Nokea
The health care provider recommends a carotid endarterectomy for a patient with carotid atherosclerosis and a history of transient ischemic attacks (TIA). The patient asks the nurse to describe the procedure. Which of the following responses by the nurse is appropriate?
- A. The carotid endarterectomy involves surgical removal of plaque from an artery in the neck.
- B. The diseased portion of the artery in the brain is removed and replaced with a synthetic graft.
- C. A wire is threaded through an artery in the leg to the clots in the carotid artery and the clots are removed.
- D. A catheter with a deflated balloon is positioned at the narrow area, and the balloon is inflated to flatten the plaque.
Correct Answer: A
Rationale: 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 removed' 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 MERCI procedure.
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The nurse is caring for a patient who had a stroke and is in the acute phase of care. Which of the following systems is priority?
- A. Neurological system
- B. Respiratory system
- C. Gastro-intestinal system
- D. Genito-urinary system
Correct Answer: B
Rationale: During the acute phase following a stroke, management of the respiratory system is a nursing priority. Stroke patients are particularly vulnerable to respiratory problems as it has been shown that respiratory muscle strength decreases following stroke. Advancing age and immobility increase the risk for atelectasis and pneumonia.
The nurse is receiving a change-of-shift report. Which of the following patients should the nurse see first?
- A. A patient with right-sided weakness who has an infusion of tPA prescribed
- B. A patient who has atrial fibrillation and a new prescription for warfarin
- C. A patient who experienced a transient ischemic attack yesterday who has a dose of Aspirin due
- D. A patient with a subarachnoid hemorrhage 2 days ago who has nimodipine scheduled
Correct Answer: A
Rationale: tPA needs to be infused within the first few hours after stroke symptoms start in order to be effective in minimizing brain injury. The other medications also should be given as quickly as possible, but timing of the medications is not as critical.
The nurse is caring for a patient who has had a stroke and has a new prescription to attempt oral feedings. After assessing the patient's gag reflex, which of the following actions should the nurse do next?
- A. Order a varied puréed diet.
- B. Assess the patient's appetite.
- C. Assist the patient into a chair.
- D. Offer the patient a sip of juice.
Correct Answer: C
Rationale: The patient should be as upright as possible before attempting feeding to make swallowing easier and decrease aspiration risk. To assess swallowing ability, the nurse should initially offer water or ice to the patient. Puréed diets are not recommended because the texture is too smooth. The patient may have a poor appetite, but the oral feeding should be attempted regardless.
The nurse is caring for a patient with sudden-onset right-sided weakness who has a CT scan and is diagnosed with an intracerebral hemorrhage. Which of the following information about the patient is most important to communicate to the health care provider?
- A. The patient's speech is difficult to understand.
- B. The patient's blood pressure is 144/90 mm Hg.
- C. The patient takes a diuretic because of a history of hypertension.
- D. The patient has atrial fibrillation and takes warfarin.
Correct Answer: D
Rationale: The use of warfarin will have contributed to the intracerebral bleeding and remains a risk factor for further bleeding. Administration of vitamin K is needed to reverse the effects of the warfarin, especially if the patient is to have surgery to correct the bleeding. The history of hypertension is a risk factor for the patient but has no immediate effect on the patient's care. The BP of 144/90 indicates the need for ongoing monitoring but not for any immediate change in therapy. Slurred speech is consistent with a left-sided stroke, and no change in therapy is indicated.
A patient who has a history of a transient ischemic attack (TIA) has an order for Aspirin 160 mg daily. When the nurse is administering the medications, the patient says, 'I don't need the Aspirin today. I don't have any aches or pains.' Which of the following actions should the nurse take?
- A. Document that the Aspirin was refused by the patient.
- B. Tell the patient that the Aspirin is used to prevent aches.
- C. Explain that the Aspirin is ordered to decrease stroke risk.
- D. Call the health care provider to clarify the medication order.
Correct Answer: C
Rationale: Aspirin is ordered to prevent stroke in patients who have experienced TIA. Documentation of the patient's refusal to take the medication is an inadequate response by the nurse. There is no need to clarify the order with the health care provider. The Aspirin is not ordered to prevent aches and pains.