CVA QUESTIONS FOR EXAM II
a. African Americans
b. Women who smokes
c. Individuals
with hypertension and diabetes
d. Those who are obese with increased dietary intake to fat
a. Chronic anemia
b. Chronic hypercapnia
c. Development of collateral circulation
d. Congenital
cerebrovascular anomalies
2 a. Onset unrelated to activity 1. Thrombic
3 b. Rupture of athrosclorotic vessels 2. Embolic
3 c. Carries the poorest prognosis 3. Intracerebral hem.
1 d. Types most often signaled by TIAs 4. Subarachnoid
3 e. Most common of sudden death
3 f. Creates mass that compresses brain
4 g. Symptoms of meningeal irritation
1 h. Commonly occurs during or after sleep
2
i. Quick onset and
resolution
3,4 j. Caused by rupture of intracranial aneurysm
3,4 k. Strong associated with hypertension
3 l. Associated with sudden severe headache
2 m. Associated with endocardial disorders
a. Is ready for aggressive rehabilitation
b. Can
be expected to recover with minimal residual effects
c. Has experienced a TIA that is a warning sign of a more serious stroke.
d. Will show signs of deteriorating neurologic function as edema increases.
a. The amount of tissue area involved
b. The rapidity of the onset of symptoms
c. The
brain area perfused by the effected artery
d. The presence or absence of collateral circulation
a. Aphasia Left side
b. Left
homonymous hemianopia Right side
c. Agnosia Right
side
d. Quick
and impulsive behavior Right side
e. Inability
to remember words Left side
f.
Neglect of the left side of body Right side
a. Receptive
aphasia is characterized by a lack of comprehension of both written and verbal
language…. TRUE Receptive aphasia is when neither the sounds
of speech nor its meaning can be understood.
b. Dysarthria
results from a disturbance in the Broca’s area and is an impairment in speaking
and writing…..FALSE Broca’s area
of the brain cause expressive aphasia (difficulty in speaking and writing).
c. A lesion that affects both Wernick’s and Broca’s area is most likely to cause global asphasia…..TRUE
d. A non-fluent dysphasia is characterized by the presence of speech that contains little meaningful communication…..TRUE
e. The long-term effect of paralysis of an extremity resulting from a stroke is flaccidity….FALSE Spasticity
a. Involves intra cranial surgery to join a superficial extracranial artery to an intracranial artery.
b. Is used to restore blood circulation to the brain following the obstruction of a cerebral artery
c. Involves
removing an atherosclerotic plaque in the carotid artery to prevent an
impending stroke.
d. Is used to open an arterial stenosis in a carotid artery with a balloon to restore cerebral circulation.
a. IV fluid replacement
b. Administration of osmotic diuretics to reduce cerebral edema
c. Initiation of hypothermia to decrease oxygen needs of the brain.
d. Maintenance
of the respiratory function with a patent airway and oxygen airway and oxygen
administration.
a. Hyperventilation therapy
b. Surgical clipping of aneurysm
c. Administration
of hyperosmotic agents
d. Administration of thrombolytics
a. Stabilization of neurologic signs within 24 hours.
b. Bilateral motor and sensory deficits of all extremities.
c. Absence of s/s of neurological deficits within 24 hours.
d. Intermittent
progression of deteriorating neurological status for up to 72 hours.
12. A dx of ruptured cerabral aneurysm has been made in a pt with
manifestations of a stroke. The nurse anticipates that tx options that
would ve evaluated for this pt include:
a.
hyperventilation therapy
b.
surgical clipping of aneurysm
c. admin of hyperosmotic agents
d.
admin of thromgolytic agents
13. The use of a clinical pathway for a pt
with a stroke:
a. eliminates the need
for continued documentation of care
b. is a specific
standardized NCP for the pt and the family
c. requires that a pt
with a stroke is D/C'd on the 4th day
d. directs the
healthcare team in daily interventions needed to meet D/C outcomes
NOTE!!!! For some reason I did not have #8, 10, or
15. Mary will come up with 16 through
26. Thanks
Feb. 23 - Group Questions correct answers in bold
14. During the acute phase of a stroke, the nurse assesses the pt’s vs. and neuro status q 4 hr. A stroke-in-evolution would be manifested by:
a.
stabilization
of neuro signs within 24 hrs
b.
bilateral
motor and sensory deficits of all extremities
c.
absence
of signs or symptoms of neurological deficit within 24 hrs
d.
intermittent progression of
deteriorating neurological status for up to 72 hrs
No # 15
16.
(p
1663-65) A nursing intervention that is indicated for the patient with
hemiplegia is:
a.
the
use of a footboard to prevent plantar flexion – no, it can actually cause a problematic neuro response
b.
immobilization
of effected arm against the chest with a sling – no, will cause atrophy
c.
positioning
the pt in bed with every joint lower than the joint proximal to it – no, elevate
d.
having the pt perform
passive ROM of the affected limb with the unaffected limb
17.
