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Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
Chapter 67 : Management of Patients with Cerebrovascular Disorders Questions
Question 1 of 5
As a member of the stroke team, the nurse knows that thrombolytic therapy carries the potential for benefit and for harm. The nurse should be cognizant of what contraindications for thrombolytic therapy? Select all that apply.
Correct Answer: B,D,E
Rationale: Recent intracranial pathology, anticoagulation (INR >1.7), and symptom onset >3 hours are thrombolytic contraindications. INR above 1.0 is too low, and sudden onset is not a contraindication.)
Question 2 of 5
Stroke after a major ischemic stroke, a possible complication is cerebral edema. Nursing care during the immediate recovery period from an ischemic stroke should include which of the following?
Correct Answer: A
Rationale: Positioning to avoid hypoxia reduces ICP in ischemic stroke recovery. High PaCO2 and early mobilization increase ICP; hypertonic saline is for hyponatremia.
Question 3 of 5
The nurse is caring for a patient recovering from an ischemic stroke. What intervention best addresses a potential complication after an ischemic stroke?
Correct Answer: B
Rationale: Deep breathing and coughing prevent pneumonia, a common stroke complication. Frequent meals, prolonged catheters, and fiber limits are not indicated.
Question 4 of 5
During a patients recovery from stroke, the nurse should be aware of predictors of stroke outcome in order to help patients and families set realistic goals. What are the predictors of stroke outcome? Select all that apply.
Correct Answer: A,C,E
Rationale: NIHSS score, LOC, and age predict stroke outcomes. Race and gender are not significant predictors.
Question 5 of 5
A nursing student is writing a care plan for a newly admitted patient who has been diagnosed with a stroke. What major nursing diagnosis should most likely be included in the patients plan of care?
Correct Answer: D
Rationale: Disturbed sensory perception is a common stroke-related diagnosis due to sensory deficits. Other options are less directly associated.