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1. In promoting health maintenance for prevention of 7. True of False: If the answer is false, correct it to make
strokes, the nurse focuses teaching toward? it true.
12. A dx of ruptured cerebral aneurysm has been 18. 4 days following a stroke a pt is to start on PO fluids
made in a pt with manifestations of a stroke. The nurse & feedings. Before starting PO feedings the nurse
anticipates that tx options that wouldve evaluated for should first:
this pt include:
a. check pts gag reflex
a. hyperventilation therapy
b. order soft diet
b. surgical clipping of aneurysm
c. raise HOB
c. admin of hyperosmotic agent
d. eval pts ability to swallow sips of ice and water
d. admin of thrombolytic agents
19. An appropriate food for a pt with a stroke who has
mild dysphasia is:
a. stabilization of neuro signs within 24 hrs 21. (p 1665-68) To promote communication during
rehab of the pt with aphasia an appropriate nursing
b. bilateral motor and sensory deficits of all intervention is to:
extremities
a. use gestures, pictures, music to stimulate
c. absence of signs or symptoms of neurological response
deficit within 24 hrs
b. talk about ADLs that are familiar to the pt
d. intermittent progression of deteriorating
neurological status for up to 72 hrs c. structure statements so pt doesnt have to
respond verbally
16. (p 1663-65) A nursing intervention that is indicated
for the patient with hemiplegia is: d. use flash cards with simple words and pictures to
promote language recall
a. the use of a footboard to prevent plantar flexion
no, it can actually cause a problematic neuro response 22. A pt with rt. hemisphere stroke has a nursing
diagnosis of unilateral neglect R/T sensory perceptual
b. immobilization of effected arm against the chest deficits. During the pts rehab it is important that the
with a sling no, will cause atrophy nurse:
c. positioning the pt in bed with every joint lower a. avoid positioning pt on the effected side
than the joint proximal to it no, elevate
b. place objects on pts unaffected side
d. having the pt perform passive ROM of the
affected limb with the unaffected limb c. teach pt to consciously care for the affected side
17. A newly admitted pt who has suffered a rt. d. protect the affected side from injury with pillows
hemisphere stroke has a nursing dx of and supports
sensory/perceptual alteration rt. visual deficit. Early in 23. A pt with a stroke has rt. sided hemiplegia. The
the care of the pt the nurse should: nurse prepares family members to help control behavior
a. place objects on rt. side within pts vision changes seen with this type of stroke by teaching them
to:
b. approach pt from left side to encourage pt to turn
head c. distract the pt from inappropriate emotional
responses
c. place objects on pts left side to assess pts ability
to compensate 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 4. What strategies might the home health nurse use
significance of residual stroke damage to promote to help John and his family cope with his emotional
problem solving and planning lability?
25. List 3 potential problems R/T the geriatric stroke Loss of function can and often does lead to depression.
pt: OT and PT consults could help John by offering new
ways to do the old tasks. This can be accomplished
1. caregiver role strain
through devices (such as modified utensils, cups, etc.)
2. dec ADL function, return to prior function less and through motor training. Helping John get back near
likely & more difficult his prior level of functioning should help him
emotionally.
3. Erikson, task unfulfilled ego vs. integrity (dec
integrity), despair, inc dependency, change in spouse
now pt relationship
5. What lifestyle changes should John make to reduce
26. Answer first 3 questions R/T the critical thinking the likelihood of another stroke?
case study p. 1669 in text
Quit smoking and drinking, get his HTN under control
1. >75 nonmodifiable, obesity, dec activity, poor diet, and get on a better diet and possibly an exercise
smoker, drinker, HTN if good control = prevention. MI routine.
9% chance repeat within 6 yrs
Drinker
HTN good control of HTN is considered most 7. What factors should the nurse assess for in relation
significant therapy in prevention of strokes. to further outpatient rehabilitation for John?
MI 9% chance that man will have a stroke within 6 patient should learn techniques to monitor and
years of MI maintain physical wellness
2. Are Johns reported symptoms and behaviors exhibit problem solving skills with self-care
typical of a person having a right brain stroke? avoid complications associated with stoke.
Yes, but the symptoms could be much worse. establish and maintain a useful communication system
ie. Paralyzed left side, left sided neglect, spatial- maintain nutritional and hydration status
perceptual deficits, etc.
list community resources for equipment, supplies, and
support
3. How can John and his family address activity issues establish flexible role behaviors to promote family
such as driving after the stroke? cohesiveness
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- 8. Based on the assessment data provided, write one
perceptual deficits, tendency to deny or minimize or more nursing diagnoses. Are there any collaborative
problems, rapid performance, short attention span, problems?
impulsiveness, safety problems, impaired judgment, and impaired verbal communication
impaired time concepts. John is not safe behind the
wheel of a car, and his family should try and work out self-care deficits R/T homonymous hemianopsia
other arrangements for his transportation. He might,
self-esteem disturbance
however, be able to drive a golf cart with supervision.
energy field disturbance