Which information provided by the patient would help distinguish a hemorrhagic stroke from a thrombotic stroke?
Presence of motor weakness.
Sensory changes.
Sudden onset of severe headache.
History of hypertension.
The Correct Answer is C
Choice A rationale
Motor weakness is a common symptom in both hemorrhagic and thrombotic strokes because both types of stroke disrupt blood flow to brain regions responsible for motor control. Ischemic damage or compression from hemorrhage within motor cortex or descending motor tracts can lead to similar presentations of contralateral hemiparesis or hemiplegia, making it non-specific for differentiation.
Choice B rationale
Sensory changes, such as paresthesia or numbness, can occur in both hemorrhagic and thrombotic strokes. This is due to damage to sensory pathways in the brain, including the thalamus or somatosensory cortex. The specific location and extent of brain injury determine the precise sensory deficits, which can be similar regardless of stroke etiology.
Choice C rationale
A sudden onset of severe headache is a hallmark symptom distinguishing hemorrhagic stroke. This intense headache, often described as "the worst headache of my life," results from the rapid increase in intracranial pressure and meningeal irritation caused by blood extravasation into the subarachnoid space or brain parenchyma, unlike thrombotic strokes.
Choice D rationale
A history of hypertension is a significant risk factor for both hemorrhagic and thrombotic strokes. Chronic uncontrolled hypertension damages arterial walls, predisposing them to rupture in hemorrhagic stroke or promoting atherosclerosis and thrombus formation in ischemic stroke. Therefore, its presence does not specifically differentiate between the two types.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Nitroglycerin is a vasodilator used for angina and does not directly interact with contrast media to cause acute kidney injury. Its primary mechanism involves nitric oxide release, leading to smooth muscle relaxation and improved blood flow, unrelated to renal clearance of contrast.
Choice B rationale
Carvedilol is a beta-blocker that primarily affects heart rate and blood pressure. It does not have a direct interaction with iodinated contrast material that specifically increases the risk of acute kidney injury; its metabolism and excretion pathways do not significantly involve competitive renal mechanisms.
Choice C rationale
Metformin, an oral hypoglycemic agent, interacts with iodinated contrast material. In the presence of acute kidney injury induced by the contrast, metformin can accumulate, leading to lactic acidosis. This risk is due to its renal excretion and interference with mitochondrial respiration.
Choice D rationale
Atorvastatin is a statin used for lipid lowering. It primarily undergoes hepatic metabolism and does not have a known significant interaction with iodinated contrast media that predisposes clients to acute kidney injury. Its mechanism of action is unrelated to renal elimination or nephrotoxicity with contrast.
Correct Answer is B
Explanation
Choice A rationale
Methotrexate does not have a significant interaction with vitamin K. Methotrexate's primary mechanism of action involves inhibiting dihydrofolate reductase, thereby interfering with folate metabolism and DNA synthesis. Vitamin K is crucial for blood clotting factors. There is no contraindication for vitamin K rich foods.
Choice B rationale
Methotrexate excretion is primarily renal, and adequate hydration is critical to prevent nephrotoxicity and facilitate drug elimination. Drinking at least 2 liters of water daily helps maintain good kidney function, ensuring that methotrexate and its metabolites are efficiently cleared from the body, thus minimizing the risk of drug accumulation and associated toxicities.
Choice C rationale
Methotrexate for rheumatoid arthritis is typically administered once weekly, not daily, to mitigate severe adverse effects such as bone marrow suppression, hepatotoxicity, and gastrointestinal complications. Daily dosing would lead to rapid accumulation and dangerously high systemic concentrations, overwhelming the body's detoxification pathways.
Choice D rationale
Alcohol-based mouthwashes should be avoided when taking methotrexate because alcohol can cause mucosal irritation and increase the risk of oral mucositis, a common side effect of methotrexate. Additionally, alcohol can exacerbate hepatotoxicity, a significant concern with methotrexate therapy, by increasing metabolic burden on the liver.
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