Chapter 60: Nursing Management: Stroke
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who experiences a brief episode of tinnitus, diplopia, and
dysarthria with no residual effects. Which of the following actions should the nurse
anticipate as treatment for this client?
a. Prophylactic clipping of cerebral aneurysms
b. Heparin via continuous intravenous infusion
c. Oral administration of low dose Aspirin therapy
d. Therapy with tissue plasminogen activator (tPA)
ANS: C
The client’s symptoms are consistent with transient ischemic attack (TIA), and drugs that
inhibit platelet aggregation are prescribed after a TIA to prevent stroke. Continuous
heparin infusion is not routinely used after TIA or with acute ischemic stroke. The client’s
symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic
stroke, not for TIA.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a client who has recently had a stroke. When reviewing the clients’
laboratory report, which of the following results should the nurse report the health care
provider?
a. PaCO2 51 mm Hg
b. pH 7.41
c. PaO2 96 mm Hg
d. WBC 9.2 ´ 109/L
ANS: A
All of the lab values are within normal range except for the PaCO2. A high PaCO2 is a
potent vasodilator that increases cerebral blood flow.
DIF: Cognitive Level: Analysis TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is admitting a client who had a stroke and is experiencing right-sided arm and
leg paralysis and facial drooping on the right side. Which of the following clinical
manifestations should the nurse expect to find?
a. Impulsive behaviour
b. Right-sided neglect
c. Hyperactive left-sided reflexes
d. Difficulty in understanding commands
ANS: D
Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with
comprehension and use of language. The left-side reflexes are likely to be intact.
Impulsive behaviour and neglect are more likely with a right-side stroke.
, DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
4. The nurse receives a verbal report that a client has an occlusion of the left posterior
cerebral artery. Which of the following findings should the nurse anticipate?
a. Dysphasia
b. Confusion
c. Visual deficits
d. Poor judgement
ANS: C
Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs
with middle cerebral artery involvement. Cognitive deficits and changes in judgement are
more typical of anterior cerebral artery occlusion.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
5. The health care provider prescribes clopidogrel for a client with cerebral atherosclerosis.
Which of the following information should the nurse include when teaching the client
about the new medication?
a. Monitor and record the blood pressure daily.
b. Call the health care provider if stools are tarry.
c. It will dissolve clots in the cerebral arteries.
d. It will reduce cerebral artery plaque formation.
ANS: B
Plavix inhibits platelet function as it increases the risk for bleeding, so clients should be
advised to notify the health care provider about any signs of bleeding. The medication
does not lower blood pressure, decrease plaque formation, or dissolve clots.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. The health care provider recommends a carotid endarterectomy for a client with carotid
atherosclerosis and a history of transient ischemic attacks (TIAs). The client 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.”
ANS: A
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who experiences a brief episode of tinnitus, diplopia, and
dysarthria with no residual effects. Which of the following actions should the nurse
anticipate as treatment for this client?
a. Prophylactic clipping of cerebral aneurysms
b. Heparin via continuous intravenous infusion
c. Oral administration of low dose Aspirin therapy
d. Therapy with tissue plasminogen activator (tPA)
ANS: C
The client’s symptoms are consistent with transient ischemic attack (TIA), and drugs that
inhibit platelet aggregation are prescribed after a TIA to prevent stroke. Continuous
heparin infusion is not routinely used after TIA or with acute ischemic stroke. The client’s
symptoms are not consistent with a cerebral aneurysm. tPA is used only for acute ischemic
stroke, not for TIA.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
2. The nurse is caring for a client who has recently had a stroke. When reviewing the clients’
laboratory report, which of the following results should the nurse report the health care
provider?
a. PaCO2 51 mm Hg
b. pH 7.41
c. PaO2 96 mm Hg
d. WBC 9.2 ´ 109/L
ANS: A
All of the lab values are within normal range except for the PaCO2. A high PaCO2 is a
potent vasodilator that increases cerebral blood flow.
DIF: Cognitive Level: Analysis TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. The nurse is admitting a client who had a stroke and is experiencing right-sided arm and
leg paralysis and facial drooping on the right side. Which of the following clinical
manifestations should the nurse expect to find?
a. Impulsive behaviour
b. Right-sided neglect
c. Hyperactive left-sided reflexes
d. Difficulty in understanding commands
ANS: D
Right-sided paralysis indicates a left-brain stroke, which will lead to difficulty with
comprehension and use of language. The left-side reflexes are likely to be intact.
Impulsive behaviour and neglect are more likely with a right-side stroke.
, DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
4. The nurse receives a verbal report that a client has an occlusion of the left posterior
cerebral artery. Which of the following findings should the nurse anticipate?
a. Dysphasia
b. Confusion
c. Visual deficits
d. Poor judgement
ANS: C
Visual disturbances are expected with posterior cerebral artery occlusion. Aphasia occurs
with middle cerebral artery involvement. Cognitive deficits and changes in judgement are
more typical of anterior cerebral artery occlusion.
DIF: Cognitive Level: Application TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
5. The health care provider prescribes clopidogrel for a client with cerebral atherosclerosis.
Which of the following information should the nurse include when teaching the client
about the new medication?
a. Monitor and record the blood pressure daily.
b. Call the health care provider if stools are tarry.
c. It will dissolve clots in the cerebral arteries.
d. It will reduce cerebral artery plaque formation.
ANS: B
Plavix inhibits platelet function as it increases the risk for bleeding, so clients should be
advised to notify the health care provider about any signs of bleeding. The medication
does not lower blood pressure, decrease plaque formation, or dissolve clots.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. The health care provider recommends a carotid endarterectomy for a client with carotid
atherosclerosis and a history of transient ischemic attacks (TIAs). The client 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.”
ANS: A
