Stroke Nursing SCRN
Stroke Nursing Review SCRN
Which of the following findings suggest stroke in the posterior circulation?
A. Receptive aphasia
B. Inappropriate behavior
D. Left-sided neglect
Answer: C. Quadriplegia
The posterior circulation is chiefly supplied by the vertebral arteries. These two vessels quickly merge to become the short basilar artery. The posterior circulation perfuses the occipital lobe, as well as the lower, more primitive parts of the brain: the thalamus, cerebellum, midbrain, pons, and medulla. Locked-in syndrome (pons infarct) and quadriplegia can occur following posterior stroke. Visual and sensory changes also characterize posterior circulation stroke. Receptive aphasia transpires when Wernicke's area of auditory interpretation (in the dominant temporal-parietal area) is affected. Left-sided neglect suggests right (non-dominant) middle cerebral artery infarction. Impaired social skills, judgment, or personality suggest frontal lobe stroke. Of the functions listed, only quadriplegia could not be explained by an anterior circulation stroke.
A diabetic patient is admitted for a transient ischemic attack. The patient is hypertensive and hyperlipidemic. Which of the following physiologic goals is a target for this patient?
A. Low-density lipoprotein <100 mg/dL
B. HbA1c <8.0%
C. Blood pressure <150/80 mm Hg
D. Fasting serum glucose <140 mg/dL
Answer: A. Low-density lipoprotein <100 mg/dL
The 2014 American Diabetic Association (ADA) recommendations for most adult diabetics include maintaining a blood pressure less than 140/90 mm Hg and a low-density lipoprotein (LDL) level of less than 100 mg/dL. The ADA has also adopted the conservative goals of a hemoglobin A1c level ≤ 7% and a target premeal glucose level of 80-130 mg/dL. However, glycemic goals, blood pressure objectives, and LDL level targets that are either more or less stringent than those described may be appropriate for individual patients based on duration of diabetes, comorbid conditions, and the presence of known cardiovascular disease. Individualizing treatment plans is an important part of stroke prevention in the diabetic patient.
A patient's clinical findings and brain computed tomogram (CT) strongly suggest acute ischemic stroke. The patient has no contraindications to intravenous (IV) fibrinolytic therapy. American Stroke Association guidelines recommend r-tPA administration be initiated within 60 minutes of
A. emergency department arrival.
B. symptom onset.
C. CT scan interpretation.
D. stroke team evaluation.
Answer: A. emergency department arrival.
r-tPA (alteplase) is currently the only drug indicated for the fibrinolysis of intracranial clots in the patient with acute ischemic stroke. Besides its myriad contraindications, the most important drug limitation is the timeframe in which r-tPA must be initiated. IV alteplase can only be given for up to 3 hr (in some cases up to 4.5 hr) after ischemic stroke onset, thus providing a very narrow window of opportunity. Even when EMS is contacted immediately, the time required for each step of the notification, transportation, evaluation, and intervention process rapidly consumes valuable minutes. Delays can quickly eliminate a patient's fibrinolytic therapy option. The goal from the time a patient reaches the hospital to the commencement of r-tPA therapy is ≤60 minutes. Early administration enhances outcome.
A patient presents 90 minutes after the onset of aphasia and right facial droop. Which imaging study of the head is most likely to be ordered first?
A. Magnetic resonance imaging (MRI)
B. Computed tomography (CT) scan
C. Digital subtraction angiography
D. CT angiography (CTA)
Answer: B. Computed tomography (CT) scan
Non-enhanced (a.k.a. noncontrast) computed tomography (NECT) is the most commonly employed neuroimaging study for the acute evaluation of apparent stroke. These scans are readily available, even at even small facilities. They are cost-effective and non-invasive. However, the primary value of a brain CT in the hyperacute phase is its ability to detect blood, thus ruling OUT a hemorrhagic event, rather than ruling IN ischemic stroke, and facilitating patient selection for fibrinolytic therapy. Other imaging modalities have increased sensitivity for identifying stroke location, extent, and etiology, but are more invasive, and more expensive.
Family members ask why an aneurysmal subarachnoid hemorrhage (aSAH) patient is scheduled for cerebral angiography when a non-enhanced computed tomography (NECT) scan was just performed. The best response is, "Cerebral angiography
A. is the most sensitive test for diagnosing cerebrovascular disorders."
B. provides results much faster than NECT."
C. is the only test that images aneurysmal blood around cerebral tissue."
D. is considered safer than NECT imaging."
Answer: A. is the most sensitive test for diagnosing cerebrovascular disorders."
NECT is the initial study of choice for the evaluation of patients with suspected aSAH. After an aSAH is confirmed, cerebral angiography (CA) is performed to visualize the vascular anatomy and identify the aneurysm's location, size, and shape. Despite the development of more sophisticated diagnostic testing, cerebral angiography remains the "gold standard." CA is highly accurate, sensitive, and specific. However, CA is invasive and requires contrast for visualization. Compared to NECT, CA takes more time to perform and puts patients at risk for serious complications such as arterial perforation, catheter insertion site bleeding, stroke, and death. Several other imaging studies can identify blood in the brain.
Stroke Nursing Review SCRN
Stroke Nursing Review SCRN®
Pocket Study Guide Volume 1
Laura M. Criddle PhD APRN CCRN CNRN SCRN FAEN
Marylyn Kajs-Wyllie MSN APRN CCRN CNRN SCRN