Podcast
Questions and Answers
Which of the following is the most common type of stroke?
Which of the following is the most common type of stroke?
- Hemorrhagic stroke
- Embolic stroke
- Ischemic stroke (correct)
- Subarachnoid hemorrhage
A patient has been diagnosed with a TIA. What does this condition indicate?
A patient has been diagnosed with a TIA. What does this condition indicate?
- Irreversible brain damage
- Temporary blockage of cerebral blood flow (correct)
- A massive brain infarction
- Complete rupture of cerebral artery
Which term refers to the brain tissue surrounding the core area of infarct that may be salvaged with timely intervention?
Which term refers to the brain tissue surrounding the core area of infarct that may be salvaged with timely intervention?
- Penumbra (correct)
- Embolus
- Hematoma
- Aneurysm
What is the most common cause of an embolic stroke?
What is the most common cause of an embolic stroke?
Which type of hemorrhagic stroke typically involves bleeding in the brain tissue itself and is often related to hypertension?
Which type of hemorrhagic stroke typically involves bleeding in the brain tissue itself and is often related to hypertension?
A patient with a suspected stroke arrives at the ER. What is the priority diagnostic test to be done immediately?
A patient with a suspected stroke arrives at the ER. What is the priority diagnostic test to be done immediately?
Which of the following is a modifiable risk factor for stroke?
Which of the following is a modifiable risk factor for stroke?
The main goal of thrombolytic therapy in ischemic stroke is to:
The main goal of thrombolytic therapy in ischemic stroke is to:
A major complication of subarachnoid hemorrhage is:
A major complication of subarachnoid hemorrhage is:
Hemianopia is defined as:
Hemianopia is defined as:
What is the purpose of the NIH Stroke Scale (NIHSS)?
What is the purpose of the NIH Stroke Scale (NIHSS)?
What is the significance of the “FAST” acronym in stroke recognition?
What is the significance of the “FAST” acronym in stroke recognition?
Which medication is most appropriate for preventing future ischemic strokes in a patient with atrial fibrillation?
Which medication is most appropriate for preventing future ischemic strokes in a patient with atrial fibrillation?
Dysarthria refers to:
Dysarthria refers to:
Which of the following is a hallmark symptom of a left-sided stroke?
Which of the following is a hallmark symptom of a left-sided stroke?
A patient with a right-sided stroke is most likely to exhibit:
A patient with a right-sided stroke is most likely to exhibit:
What is the primary action of tissue plasminogen activator (tPA)?
What is the primary action of tissue plasminogen activator (tPA)?
What is the therapeutic time window for administering tPA in eligible stroke patients?
What is the therapeutic time window for administering tPA in eligible stroke patients?
Which electrolyte level should be monitored closely in a stroke patient receiving IV fluids?
Which electrolyte level should be monitored closely in a stroke patient receiving IV fluids?
What should the nurse assess first in a post-stroke patient?
What should the nurse assess first in a post-stroke patient?
A 76-year-old male is admitted with an ischemic stroke. His BP is 180/100, and he is eligible for tPA. What is the nurse's priority action?
A 76-year-old male is admitted with an ischemic stroke. His BP is 180/100, and he is eligible for tPA. What is the nurse's priority action?
A client with a hemorrhagic stroke suddenly becomes unresponsive with a fixed, dilated pupil. What should the nurse do first?
A client with a hemorrhagic stroke suddenly becomes unresponsive with a fixed, dilated pupil. What should the nurse do first?
A client who had a stroke is unable to swallow liquids. What is the most appropriate nursing intervention?
A client who had a stroke is unable to swallow liquids. What is the most appropriate nursing intervention?
The nurse is teaching a patient recovering from a TIA. Which statement indicates understanding?
The nurse is teaching a patient recovering from a TIA. Which statement indicates understanding?
A patient is 1 hour post-tPA infusion. Which assessment finding is most concerning?
A patient is 1 hour post-tPA infusion. Which assessment finding is most concerning?
During ambulation, a post-stroke patient with left-sided weakness begins to fall. What is the nurse's best action?
During ambulation, a post-stroke patient with left-sided weakness begins to fall. What is the nurse's best action?
A patient recovering from a right hemisphere stroke exhibits impulsive behavior. What safety measure is most appropriate?
A patient recovering from a right hemisphere stroke exhibits impulsive behavior. What safety measure is most appropriate?
