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Understanding Medical Surgical Nursing 4th Edition Williams Hopper Test Bank

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Understanding Medical Surgical Nursing 4th Edition Williams Hopper Test Bank

ISBN-13: 978-0-8036-2219-7

 

 

Description

Understanding Medical Surgical Nursing 4th Edition Williams Hopper Test Bank

ISBN-13: 978-0-8036-2219-7

 

 

 

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Chapter 49. Nursing Care of Patients With Cerebrovascular Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   The nurse is caring for a patient admitted to the emergency department with right-sided weakness and difficulty speaking. Within an hour, the symptoms have subsided, and the patient receives a diagnosis of transient ischemic attack (TIA). The patient asks, “What is a TIA?” What information should be included when assisting with teaching the patient about TIA?

a. “Your brain was temporarily deprived of oxygen.”
b. “You had a small hemorrhage in your brain.”
c. “You have a vessel that is occluded, blocking the blood supply to your brain.”
d. “The neurons in your brain are tangled, so messages get mixed up.”

 

 

____     2.   The nurse is assisting with teaching a patient who has had a transient ischemic attack (TIA). On which understanding should a nurse base teaching?

a. TIAs are not serious, and the patient should have no further problems.
b. A TIA is predictive that the patient will have a heart attack within 1 year.
c. A TIA is a forewarning that the patient is at risk for a cerebrovascular accident (stroke).
d. A TIA is a medical emergency that requires immediate surgical intervention.

 

 

____     3.   Which area of the brain is affected in a patient who has right-sided weakness and aphasia due to a transient ischemic attack (TIA)?

a. Right hemisphere
b. Left hemisphere
c. Occipital lobe
d. Medulla

 

 

____     4.   A patient is admitted to a medical unit with a cerebrovascular accident (stroke). The patient is flaccid on the left side and is unable to speak but seems to understand everything the nurse says. Which of the following terms would the nurse use to document the patient’s communication impairment?

a. Sensory aphasia
b. Expressive aphasia
c. Motor dysphagia
d. Receptive dysphagia

 

 

____     5.   Which term describes left-sided flaccidity in a patient who has had a stroke?

a. Ipsilateral paraplegia
b. Contralateral quadriparesis
c. Contralateral hemiplegia
d. Ipsilateral hemiparesis

 

 

____     6.   A patient presents in the emergency department with symptoms of a stroke. Which of the following medications would the nurse expect may be given to the patient if diagnostic testing confirms an ischemic stroke?

a. Heparin
b. Warfarin (Coumadin)
c. Clopidogrel (Plavix)
d. Tissue-type plasminogen activator (tPA)

 

 

____     7.   Some patients are placed on antiplatelet agents to prevent strokes. Which agent is an example of an antiplatelet agent?

a. Acetaminophen (Tylenol)
b. Warfarin (Coumadin)
c. Aspirin
d. Tissue-type plasminogen activator (tPA)

 

 

____     8.   The nurse is providing care for a patient with symptoms of impending stroke who is scheduled to have a cerebral angiogram. Which of the following statements would the nurse include when assisting with patient teaching?

a. “This test is done to examine cerebrospinal fluid for signs of bleeding.”
b. “The angiogram is done to help identify swelling in the brain.”
c. “This test is designed to detect vascular lesions in the brain.”
d. “We need to do this to evaluate electrical function of the brain.”

 

 

____     9.   The nurse is caring for a hospitalized patient who has had a stroke and is waiting to be transferred to a rehabilitation facility. What nursing action can best maximize the patient’s rehabilitation potential while awaiting the transfer?

a. Teach the patient what to expect at the rehabilitation facility.
b. Keep the patient on bedrest to conserve energy for rehabilitation.
c. Turn the patient every 2 hours to prevent pressure ulcers and contractures.
d. Call the physical therapist for bedside rehabilitation until the transfer.

