(Osborn) Chapter 30: Learning Outcomes (Number and Title)

[Osborn] chapter 30
Learning Outcomes [Number and Title]

Learning Outcome 1
Identify and distinguish between the different types of strokes
and their reported impact on rehabilitation and recovery to a
functional status.
Learning Outcome 2
Describe the basic pathophysiology of each type of identified
stroke.
Learning Outcome 3
Explain the events of the ischemic cascade as it relates to the
pathophysiology of strokes.
Learning Outcome 4
Compare and contrast the different medical management
options for the treatment of ruptured aneurysms.
Learning Outcome 5
Explain nursing interventions associated with management of
vasospasm.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. Which of the following assessment data alerts the nurse to the fact that the client is at risk for an
embolic stroke?
1.
2.
3.
4.
History of atrial fibrillation

Blood sugar of 110 mg
BP 108/68
Right partial lobectomy 6 months ago
Correct Answer: History of atrial fibrillation

Rationale: Embolisms from cardiac sources are referred to as cardiogenic embolisms. The most common
cause is atrial fibrillation, which accounts for almost 20% of all ischemic (embolic) strokes. Hypotension,
a normal blood glucose level, and a partial lobectomy are not risk factors for embolic strokes.
Cognitive Level: Applying
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1
2. After being informed that their father has experienced a stroke that has affected a portion of his
cerebrum, the clients family asks the nurse, What affect will aphasia have on his life? The nurse
responds by stating:
1.
2.
3.
4.
The way he communicates with you will change.

Youll have to speak very loudly when you talk.
He will likely become depressed until he adjusts to the dysfunction.
Perhaps you should learn about the different options for speech therapy.
Correct Answer: The way he communicates with you will change.

Rationale: Aphasia is the term used to denote problems with verbal communication. The Brocas area in
the cerebrum regulates verbal expressionthe ability to say words. Speaking loudly is more related to a
hearing problem; doing so will have little impact on the clients ability to communicate verbally.
Depression may occur but it does not address the clients verbal communication issues. Speech therapy
may be an option for rehabilitation but it does not provide an answer to the question asked.
Nursing Process: Implementation
LO: 1
3. A nurse is preparing an educational program focusing on various types of strokes. Which of the
following should be included in a discussion of ischemic strokes?
Select all that apply.
1.
2.
3.
4.
5.
Atherosclerotic thrombotic
Cardioembolic
Lacunar
Subarachnoid hemorrhagic
Intracerebral hemorrhagic
Correct Answer:
1. Atherosclerotic thrombotic
2. Cardioembolic
3. Lacunar
Rationale: Atherosclerotic thrombotic. Atherosclerotic thrombotic strokes are considered ischemic in
nature because they restrict or obstruct blood flow to a portion of the brain, resulting in cellular death.
Cardioembolic. Cardioembolic strokes are considered ischemic in nature because they restrict or obstruct
blood flow to a portion of the brain, resulting in cellular death. Lacunar. Lacunar strokes are considered
ischemic in nature because they restrict or obstruct blood flow to a portion of the brain, resulting in
cellular death. Subarachnoid hemorrhagic. Subarachnoid hemorrhagic strokes are a result of a severe
blood loss from the vascular system of the brain. Intracerebral hemorrhagic. Intracerebral hemorrhagic
strokes are a result of a severe blood loss from the vascular system of the brain.
LO: 1
4. A poststroke client is going home on oral warfarin (Coumadin). During discharge teaching, which
statement by the client would reflect an understanding of the effects of this medication?
1.
2.
3.
4.
I dont like green vegetables, so not eating them will be a pleasure.

