CVA QUESTIONS FOR EXAM II

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.

a. African Americans a. Receptive aphasia is characterized by a lack of

b. Women who smokes comprehension of both written and verbal
c. Individuals with hypertension and diabetes language. TRUE Receptive aphasia is when
d. Those who are obese with increased dietary intake neither the sounds of speech nor its meaning can
to fat be understood.
b. Dysarthria results from a disturbance in the Brocas
2. One thing that may lead to decreased blood flow to
area and is an impairment in speaking and
the brain and the development of atherosclerotic
writing..FALSE Brocas area of the brain cause
plaquing in cerebral vessels is?
expressive aphasia (difficulty in speaking and
a. Chronic anemia writing).
b. Chronic hypercapnia c. A lesion that affects both Wernicks and Brocas
c. Development of collateral circulation area is most likely to cause global asphasia..TRUE
d. Congenital cerebrovascular anomalies d. A non-fluent dysphasia is characterized by the
presence of speech that contains little meaningful
3. Match the characteristics with the appropriate types
communication..TRUE
of stroke.
e. The long-term effect of paralysis of an extremity
resulting from a stroke is flaccidity.FALSE
Spasticity

8. A patient is scheduled for a carotid endarterectomy.

The nurse explains to the patient that this surgery.

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
4. A patient with right sided paresthias and hemiparesis artery with a balloon to restore cerebral
is hospitalized. In 24 hours, the patients symptoms are circulation.
unchanged. In planning care for the patient, the nurse
recognizes that the patient.. 9. An essential intervention in the emergency
management of a stroke patient is?
a. Is ready for aggressive rehabilitation
b. Can be expected to recover with minimal residual a. IV fluid replacement
effects b. Administration of osmotic diuretics to reduce
c. Has experienced a TIA that is a warning sign of a cerebral edema
more serious stroke. c. Initiation of hypothermia to decrease oxygen
d. Will show signs of deteriorating neurologic needs of the brain.
function as edema increases. d. Maintenance of the respiratory function with a
patent airway and oxygen airway and oxygen
5. The neurologic functions that are affected by a stroke administration.
are primarily r/t?
10. A diagnosis of ruptured cerebral aneurysm has been
a. The amount of tissue area involved made in a patient with manifestations of a stroke. The
b. The rapidity of the onset of symptoms nurse anticipates that the treatment options that would
c. The brain area perfused by the effected artery be evaluated for this patient includes?
d. The presence or absence of collateral circulation
a. Hyperventilation therapy
6. Indicate whether the following manifestations of a b. Surgical clipping of aneurysm
stroke are more likely to occur with right brain damage c. Administration of hyperosmotic agents
or left brain damage? d. Administration of thrombolytics
a. Aphasia Left side 11. During the acute phase of a stroke, the nurse
assesses the patients VS and neurostatus every 4 hours.
b. Left homonymous hemianopia Right side
A stroke in evolution would be manifested by?
c. Agnosia Right side
a. Stabilization of neurologic signs within 24 hours.
d. Quick and impulsive behavior Right side b. Bilateral motor and sensory deficits of all
extremities.
e. Inability to remember words Left side c. Absence of s/s of neurological deficits within 24
f. Neglect of the left side of body Right side hours.
d. Intermittent progression of deteriorating d. patch pts affected eye to encourage pt to turn
neurological status for up to 72 hours. head to scan environment

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:

13. The use of a clinical pathway for a pt with a a. fruit juices

stroke:
b. pureed beef
a. eliminates the need for continued documentation of
c. scrambled eggs
care
d. fortified milkshakes
b. is a specific standardized NCP for the pt and the
family 20 A pt who has suffered a stroke is experiencing
urinary incontinence. Nursing management of the pt
c. requires that a pt with a stroke is D/C'd on the 4th day
includes:
d. directs the healthcare team in daily interventions
a) limiting fluid intake
needed to meet D/C outcomes
b) ambulating pt to bathroom q 4 hr
14. During the acute phase of a stroke, the nurse c) determining the pattern and cause
assesses the pts vs. and neuro status q 4 hr. A stroke- d) using incontinence briefs to reduce effects of
in-evolution would be manifested by: incontinence

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
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
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 doesnt 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 pts rehab it is important that the
nurse:
a. avoid positioning pt on the effected side
b. place objects on pts unaffected side
c. teach pt to consciously care for the affected side

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 pts vision
b. approach pt from left side to encourage pt to turn
head
c. place objects on pts left side to assess pts ability
to compensate
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 Johns 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 Johns 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 Johns
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?
patient should learn techniques to monitor and
maintain physical wellness
demonstrate self-care skills
exhibit problem solving skills with self-care
avoid complications associated with stoke.
establish and maintain a useful communication system
maintain nutritional and hydration status
list community resources for equipment, supplies, and
support
establish flexible role behaviors to promote family
cohesiveness
8. Based on the assessment data provided, write one
or more nursing diagnoses. Are there any collaborative
problems?
impaired verbal communication
self-care deficits R/T homonymous hemianopsia
self-esteem disturbance
energy field disturbance