 

 

____   10.   The nurse is assisting in preparing a patient for transfer to a rehabilitation facility after a stroke. What is most likely the goal for rehabilitation?

a. To cure any effects of the stroke
b. To maximize remaining abilities
c. To monitor neurological status
d. To determine the extent of neurological deficits

 

 

____   11.   A patient is admitted to the hospital with a severe headache and photophobia. A lumbar puncture confirms a bleeding aneurysm. What nursing interventions should the nurse anticipate assisting with to prevent increased intracranial pressure (ICP) during the acute phase of illness?

a. Quiet room, head of bed up, and stool softeners
b. Morphine, dark glasses, and expectorants
c. Range of motion exercises, bedside commode, and suctioning as needed
d. Coughing and deep breathing exercises and tranquilizers

 

 

____   12.   The nurse is caring for a patient admitted to the intensive care unit with a subarachnoid bleed. Vital signs are as follows: blood pressure (BP) 120/74 mm Hg, pulse 70 beats/min, and respirations 16 breaths/min. Several hours later, the patient requests help to have a bowel movement. The patient refuses a bedpan and asks to use a bathroom. When told that this is not possible, the patient becomes angry and belligerent and starts yelling at the nurse. Vital signs are now BP 160/60 mm Hg, pulse 48 beats/min, and respirations 12 breaths/min. The neurosurgeon has been paged but has not yet responded. With which of the following actions should the LPN anticipate assisting the RN?

a. Waiting for the neurosurgeon to call back with orders
b. Administering an as-needed dose of a sedative that is ordered
c. Helping the patient to get up on a bedside commode
d. Paging security to restrain the patient from harming the nurse

 

 

____   13.   A patient experiencing bilateral hemiparesis, dysphasia, visual changes, altered level of consciousness, ataxia, and dysphagia has most likely had a stroke involving which artery?

a. Carotid
b. Vertebrobasilar/cerebellar
c. Middle cerebral
d. Posterior cerebral

 

 

____   14.   Which type of cerebrovascular accident has the slowest rate of recovery and the highest probability of causing extensive neurological deficits?

a. Reversible ischemic neurological deficit (RIND)
b. Cerebral aneurysm
c. Subarachnoid hemorrhage (SAH)
d. Thrombotic stroke

 

 

____   15.   A patient enters the emergency department with right-sided weakness and vision changes. What assessment finding should be communicated to the RN or physician immediately?

a. Blood pressure 148/92 mm Hg
b. Onset of symptoms occurred 90 minutes ago
c. Blood glucose 150 mg/dL
d. History of transient ischemic attack (TIA) 3 months ago

 

 

____   16.   The nurse is providing care for a patient recently admitted with transient ischemic attack (TIA). Which of the following statements indicates that further teaching is required?”

a. “My risk for Alzheimer’s disease is increased now, so I’ll have to stop driving.”
b. “The risk factors and symptoms of a TIA are just like those of a stroke.”
c. “I recognize how important it is to take my anti-hypertension medications regularly.”
d. “I need to stop smoking to help lower my chances of this happening again.”

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____   17.   The nurse is assisting with a community education program about stroke prevention. Which of the following are nonmodifiable risk factors for stroke that the nurse should include? (Select all that apply.)

a. Gender
b. Diabetes
c. Heredity
d. Elevated blood lipids
e. Smoking
f. Obesity

 

 

____   18.   The nurse is providing care for a patient with expressive aphasia. Which of the following would the nurse expect to find in the patient’s plan of care? (Select all that apply.)

a. Speak loudly.
b. Gesture or pantomime the message.
c. Speak slowly and clearly.
d. Provide pencil and paper.
e. Obtain an interpreter.
f. Use a picture board.

 

 

____   19.   Which of the following demographic groups are at higher than average risk of stroke? (Select all that apply.)

a. African Americans
b. American Indians
c. Men and women 75 years old or older
d. Asian Americans
e. Pregnant women
f. Individuals who have had a transient ischemic attack (TIA)

 

 

____   20.   The nurse is involved in a blood pressure clinic in the community, and an individual with possible stroke symptoms is brought for evaluation. Which of the following findings in the F.A.S.T. assessment indicate the need to call emergency personnel? (Select all that apply.)

a. When asked to close the eyes and hold arms straight in front, one arm drifts downward.
b. The patient sways when asked to stand still with eyes closed.
c. The patient is unable to repeat a stated phrase exactly as it was stated.
d. The patient’s face shows signs of uneven symmetry when asked to smile.
e. The patient is unable to follow directions during the assessment.