I will stop taking this medicine if I notice any bruising.
It will be OK for me to eat anything, as long as it is low-fat.
Ill check my blood pressure frequently while taking this medication.
Correct Answer: I dont like green vegetables, so not eating them will be a pleasure.
Rationale: Warfarin is a vitamin K antagonist. Green, leafy vegetables contain vitamin K, and will
therefore interfere with the therapeutic effects of the drug. Bruising is a common side effect, and the drug
should not be stopped unless by prescriber order. Low-fat foods do not interfere with warfarin therapy.
Warfarin is not prescribed to affect the blood pressure.
LO: 2
5. When the nurse reinforces education regarding the risks of bypass procedures for a client who has
experienced an ischemic stroke, which of the following is included?
1.
2.
3.
4.
5.
Hemorrhage
Infection
Thrombotic stroke
Unstable blood pressure
Renal failure
Correct Answer:
1. Hemorrhage
2. Infection
3. Thrombotic stroke
4. Unstable blood pressure
Rationale: Hemorrhage. Bypass procedures carry significant risk to the patient, including hemorrhage of
the vessel. Infection. All surgical procedures, including bypass procedures, carry risks of infection and
alteration in wound healing. Thrombotic stroke. Bypass procedures carry significant risk to the patient,
such as stroke due to clot in the graft or stroke due to a variety of other factors. Unstable blood pressure.
Bypass procedures carry significant risk to the patient, such as blood pressure instability. Renal failure.
Renal failure is not considered a classic risk for these procedures.
Nursing Process: Planning
LO: 2
6. A 27-year-old male arrives at the emergency room reporting a sudden severe-onset headache. He denied
any recent head trauma and added that he was, just partying with friends before the headache began.
Diagnostic studies confirm he is experiencing an intracerebral hemorrhage. The nurse recognizes that the
greatest risk factor for such a stroke in his age group is:
1.
2.
3.
4.
Amphetamine abuse.
Hypertension.
Cigarette smoking.
Undiagnosed diabetes mellitus.
Correct Answer: Amphetamine abuse.

Rationale: Sudden onset of symptoms, especially a severe headache, is a common sign of intracerebral
hemorrhage. When this type of stroke is seen in a young adult, and trauma is ruled out as the cause, drug
use should be suspected, specifically cocaine or amphetamines. Cigarette smoking, hypertension, and
diabetes mellitus are risk factors for ischemic strokes.
Nursing Process: Assessments
LO: 2
7. An emergency department nurse caring for a client who has been diagnosed with an ischemic stroke
that preceded a fall anticipates the need to initially prepare the client for:
1.
2.
3.
4.
Administration of t-PA (tissue plasminogen activator).

A CT scan (computerized tomography).
Full-body x-ray series.
Craniotomy.
Correct Answer: Administration of t-PA (tissue plasminogen activator).

Rationale: The administration of t-PA does not affect the infarcted, necrotic core, but may revitalize the
penumbra and limit the extent of damage caused by ischemic stroke, thus minimizing the effects of the
stroke. A CT scan is a diagnostic tool to confirm the diagnosis of an ischemic stroke. An x-ray series is
directed toward the identification of possible bone damage resulting from the fall but would not take
priority over t-PA administration. A craniotomy evacuates a hematoma to relieve mass effect resulting
from a hemorrhagic stroke.
LO: 3
8. A client is admitted with signs of a stroke (CVA). On admission, vital signs were: blood pressure
128/70, pulse 68, and respirations 20, pupils equal and reactive, client awake and responding to verbal
stimuli. Two hours later the client is not awake but is easily aroused, has a blood pressure of 140/70, pulse
52, respirations 18, and the left pupil is now slower than the right pupil in reacting to light. These findings
are a result of:
1.
2.
3.
4.
Increased intracranial pressure.

Impending brain death.
Reperfusion injury.
Normal stabilization poststroke.
Correct Answer: Increased intracranial pressure.

Rationale: Rising systolic blood pressure, falling pulse, and a pupil that has become sluggish suggest
increasing intracranial pressure (IICP) and require notification of the health care provider. The most
current assessment findings indicate that the clients condition is becoming more unstable. Brain death is
diagnosed by lack of brain waves and inability to maintain vital function. Reperfusion injury results in
further injury to already damaged tissue that is compromised, and may be seen most often with
thrombolytic therapy.
LO: 3
9. The nursing caring for a client who experienced an ischemic stroke 8 hours ago recognizes that the
medication being administered for the purpose of preventing further obstruction of vascular cerebral
blood flow is:
1.
2.
3.
4.
5.
Intravenous heparin.
Subcutaneous low-molecular-weight heparin.
Intravenous mannitol.
Intravenous dopamine.
Subcutaneous insulin.
Correct Answer:
1. Intravenous heparin.
2. Subcutaneous low-molecular-weight heparin.
Rationale: Intravenous heparin. Anticoagulation with IV infusion of heparin for several days during the
acute care management of a patient with ischemic stroke is common. Subcutaneous low-molecularweight heparin. Some institutions use low-molecular-weight heparin (LMWH) subcutaneously instead of
intravenous heparin. Intravenous mannitol. Intravenous mannitol is utilized to reduce intracranial
pressure and brain mass. Intravenous dopamine. Intravenous dopamine is a vasopressor directed at
stabilizing blood pressure. Subcutaneous insulin. Subcutaneous insulin may be used to manage
hyperglycemia resulting from ineffective utilization of glucose.
LO: 3
10. A client is being treated in the emergency department for a possible aneurysmal subarachnoid
hemorrhage (SAH). The nurse recognizes which of the following assessment data as risk factors for such
a neurological emergency?
Select all that apply
1.
2.
3.
4.
5.
Takes an alpha blocker daily

