A patient is admitted with a stroke that occurred in the left hemisphere of the brain. The nurse would expect the patient to have weakness or paralysis:
On the right side of the body.
On the left side of the body.
On neither side of the body.
On both sides of the body.
The Correct Answer is A
Choice A rationale
The motor pathways in the brain, specifically the corticospinal tract, undergo decussation or crossing over at the level of the medulla oblongata. This means that the motor neurons originating in the left hemisphere of the brain control the muscle movements on the right side of the body. When a stroke occurs in the left hemisphere, the resulting damage to these neurons manifests as contralateral weakness or paralysis on the right side.
Choice B rationale
Due to the contralateral organization of the central nervous system, injury to the left side of the brain does not typically result in isolated weakness on the same side. Ipsilateral weakness would only occur if the damage was below the point of decussation in the spinal cord. In the context of a hemispheric stroke, the physical deficits appear on the opposite side of the brain lesion. Therefore, left sided weakness would indicate a right hemisphere stroke.
Choice C rationale
A stroke involving the left hemisphere typically impacts the primary motor cortex or the internal capsule, which are essential for voluntary movement. It is medically expected that such an event will produce some level of neurological deficit unless the stroke was extremely small or located in a non functional area. Weakness or paralysis is a classic symptom of middle cerebral artery strokes. Suggesting that no side is affected ignores the basic principles of clinical neurology.
Choice D rationale
Weakness on both sides of the body, or quadriparesis, usually indicates a lesion in the brainstem or a very large bilateral injury, rather than a stroke confined to the left hemisphere. The brainstem contains the motor pathways for both sides before they fully separate or decussate. A focal stroke in one hemisphere is characterized by hemiparesis or hemiplegia, affecting only one half of the body. Bilateral weakness is not a standard expectation for a unilateral hemispheric stroke.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Myocardial infarction involves ischemia and necrosis of the heart muscle, often presenting with chest pain that may radiate to the left arm or jaw. While epigastric pain can occur, the negative electrocardiogram and normal cardiac enzymes (such as Troponin I < 0.04 ng/mL) significantly lower the probability of a cardiac event. The specific trigger of a high-fat meal and radiation to the back is much more characteristic of gallbladder disease than coronary occlusion.
Choice B rationale
Cholecystitis is inflammation of the gallbladder, often caused by gallstones obstructing the cystic duct. High-fat meals trigger the release of cholecystokinin, which causes the gallbladder to contract to release bile. If obstructed, this contraction causes sharp pain in the right upper quadrant that frequently radiates to the right scapula or back. This classic presentation, combined with the lack of cardiac markers and the dietary trigger, strongly suggests the gallbladder is the source of the pain.
Choice C rationale
Gastroesophageal reflux occurs when stomach acid backs up into the esophagus, causing a burning sensation in the chest known as heartburn. While it is often triggered by eating, it typically causes retrosternal burning rather than sharp right upper quadrant pain that radiates to the back. Reflux does not usually present with the severity and specific radiation pattern seen in biliary colic or cholecystitis, making it a less likely primary diagnosis for this specific patient.
Choice D rationale
Appendicitis is the inflammation of the vermiform appendix, typically presenting with periumbilical pain that later localizes to the right lower quadrant at McBurney's point. While it can cause nausea and vomiting, the pain is not usually triggered specifically by high-fat meals, nor does it typically radiate to the back from the right upper quadrant. The anatomical location of the pain in this scenario is too high for a standard presentation of acute appendicitis.
Correct Answer is A
Explanation
Choice A rationale
Hepatitis B is a DNA virus that is highly contagious through parenteral routes. It is found in the highest concentrations in blood, with lower concentrations in semen and vaginal secretions. Transmission occurs when these fluids enter the body of a non-immune person through breaks in the skin or mucous membranes. This can happen through sexual intercourse, sharing needles, or from an infected mother to her infant during childbirth. It is not spread through air.
Choice B rationale
Respiratory droplets are the primary mode of transmission for viruses like influenza or SARS-CoV-2, which infect the respiratory tract. Hepatitis B is not a respiratory virus; it does not replicate in the lungs or shed through coughing and sneezing. Therefore, being in the same room as an infected person or breathing the same air does not pose a risk for contracting the virus. Transmission requires more direct contact with specific internal body fluids.
Choice C rationale
Contaminated food and water are vehicles for enterically transmitted viruses like Hepatitis A and E. These viruses are shed in the feces and enter the new host through the mouth. Hepatitis B, however, is not shed in feces in significant amounts and is not hardy enough to survive the digestive processes or environmental conditions typical of foodborne transmission. Consequently, eating food prepared by someone with Hepatitis B is not considered a significant risk.
Choice D rationale
Casual contact, such as hugging, shaking hands, or sharing utensils, does not transmit Hepatitis B. The virus cannot penetrate intact skin and is not found in sweat or tears in levels sufficient for transmission. Education regarding this is vital to reduce the stigma associated with the diagnosis. Patients do not need to be isolated from family members in a household setting, provided they do not share personal items like razors or toothbrushes.
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