A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?

Complete blood count (CBC)

Electroencephalogram (EEG)

Computed tomography (CT) scan

Chest radiograph (chest x-ray)

Answer and Explanation

The Correct Answer is C

A) "Complete blood count (CBC)":
. A CBC can provide important information about the patient's overall health, including potential signs of infection, anemia, or other underlying conditions. However, in the context of acute neurological symptoms such as left-sided weakness, CT scan is the priority test because it will help quickly determine if there is an acute neurological event, such as a stroke or hemorrhage. While a CBC might be useful later to assess for underlying
conditions or potential causes, it is not the first test to perform in this scenario.

B) "Electroencephalogram (EEG)":
. An EEG is primarily used to diagnose and assess seizure activity or epileptic disorders. While seizures can cause neurological deficits, the patient's sudden onset of left-sided weakness is more suggestive of a stroke, not a seizure. The priority is to rule out stroke with a CT scan, not to assess for seizures with an EEG.

C) "Computed tomography (CT) scan":
. A CT scan is the first diagnostic test to perform in patients with acute neurological deficits such as sudden-onset weakness, especially when a stroke is suspected. A CT scan can quickly detect if the cause is an ischemic stroke (lack of blood flow due to a clot) or a hemorrhagic stroke (bleeding in the brain). Time is critical in the management of stroke, as early intervention with treatments like tPA (tissue plasminogen activator) for ischemic stroke can greatly improve outcomes. The CT scan can help determine if the patient is a candidate for thrombolysis or if other interventions are needed.

D) "Chest radiograph (chest x-ray)":
. While a chest x-ray can be useful for diagnosing respiratory issues, such as pneumonia or congestion, it is not helpful in evaluating the cause of acute neurological symptoms like left-sided weakness. The priority test is a CT scan to evaluate the brain and rule out conditions like stroke or hemorrhage, not a chest x-ray.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Have the client lay prone for 30 minutes. 3-4 times a day:
This statement is correct. Lying prone (on the stomach) for 30 minutes several times a day helps to prevent hip flexion contractures, which are common complications after an above-the-knee amputation. By lying prone, the residual limb is stretched and the hip joint is kept in an extended position, which helps maintain proper alignment and reduces the risk of contractures. This is a key part of postoperative care to promote optimal positioning and rehabilitation.

B. Continue using the limb prosthesis even if the skin appears irritated:
This statement is incorrect. If the skin becomes irritated or damaged, the prosthesis should not be used until the skin has healed. Continued use of the prosthesis in the presence of skin irritation can cause further damage, leading to ulcers or infections. It is essential to regularly check the residual limb for irritation, redness, or sores and adjust the prosthesis as needed. If irritation is present, the prosthesis should be removed, and appropriate skin care should be provided.

C. Withhold medication for phantom limb pain as it isn't real pain:
This statement is incorrect. Phantom limb pain is real and a common experience for individuals after an amputation. It occurs when the brain perceives pain sensations in the area where the limb used to be, even though the limb is no longer there. Phantom limb pain is often treated with pain medications, including analgesics, anticonvulsants, or antidepressants, and should not be withheld. Proper management of phantom limb pain is important for the client's comfort and overall well-being.

D. Keep the residual limb elevated to achieve as close to 90-degree hip flexion as possible:
This statement is incorrect. While it is important to elevate the residual limb after surgery to reduce swelling, it should not be elevated to the point where the hip joint is flexed to 90 degrees. Elevating the limb too much or for prolonged periods can increase the risk of developing a hip flexion contracture, which would impair mobility. The residual limb should be elevated slightly, but the hip joint should not be excessively flexed. Ideally, the limb should be positioned in a neutral or extended position when elevated.

A. Recent thoracic surgery within the past week B. Uncontrolled hypertensive crisis C. Age over 65 years D. Head trauma with active cerebral hemorrhage

Correct Answer is C

Explanation

A. Recent thoracic surgery within the past week:
Recent surgery, especially in the thoracic region, is a contraindication for the use of tissue plasminogen activator (tPA) in stroke treatment. tPA is a thrombolytic agent that dissolves clots, but it also increases the risk of bleeding, including in areas where surgery has recently occurred. Using tPA in this situation can potentially lead to life-threatening bleeding complications.

B. Uncontrolled hypertensive crisis:
Uncontrolled hypertension is a contraindication for tPA. High blood pressure can increase the risk of hemorrhagic transformation (bleeding into the brain) when using thrombolytic therapy like tPA. A hypertensive crisis (typically systolic BP > 185 mmHg or diastolic BP > 110 mmHg) must be managed and brought under control before administering tPA to minimize the risk of bleeding complications.

C. Age over 65 years:
While age over 65 years may increase the risk of complications from tPA, it is not an absolute contraindication for its use. Guidelines for tPA administration in stroke patients typically focus more on factors like time from symptom onset (usually within 4.5 hours), the presence of contraindications like recent surgery or uncontrolled hypertension, and the overall clinical condition. Age itself is not a reason to withhold tPA unless other risk factors are present.

D. Head trauma with active cerebral hemorrhage:
Head trauma with active cerebral hemorrhage is a definitive contraindication for tPA. Since tPA is a clot-busting drug, it can worsen bleeding in the brain, especially in cases where there is ongoing hemorrhage from trauma. This significantly increases the risk of severe neurological damage and even death, so tPA should not be administered in such situations.

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A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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