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8 Cards in this Set

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A patient with right-sided paresthesias and hemiparesis is hospitalized and diagnosed with a thrombotic stroke. Over the next 72 hours the nurse plans care with the knowledge that the patient:

a. is ready for aggressive rehabilitation
b. will show gradual improvement of the initial neurologic deficits
c. may show signs of deteriorating neurologic function as cerebral edema increases
d. should not be turned or exercised to prevent extension of the thrombus and increased neurologic deficits
c. When cerebral infarction occurs, the ischemic cascade causes an inflammatory response that leads to edema and extension of tissue damage. In ischemic strokes, symptoms may progress in the first 72 hours as infarction and cerebral edema increase. Repositioning and passive ROM should be started the first day to prevent complications, but aggressive rehab is not started until the patient's condition is stable.
The neurologic functions that are affected by a stroke are primarily related to:

a. the amount of tissue area involved
b. the rapidity of the onset of symptoms
c. the brain area perfused by the affected artery
d. the presence or absence of collateral circulation
c. Clinical manifestations of altered neurologic function differ, depending primarily on the specific cerbral artery involved and the area of the brain that is perfused by the artery. The degree of impairment depends on rapidity of onset, the size of the lesion, and the presence of collateral circulation.
A patient is admitted to the hospital with a left hemiplegia. To determine the size, location, and whether a stroke is ischemic or hemorrhagic the nurse anticipates that the physician will request a:

a. CT scan
b. lumbar puncture
c. cerebral arteriogram
d. positron emission tomography (PET)
a. A CT scan is the most commonly used diagnostic test to determine the size and location of the lesion and to differentiate a thrombotic stroke from a hemorrhagic stroke.
The incidence of ischemic stroke in patients with TIAs and other risk factors is reduced with the administration of:

a. furosemide (Lasix)
b. lovastatin (Mevacor)
c. daily low-dose aspirin
d. nimodipine (Nimotop)
c. The administration of antiplatelet agents, such as aspirin, dipyridamole (Persantine), and ticlopidine (Ticlid), reduces the incidence of stroke in those at risk. Anticoagulants are also used for prevention of embolic strokes but increasethe risk for hemorrhage.
An essential intervention in the emergency management of the patient with a stroke is:

a. IV fluid replacement
b. administration of osmotic diuretics to reduce cerbral edema
c. initiation of hypothermia to decrease the oxygen needs of the brain
d. maintenance of respiratory function with a patent airway and oxygen administration
d. The first priority in acute management of the patient with a stroke is preservation of life. Because the patient iwth a stroke may be unconscious or have a reduced gag reflex, it is most important to maintain a patent airway for the patient and provide oxygen if respiratory effort is impaired.
A newly admitted patient who has suffered a right brian stroke has a nursing dx of disturbed visual sensory perception r/t homonymous hemianopsia. Early in the care of the patient, the nurse should:

a. place objects on the right side within the patient's field of vision
b. approach the pt from the left side to encourage the patient to turn the head
c. place objects on the patient's left side to assess the patient's ability to compensate
d. patch the affected eye to encourage the patient to turn the head to scan the environment
a. The presence of homonymous hemianopia in a patient with right-hemisphere brain damage causes a loss of vision in the left field. Early in the care of the patient, objects should be placed on the right side of the patient in the field of vision, and the nurse should approach the patient from the right side. Later in treatment, patients should be taught to turn the head and scan the environment and should be approached from the affected side to encourage head turning.
Four days following a stroke, a patient is to start oral fluids and feedings. Before feeding the patient, the nurse should first:

a. check the patient's gag reflex
b. order a soft diet for the patient
c. raise the head of the bed to a sitting position
d. evaluate the patient's ability to swallow small sips of ice water
a. The first step in providing oral feedings for a patient with a stroke is ensuring that the patient has an intact gag reflex, because feedings will not be provided if the gag reflex is impaired.
An appropriate food for a patient with a stroke who has mild dysphagia is:

a. fruit juices
b. pureed meat
c. scrambled eggs
d. fortified milkshakes
c. Soft foods that provide enought texture, flavor, and bulk to stimulate swallowing should be used for the patient with dysphasia.