Cerebrovascular Accident/Stroke (15 Questions)

1. Mme Ginette Tremblay, 68 years old, is brought to the Emergency Department by ambulance. Her husband states that at 09:00, she suddenly dropped her coffee cup and could not speak clearly. It is now 10:15.

Upon assessment, the nurse notes:
*Right-sided facial droop.
*Right arm drift.
*Expressive aphasia.
*BP: 195/110 mmHg.
*HR: 90 bpm.

The physician is preparing to administer Alteplase (tPA). The order set includes:
*"Administer Labetalol 10 mg IV push STAT if SBP > 185 mmHg."
*"Maintain BP < 185/110 mmHg prior to and during tPA administration."

Question:
What is the nurse’s priority intervention to ensure the patient remains eligible for thrombolytic therapy? *

Insert an indwelling urinary catheter to monitor output.

Administer the Labetalol 10 mg IV push immediately.

Elevate the head of the bed to 90 degrees to reduce intracranial pressure.

Obtain consent from the husband immediately.

2. M. Jacques Bernier, 72 years old, is recovering from a Left Middle Cerebral Artery (MCA) stroke. He has right-sided hemiplegia and dysphagia.

The medical orders read:
*"NPO pending swallowing evaluation by Speech-Language Pathology."
*"IV Normal Saline at 100 mL/hr."

A family member arrives and offers M. Bernier a sip of water from a bottle, thinking his mouth looks dry. M. Bernier takes a sip and begins to cough forcefully.

Question:
What is the nurse’s immediate action? *

Ask the patient to take a deep breath and swallow again.

Suction the oral cavity if needed and strictly enforce the NPO status.

Auscultate the lungs to check for aspiration pneumonia immediately.

Request an order for thickened liquids.

3. Mme Sophie Gagnon, 55 years old, is admitted to the ICU with a Subarachnoid Hemorrhage (SAH) from a ruptured aneurysm. She is currently alert.

The physician orders:
*"Nimodipine 60 mg PO q4h."
*"Hold Nimodipine if HR < 60 or SBP < 90."
*"Strict bedrest."

Mme Gagnon’s vital signs are BP 130/70 mmHg, HR 72 bpm. She asks, "Why do I have to take this pill so often?"

Question:
What is the nurse’s best explanation regarding the purpose of this medication? *

"It helps dissolve the blood clot that is causing your headache."

"It prevents the blood vessels in your brain from cramping (spasm), which could cause another stroke."

"It is a painkiller specifically for the type of headache caused by bleeding."

"It keeps your blood pressure very low to prevent the aneurysm from bursting again."

4. M. Pierre Dubois, 60 years old, has suffered a Right CVA. He has Left Unilateral Neglect.

The rehabilitation orders include:
*"Up in chair TID for meals."
*"Encourage scanning techniques."

During lunch, the nurse notes that M. Dubois has eaten all the food on the right side of his plate but has left the food on the left side untouched. He complains that he is still hungry.

Question:
What is the nurse’s most appropriate intervention? *

Rotate the plate 180 degrees without saying anything so he sees the food.

Feed him the remaining food to ensure adequate nutrition.

Verbally cue him to look to the left and guide his hand to the left side of the plate.

Document that the patient has a poor appetite.

5. Mme Claudette Roy, 78 years old, is admitted with an Ischemic Stroke but arrived too late for tPA. Her BP is 200/105 mmHg.

The physician writes the following order:
*"Do NOT treat blood pressure unless SBP > 220 mmHg or DBP > 120 mmHg."

The nurse’s colleague asks, "Why aren't we giving her blood pressure pills? Isn't that dangerous?"

Question:
What is the nurse’s correct rationale? *

"The doctor forgot to write the order; I will call to get one."

"High blood pressure pushes blood into the brain area surrounding the stroke to keep the tissue alive."

"Her autoregulation is broken, so the reading is likely false."

"Lowering the blood pressure will cause the clot to break off and travel to the lungs."

6 .M. Luc Morin, 45 years old, experienced a transient loss of vision and weakness in his left hand that lasted 20 minutes. He is diagnosed with a Transient Ischemic Attack (TIA).

The discharge orders include:
*"Clopidogrel (Plavix) 75 mg PO daily."
*"Aspirin (ASA) 81 mg PO daily."

M. Morin asks, "Since the symptoms went away, why do I need two blood thinners?"

Question:
What is the nurse’s best response? *

"The combination prevents platelets from clumping together, reducing your high risk of a major stroke in the next few days."

"One medication is for your heart, and the other is specifically for your brain."

"You will only take these for 2 days until the symptoms are completely gone."

"This dissolves the remaining clot that caused the attack."

7. Mme Valérie Bouchard, 64 years old, is receiving a tPA (Alteplase) infusion for an ischemic stroke.

The standing orders are:
*"Monitor Neuro Vitals q15min."

