NSG 3250 Exam 3 Review – Adult Health:
Comprehensive Cerebrovascular Disorders
Examination
Course: NSG 3250 - Adult Health
Topic: Cerebrovascular Accidents (Stroke), Transient Ischemic Attacks (TIA),
Increased Intracranial Pressure (ICP), and Related Nursing Management
Section 1: Intermediate Level Questions**
**1. What is the primary difference between a Transient Ischemic Attack (TIA) and
an Ischemic Stroke?**
**Answer:** A TIA is characterized by transient neurological dysfunction
resulting from focal brain, spinal cord, or retinal ischemia, but **without acute
infarction** (no permanent tissue damage). Symptoms typically last less than 1
hour. An ischemic stroke, conversely, involves **acute infarction** (permanent
tissue damage) in the brain due to prolonged ischemia, leading to persistent
neurological deficits. While TIA symptoms resolve, patients who experience a TIA
are at a significantly higher risk for a future thrombotic stroke.
**2. How is a stroke definitively diagnosed in the acute setting, particularly to
differentiate between ischemic and hemorrhagic types?**
**Answer:** The primary diagnostic tool in the acute setting is a **non-contrast
Computed Tomography (CT) scan of the head**. This imaging is rapid and highly
,effective at ruling out intracranial hemorrhage, which is crucial before
considering thrombolytic therapy for ischemic stroke. A CT scan can also show
early signs of ischemic stroke, though it may be normal in the very early stages.
**3. A patient presents with sudden onset of right-sided weakness and difficulty
speaking. Which cerebral hemisphere is most likely affected?**
**Answer:** The **left cerebral hemisphere** is most likely affected. The left
hemisphere controls motor function on the right side of the body. Additionally, in
about 95% of right-handed individuals and 70% of left-handed individuals, the left
hemisphere is dominant for language, so aphasia (difficulty speaking) points to
left hemispheric involvement.
**4. Patients with a right-hemisphere stroke often exhibit specific cognitive and
perceptual deficits. List three common deficits associated with a right-
hemisphere stroke.**
**Answer:**
1. **Left-sided neglect/inattention:** Difficulty or inability to attend to stimuli on
the left side of their body or environment.
2. **Spatial-perceptual deficits:** Issues with judging distances, size, position,
and relationships between objects.
3. **Impulsivity and poor judgment:** Tendency to act quickly without
considering consequences, often leading to safety concerns.
4. **Denial or minimization of problems (anosognosia):** Lack of awareness of
their deficits.
5. **Visual field defects:** Often left homonymous hemianopsia.
**5. Which two major categories classify all strokes?**
**Answer:**
1. **Ischemic Stroke:** Caused by a blockage of blood flow to the brain (e.g.,
by a clot).
2. **Hemorrhagic Stroke:** Caused by bleeding into the brain tissue or
surrounding spaces.
,**6. Describe the main difference between a thrombotic ischemic stroke and an
embolic ischemic stroke.**
**Answer:**
* **Thrombotic Ischemic Stroke:** Occurs when a blood clot (thrombus) forms
in an artery supplying blood to the brain, typically at the site of atherosclerotic
plaque buildup, and blocks blood flow. Often has a more gradual or "stuttering"
onset.
* **Embolic Ischemic Stroke:** Occurs when a blood clot or other debris
(embolus) forms elsewhere in the body (e.g., in the heart due to atrial fibrillation,
or from a carotid artery plaque) and travels to the brain, lodging in a smaller
artery and blocking blood flow. Often has a sudden, abrupt onset.
**7. A patient with a history of TIA is at highest risk for which type of stroke?**
**Answer:** A patient with a TIA is at highest risk for a **thrombotic ischemic
stroke**. The underlying pathophysiology (atherosclerosis) that causes a TIA is
the same that leads to a thrombotic stroke. The TIA serves as a warning sign.
**8. What is the critical time window for the administration of intravenous
thrombolytic therapy (Alteplase/tPA) in acute ischemic stroke?**
**Answer:** The critical time window for IV tPA is typically **within 3 to 4.5
hours** from the onset of stroke symptoms for eligible patients. Strict criteria
must be met, and this window can vary slightly based on individual patient
factors and institutional guidelines.