 

 

____   21.   A patient has been prescribed pravastatin (Pravachol) to reduce cholesterol level after having a transient ischemic attack (TIA). What possible side effects should the nurse include in teaching the patient about this drug? (Select all that apply.)

a. Muscle aches
b. Confusion
c. Purple toe
d. Diarrhea
e. Irritability
f. Heartburn

 

 

____   22.   The LPN has been asked to help a patient eat who has impaired swallowing due to a stroke. What should be included in the plan of care? (Select all that apply.)

a. Place the patient in high Fowler’s position or in a chair for meals.
b. Offer the patient a straw for liquids.
c. Stay with the patient during meals.
d. Instruct the patient to try to chew on both sides of the mouth.
e. Have suction equipment available.
f. Encourage the patient to eat slowly.

 

 

____   23.   The nurse is assisting with a community education program related to cerebral vascular accidents. Which of the following would be included in a list of symptoms that should prompt immediate medical attention? (Select all that apply.)

a. Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
b. Sudden confusion, trouble speaking, or understanding
c. Sudden trouble seeing in one or both eyes
d. Sudden loss of hearing, ringing in the ears, or stabbing ear pain
e. Sudden trouble walking, dizziness, or loss of balance or coordination
f. Sudden severe headache with no known cause

 

 

Completion

Complete each statement.

 

  1. For thrombolytic medications to be effective in reversing stroke symptoms, they must be administered within ____________________ hour(s) of onset of symptoms.

 

  1. The nurse is caring for a patient admitted with new onset stroke symptoms. The nurse is aware that in order to maximize functioning and limit long-term complications, the patient should be mobilized within ____________________ hour(s).

 

 

Chapter 49. Nursing Care of Patients With Cerebrovascular Disorders

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  A

TIA is a temporary impairment of the cerebral circulation causing neurological impairment that lasts less than 24 hours. A hemorrhage would cause a hemorrhagic stroke. A fully occluded vessel causes an ischemic stroke. Tangled messages refers to Alzheimer’s disease.

 

PTS:   1                    DIF:    Easy               REF:   Page 1190

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 1

 

  1. ANS:  C

About a third of patients who experience a TIA will have a stroke in the future. Urgent evaluation of TIA is essential in order to decrease the risk of stroke. There are no data related to myocardial infarction (MI) prediction. It is not a surgical problem.

 

PTS:   1                    DIF:    Easy               REF:   Page 1190

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Comprehension | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 1

 

  1. ANS:  B

Symptom onset is sudden and generally involves one side of the body—the side of the body opposite to the damaged area.

 

PTS:   1                    DIF:    Easy               REF:   Page 1190

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 1

 

  1. ANS:  B

Aphasia may be expressive, in which the patient knows what he or she wants to say but cannot speak or make sense, or may be receptive, with an inability to understand spoken or written words. The patient experiencing receptive aphasia is unable to understand language. Dysphagia refers to difficulty swallowing.

 

PTS:   1                    DIF:    Easy               REF:   Page 1190

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 5

 

  1. ANS:  C

Ipsilateral means the same side. A patient with a stroke has symptoms on the opposite side of the stroke, which is called contralateral. One-sided flaccidity is called hemiplegia. Quad refers to all four extremities; para refers to the lower extremities.

 

PTS:   1                    DIF:    Medium         REF:   Page 1192

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 1

 

  1. ANS:  D

tPA is a thrombolytic agent that can break down the thrombus causing the occlusion, which can potentially prevent or completely reverse the symptoms of an ischemic stroke. Heparin, warfarin, and clopidogrel can help prevent clots but are not effective in breaking up an existing clot.

