Stroke and TIA NCLEX

Stroke and TIA NCLEX Leave the first rating Terms in this set (30) Science MedicineNursing Save After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no residual effects, the nurse anticipates teaching the patient about

• cerebral aneurysm clipping.
• heparin intravenous infusion.
• oral low-dose aspirin therapy.
• tissue plasminogen activator (tPA).
• The patient's symptoms are consistent with

transient ischemic attack (TIA), and drugs that inhibit platelet aggregation are prescribed after a TIA to prevent stroke. Continuous heparin infusion is not routinely used after TIA or with acute ischemic stroke. The patient's symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic stroke, not for TIA.A 68-year-old patient is being admitted with a possible stroke.Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin?

• The patient has dysphasia.
• The patient has atrial fibrillation.
• The patient reports that symptoms

began with a severe headache.

• The patient has a history of brief

episodes of right-sided hemiplegia.

• A sudden onset headache is typical of a

subarachnoid hemorrhage, and aspirin is contraindicated. Atrial fibrillation, dysphasia, and transient ischemic attack (TIA) are not contraindications to aspirin use, so the nurse can administer the aspirin.

A 73-year-old patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find?

• Impulsive behavior
• Right-sided neglect
• Hyperactive left-sided tendon

reflexes

• Difficulty comprehending

instructions

• Right-sided paralysis indicates a left-brain stroke,

which will lead to difficulty with comprehension and use of language. The left-side reflexes are likely to be intact. Impulsive behavior and neglect are more likely with a right-side stroke.During the change of shift report a nurse is told that a patient has an occluded left posterior cerebral artery. The nurse will anticipate that the patient may have

• dysphasia.
• confusion.
• visual deficits.
• poor judgment.
• Visual disturbances are expected with posterior

cerebral artery occlusion. Aphasia occurs with middle cerebral artery involvement. Cognitive deficits and changes in judgment are more typical of anterior cerebral artery occlusion.When teaching about clopidogrel (Plavix), the nurse will tell the patient with cerebral atherosclerosis

• to monitor and record the blood

pressure daily.

• that Plavix will dissolve clots in the

cerebral arteries.

• that Plavix will reduce cerebral

artery plaque formation.

• to call the health care provider if

stools are bloody or tarry.

• Clopidogrel (Plavix) inhibits platelet function and

increases the risk for gastrointestinal bleeding, so patients should be advised to notify the health care provider about any signs of bleeding. The medication does not lower blood pressure, decrease plaque formation, or dissolve clots.

A patient with carotid atherosclerosis asks the nurse to describe a carotid endarterectomy. Which response by the nurse is accurate?

• "The obstructing plaque is

surgically removed from an artery in the neck."

• "The diseased portion of the artery

in the brain is replaced with a synthetic graft."

• "A wire is threaded through an

artery in the leg to the clots in the carotid artery and the clots are removed."

• "A catheter with a deflated balloon

is positioned at the narrow area, and the balloon is inflated to flatten the plaque."

• In a carotid endarterectomy, the carotid artery is

incised and the plaque is removed. The response beginning, "The diseased portion of the artery in the brain is replaced" describes an arterial graft procedure. The answer beginning, "A catheter with a deflated balloon is positioned at the narrow area" describes an angioplasty. The final response beginning, "A wire is threaded through the artery" describes the mechanical embolus removal in cerebral ischemia (MERCI) procedure.A patient admitted with possible stroke has been aphasic for 3 hours and his current blood pressure (BP) is 174/94 mm Hg. Which order by the health care provider should the nurse question?

• Keep head of bed elevated at

least 30 degrees.

• Infuse normal saline intravenously

at 75 mL/hr.

• Administer tissue plasminogen

activator (tPA) per protocol.

• Administer a labetalol

(Normodyne) drip to keep BP less than 140/90 mm Hg.

• Because elevated BP may be a protective

response to maintain cerebral perfusion, antihypertensive therapy is recommended only if mean arterial pressure (MAP) is >130 mm Hg or systolic pressure is >220 mm Hg. Fluid intake should be 1500 to 2000 mL daily to maintain cerebral blood flow. The head of the bed should be elevated to at least 30 degrees, unless the patient has symptoms of poor tissue perfusion. tPA may be administered if the patient meets the other criteria for tPA use.

A 56-year-old patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for

• surgical endarterectomy.
• transluminal angioplasty.
• intravenous heparin administration.
• tissue plasminogen activator (tPA)

infusion.

• The patient's history and clinical manifestations

suggest an acute ischemic stroke and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan).Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.A female patient who had a stroke 24 hours ago has expressive aphasia.The nurse identifies the nursing diagnosis of impaired verbal communication. An appropriate nursing intervention to help the patient communicate is to

• ask questions that the patient can

answer with "yes" or "no."

• develop a list of words that the

patient can read and practice reciting.

• have the patient practice her facial

and tongue exercises with a mirror.

• prevent embarrassing the patient

by answering for her if she does not respond.

• Communication will be facilitated and less

frustrating to the patient when questions that require a "yes" or "no" response are used. When the language areas of the brain are injured, the patient might not be able to read or recite words, which will frustrate the patient without improving communication. Expressive aphasia is caused by damage to the language areas of the brain, not by the areas that control the motor aspects of speech.The nurse should allow time for the patient to respond.