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Chapter 38: Caring for Clients with
Cerebrovascular Disorders
a
Administering heparin, an anticoagulant, could increase the bleeding associated with hemorrhagic
stroke. Therefore, the nurse should question this order to prevent additional hemorrhage in the brain.
In a client with hemorrhagic stroke, the healthcare provider may use dexamethasone (Decadron) to
decrease cerebral edema and pressure, methyldopa (Aldomet) to reduce blood pressure, and
phenytoin (Dilantin) to prevent seizures. - ✔✔A healthcare provider orders several drugs for a client
with hemorrhagic stroke. Which drug order should the nurse question?
a. Heparin sodium
b. Dexamethasone
c. Methyldopa
d. Phenytoin
b
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Taken together warfarin and garlic can greatly increase the INR, increasing the risk of bleeding -
✔✔A patient who has had a previous stroke and is taking warfarin tells the nurse that he started
taking garlic to help reduce his blood pressure. The nurse knows that garlic when taken together with
warfarin will produce which type of interaction?
a. No drug to drug interactions, may be taken together
b. Can greatly increase the international normalization ratio (INR), increasing the risk of bleeding
c. Can cause platelet aggregation, increasing the risk of blood clotting
d. May increase cerebral blood flow, causing migraine headaches
a
Rapid diagnosis of stroke and initiation of thrombolytic therapy (within 3 hours) in clients with
ischemic stroke leads to a decrease in the size of the stroke and an overall improvement in functional
outcome after 3 months. - ✔✔An emergency department nurse is awaiting the arrival of a client with
signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The
treatment window for thrombolytic therapy is which of the following?
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a. Three hours
b. One hour
c. Two hours
d. Six hours
a
A neurologic examination during an attack reveals neurologic deficits. Auscultation of the artery may
reveal a bruit (abnormal sound caused by blood flowing over a rough surface within one or both
carotid arteries). The term for the auscultated discovery is "bruit." - ✔✔A client reports
light-headedness, speech disturbance, and left-sided weakness that have lasted for several hours. In
the examination, an abnormal sound is auscultated in an artery leading to the brain. What is the term
for the auscultated discovery?
a. bruit
b. diplopia
c. atherosclerotic plaque
d. TIA
a
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Formation of a thrombus at the site of the endarterectomy is suspected if there is a sudden new onset
of neurologic deficits, such as weakness on one side of the body. - ✔✔A patient had a carotid
endarterectomy yesterday and when the nurse arrived in the room to perform an assessment, the
patient states, "All of a sudden, I am having trouble moving my right side." What concern should the
nurse have about this complaint?
a. A thrombus formation at the site of the endarterectomy
b. This is a normal occurrence after an endarterectomy and would not be a concern.
c. Bleeding from the endarterectomy site
d. Surgical wound infection
c
The patient and family are provided with information that will enable them to cooperate with the care
and restrictions required during the acute phase of hemorrhagic stroke and to prepare them to return
home. Patient and family teaching includes information about the causes of hemorrhagic stroke and
its possible consequences. Symptoms of hydrocephalus include gradual onset of drowsiness and
behavioral changes. Hypertension is the most serious risk factor, suggesting that appropriate
antihypertensive treatment is essential for a patient being discharged. Seizure activity is not normal;
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complaints of a serious headache should be called to the health care provider before any medication
is taken. Drowsiness is not normal. - ✔✔The nurse is preparing discharge teaching for a patient who
is being discharged after hospitalization for a hemorrhagic stroke. What should be included in the
discharge teaching for this patient?
a. Intermittent seizures can be expected.
b. Take ibuprofen for complaints of a serious headache.
c. Take antihypertensive medication as ordered.
d. Drowsiness is normal for the first week after discharge.
d
A headache may be an indication that the aneurysm is leaking. The nurse should notify the health
care provider immediately. The health care provider will decide whether administration of an
analgesic is indicated. Informing the nurse manager is not necessary. Sitting with the client is
appropriate, once the health care provider has been notified of the change in the client's condition. -
✔✔A client diagnosed with a cerebral aneurysm reports a severe headache to the nurse. What
action is a priority for the nurse?
a. Sit with the client for a few minutes.
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b. Administer an analgesic.
c. Inform the nurse manager.
d. Call the health care provider immediately.
d
The client with homonymous hemianopsia (loss of half of the visual field) turns away from the affected
side of the body and tends to neglect that side and the space on that side; this is called
amorphosynthesis. In such instances, the client cannot see food on half of the tray, and only half of
the room is visible. It is important for the nurse to remind the client constantly of the other side of the
body, to maintain alignment of the extremities, and if possible, to place the extremities where the
client can see them. Clients with a decreased field of vision should be approached on the side where
visual perception is intact. All visual stimuli (clock, calendar, and television) should be placed on this
side. The client can be taught to turn the head in the direction of the defective visual field to
compensate for this loss. Increasing the natural or artificial lighting in the room and providing
eyeglasses are im - ✔✔A client is diagnosed with a right-sided stroke. The client is now experiencing
hemianopsia. How might the nurse help the client manage her potential sensory and perceptional
difficulties?
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