 

PTS:   1                    DIF:    Easy               REF:   Page 1194

KEY:  Client Need: PHYS—Pharmacological Therapies | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 2

 

  1. ANS:  C

Aspirin is a platelet aggregation inhibitor. Tylenol is an analgesic but does not affect platelet function. Warfarin is an anticoagulant, and tPA is a thrombolytic agent.

 

PTS:   1                    DIF:    Easy               REF:   Page 1195

KEY:  Client Need: PHYS—Pharmacological Therapies | Cognitive Level: Recall | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 3

 

  1. ANS:  C

A cerebral angiogram may be completed to determine the patency of cerebral vessels and the status of any collateral circulation. A lumbar puncture is done to examine cerebrospinal fluid (CSF). Edema may be identified by radiography. An electroencephalogram (EEG) shows electrical function.

 

PTS:   1                    DIF:    Easy               REF:   Page 1198

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 2

 

  1. ANS:  D

Rehabilitation should begin as soon as the patient is stable. Waiting until the patient is at the rehabilitation facility to begin therapy wastes valuable time.

 

PTS:   1                    DIF:    Easy               REF:   Page 1197

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 3

 

  1. ANS:  B

Rehabilitation can help the patient maximize remaining abilities. At this point, the patient’s neurological status should be stable, and all the diagnostic work has been completed. Cure is not realistic.

 

PTS:   1                    DIF:    Easy               REF:   Page 1199

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 4

 

  1. ANS:  A

A quiet room with minimal stressors, elevated head, and stool softeners can help reduce ICP. Morphine and tranquilizers are not usually recommended because they can make neurological assessment difficult. Expectorants can promote coughing, which can raise ICP. Exercises, moving, and suctioning can also raise ICP.

 

PTS:   1                    DIF:    Easy               REF:   Page 1194

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5

 

  1. ANS:  B

Patients with subarachnoid hemorrhage are at risk for rebleeding. Straining to have a bowel movement and agitation both increase the risk of rebleed. The patient may need to be sedated until the physician can be contacted. Bringing in security will be upsetting to the patient and can also increase the risk of raising the BP and bleeding.

 

PTS:   1                    DIF:    Medium         REF:   Page 1198

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5

 

  1. ANS:  B

These are symptoms of vertebrobasilar/cerebellar occlusion. Carotid and middle cerebral occlusions are not associated with ataxia or dysphagia.

 

PTS:   1                    DIF:    Hard              REF:   Page 1192

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 1

 

  1. ANS:  C

SAH is caused by rupture of blood vessels on the surface of the brain. This type of infarct has the slowest rate of recovery and the highest probability of leaving the patient with extensive neurological deficits. Aneurysms are often asymptomatic if they do not bleed. RIND is reversible.

 

PTS:   1                    DIF:    Medium         REF:   Page 1197

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 1

 

  1. ANS:  B

All the data are significant. However, the onset of symptoms is within the time frame for the patient to receive a thrombolytic. If the nurse acts quickly, the patient’s stroke may be able to be reversed.

 

PTS:   1                    DIF:    Hard              REF:   Page 1194

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Analysis | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5

 

  1. ANS:  A

The risk factors, causes, and symptoms of a TIA are identical to a cerebrovascular accident (CVA). Patients who have had a TIA have an increased risk of having a stroke. Treatment, therefore, is mostly focused on minimizing the patient’s risk factors for a stroke. Modifiable risk factors are those risks that can be changed by treatment, such as treating high blood pressure, or by lifestyle modification, such as stopping smoking. There is no association between TIA and the development of Alzheimer’s disease.

 

PTS:   1                    DIF:    Medium         REF:   Page 1195

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 3

 

MULTIPLE RESPONSE

 

  1. ANS:  A, C

The patient can control diabetes, heart disease, diet, exercise, lipids, and smoking to some degree. Gender and heredity are not modifiable.