Forty-five minutes into the infusion, Mme Bouchard complains of a sudden, severe headache and nausea. She becomes drowsy (GCS drops from 15 to 13).

Question:
What is the nurse’s priority action? *

Administer Gravol 50 mg IV for nausea.

Stop the tPA infusion immediately.

Dim the lights to treat the migraine.

Check the blood pressure to see if it is elevated.

8. M. Robert Lefebvre, 58 years old, has Broca’s Aphasia (Expressive Aphasia) following a left-sided stroke.

The nursing care plan includes:
*"Use communication aids."
*"Allow time for response."

M. Lefebvre is visibly frustrated, pointing at the table and trying to say "water" but unable to form the word.

Question:
Which communication strategy should the nurse use to reduce frustration? *

Speak loudly and slowly to help him understand.

Encourage him to write the word down if he cannot say it.

Ask him questions that can be answered with "Yes" or "No" or use a picture board.

Complete his sentences for him so he can relax.

9. Mme Isabelle Fortin, 70 years old, is being discharged after a stroke caused by Atrial Fibrillation.

The discharge orders include:
*"Warfarin (Coumadin) 5 mg PO daily at 17:00."
*"Follow up INR checks weekly."

The nurse is teaching about diet.

Question:
What instruction regarding Vitamin K intake is essential for patient safety? *

"You must completely eliminate green leafy vegetables like spinach to prevent clots."

"You can eat green leafy vegetables, but you must keep the amount consistent every day."

"Take a Vitamin K supplement daily to help your blood clot if you get cut."

"You should only eat cooked vegetables, not raw ones."

11. M. Henri Gagnon, 70 years old, is recovering from a Right CVA resulting in left-sided hemiparesis. The physiotherapist has cleared him to ambulate with a quad cane.

The transfer orders are:
"Ambulate with assistance of 1 nurse and quad cane."
"Weight bearing as tolerated."

The nurse observes M. Gagnon holding the cane in his left hand. He is preparing to take his first step.

Question:
What is the nurse’s immediate corrective instruction? *

"Keep the cane in your left hand, but move the cane and your right foot forward at the same time."

"Stop, please. You must hold the cane in your right hand."

"Hold the cane with both hands to ensure you have maximum stability."

"You should move your strong leg forward first, then the cane."

12. Mme Lise Poirier, 82 years old, is admitted with a brainstem stroke. She is alert but has severe Dysarthria (slurred, slow speech) and facial weakness.

The dietary orders are:
*"Minced diet."
*"Nectar-thickened liquids."
*"Up in chair for meals."

During lunch, the nurse notes that Mme Poirier continues to chew the same bite of food for a long time, and her left cheek looks puffed out.

Question:
What is the nurse’s priority intervention? *

Encourage her to take a drink of thickened liquid to wash the food down.

Inspect the left side of the mouth for "pocketing" of food.

Switch her to a pureed diet immediately.

Ask her to speak to assess if her voice sounds "wet" or gurgly.

13. M. Sylvain Côté, 55 years old, received tPA (Alteplase) 12 hours ago for an Ischemic Stroke. He is currently stable in the ICU.

The physician’s standing orders regarding blood pressure are:
*"Administer Labetalol 10 mg IV if SBP > 180 mmHg or DBP > 105 mmHg."

The monitor alarms: BP 188/110 mmHg. The nurse prepares the medication. A student nurse asks, "I thought we wanted high blood pressure to help the brain perfusion?"

Question:
What is the nurse’s best explanation to the student? *

"That is only true for hemorrhagic strokes; this is ischemic."

"Now that he has received tPA, high blood pressure increases the risk of bleeding into the brain."

"The medication helps sedate him so he can rest better."

"We only treat the diastolic number; the top number doesn't matter."

14. Mme Claire Dubé, 60 years old, is admitted with a Hemorrhagic Stroke (Intracerebral Hemorrhage). She is bedbound and complains of constipation.

The physician orders:
*"Docusate Sodium (Colace) 100 mg PO BID."
*"Senna (Senokot) 8.6 mg PO daily PRN."

Question:
What is the primary neurological rationale for aggressively managing this patient's bowel routine? *

To prevent intestinal obstruction due to immobility.

To prevent the absorption of toxins from the colon that worsen confusion.

To allow for easier cleanup since she is incontinent.

To prevent the Valsalva maneuver, which raises intracranial pressure (ICP).

15. M. Jean-Paul Turcotte, 65 years old, has Flaccid Hemiplegia of the left arm following a major stroke. He is lying in bed, and the orderly arrives to help the nurse reposition him up in bed.

The nurse observes the orderly reaching for the patient’s left arm to pull him up.

Question:
What is the nurse’s immediate safety intervention? *

Stop the orderly and explain that pulling the flaccid arm can cause shoulder subluxation.

Instruct the orderly to pull only by the wrist, not the shoulder.

Allow the orderly to proceed but support the patient's head.

Apply a sling to the arm before moving the patient.