Age 58
History of rheumatoid arthritis
Smoker, pack a day
Diesel truck mechanic
Correct Answer:
1. Takes an alpha blocker daily
2. Age 58
3. History of rheumatoid arthritis
4. Smoker, pack a day
Rationale: Takes an alpha-blocker daily. Hypertension (may be treated with a daily dose of an alphablocker) is considered a risk factor for a cerebral aneurysm. Age 58. Age greater than 40 is considered a
risk factor for a cerebral aneurysm. History of rheumatoid arthritis. A history of a connective tissue
disorder (e.g., rheumatoid arthritis) is considered a risk factor for a cerebral aneurysm. Smoker, pack a
day. Smoking is considered a risk factor for a cerebral aneurysm. Diesel truck mechanic. There is no
known increased risk related to work as a diesel truck mechanic.
Cognitive Level: Analyzing
LO: 4
11. A diagnosis of inappropriate antidiuretic hormone syndrome is made for a client who recently
experienced a subarachnoid hemorrhage (SAH) and is hyponatremic. The nurse recognizes the
importance of:
1.
2.
3.
4.
5.
Administering oral salt supplements.

Strictly monitoring intake and output.
Monitoring hypertonic IV fluid therapy.
Securing a serum sodium level every 6 hours.
Restricting the clients fluids to 200 ml daily.
Correct Answer:
1. Administering oral salt supplements.
2. Strictly monitoring intake and output.
3. Monitoring hypertonic IV fluid therapy.
4. Securing a serum sodium level every 6 hours.
Rationale: Administering oral salt supplements. Generally, the treatment for hyponatremia in SAH is
hypertonic saline with oral salt supplements, if possible. Strictly monitoring intake and output. It is
important for the patients fluid intake and output to be carefully monitored. Monitoring hypertonic IV
fluid therapy. It is important for the patients fluid intake and output to be carefully monitored because
poor management of hypertonic fluid intake can result in cardiac overload problems. Securing a serum
sodium level every 6 hours. It is very important for the patients serum sodium levels to be monitored
frequently, every 6 hours if the patient is receiving hypertonic saline. Restricting the clients fluids to
200 ml daily. Fluid restriction in this setting is absolutely contraindicated.
LO: 4
12. A client is given the option of either endovascular coiling or neurosurgical clipping in response to
experiencing an intracranial aneurysm. The nurse understands that the benefits of endovascular coiling
include:
1.
2.
3.
4.
5.
The probability of being disability-free at 1 year is high.

Postprocedure hospital stay is significantly shorter.
The procedure requires less surgical expertise.
Most aneurysms are suitable for the procedure.
The financial expense is marginally less.
Correct Answer:
1. The probability of being disability-free at 1 year is high.
2. Postprocedure hospital stay is significantly shorter.
Rationale: The probability of being disability-free at 1 year is high. The outcome for survival free of
disability at 1 year is significantly higher with endovascular coiling. Postprocedure hospital stay is
significantly shorter. There is a decreased hospital length of stay associated with the procedure. The
procedure requires less surgical expertise. Treatment would occur at a hospital with neurosurgeons
specially trained in the procedure. Most aneurysms are suitable for the procedure. The choice of
treatment should be based on the angiographic demonstration of the aneurysm. The financial expense is
marginally less. The expense of endovascular coiling is actually higher than that of surgical clipping, but
the expense is more than compensated for by the decreased hospital length of stay and the patients earlier
return to work and normal activities of daily living (ADLs)
LO: 4
13. A client is being treated for an aneurysmal subarachnoid hemorrhage (SAH) that occurred 10 days
ago. The nurse recognizes that the client is at risk for decreased cerebral blood flow and is especially
concerned when the client:
1.
2.
3.
4.
5.
Has a temperature of 101 F.

