NURS 355 EXAM III: STROKE ACTUAL QUESTIONS
AND ANSWERS 2024 GRADED A+
Exemplar:
67 year old female, who had a left side-sided stroke 2 weeks ago
What will I see?
Language deficits, issues with speech
Assessments:
Neurological assessment (person, place, time situation)
Exemplar:
Left-sided stroke symptoms:
Hypertonicity
Right-sided weakness
Postural instability
Dysphagia (impaired swallowing)
Aphasia
Unable to communicate: unable to speak and comprehend (pt will not be able to follow
instructions)
Immobility
With this type of aphasia, patients are AWARE of their speaking difficulties, but
often have trouble expressing their thoughts through words or writing.
Expressive aphasia (broca's area)
With this type of aphasia, patients are UNAWARE of their speaking difficulties,
and may speak long sentences with no meaning. They also have difficulty
understanding written/spoken language and have incoherent speech
Receptive aphasia (wernick'es area)
A patient who is experiencing dysphagia should eat:
spoon-thick consistency foods NOT fluid consistency, b/c it reduces the risk of
aspiration
Avoid thin liquids
Use thickeners
(e.g. patient at VA who was using thickened water)
Exemplar:
Signs (motor dysfunction) of patient with left-sided stroke:
Urinary retention: assess PVR
Decreased ventilation
Constipation
Orthostatic hypotension
Exemplar:
Priorities:
1. Patient safety: Ability to swallow: Use a tongue depressant to test their gag reflex,
make sure that the patient is sitting up, avoid giving water
, 2. Neuro assessment: Pupils
3. Cardiopulmonary assessment: assess if there is aspiration, and check for clear lungs,
check for orthostatic hypotension, assess for bilateral pulses
Why do patient's with Parkinson's have orthostatic hypotension?
Low dopamine levels. The neurons are not communicating very well because they have
low dopamine levels
Three reasons why people have orthostatic hypotension:
1. Low blood volume
2. Compliance of blood vessels
3. Neuro deficit: e.g. MS, Parkinson's, spinal cord injuries (in order for compliance to
work, activation of autonomic NS)
What is aphasia?
Unable to understand and express speech
Stroke:
Upper motor neuron dysfunction (hypertonicity)
How to treat post-stroke?
Aspirin (given within 48 hours) after ischemic stroke
Left-sided brain
Spoken/written language
Speech/communication
Numbers, letters
Logical, analysis
Right-sided brain
Nonverbal information (music, images)
Drawing, creativity
Spatial (faces, shapes, maps)
If a person is having a left-sided stroke, all the symptoms will be on the
right side
If a person is having a right-sided stroke, all the symptoms will be on the
left side
Hemiplegia:
Unilateral weakness
Spinal cord injury
example of upper motor tonicity
What is preventative education that you would give to a patient that is having a
TIA (transient ischemic attack?)
Teach them about FAST acronym
TIA symptoms disappear within 24 hours
A patient with a TIA means that they are at increase risk for stroke
Avoid giving aspirin, why?
They may have an hemorrhagic stroke
A patient with right sided stroke responds better to verbal directions
AND ANSWERS 2024 GRADED A+
Exemplar:
67 year old female, who had a left side-sided stroke 2 weeks ago
What will I see?
Language deficits, issues with speech
Assessments:
Neurological assessment (person, place, time situation)
Exemplar:
Left-sided stroke symptoms:
Hypertonicity
Right-sided weakness
Postural instability
Dysphagia (impaired swallowing)
Aphasia
Unable to communicate: unable to speak and comprehend (pt will not be able to follow
instructions)
Immobility
With this type of aphasia, patients are AWARE of their speaking difficulties, but
often have trouble expressing their thoughts through words or writing.
Expressive aphasia (broca's area)
With this type of aphasia, patients are UNAWARE of their speaking difficulties,
and may speak long sentences with no meaning. They also have difficulty
understanding written/spoken language and have incoherent speech
Receptive aphasia (wernick'es area)
A patient who is experiencing dysphagia should eat:
spoon-thick consistency foods NOT fluid consistency, b/c it reduces the risk of
aspiration
Avoid thin liquids
Use thickeners
(e.g. patient at VA who was using thickened water)
Exemplar:
Signs (motor dysfunction) of patient with left-sided stroke:
Urinary retention: assess PVR
Decreased ventilation
Constipation
Orthostatic hypotension
Exemplar:
Priorities:
1. Patient safety: Ability to swallow: Use a tongue depressant to test their gag reflex,
make sure that the patient is sitting up, avoid giving water
, 2. Neuro assessment: Pupils
3. Cardiopulmonary assessment: assess if there is aspiration, and check for clear lungs,
check for orthostatic hypotension, assess for bilateral pulses
Why do patient's with Parkinson's have orthostatic hypotension?
Low dopamine levels. The neurons are not communicating very well because they have
low dopamine levels
Three reasons why people have orthostatic hypotension:
1. Low blood volume
2. Compliance of blood vessels
3. Neuro deficit: e.g. MS, Parkinson's, spinal cord injuries (in order for compliance to
work, activation of autonomic NS)
What is aphasia?
Unable to understand and express speech
Stroke:
Upper motor neuron dysfunction (hypertonicity)
How to treat post-stroke?
Aspirin (given within 48 hours) after ischemic stroke
Left-sided brain
Spoken/written language
Speech/communication
Numbers, letters
Logical, analysis
Right-sided brain
Nonverbal information (music, images)
Drawing, creativity
Spatial (faces, shapes, maps)
If a person is having a left-sided stroke, all the symptoms will be on the
right side
If a person is having a right-sided stroke, all the symptoms will be on the
left side
Hemiplegia:
Unilateral weakness
Spinal cord injury
example of upper motor tonicity
What is preventative education that you would give to a patient that is having a
TIA (transient ischemic attack?)
Teach them about FAST acronym
TIA symptoms disappear within 24 hours
A patient with a TIA means that they are at increase risk for stroke
Avoid giving aspirin, why?
They may have an hemorrhagic stroke
A patient with right sided stroke responds better to verbal directions
