A nurse is caring for a client who presented with unilateral facial droop and weakness that lasted for about an hour before resolving spontaneausly without intervention. Which of the following is true regarding this situation?
The blockage is most likely in the right parietal region
This type of event can be one of the primary warning sign of a future stroke
The signs and symptoms are most consistent with an acute hemorrhagic stroke
The signs and symptoms are most consistent with a focal awareness seizure.
The Correct Answer is B
A. The blockage is most likely in the right parietal region:
While a facial droop and weakness can be indicative of a stroke, the specific location of the blockage cannot be definitively determined based on the symptoms alone. A right-sided facial droop suggests that the lesion or event likely involves the left side of the brain, particularly the frontal or temporal regions, as these areas are typically associated with facial motor control. A parietal lesion would more commonly result in sensory deficits or spatial issues, not primarily facial droop. Therefore, this statement is not correct in this case.
B. This type of event can be one of the primary warning signs of a future stroke:
The client’s presentation of unilateral facial droop and weakness that resolves spontaneously within an hour is highly consistent with a transient ischemic attack (TIA). A TIA, often referred to as a "mini-stroke," is characterized by temporary neurological deficits that resolve without permanent damage. TIAs are considered warning signs of a potential future stroke, and the client should be evaluated promptly to address risk factors and prevent a more serious, permanent stroke.
C. The signs and symptoms are most consistent with an acute hemorrhagic stroke:
An acute hemorrhagic stroke typically presents with sudden and severe neurological deficits, such as a severe headache, vomiting, and loss of consciousness. Hemorrhagic strokes do not typically resolve spontaneously within an hour. The client's symptoms (unilateral facial droop and weakness that resolve within an hour) are more indicative of a TIA, not a hemorrhagic stroke. A hemorrhagic stroke would likely result in sustained deficits and a more urgent clinical presentation.
D. The signs and symptoms are most consistent with a focal awareness seizure:
Focal awareness seizures (previously known as simple partial seizures) generally involve abnormal electrical activity in a specific area of the brain, leading to symptoms such as motor twitches or sensory disturbances, but not typically a full facial droop or weakness. These seizures do not cause symptoms that resolve in such a short time, nor do they present with unilateral weakness in the manner described here. Therefore, this scenario is not consistent with a seizure disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "Following up with your dentist frequently will be important.":
This is the correct and important advice to give. Phenytoin (Dilantin), an anticonvulsant, can cause gum overgrowth (gingival hyperplasia), which makes it important for the patient to have regular dental check-ups. Poor oral hygiene combined with gingival hyperplasia can increase the risk of infection and other oral health issues. Therefore, advising the patient to follow up frequently with a dentist is essential to manage this side effect.
B. "Take an antacid with the medication if indigestion occurs.":
advice. Taking an antacid with phenytoin can interfere with its absorption. Antacids, especially those containing aluminum or magnesium, can reduce the effectiveness of phenytoin, leading to suboptimal therapeutic levels. It’s important to separate phenytoin from antacids by at least 2 hours to avoid this interaction. Therefore, antacids should not be used with phenytoin to manage indigestion.
C. "Alcoholic beverages should be limited to 1-2 per day while taking phenytoin.":
This is inaccurate advice. Alcohol can significantly affect the metabolism of phenytoin, increasing the risk of both toxicity and reduced effectiveness. Alcohol may lower the seizure threshold and interfere with the therapeutic effect of phenytoin, especially in higher amounts. Therefore, it is generally recommended that patients taking phenytoin avoid alcohol altogether, or at the very least limit consumption significantly and discuss it with their healthcare provider.
D. "Phenytoin may turn your urine orange.":
information. Phenytoin does not cause urine to turn orange. Urine discoloration can occur with some medications (like rifampin, for example), but not with phenytoin. This statement could cause unnecessary confusion for the patient. It is essential to provide accurate information to avoid misconceptions about medication side effects.
Correct Answer is ["B","C","E"]
Explanation
A) Aim to keep your HDL cholesterol as low as possible:
High-density lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol because it helps remove excess cholesterol from the bloodstream, thereby reducing the risk of atherosclerosis and coronary artery disease. The goal should be to raise HDL cholesterol levels, not lower them. Higher levels of HDL are associated with a lower risk of heart disease.
B) Controlling your diabetes is an important factor:
Diabetes is a major risk factor for coronary artery disease (CAD). Uncontrolled blood sugar levels can lead to damage of the blood vessels, increase the risk of atherosclerosis, and raise the likelihood of heart disease. Proper management of diabetes through diet, medication, and lifestyle changes is essential to reduce the risk of CAD.
C) Exercising and achieving your goal weight are recommended:
Regular exercise and maintaining a healthy weight are crucial for reducing the risk of coronary artery disease. Exercise helps improve cardiovascular health, lowers blood pressure, increases HDL cholesterol, and helps control body weight and blood sugar. Achieving and maintaining a healthy weight reduces the strain on the heart and lowers the risk of developing CAD.
D) Increase saturated fat intake and limit unsaturated fats:
Saturated fats can raise low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol, which contributes to plaque buildup in the arteries and increases the risk of heart disease. Unsaturated fats, found in foods like olive oil, avocados, and fatty fish, are healthier and can help reduce cholesterol levels and improve heart health. The goal should be to limit saturated fats and increase the intake of unsaturated fats.
E) It is important to keep your blood pressure within normal limits:
High blood pressure is a significant risk factor for coronary artery disease. It can lead to the hardening and narrowing of the arteries, increasing the risk of heart attacks, strokes, and other cardiovascular events. Keeping blood pressure within normal limits through lifestyle changes, such as reducing salt intake, managing stress, exercising, and taking medications if needed, is essential for heart health.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.