RNSG 2432 - CVA / Brain aneurysm Questions With
Complete Solutions
(3-7) severe coma
(9-12) Moderate
(13-14) Mild Correct Answer What is the Glascow Coma Scale
*Ensure patent airway!*
Call "Stroke Alert" Code
Remove dentures, keep patient NPO
Obtain pulse oximetry
Maintain adequate Sa02 ( > than 95%) ; O2 if necessary
Maintain BP within parameters (check MAP)
*Obtain CT scan, immediately!*
Obtain baseline labs (ex: glucose), Obtain IV access
Position head midline; HOB 30 (if no shock/injury, or cervical
damage)
Institute seizure precautions-suction, pad rails
NIH Stroke Scale, Glasgow Coma Scale
*Anticipate thrombolytic therapy for ischemic stroke* Correct
Answer What is involved in the initial stroke assessment/
intervention?
*Treatment must be initiated promptly after screening CT to r/o
hemorrhagic stroke *
-- Reestablish blood flow through blocked artery
-- Other fibrinolytic agents cannot be substituted for t-PA
*IV t-PA MUST be administered within 3 to 4.5 hours of
symptom onset.* May be given intraarterial (up to 6 hours)
-- insert a foley, NG tube & multiple IVs before administration
-- Control of BP is critical!
,--*Timing is the most important factor here!!* Correct Answer
Describe Thrombolytic Recombinant Alteplase (tPA) therapy.
1) Anti-hypertensives: *maintain normal BP (SBP <160)*
2) Seizure Prophylaxis: phenytoin (Dilantin), levetiracetam
(Keppra), lamotrigine (Lamictal) - seizure activity may result in
further neuronal injury & contribute to coma
3) Aneurysm precautions (decrease external and internal stimuli)
-- mainly for SAH
4) Meds for aneurysms (aneurysm precautions; stool softeners,
antiemetic, for headache, to sedate)
5) Meds that prevent re-bleed: Aminacproic Acid (Ammicar)
fibrolysis inhibitor to prevent lysis of the formed clot/ prevent
rebleed -- mainly SAH
6) Meds to prevent vasospasms (SAH):
- *before surgery*: (Calcium Channel blocker) Nimodipine,
minimize cerebral damage
- *after surgery*: 'Triple H therapy' (hypertension, hypervolemia
and hemodilution)-- vasodilators (Isuprel); induced arterial
hypertension (Dopamine); hypervolemic hemodilution
(Albumin)
Surgical:
1) Immediate evacuation of aneurysm-induced hematomas,
Correct Answer What is treatment for a hemorrhagic stroke
(ICH & SAH)?
1)* CT = single most important dx tool*- Can rapidly
distinguish between hemorrhagic & ischemic stroke
2) CT angiography (CTA) - visualization of cerebral blood
vessels & estimation of perfusion
, 3) MRI- determine extent of brain injury
4) Magnetic resonance angiography (MRA)- can detect vascular
lesions & blockages
5) Cerebral angiography- Identify source of SAH
*Risks = lodging embolus, vasospasm, inducing further
hemorrhage, allergic reaction to contrast media*
6) Transcranial Doppler - Measures velocity of blood flow in
cerebral arteries
7) Lumbar Puncture -Look for evidence of RBC's in
cerebrospinal fluid (contraindicated if signs of IICP)
Additional Dx:
CBC, Electrolytes, Renal & hepatic profiles, Blood glucose ,
Lipid profile, CSF analysis ,Coag studies , EKG Correct
Answer What diagnostic tests would be ordered for a patient
with a potential stroke?
