The nurse is caring for a client with an ischemic stroke who has apraxia. Which of the following deficits would the nurse expect the client to have?

Inability to see objects on one side of the visual field

Inability to perform a previously learned action

Inability to repeat a simple sentence

Inability to hear from the ear on the affected side

Answer and Explanation

The Correct Answer is B

A. Inability to see objects on one side of the visual field: This describes hemianopsia, not apraxia.

B. Inability to perform a previously learned action: Apraxia is the loss of the ability to perform skilled movements or gestures despite having the desire and physical ability to do so.

C. Inability to repeat a simple sentence: This describes aphasia, specifically expressive or receptive aphasia.

D. Inability to hear from the ear on the affected side: This describes hearing loss, which is unrelated to apraxia.

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Correct Answer is A

Explanation

A. BP 170/64, pulse 58: Cushing's triad includes increased systolic blood pressure with widened pulse pressure, bradycardia, and irregular respirations, indicating increased intracranial pressure.

B. BP 180/90, pulse 96: Hypertension is present, but the elevated pulse does not align with bradycardia seen in Cushing's triad.

C. BP 110/70, pulse 100: These values do not reflect the classic signs of Cushing's triad.

D. BP 100/60, pulse 54: While bradycardia is present, hypotension does not align with Cushing’s triad.

A. 0.9% normal saline IV at 100 mL/hr continuous B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr C. Laboratory testing of serum potassium upon admission D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain E. Treats certain arrhythmias through the process of ablation

Correct Answer is A

Explanation

A. 0.9% normal saline IV at 100 mL/hr continuous: This order requires clarification. In acute heart failure, fluid management is crucial. A continuous IV infusion of normal saline could exacerbate fluid overload and worsen heart failure. Typically, IV fluids are given cautiously or restricted in heart failure cases.

B. Bumetanide (Bumex) 1 mg IV bolus every 12 hr: This is a loop diuretic, which is appropriate for managing fluid overload in heart failure.

C. Laboratory testing of serum potassium upon admission: This is appropriate, as diuretics like Bumex can lower potassium levels, so it is important to monitor electrolyte levels.

D. Morphine sulfate 2 mg IV bolus every 2 hr PRN pain: This is appropriate for pain management and to help with anxiety and breathing difficulties in acute heart failure.

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The nurse is caring for a client with an ischemic stroke who has apraxia. Which of the following deficits would the nurse expect the client to have?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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