Cerebrovascular Accident Quiz


1.     A 78 year old client is admitted to the emergency department with numbness and weakness of the left arm and slurred speech.  Which nursing intervention is priority?
A.   Prepare to administer recombinant tissue plasminogen activator (rt-PA).
B.   Notify the speech pathologist for an emergency consult.
C.   Discuss the precipitating factors that caused the symptoms.
D.   Schedule for A STAT computer tomography (CT) scan of the head.

2.     Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?
A.   Cardiomyopathy
B.   Low blood pressure
C.   Endocarditis
D.   Polycythemia

3.     The client has had a right-sided cerebrovascular accident. In transferring the client from the wheelchair to bed, in what position should a client be placed to facilitate safe transfer?
A.   Weakened (L) side of the client away from bed.
B.   Weakened (L) side of the cient next to bed.
C.   Weakened (R) side of the cient away from bed.
D.   Weakened (R) side of the client next to bed.

4.     A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA?
A.   Obesity
B.   Caucasian race
C.   Bronchial asthma
D.   Female sex

5.     A 70 yr-old client with a diagnosis of leftsided cerebrovascular accident is admitted to the facility. To prevent the development of diffuse osteoporosis, which of the following objectives is most appropriate?
A.   Promoting range-of-motion (ROM) exercises
B.   Promoting weight-bearing exercises
C.   Maintaining vitamin levels
D.   Maintaining protein levels

6.     A client who recently had a cerebrovascular accident requires a cane to ambulate. When teaching about cane use, the rationale for holding a cane on the uninvolved side is to:
A.   maintain stride length
B.   prevent leaning
C.   prevent edema
D.   distribute weight away from the involved side

7.     After a cerebrovascular accident, a 75 yr old client is admitted to the health care facility. The client has left-sided weakness and an absent gag reflex. He’s incontinent and has a tarry stool. His blood pressure is 90/50 mm Hg, and his hemoglobin is 10 g/dl. Which of the following is a priority for this client?
A.   keeping skin clean and dry
B.   checking stools for occult blood
C.   performing range-of-motion exercises to the left side
D.   elevating the head of the bed to 30 degrees

8.     What is a priority nursing assessment in the first 24 hours after admission of the client with a thrombotic stroke?
A.   Vowel sounds
B.   Cholesterol level
C.   Pupil size and papillary response
D.   Echocardiogram

9.     A male client who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, the nurse should:
A.   perform passive range-of-motion (ROM) exercises
B.   reduce the client’s fluid intake
C.   encourage the client to use a footboard
D.   turn him frequently

10.            The nurse and unlicensed assistive personnel (UAP) are caring for a client with right-sided paralysis.  Which action by the UAP requires the nurse to intervene?
A.   The assistant places her hand under the client’s right axilla to help him/her move up in bed.
B.   The assistant praises the client for attempting to perform ADL’s independently.
C.   The assistant places the client on the back with the client’s head to the side.
D.   The assistant places a gait belt around the client’s waist prior to ambulating.

11.            Which action should take the highest priority when caring for a client with hemiparesis caused by a cerebrovascular accident (CVA)?
A.   Place the client on the affected side
B.   Use hand rolls or pillows for support
C.   Apply antiembolism stockings
D.   Perform passive range-of-motion (ROM) exercises

12.            A nurse is caring for a 2 year-old child after corrective surgery for Tetralogy of Fallot. The mother reports that the child has suddenly begun seizing. The nurse recognizes this problem is probably due to
A.   Medication reaction
B.   A cerebral vascular accident
C.   Postoperative meningitis
D.   Metabolic alkalosis

13.            The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform?
A.   Call the physician immediately
B.   Sit with the client for a few minutes
C.   Inform the nurse manager
D.   Administer an analgesic

14.            Which client would the nurse identify as being most at risk for experiencing a CVA?
A.   A 39-year-old pregnant female
B.   A 67-year-old Caucasian male
C.   A 55-year-old African American male
D.   An 84-year-old Japanese female