A nurse is reviewing lab results for a stroke patient on warfarin. Which lab value should be closely monitored?
A nurse is reviewing lab results for a stroke patient on warfarin. Which lab value should be closely monitored?
The nurse is caring for a patient with expressive aphasia. What is the best communication strategy?
The nurse is caring for a patient with expressive aphasia. What is the best communication strategy?
A client with a suspected stroke arrives 90 minutes after symptom onset. What is the nurse's first priority?
A client with a suspected stroke arrives 90 minutes after symptom onset. What is the nurse's first priority?
Which of the following interventions would be most appropriate to prevent aspiration in a post-stroke patient with dysphagia?
Which of the following interventions would be most appropriate to prevent aspiration in a post-stroke patient with dysphagia?
The nurse is caring for a patient post-ischemic stroke with a new order for aspirin. What is the purpose of this medication?
The nurse is caring for a patient post-ischemic stroke with a new order for aspirin. What is the purpose of this medication?
A client with an intracerebral hemorrhage is scheduled for surgery. What is the nurse's top pre-op priority?
A client with an intracerebral hemorrhage is scheduled for surgery. What is the nurse's top pre-op priority?
A patient presents with sudden confusion, slurred speech, and facial droop. What is the nurse's immediate action?
A patient presents with sudden confusion, slurred speech, and facial droop. What is the nurse's immediate action?
A patient receiving IV fluids post-stroke begins to exhibit increased confusion and lethargy. Which lab should the nurse check?
A patient receiving IV fluids post-stroke begins to exhibit increased confusion and lethargy. Which lab should the nurse check?
A nurse is providing discharge teaching to a patient post-stroke. Which statement shows correct understanding?
A nurse is providing discharge teaching to a patient post-stroke. Which statement shows correct understanding?
A patient develops a sudden severe headache and vomiting during tPA infusion. What is the priority action?
A patient develops a sudden severe headache and vomiting during tPA infusion. What is the priority action?
Which finding in a stroke patient indicates improvement in the plan of care?
Which finding in a stroke patient indicates improvement in the plan of care?
A nurse assesses a patient post-tPA with an NIHSS score that increased from 5 to 10. What is the priority action?
A nurse assesses a patient post-tPA with an NIHSS score that increased from 5 to 10. What is the priority action?
Which patient is most at risk for an embolic stroke?
Which patient is most at risk for an embolic stroke?
A nurse is assessing a client suspected of having a stroke. Which of the following are common signs of a stroke? (Select all that apply)
A nurse is assessing a client suspected of having a stroke. Which of the following are common signs of a stroke? (Select all that apply)
The nurse is caring for a client who has returned from the ED after receiving tPA. Which actions are appropriate in the first 24 hours? (Select all that apply)
The nurse is caring for a client who has returned from the ED after receiving tPA. Which actions are appropriate in the first 24 hours? (Select all that apply)
Which of the following are modifiable risk factors for stroke? (Select all that apply)
Which of the following are modifiable risk factors for stroke? (Select all that apply)
A nurse is preparing to discharge a stroke patient with right-sided hemiplegia. Which of the following are appropriate discharge plans? (Select all that apply)
A nurse is preparing to discharge a stroke patient with right-sided hemiplegia. Which of the following are appropriate discharge plans? (Select all that apply)
Which assessments are part of the National Institutes of Health Stroke Scale (NIHSS)? (Select all that apply)
Which assessments are part of the National Institutes of Health Stroke Scale (NIHSS)? (Select all that apply)
Which interventions can help prevent aspiration in a post-stroke patient with dysphagia? (Select all that apply)
Which interventions can help prevent aspiration in a post-stroke patient with dysphagia? (Select all that apply)
The nurse suspects a hemorrhagic stroke. Which of the following signs would support this diagnosis? (Select all that apply)
The nurse suspects a hemorrhagic stroke. Which of the following signs would support this diagnosis? (Select all that apply)
Which of the following are complications that may occur after a hemorrhagic stroke? (Select all that apply)
Which of the following are complications that may occur after a hemorrhagic stroke? (Select all that apply)
A nurse is teaching about stroke prevention. Which lifestyle changes should be encouraged? (Select all that apply)
A nurse is teaching about stroke prevention. Which lifestyle changes should be encouraged? (Select all that apply)
The nurse is caring for a patient with a left hemisphere stroke. Which findings would the nurse expect? (Select all that apply)
The nurse is caring for a patient with a left hemisphere stroke. Which findings would the nurse expect? (Select all that apply)
Flashcards
Ischemic Stroke
Ischemic Stroke
Most common type of stroke, caused by blockage in cerebral blood flow.