Reports a stiff neck.
Seems unable to verbalize his needs.
Has unequal but reactive pupils.
Has difficulty starting his flow of urine.
Correct Answer:
1. Has a temperature of 101 F.
2. Reports a stiff neck.
3. Seems unable to verbalize his needs.
Rationale: Has a temperature of 101 F. The peak incidence of vasospasm is from 3 to 14 days from the
incidence of SAH, although it may occur up to 21 days after the bleed occurs. Signs of vasospasm include
fever. Reports a stiff neck. The peak incidence of vasospasm is from 3 to 14 days from the incidence of
SAH, although it may occur up to 21 days after the bleed occurs. Signs of vasospasm include neck
stiffness. Seems unable to verbalize his needs. The peak incidence of vasospasm is from 3 to 14 days
from the incidence of SAH, although it may occur up to 21 days after the bleed occurs. Signs of
vasospasm include aphasia. Has unequal but reactive pupils. Signs of vasospasm do not include
abnormal pupil size or reaction. Has difficulty starting his flow of urine. Signs of vasospasm do not
include urinary hesitation.
LO: 5
14. The nurse is caring for a client who is being treated for cerebral vasospasm with a medical treatment
referred to as triple-H therapy. Which of the following assessment data confirm that the treatment is
currently effective?
1.
2.
3.
4.
5.
BP 170/96
Hematocrit 34%
Mean arterial pressure (MAP) 110 mmHg
Intercranial pressure (ICP) 10 mmHg
Urine output 40 ml/hr
Correct Answer:
1. BP 170/96
2. Hematocrit 34%
3. Mean arterial pressure (MAP) 110 mmHg
4. Intercranial pressure (ICP) 10 mmHg
Rationale:
BP 170/96. Triple-H therapy consists of hypertension, hemodilution, and hypervolemia. The goal of
triple-H therapy is to increase cerebral perfusion pressure and CBF, therefore reducing the risk for further
neurological deficits. Systolic blood pressure should be kept at no less than 160 mmHg. Hematocrit
34%. Triple-H therapy consists of hypertension, hemodilution, and hypervolemia. The goal of triple-H
therapy is to increase cerebral perfusion pressure and CBF, therefore reducing the risk for further
neurological deficits. Hematocrit should be between 32% and 35% to reflect good cerebral perfusion.
Mean arterial pressure (MAP) 110 mmHg. Triple-H therapy consists of hypertension, hemodilution,
and hypervolemia. The goal of triple-H therapy is to increase cerebral perfusion pressure and CBF,
therefore reducing the risk for further neurological deficits. Mean arterial pressure (MAP) should be
between 60 and 150 mmHg. Intercranial pressure (ICP) 10 mmHg. Triple-H therapy consists of
hypertension, hemodilution, and hypervolemia. The goal of triple-H therapy is to increase cerebral
perfusion pressure and CBF, therefore reducing the risk for further neurological deficits. Systolic blood
pressure should be kept at no less than 160 mmHg. Urine output 40 ml/hr. Urine output is not considered
an assessment value for monitoring triple-H therapy.
Nursing Process: Evaluation
LO: 5
15. The nurse is caring for a client who is at risk for developing cerebral vasospasm. The nurse recognizes
which of the following as an inappropriate order for such a client?
1.
2.
3.
4.
Discontinue IV fluids when tolerating fluids.

Hold clients carvedilol (Coreg).
Monitor blood pressure hourly.
Monitor serum electrolytes daily.
Correct Answer: Discontinue IV fluids when tolerating fluids.

Rationale: Patients with subarachnoid hemorrhage are at significant risk for vasospasm. Do not
discontinue IV fluids even if the patient has adequate oral intake. Monitor blood pressure at least hourly.
Do not administer antihypertensive medications without parameters for administration. Monitoring serum
electrolytes, especially sodium, is appropriate.
LO: 5

(Osborn) Chapter 30: Learning Outcomes (Number and Title)

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(Osborn) Chapter 30: Learning Outcomes (Number and Title)

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[Osborn] chapter 30

Learning Outcomes [Number and Title]

History of atrial fibrillation

Correct Answer: History of atrial fibrillation

The way he communicates with you will change.

Correct Answer: The way he communicates with you will change.

I dont like green vegetables, so not eating them will be a pleasure.

Correct Answer: Amphetamine abuse.

Administration of t-PA (tissue plasminogen activator).

Correct Answer: Administration of t-PA (tissue plasminogen activator).

Increased intracranial pressure.

Correct Answer: Increased intracranial pressure.

Takes an alpha blocker daily

Administering oral salt supplements.

The probability of being disability-free at 1 year is high.

Has a temperature of 101 F.

Discontinue IV fluids when tolerating fluids.

Correct Answer: Discontinue IV fluids when tolerating fluids.

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