15.            The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA).  Which medication would the nurse anticipate being ordered for the client on discharge?
A.   A beta-blocker medication
B.   An anti-hyperuricemic medication
C.   An oral anticoagulant medication
D.   A thrombolytic medication

16.            During the first 24 hours after thrombolytic therapy for ischemic stroke, the primary goal is to control the client’s:
A.   Respirations
B.   Pulse
C.   Blood pressure
D.   Temperature

17.            The nurse is formulating a teaching plan for a client who has just experienced a transient ischemic attack (TIA). Which fact should the nurse include in the teaching plan?
A.   TIA may be a warning that the client may have cerebrovascular accident (CVA)
B.   Most clients have residual effects after having a TIA
C.   TIA symptoms may last 24 to 48 hours
D.   The most common symptom of TIA is the inability to speak

18.            Regular oral hygiene is an essential intervention for the client who has had a stroke.  Which of the following nursing measures is inappropriate when providing oral hygiene?
A.   Keeping portable suctioning equipment at the bedside.
B.   Opening the client’s mouth with a padded tongue blade.
C.   Cleaning the client’s mouth and teeth with a toothbrush.
D.   Placing the client on the back with a small pillow under the head.

19.            Ms. Pooja. has had a CVA (cerebrovascular accident) and has severe right-sided weakness. She has been taught to walk with a cane. The nurse is evaluating her use of the cane prior to discharge. Which of the following reflects correct use of the cane?
A.   Holding the cane in her right hand, Ms. Pooja. moves the cane forward first, then her left leg, and finally her right leg
B.   Holding the cane in her right hand, Ms. Pooja. moves the cane and her right leg forward, then moves her left leg forward.
C.   Holding the cane in her left hand, Ms. Pooja. moves the cane and her left leg forward, then moves her right leg forward
D.   Holding the cane in her left hand, Ms. Pooja. moves the cane forward first, then her right leg, and finally her left leg

20.            What is the expected outcome of thrombolytic drug therapy?
A.   Dissolved emboli
B.   Prevention of hemorrhage
C.   Vasoconstriction
D.   Increased vascular permeability