**9. What is "hemianopsia" and how does it manifest in a stroke patient?**
**Answer:** Hemianopsia is the **loss of vision in half of the visual field** in one
or both eyes. In stroke, it often manifests as **homonymous hemianopsia**,
where the same half of the visual field is lost in both eyes (e.g., loss of the right
visual field in both eyes). This occurs due to damage to the optic pathways in the
brain. Patients may neglect food on one side of their plate or bump into objects
on the affected side.
, **10. Why is maintaining a quiet and calm environment crucial for a patient with
increased intracranial pressure (ICP)?**
**Answer:** A quiet and calm environment minimizes external stimuli (noise,
light, excessive handling). These stimuli can trigger stress responses, leading to
increased cerebral metabolic demand, vasodilation, and an increase in cerebral
blood volume, all of which can **elevate ICP**. Reducing environmental stimuli
helps to keep ICP stable and lower.
**11. Which type of intravenous fluid should be *avoided* in patients with stroke
or increased ICP, and why?**
**Answer:** **Hypotonic solutions** (e.g., D5W, 0.45% Saline) should be
avoided. These solutions have a lower osmolality than blood plasma, causing
fluid to shift from the intravascular space into the cells (including brain cells).
This fluid shift can exacerbate or cause **cerebral edema**, leading to a further
increase in ICP.
**12. When assessing a stroke patient, what is the single most important question
to ask to guide acute treatment decisions?**
**Answer:** "When was the patient last known to be normal (LKN) or when did
the symptoms begin?" This precise time of symptom onset is critical for
determining eligibility for acute reperfusion therapies like IV tPA or mechanical
thrombectomy.
**13. A nurse is caring for a patient with severe expressive (Broca's) aphasia.
What are three effective nursing communication strategies?**
**Answer:**
1. **Be patient and allow ample time for the patient to respond.** Do not rush
or interrupt.
2. **Use short, simple sentences and questions.** Avoid complex or abstract
language.
3. **Encourage non-verbal communication:** Use gestures, facial expressions,
pointing, or a communication board/picture chart. Ask yes/no questions if
possible.
Comprehensive Cerebrovascular Disorders
Examination
Course: NSG 3250 - Adult Health
Topic: Cerebrovascular Accidents (Stroke), Transient Ischemic Attacks (TIA),
Increased Intracranial Pressure (ICP), and Related Nursing Management
Section 1: Intermediate Level Questions**
**1. What is the primary difference between a Transient Ischemic Attack (TIA) and
an Ischemic Stroke?**
**Answer:** A TIA is characterized by transient neurological dysfunction
resulting from focal brain, spinal cord, or retinal ischemia, but **without acute
infarction** (no permanent tissue damage). Symptoms typically last less than 1
hour. An ischemic stroke, conversely, involves **acute infarction** (permanent
tissue damage) in the brain due to prolonged ischemia, leading to persistent
neurological deficits. While TIA symptoms resolve, patients who experience a TIA
are at a significantly higher risk for a future thrombotic stroke.
**2. How is a stroke definitively diagnosed in the acute setting, particularly to
differentiate between ischemic and hemorrhagic types?**
**Answer:** The primary diagnostic tool in the acute setting is a **non-contrast
Computed Tomography (CT) scan of the head**. This imaging is rapid and highly
,effective at ruling out intracranial hemorrhage, which is crucial before
considering thrombolytic therapy for ischemic stroke. A CT scan can also show
early signs of ischemic stroke, though it may be normal in the very early stages.
**3. A patient presents with sudden onset of right-sided weakness and difficulty
speaking. Which cerebral hemisphere is most likely affected?**
**Answer:** The **left cerebral hemisphere** is most likely affected. The left
hemisphere controls motor function on the right side of the body. Additionally, in
about 95% of right-handed individuals and 70% of left-handed individuals, the left
hemisphere is dominant for language, so aphasia (difficulty speaking) points to
left hemispheric involvement.
**4. Patients with a right-hemisphere stroke often exhibit specific cognitive and
perceptual deficits. List three common deficits associated with a right-
hemisphere stroke.**
**Answer:**
1. **Left-sided neglect/inattention:** Difficulty or inability to attend to stimuli on
the left side of their body or environment.