TIA (Transient Ischemic Attack)
TIA (Transient Ischemic Attack)
Temporary blockage of cerebral blood flow, often called a mini-stroke.
Penumbra
Penumbra
Brain tissue surrounding an infarct's core area, potentially salvageable with intervention.
Atrial fibrillation (AFib)
Atrial fibrillation (AFib)
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Intracerebral hemorrhage (ICH)
Intracerebral hemorrhage (ICH)
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Non-contrast CT Importance
Non-contrast CT Importance
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Hypertension
Hypertension
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Thrombolytic Therapy Goal
Thrombolytic Therapy Goal
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Vasospasm after SAH
Vasospasm after SAH
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Hemianopia
Hemianopia
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NIH Stroke Scale (NIHSS)
NIH Stroke Scale (NIHSS)
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FAST acronym
FAST acronym
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Warfarin
Warfarin
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Dysarthria
Dysarthria
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Right-sided Hemiplegia
Right-sided Hemiplegia
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Breaking down existing clots during ischemic stroke
Breaking down existing clots during ischemic stroke
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Within 4.5 hours of symptom onset
Within 4.5 hours of symptom onset
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Sodium Monitoring
Sodium Monitoring
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First Assessment in Stroke
First Assessment in Stroke
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Chin-Tuck With Dysphagia
Chin-Tuck With Dysphagia
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Study Notes
- Ischemic stroke is the most common type, accounting for approximately 87% of all strokes and results from a blockage in cerebral blood flow.
- A TIA (Transient Ischemic Attack) is a temporary episode of neurological dysfunction without permanent damage, often called a "mini-stroke," and involves a temporary blockage of cerebral blood flow.
- Penumbra refers to the brain tissue surrounding the core area of an infarct that may be salvaged with timely intervention; it is ischemic but potentially reversible tissue.
- Atrial fibrillation is a common cause of embolic strokes because clots originate from the heart, especially in patients with this condition.
- Intracerebral hemorrhage (ICH) involves bleeding directly into the brain parenchyma and is commonly caused by hypertension.
- A non-contrast CT scan of the head is the priority diagnostic test for a suspected stroke to differentiate between ischemic and hemorrhagic stroke quickly.
- Hypertension, along with smoking, diabetes, and high cholesterol, is a leading modifiable risk factor for stroke.
- Thrombolytics like alteplase (tPA) are used in ischemic stroke to dissolve the clot blocking blood flow to the brain and restore perfusion.
- Vasospasm is a serious and common complication of subarachnoid hemorrhage (SAH) that commonly results from ruptured aneurysms.
- Hemianopia is a visual field deficit and is defined as loss of vision in half the visual field; it commonly occurs after a stroke affecting the occipital lobe or optic pathways.
- The NIH Stroke Scale (NIHSS) quantifies stroke severity and guides treatment decisions objectively.
- The "FAST" acronym in stroke recognition stands for Face drooping, Arm weakness, Speech difficulties, and Time to call 911, assisting in early stroke identification.
- Warfarin, an anticoagulant, is used in AFib patients to prevent clot formation and future embolic strokes.
- Dysarthria is a motor speech disorder causing slurred speech due to weakened or paralyzed speech muscles from brain damage.
- Right-sided hemiplegia, or paralysis, is a hallmark symptom of a left-sided stroke, impacting the right side of the body as well as language and logic.
- Right-sided strokes cause contralateral deficits, resulting in left-sided weakness.
- Tissue plasminogen activator (tPA) is a thrombolytic that breaks down existing clots during an acute ischemic stroke.
- The therapeutic time window for administering tPA in eligible stroke patients is within 4.5 hours of symptom onset, with the standard time window being 3–4.5 hours.
- Sodium electrolyte levels should be closely monitored in stroke patients receiving IV fluids, as hyponatremia can worsen cerebral edema.
- Airway and breathing should be assessed first in a post-stroke patient, as stroke can impair protective reflexes.
- For a 76-year-old male with an ischemic stroke and a BP of 180/100 who is eligible for tPA: notify the provider if the BP is too high for tPA; BP must be <185/110 mmHg to safely administer tPA.
