Stroke, TIA, Parkinson's disease Questions and Answers Already Verified
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Stroke, TIA, Parkinson\'s Disease
Stroke, TIA, Parkinson's disease Questions and Answers Already Verified
In promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in
a. African Americans
b. women who smoke
iduals with hypertension and ...
Stroke, TIA, Parkinson's disease Questions and Answers
Already Verified
In promoting health maintenance for prevention of strokes, the nurse
understands that the highest risk for the most common type of stroke is present
in
a. African Americans
b. women who smoke
c.individuals with hypertension and diabetes
d. those who are obese with high dietary fat intake
C: Individuals with hypertension and diabetes- The highest risk factors for thrombotic
stroke are hypertension and diabetes. African Americans have a higher risk for stroke
than do white persons but probably because they have a greater incidence of
hypertension. Factors such as obesity, diet high in saturated fats and cholesterol,
cigarette smoking, and excessive alcohol use are also risk factors but carry less risk
than hypertension.
A thrombus that develops in a cerebral artery does not always cause a loss of
neurologic function because
a. the body can dissolve the atherosclerotic plaques as they form
b. some tissues of the brain do not require constant blood supply to prevent
damage
c. circulation through the circle of Willis may provide blood supply to the affected
area of the brain
d. neurologic deficits occur only when major arteries are occluded by thrombus
formation around an atherosclerotic plaque
C: Circulation through the circle of Willis may provide blood supply to the affected area
of the brain.
The communication between cerebral arteries in the circle of Willing provides a
collateral circulation, which may maintain circulation to an area of the brain if its original
blood supply is obstructed. ALl areas of the brain require constant blood supply, and
atherosclerotic plaques are not readily reversed. Neurologic deficits can result from
ischemia cause by many factors.
A patient comes to the emergency department immediately after experiencing
numbness of the face and an inability to speak, but while the patient awaits
examination, the symptoms disappear and the patient request discharge. The
nurse stresses that it is important for the patient to be evaluated primarily
because
a. the patient has probably experienced an asymptomatic lacunar stroke
b. the symptoms are likely to return and progress to worsening neurologic deficit
in the next 24 hours
c. neurologic deficits that are transient occur most often as a result of small
hemorrhages that clot off
d. the patient has probably experienced a transient ischemic attack (TIA), which is
a sign of progressive cerebral vascular disease
,D: The patient has probably experienced a transient ischemic attack (TIA), which is a
sign of progressive cerebral vascular disease- A TIA is a temporary focal loss of
neurologic function caused by ischemia of an area of the brain, usually lasting only
about 3 hours. TIAs may be due to microemboli from heart disease or carotid or
cerebral thrombi and are a warning of progressive disease. Evaluation is necessary to
determine the cause of the neurologic deficit and provide prophylactic treatment if
possible.
The neurologic functions that are affected by a stroke are primarily related to
a. the amount of tissue area involved
b. the rapidity of onset of symptoms
c. the brain area perfused by the affected artery
d. the presence or absence of collateral circulation
C: The brain area perfused by the affected artery- clinical manifestation of altered
neurologic function differ, depending primarily on the specific cerebral 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
and location and to ascertain whether a stroke is ischemic or hemorrhagic, the
nurse anticipates that the health care provider will request a
a. CT scan
b. lumbar puncture
c. cerebral arteriogram
d. positron emission tomography (PET)
A: CT scan- 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. Positron emission tomography (PET) will show the metabolic activity of the brain
and provide a depiction of the extent of tissue damage after a stroke. Lumbar punctures
are not performed routinely because of the chance of increased intracranial pressure
causing herniation. Cerebral arteriograms are invasive and may dislodge an embolism
or cause further hemorrhage; they are performed only when no other test can provide
the needed information.
The incidence of ischemic stroke in patients with TIAs and other risk factors is
reduced with administration of
a. furosemide (Lasix)
b. lovastatin (Mevacor)
c. daily low dose aspirin
d. nimodipine (Nimotop)
C: Daily low dose aspirin- the administration of antiplatelet agents, such as aspirin,
dipyridamole (Persantine), and ticlopdipine (Ticlid), reduces the incidence of stroke in
those at risk. Anticoagulants are also used for prevention of embolic strokes but
increase the risk for hemorrhage. Diuretics are not indicated for stroke prevention other
than for their role in controlling BP, and antilipemic agents have bot been found to have
a significant effect on stroke prevention. The calcium channel blocker nimodipine is
used in patients with subarachnoid hemorrhage to decrease the effects of vasospasm
, and minimize tissue damage.
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The priority intervention in the emergency department for the patient with a
stroke is
a. intravenous fluid replacement
b. administration of osmotic diuretics to reduce cerebral 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: Maintenance of respiratory function with a patent airway and oxygen administration-
the first priority in acute management of the patient with a stroke is preservation of life.
Because the patient with 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. IV fluid replacement, treatment with osmotic diuretics, and
perhaps hypothermia may be used for further treatment.
During the acute phase of a stroke, the nurse assesses the patient's vital signs
and neurologic status every 4 hours. A cardiovascular sign that the nurse would
see as the body attempts to increase cerebral blood flow is
a. hypertension
b. fluid overload
c. cardiac dysrhythmias
d. S3 and S4 heart sounds
A: Hypertension- The body responds to the vasopasm and a decreased circulation to
the brain that occurs with a stroke by increasing the BP, frequently resulting in
hypertension. The other options are important cardiovascular factors to assess, but they
do not result from impaired cerebral blood flow.
A nursing intervention is indicated for the patient with hemiplegia is
a. the use of a footboard to prevent plantar flexion
b. immobilization of the affected arm against the chest with a sling
c. positioning the patient in bed with each joint lower than the joint proximal to it
d. having the patient perform passive ROM of the affected limb with the
unaffected limb
D: Having the patient perform passive ROM of the affected limb with the unaffected
limb- active ROM should be initiated on the unaffected side as soon as possible, and
passive ROM of the affected side should be started on the first day. Having the patient
actively exercise the unaffected side provides the patient with active and passive ROM
as needed. Use of footboards is controversial because they stimulate plantar flexion.
The unaffected arm should be supported, but immobilization may precipitate a painful
shoulder-hand syndrome. The patient should be positioned with each joint higher than
the joint proximal to it to prevent dependent edema.
A newly admitted patient who has suffered a right sided brain stroke has a
nursing diagnosis of disturbed visual sensory perception related to 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 patient from the left side to encourage the patient to turn the
head
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