2. **Spatial-perceptual deficits:** Issues with judging distances, size, position,
and relationships between objects.
3. **Impulsivity and poor judgment:** Tendency to act quickly without
considering consequences, often leading to safety concerns.
4. **Denial or minimization of problems (anosognosia):** Lack of awareness of
their deficits.
5. **Visual field defects:** Often left homonymous hemianopsia.
**5. Which two major categories classify all strokes?**
**Answer:**
1. **Ischemic Stroke:** Caused by a blockage of blood flow to the brain (e.g.,
by a clot).
2. **Hemorrhagic Stroke:** Caused by bleeding into the brain tissue or
surrounding spaces.
,**6. Describe the main difference between a thrombotic ischemic stroke and an
embolic ischemic stroke.**
**Answer:**
* **Thrombotic Ischemic Stroke:** Occurs when a blood clot (thrombus) forms
in an artery supplying blood to the brain, typically at the site of atherosclerotic
plaque buildup, and blocks blood flow. Often has a more gradual or "stuttering"
onset.
* **Embolic Ischemic Stroke:** Occurs when a blood clot or other debris
(embolus) forms elsewhere in the body (e.g., in the heart due to atrial fibrillation,
or from a carotid artery plaque) and travels to the brain, lodging in a smaller
artery and blocking blood flow. Often has a sudden, abrupt onset.
**7. A patient with a history of TIA is at highest risk for which type of stroke?**
**Answer:** A patient with a TIA is at highest risk for a **thrombotic ischemic
stroke**. The underlying pathophysiology (atherosclerosis) that causes a TIA is
the same that leads to a thrombotic stroke. The TIA serves as a warning sign.
**8. What is the critical time window for the administration of intravenous
thrombolytic therapy (Alteplase/tPA) in acute ischemic stroke?**
**Answer:** The critical time window for IV tPA is typically **within 3 to 4.5
hours** from the onset of stroke symptoms for eligible patients. Strict criteria
must be met, and this window can vary slightly based on individual patient
factors and institutional guidelines.
**9. What is "hemianopsia" and how does it manifest in a stroke patient?**
**Answer:** Hemianopsia is the **loss of vision in half of the visual field** in one
or both eyes. In stroke, it often manifests as **homonymous hemianopsia**,
where the same half of the visual field is lost in both eyes (e.g., loss of the right
visual field in both eyes). This occurs due to damage to the optic pathways in the
brain. Patients may neglect food on one side of their plate or bump into objects
on the affected side.
, **10. Why is maintaining a quiet and calm environment crucial for a patient with
increased intracranial pressure (ICP)?**
**Answer:** A quiet and calm environment minimizes external stimuli (noise,
light, excessive handling). These stimuli can trigger stress responses, leading to
increased cerebral metabolic demand, vasodilation, and an increase in cerebral
blood volume, all of which can **elevate ICP**. Reducing environmental stimuli
helps to keep ICP stable and lower.
**11. Which type of intravenous fluid should be *avoided* in patients with stroke
or increased ICP, and why?**
**Answer:** **Hypotonic solutions** (e.g., D5W, 0.45% Saline) should be
avoided. These solutions have a lower osmolality than blood plasma, causing
fluid to shift from the intravascular space into the cells (including brain cells).
This fluid shift can exacerbate or cause **cerebral edema**, leading to a further
increase in ICP.
**12. When assessing a stroke patient, what is the single most important question
to ask to guide acute treatment decisions?**
**Answer:** "When was the patient last known to be normal (LKN) or when did
the symptoms begin?" This precise time of symptom onset is critical for
determining eligibility for acute reperfusion therapies like IV tPA or mechanical
thrombectomy.
**13. A nurse is caring for a patient with severe expressive (Broca's) aphasia.
What are three effective nursing communication strategies?**
**Answer:**
1. **Be patient and allow ample time for the patient to respond.** Do not rush
or interrupt.
2. **Use short, simple sentences and questions.** Avoid complex or abstract
language.
3. **Encourage non-verbal communication:** Use gestures, facial expressions,
pointing, or a communication board/picture chart. Ask yes/no questions if
possible.