 

PTS:   1                    DIF:    Medium         REF:   Page 1191

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Recall | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 1

 

  1. ANS:  D, F

Try pencil and paper or a picture board. Speaking loudly is not helpful unless the patient has a hearing deficit also. Speaking slowly and pantomiming may be helpful for receptive aphasia, not expressive. Interpreters are used for language barriers, not for aphasia.

 

PTS:   1                    DIF:    Medium         REF:   Page 1192

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Communication and Documentation | Question to Guide Your Learning: 5

 

  1. ANS:  A, B, C, E, F

Some population groups, such as African Americans, American Indians, Alaskan natives, and Mexican Americans, have a higher than average risk. Recent studies indicate that the risk of stroke may be higher in women during pregnancy and the 6 weeks following childbirth. Patients who have had a TIA have an increased risk of having a stroke; about 24% to 29% of patients who experience a TIA will have a stroke within 5 years. Strokes are most common in people over the age of 75. Asian Americans are not as high risk.

 

PTS:   1                    DIF:    Medium         REF:   Page 1190

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Comprehension | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 1

 

  1. ANS:  A, C, D

The acronym F.A.S.T. can help identify a stroke. Ask the person to smile: If the face droops or is uneven on one side, it is abnormal. Ask the person to close his or her eyes and hold arms out in front of him or her: If an arm cannot be raised or drifts downward, it is abnormal. Ask the person to say “It is a bright and sunny day”: Any difficulty understanding or speaking is abnormal. Call 911 immediately for any abnormal findings. These are all indicators of a possible stroke. Brain cells may be dying. Inability to follow instructions is a concern but is not part of the F.A.S.T. assessment.

 

PTS:   1                    DIF:    Medium         REF:   Page 1192

KEY:  Client Need: PHYS—Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 1

 

  1. ANS:  A, D, E, F

Muscle pain or aches can signal a serious side effect (rhabdomyolysis) and should be reported. Diarrhea can cause electrolyte imbalances and should also be reported. Irritability, heartburn, hepatitis, dizziness, and headache may also occur. Purple-toe syndrome can occur with warfarin. Confusion is not a side effect of statins.

 

PTS:   1                    DIF:    Medium         REF:   Page 1195

KEY:  Client Need: PHYS—Pharmacological Therapies | Cognitive Level: Recall | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 3

 

  1. ANS:  A, C, E, F

High Fowler’s position can help reduce aspiration risk. The nurse should stay with the patient and be prepared to use suction in case aspiration does occur. Straws and thin liquids increase risk of aspiration. The patient should chew on the unaffected side; if he or she chews on the affected side, it is difficult to sense the food, and pocketing may occur. Patients should be encouraged to eat slowly and chew his or her food thoroughly.

 

PTS:   1                    DIF:    Medium         REF:   Page 1195

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Application | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 5

 

  1. ANS:  A, B, C, E, F

The five signs or symptoms recognized by the American Heart Association/American Stroke Association include sudden numbness or weakness of face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or understanding; sudden trouble seeing in one or both eyes; sudden trouble walking, dizziness, or loss of balance or coordination; and sudden severe headache with no known cause.

 

PTS:   1                    DIF:    Medium         REF:   Page 1191

KEY:  Client Need: Physiological Adaptation | Cognitive Level: Application | Integrated Processes: Teaching and Learning | Question to Guide Your Learning: 1

 

COMPLETION

 

  1. ANS:

3

If patients experiencing ischemic stroke symptoms receive treatment within 3 hours of symptom onset, they may be able to receive medication that has the potential to resolve their deficits fully.

 

PTS:   1                    DIF:    Medium         REF:   Page 1194

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Recall | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 2

 

  1. ANS:

24

Patients should be mobilized within 24 hours if possible to prevent complications of immobility. Physical and occupational therapy are provided to maximize functioning and to progress the patient toward a return to baseline functioning.

 

PTS:   1                    DIF:    Medium         REF:   Page 1196

KEY:  Client Need: PHYS—Reduction of Risk Potential | Cognitive Level: Recall | Integrated Processes: Clinical Problem-Solving Process | Question to Guide Your Learning: 3