is taking an angiotensin-converting enzyme inhibitor is at a higher risk of what side effect of alteplase? a. Petechiae b. Hematuria c. Acute kidney injury d. Orolingual angioedema d Before administering alteplase, pt BP should be below which value? a. 220/110 b. 185/110 c. 180/105 d. 120/90 b