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A patient diagnosed with a hemorrhagic stroke has been admitted to the neurologic ICU. The nurse knows that teaching for the patient and family needs to begin as soon as the patient is settled on the unit and will continue until the patient is discharged. What will family education need to include?
- A. How to differentiate between hemorrhagic and ischemic stroke
- B. Risk factors for ischemic stroke
- C. How to correctly modify the home environment
- D. Techniques for adjusting the patients medication dosages at home
Correct Answer: C
Rationale: Home environment modifications support the patient's disability needs post-stroke. Stroke differentiation and medication adjustments are not family responsibilities.
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A female patient is diagnosed with a right-sided stroke. The patient is now experiencing hemianopsia. How might the nurse help the patient manage her potential sensory and perceptional difficulties?
- A. Keep the lighting in the patients room low.
- B. Place the patients clock on the affected side.
- C. Approach the patient on the side where vision is impaired.
- D. Place the patients extremities where she can see them.
Correct Answer: D
Rationale: Placing extremities in the intact visual field reduces neglect in hemianopsia. Approaching on the intact side and keeping lighting adequate also help.
During a patients recovery from stroke, the nurse should be aware of predictors of stroke outcome in order to help patients and families set realistic goals. What are the predictors of stroke outcome? Select all that apply.
- A. National Institutes of Health Stroke Scale (NIHSS) score
- B. Race
- C. LOC at time of admission
- D. Gender
- E. Age
Correct Answer: A,C,E
Rationale: NIHSS score, LOC, and age predict stroke outcomes. Race and gender are not significant predictors.
Stroke after a major ischemic stroke, a possible complication is cerebral edema. Nursing care during the immediate recovery period from an ischemic stroke should include which of the following?
- A. Positioning to avoid hypoxia
- B. Maximizing PaCO2
- C. Administering hypertonic IV solution
- D. Initiating early mobilization
Correct Answer: A
Rationale: Positioning to avoid hypoxia reduces ICP in ischemic stroke recovery. High PaCO2 and early mobilization increase ICP; hypertonic saline is for hyponatremia.
When preparing to discharge a patient home, the nurse has met with the family and warned them that the patient may exhibit unexpected emotional responses. The nurse should teach the family that these responses are typically a result of what cause?
- A. Frustration around changes in function and communication
- B. Unmet physiologic needs
- C. Changes in brain activity during sleep and wakefulness
- D. Temporary changes in metabolism
Correct Answer: A
Rationale: Emotional responses post-stroke often stem from frustration with functional and communication deficits. Other causes should be ruled out.
A patient has been admitted to the ICU after being recently diagnosed with an aneurysm and the patients admission orders include specific aneurysm precautions. What nursing action will the nurse incorporate into the patients plan of care?
- A. Elevate the head of the bed to 45 degrees.
- B. Maintain the patient on complete bed rest.
- C. Administer enemas when the patient is constipated.
- D. Avoid use of thigh-high elastic compression stockings.
Correct Answer: B
Rationale: Complete bed rest reduces BP and bleeding risk in aneurysms. HOB elevation varies, enemas are avoided, and compression stockings are often used.