A client arrives in the emergency department with an ischemic
stroke. The nurse should first:
A. Ask what medications the client is taking
B. Complete a history and health assessment
C. Identify the time and onset of the stroke
D. Determine if the client is scheduled for any surgical
procedures Correct Answer c
A patient with right-sided hemiplegia & aphasia resulting from a
stroke most likely has involvement of the:
a) brainstem
b) vertebral artery
c) left middle cerebral artery
Complete Solutions
(3-7) severe coma
(9-12) Moderate
(13-14) Mild Correct Answer What is the Glascow Coma Scale
*Ensure patent airway!*
Call "Stroke Alert" Code
Remove dentures, keep patient NPO
Obtain pulse oximetry
Maintain adequate Sa02 ( > than 95%) ; O2 if necessary
Maintain BP within parameters (check MAP)
*Obtain CT scan, immediately!*
Obtain baseline labs (ex: glucose), Obtain IV access
Position head midline; HOB 30 (if no shock/injury, or cervical
damage)
Institute seizure precautions-suction, pad rails
NIH Stroke Scale, Glasgow Coma Scale
*Anticipate thrombolytic therapy for ischemic stroke* Correct
Answer What is involved in the initial stroke assessment/
intervention?
*Treatment must be initiated promptly after screening CT to r/o
hemorrhagic stroke *
-- Reestablish blood flow through blocked artery
-- Other fibrinolytic agents cannot be substituted for t-PA
*IV t-PA MUST be administered within 3 to 4.5 hours of
symptom onset.* May be given intraarterial (up to 6 hours)
-- insert a foley, NG tube & multiple IVs before administration
-- Control of BP is critical!
,--*Timing is the most important factor here!!* Correct Answer
Describe Thrombolytic Recombinant Alteplase (tPA) therapy.
1) Anti-hypertensives: *maintain normal BP (SBP <160)*
2) Seizure Prophylaxis: phenytoin (Dilantin), levetiracetam
(Keppra), lamotrigine (Lamictal) - seizure activity may result in
further neuronal injury & contribute to coma
3) Aneurysm precautions (decrease external and internal stimuli)
-- mainly for SAH
4) Meds for aneurysms (aneurysm precautions; stool softeners,
antiemetic, for headache, to sedate)
5) Meds that prevent re-bleed: Aminacproic Acid (Ammicar)
fibrolysis inhibitor to prevent lysis of the formed clot/ prevent
rebleed -- mainly SAH
6) Meds to prevent vasospasms (SAH):
- *before surgery*: (Calcium Channel blocker) Nimodipine,
minimize cerebral damage
- *after surgery*: 'Triple H therapy' (hypertension, hypervolemia
and hemodilution)-- vasodilators (Isuprel); induced arterial
hypertension (Dopamine); hypervolemic hemodilution
(Albumin)
Surgical:
1) Immediate evacuation of aneurysm-induced hematomas,
Correct Answer What is treatment for a hemorrhagic stroke
(ICH & SAH)?
1)* CT = single most important dx tool*- Can rapidly
distinguish between hemorrhagic & ischemic stroke
2) CT angiography (CTA) - visualization of cerebral blood
vessels & estimation of perfusion
, 3) MRI- determine extent of brain injury
4) Magnetic resonance angiography (MRA)- can detect vascular
lesions & blockages
5) Cerebral angiography- Identify source of SAH
*Risks = lodging embolus, vasospasm, inducing further
hemorrhage, allergic reaction to contrast media*
6) Transcranial Doppler - Measures velocity of blood flow in
cerebral arteries
7) Lumbar Puncture -Look for evidence of RBC's in
cerebrospinal fluid (contraindicated if signs of IICP)
Additional Dx:
CBC, Electrolytes, Renal & hepatic profiles, Blood glucose ,
Lipid profile, CSF analysis ,Coag studies , EKG Correct
Answer What diagnostic tests would be ordered for a patient
with a potential stroke?
A client arrives in the emergency department with an ischemic
stroke. The nurse should first:
A. Ask what medications the client is taking
B. Complete a history and health assessment
C. Identify the time and onset of the stroke
D. Determine if the client is scheduled for any surgical
procedures Correct Answer c
A patient with right-sided hemiplegia & aphasia resulting from a
stroke most likely has involvement of the:
a) brainstem
b) vertebral artery
c) left middle cerebral artery