A
newly admitted pt who has suffered a rt. hemisphere stroke has a nursing dx of
sensory/perceptual alteration rt. visual deficit. Early in the care of the pt the nurse should:
a.
place objects on rt. side
within pt’s vision
b.
approach
pt from left side to encourage pt to turn head
c.
place
objects on pt’s left side to assess pt’s ability to compensate
d.
patch
pt’s affected eye to encourage pt to turn head to scan environment
18.
4
days following a stroke a pt is to start on po fluids & feedings. Before starting po feedings the nurse should first:
a.
check pt’s gag reflex
b.
order
soft diet
c.
raise
HOB
d.
eval
pt’s ability to swallow sips of ice and water
19.
An
appropriate food for a pt with a stroke who has mild dysphasia is:
a.
fruit
juices
b.
pureed
beef
c.
scrambled eggs
d.
fortified
milkshakes
20
A
pt who has suffered a stroke is experiencing urinary incontinence. Nursing management of the pt includes:
21.
(p
1665-68) To promote communication during rehab of the pt with aphasia an
appropriate nursing intervention is to:
a.
use
gestures, pictures, music to stimulate response
b.
talk about ADLs that are
familiar to the pt
c.
structure
statements so pt doesn’t have to respond verbally
d.
use
flash cards with simple words and pictures to promote language recall
22.
A
pt with rt. hemisphere stroke has a nursing diagnosis of unilateral neglect R/T
sensory perceptual deficits. During the
pt’s rehab it is important that the nurse:
a.
avoid
positioning pt on the effected side
b.
place
objects on pt’s unaffected side
c.
teach pt to consciously care
for the affected side
d.
protect
the affected side from injury with pillows and supports
23.
A
pt with a stroke has rt. sided hemiplegia.
The nurse prepares family members to help control behavior changes
seen with this type of stroke by
teaching them to:
c.
distract the pt from
inappropriate emotional responses
24.
The
nurse can assist the pt and the family in coping with the long term effects of
a stroke by:
d.
helping the pt and family understand
the significance of residual stroke damage to promote problem solving and
planning
25.
List
3 potential problems R/T the geriatric stroke pt:
1.
caregiver
role strain
2.
dec
ADL function, return to prior function less likely & more difficult
3.
Erikson,
task unfulfilled – ego vs. integrity (dec integrity), despair, inc dependency,
change in spouse – now pt relationship
26.
Answer
first 3 questions R/T the critical thinking case study p. 1669 in text
1.
>75
nonmodifiable, obesity, dec activity, poor diet, smoker, drinker, HTN – if good
control = prevention. MI – 9% chance
repeat within 6 yrs
2.
yes,
but s/s could be much worse – paralyzed left side, left side neglect,
spatial/perceptual deficits
3.
not
safe to drive – seek alternatives
Pg 1669
1. How does John’s prior health history put him at risk for development of a stroke?
>75 (non modifiable)
Obesity – lack of activity and poor diet
Smoker
Drinker
HTN – good control of HTN is considered most significant therapy in prevention of strokes.
MI –9% chance that man will have a stroke within 6 years of MI
2. Are John’s reported symptoms and behaviors typical of a person having a right brain stroke?
Yes, but the symptoms could be much worse.
ie. Paralyzed left side, left sided neglect, spatial-perceptual deficits, etc.
3. How can John and his family address activity issues such as driving after the stroke?
John is anxious to get back to his old levels of functioning, but his family needs to consider that some of the symptoms of right-brain stroke are spatial-perceptual deficits, tendency to deny or minimize problems, rapid performance, short attention span, impulsiveness, safety problems, impaired judgment, and impaired time concepts. John is not safe behind the wheel of a car, and his family should try and work out other arrangements for his transportation. He might, however, be able to drive a golf cart with supervision.
4. What strategies might the home health nurse use to help John and his family cope with his emotional lability?
Loss of function can and often does lead to depression. OT and PT consults could help John by offering new ways to do the old tasks. This can be accomplished through devices (such as modified utensils, cups, etc.) and through motor training. Helping John get back near his prior level of functioning should help him emotionally.
5. What lifestyle changes should John make to reduce the likelihood of another stroke?
Quit smoking and drinking, get his HTN under control and get on a better diet and possibly an exercise routine.
6. How will homonymous hemianopsia affect John’s hygeine, eating, driving, and golf game?
In the beginning, it will be worse. But as John learns to adapt to the visual field deficit and look for things in that part of his visual field his functioning will increase. He will need to learn to be complete in his hygeine and eating. Drinving should be out of the question. His golf game may not be affected too severely if he has someone to watch where his ball goes. If he lines up properly and keeps his head down, like he is supposed to he should be OK.
7. What factors should the nurse assess for in relation to further outpatient rehabilitation for John?
8. Based on the assessment data provided, write one or more nursing diagnoses. Are there any collaborative problems?