STROKE WITH CORRECT ANSWERS A+ CREDITED CHOICHES

STROKE WITH CORRECT ANSWERS A+ CREDITED CHOICHES The nurse knows that which interventions could be implemented for a stroke client at risk for aspiration? Select all that apply. Maintain the head of the bed at least 30 degrees or greater while eating or drinking. Ensure that the client is receiving the prescribed therapeutic food preparation. Ensure the client is supervised while eating or drinking, observing for signs of aspiration and choking. Advocating for evaluation of the client by a speech language pathologist. Allow the client to watch television and visit with visitors while eating and drinking. - Correct Answer Maintain the head of the bed at least 30 degrees or greater while eating or drinking. Ensure the client is supervised while eating or drinking, observing for signs of aspiration and choking. Advocating for evaluation of the client by a speech language pathologist. The nurse is completing discharge teaching with the stroke client preparing for discharge. The client asks if the healthcare provider will continue the medications prescribed pre-stroke for hypertension and high cholesterol. What is the nurse's best response to this question? "High cholesterol and hypertension are risk factors for stroke. I would expect that the healthcare provider will continue treating these two conditions with medication after discharge." "Because you were taking these medications and still had a stroke, I doubt the healthcare provider will continue treating these conditions." "Ask the healthcare provider next time rounds are made. I am not able to answer that question for you." "Let's just wait and see what is ordered when your discharge paperwork is completed by the healthcare provider. I will address your questions at that time." - Correct Answer "High cholesterol and hypertension are risk factors for stroke. I would expect that the healthcare provider will continue treating these two conditions with medication after discharge." The nurse is explaining to the student nurse why it is important for the post-stroke client to maintain adequate blood pressure readings. What is the nurse's best explanation? "The client is able to rest more comfortably with blood pressure values in the normal range." "When blood pressure values are too low, the kidneys have to work harder. This situation creates stress on the kidneys." "After a stroke, cerebral autoregulation may not be working properly, and this intervention helps to protect the client's brain from ischemia caused by abnormally low systemic blood pressure." "If the blood pressure values are not within normal, the client must receive more medication to control the values." - Correct Answer "After a stroke, cerebral autoregulation may not be working properly, and this intervention helps to protect the client's brain from ischemia caused by abnormally low systemic blood pressure." The nurse would expect the client admitted for a stroke to be monitored for cardiac status. Which methods would the nurse expect to see ordered for this purpose? Select all that apply. Cardiac enzymes per protocol Continuous electrocardiogram monitoring Baseline 12-lead electrocardiogram Cardiac catheterization Placement of cardiac pacemaker - Correct Answer Cardiac enzymes per protocol Continuous electrocardiogram monitoring Baseline 12-lead electrocardiogram The nurse is caring for an unconscious client after a large ischemic stroke. Which assessment changes are most concerning? Select all that apply. Rising systolic blood pressure Bradycardia Equal and reactive pupils Irregular breathing pattern Hypotension - Correct Answer Tom, a 75-year-old man, was at home watching television with his wife when he began displaying strange symptoms. His wife called 911 and stated, "Something is wrong with my husband. He won't answer me when I speak to him. He is staring straight ahead and drooling from his mouth. Please send an ambulance immediately!" The ambulance arrived and transported Tom to the local emergency department. The triage nurse performs an assessment when Tom arrives. What priority nursing action should be completed? Obtain a blood pressure. Draw a serum glucose level. Obtain a sterile urine specimen. Ask the patient about his home meds. - Correct Answer Obtain a blood pressure. Of the actions listed, the nurse should quickly obtain a blood pressure. With either an ischemic or hemorrhagic stroke, close monitoring of the blood pressure is a priority to ensure that it remains within prescribed limits. The nurse would need to know the client's home medications, but not before the client has been triaged and vital signs obtained. Lab work would be drawn and glucose would be part of the metabolic panel, but this is not the priority task. Upon assessment, the nurse notes that Tom has weakness on the right side of his body. He has vomited numerous times since admission to the emergency department, has difficulty swallowing, and is drooling saliva from the right side of his mouth. He is attempting to speak but is unable to do so. Tom is exhibiting symptoms of which syndrome? Right middle cerebral artery syndrome Basilar artery syndrome Left middle cerebral artery syndrome Non-traumatic intracerebral hemorrhage syndrome - Correct Answer Basilar arte