The nurse reports that a client is at risk for a brain attack (stroke) based on which assessment finding?
A.
Jugular vein distention.
B.
Carotid bruit.
C.
Nuchal rigidity.
D.
Palpable cervical lymph node.
The correct answer is:
B. Carotid bruit
Explanation:
A carotid bruit is an abnormal sound heard over the carotid artery, typically indicating turbulent blood flow due to narrowing or blockage of the artery. This can be a sign of atherosclerosis, which increases the risk of stroke (brain attack) because it can lead to the formation of blood clots that may travel to the brain.
Here’s why the other options are less indicative of stroke risk:
- A. Jugular vein distention: This typically suggests heart failure or other conditions affecting venous return but is not specifically associated with an increased risk of stroke.
- C. Nuchal rigidity: This is stiffness of the neck, often associated with meningitis or other infections of the central nervous system, not directly related to stroke risk.
- D. Palpable cervical lymph node: Enlarged lymph nodes can indicate infections or malignancies but are not a direct risk factor for stroke.
Correct answer: B