- For a client with a hemorrhagic stroke who suddenly becomes unresponsive with a fixed, dilated pupil: notify the rapid response team immediately, as a fixed, dilated pupil is a sign of brain herniation.
- For a client who had a stroke and is unable to swallow liquids: refer for a speech therapy evaluation, as dysphagia is common post-stroke prior to resuming any oral intake.
- A statement indicating understanding of TIA recovery includes: "TIAs mean I could have a full stroke later, so I'll take my aspirin every day."
- Regarding a patient 1 hour post-tPA infusion, the most concerning assessment finding is a new onset of confusion, which may indicate hemorrhagic transformation.
- When a post-stroke patient with left-sided weakness begins to fall during ambulation, ease the patient to the floor while protecting the head to prevent injury.
- For a patient recovering from a right hemisphere stroke who exhibits impulsive behavior, a safety measure is to keep the bed alarm on at all times because right-sided strokes can lead to poor judgment and impulsivity.
- For a stroke patient on warfarin, monitor INR lab values, as warfarin affects the extrinsic pathway; INR is used to monitor its anticoagulant effect.
- For a patient with expressive aphasia, the best communication strategy is to use pictures or communication boards to help the patient express needs effectively.
- For a client with a suspected stroke who arrives 90 minutes after symptom onset, the nurse's first priority is to assess glucose and obtain a CT scan: hyperglycemia can mimic stroke symptoms, and a stat CT is essential to determine stroke type and guide treatment.
- Tucking the chin when swallowing helps protect the airway and reduce aspiration risk during swallowing for a post-stroke patient with dysphagia.
- Aspirin inhibits platelet aggregation, preventing new clots and secondary strokes after an ischemic stroke.
- Lowering blood pressure (systolic BP <180 mmHg) is the nurse's top pre-op priority to help reduce the risk of further bleeding for a client with an intracerebral hemorrhage scheduled for surgery.
- For a patient presenting with sudden confusion, slurred speech, and facial droop, notify the provider and prepare for a CT scan, as these are classic signs of stroke.
- For a patient receiving IV fluids post-stroke who begins to exhibit increased confusion and lethargy, check sodium lab levels, because hyponatremia can worsen cerebral edema and neurological status in stroke patients.
- Discharge teaching showing correct understanding includes, "if I have a sudden headache or confusion, I will call 911," since these could be signs of a new stroke or hemorrhage.
- During tPA infusion, and a patient develops a sudden severe headache and vomiting, notify the provider and stop the infusion immediately, as these are signs of possible intracranial hemorrhage.
- In a stroke patient, improved ability to follow verbal commands indicates improvement in the plan of care and shows neurological recovery.
- When assessing a patient post-tPA with an NIHSS score that increased from 5 to 10, notify the provider immediately, as a rising NIHSS score indicates neurological deterioration and possible hemorrhagic transformation.
- A 74-year-old with atrial fibrillation is most at risk for an embolic stroke, as A-fib increases the risk of clot formation.
- Common signs of stroke include facial drooping, sudden confusion, slurred speech, and sudden weakness on one side of the body.
- Initial post-tPA actions in the first 24 hours include monitoring neurological status closely, performing frequent BP checks, and monitoring for signs of bleeding; invasive procedures and anticoagulants are avoided initially.
- Modifiable stroke risk factors include smoking, hypertension, and diabetes mellitus.
- Appropriate discharge plans for a stroke patient with right-sided hemiplegia include referral to physical therapy, home safety evaluation, education on the use of assistive devices, and driving assessment before resuming driving.
- The NIHSS assesses level of consciousness, motor strength, speech and language, and visual fields.
- Interventions that help prevent aspiration in a post-stroke patient with dysphagia include elevating the head of the bed during meals, using thickened liquids as prescribed, and providing small bites and allow extra time to chew.
- Signs that would support a diagnosis of a hemorrhagic stroke include sudden severe headache, vomiting, loss of consciousness, and high blood pressure.
- Complications that may occur after a hemorrhagic stroke include brain herniation, vasospasm, intracranial bleeding, and deep vein thrombosis (DVT).
- Lifestyle changes that should be encouraged regarding stroke prevention include reducing sodium intake, stopping smoking, engaging in regular physical activity, and monitoring and controlling blood pressure.
- Expected findings for a patient with a left hemisphere stroke would be: impaired speech and language, right-sided weakness, and difficulty with math or logic.
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