ANSWER AND RATIONALS
1.     D. A CT scan will determine if the client is having a stroke or has a brain tumor or another neurological disorder. This would also determine if it is a hemorrhagic or ischemic accident and guide the treatment, because only an ischemic stroke can use rt-PA. This would make preparing to administer recombinant tissue plasminogen activator (rt-PA) not the priority since if a stroke was determined to be hemorrhagic, rt-PA is contraindicated. Discuss the precipitating factors for teaching would not be a priority and slurred speech would as indicate interference for teaching. Referring the client for speech therapy would be an intervention after the CVA emergency treatment is administered according to protocol.
2.     D. The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation
3.     A. With a right-sided cerebrovascular accident the client would have left-sided hemiplegia or weakness. The client’s good side should be closest to the bed to facilitate the transfer.
4.     A. Obesity is a risk factor for CVA. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, oral contraceptive use, emotional stress, family history of CVA, and advancing age. The client’s race, sex, and bronchial asthma aren’t risk factors for CVA.
5.     B. When the mechanical stressors of weight bearing are absent, diffuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.
6.     D. Holding a cane on the uninvolved side distributes weight away from the involved side. Holding the cane close to the body prevents leaning. Use of a cane won’t maintain stride length or prevent edema.
7.     D. Because the client’s gag reflex is absent, elevating the head of the bed to 30 degrees helps minimize the client’s risk of aspiration. Checking the stools, performing ROM exercises, and keeping the skin clean and dry are important, but preventing aspiration through positioning is the priority.
8.     C. It is crucial to monitor the pupil size and pupillary response to indicate changes around the cranial nerves. Cholesterol level is an assessment to be addressed for long-term healthy lifestyle rehabilitation. Bowel sounds need to be assessed because an ileus or constipation can develop, but is not a priority in the first 24 hours. An echocardiogram is not needed for the client with a thrombotic stroke.
9.     D. The most important intervention to prevent pressure ulcers is frequent position changes, which relieve pressure on the skin and underlying tissues. If pressure isn’t relieved, capillaries become occluded, reducing circulation and oxygenation of the tissues and resulting in cell death and ulcer formation. During passive ROM exercises, the nurse moves each joint through its range of movement, which improves joint mobility and circulation to the affected area but doesn’t prevent pressure ulcers. Adequate hydration is necessary to maintain healthy skin and ensure tissue repair. A footboard prevents plantar flexion and footdrop by maintaining the foot in a dorsiflexed position.
10. A. This action is inappropriate and would require intervention by the nurse because pulling on a flaccid shoulder joint could cause shoulder dislocation; as always use a lift sheet for the client and nurse safety. All the other actions are appropriate.
11. A. To help prevent airway obstruction and reduce the risk of aspiration, the nurse should position a client with hemiparesis on the affected side. Although performing ROM exercises, providing pillows for support, and applying antiembolism stockings can be appropriate for a client with CVA, the first concern is to maintain a patent airway.
12.  B. Polycythemia occurs as a physiological reaction to chronic hypoxemia which commonly occurs in clients with Tetralogy of Fallot. Polycythemia and the resultant increased viscosity of the blood increase the risk of thromboembolic events. Cerebrovascular accidents may occur. Signs and symptoms include sudden paralysis, altered speech, extreme irritability or fatigue, and seizures.
13. A. The headache may be an indication that the aneurysm is leaking. The nurse should notify the physician immediately. Sitting with the client is appropriate but only after the physician has been notified of the change in the client’s condition. The physician will decide whether or not administration of an analgesic is indicated. Informing the nurse manager isn’t necessary.
14. C. Africana Americans have twice the rate of CVA’s as Caucasians; males are more likely to have strokes than females except in advanced years. Oriental’s have a lower risk, possibly due to their high omega-3 fatty acids. Pregnancy is a minimal risk factor for CVA.
15. C. Thrombi form secondary to atrial fibrillation, therefore, an anticoagulant would be anticipated to prevent thrombi formation; and oral (warfarin [Coumadin]) at discharge verses intravenous. Beta blockers slow the heart rate and lower the blood pressure. Anti-hyperuricemic medication is given to clients with gout. Thrombolytic medication might have been given at initial presentation but would not be a drug prescribed at discharge.
16.  C. Controlling the blood pressure is critical because an intracerebral hemorrhage is the major adverse effect of thrombolytic therapy. Blood pressure should be maintained according to physician and is specific to the client’s ischemic tissue needs and risks of bleeding from treatment. Other vital signs are monitored, but the priority is blood pressure.
17.  A. TIA may be a warning that the client will experience a CVA, or stroke, in the near future. TIA aymptoms last no longer than 24 hours and clients usually have complete recovery after TIA. The most common symptom of TIA is sudden, painless loss of vision lasting up to 24 hours.
18.  D. A helpless client should be positioned on the side, not on the back. This lateral position helps secretions escape from the throat and mouth, minimizing the risk of aspiration. It may be necessary to suction, so having suction equipment at the bedside is necessary. Padded tongue blades are safe to use. A toothbrush is appropriate to use.
19.  D.When a person with weakness on one side uses a cane, there should always be two points of contact with the floor. When Ms. Pooja. moves the cane forward, she has both feet on the floor, providing stability. As she moves the weak leg, the cane and the strong leg provide support. Finally, the cane, which is even with the weak leg, provides stability while she moves the strong leg. She should not hold the cane with her weak arm. The use of the cane requires arm strength to ensure that the cane provides adequate stability when standing on the weak leg. The cane should be held in the left hand, the hand opposite the affected leg. If Ms. Pooja. moved the cane and her strong foot at the same time, she would be left standing on her weak leg at one point. This would be unstable at best; at worse, impossible
20. A. Thrombolytic therapy is use to dissolve emboli and reestablish cerebral perfusion.





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