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Complete blood count (CBC)A complete blood count (CBC) is a routine laboratory test that assesses various components of blood, such as red blood cells, white blood cells, and platelets. While it may not be specific to diagnosing a transient ischemic attack (TIA), it can help evaluate for underlying conditions such as anemia or thrombocytosis that could contribute to TIA symptoms or increase the risk of stroke.

Prothrombin time (PT) is a laboratory test that evaluates the clotting ability of blood and is typically used to monitor anticoagulant therapy. While abnormal coagulation parameters may be associated with certain conditions that predispose to TIA (such as atrial fibrillation), PT alone is not a specific diagnostic test for TIA.

Transesophageal echocardiogram (TEE)This is another possible diagnostic test that the provider may prescribe. TEE is a specialized echocardiogram that provides detailed images of the heart structures by inserting an ultrasound probe

The client should maintain systolic BP between 130 and 135 mm Hg.This is slightly above the recommended range. While systolic BP below 135 mm Hg is generally recommended for individuals with a history of stroke or TIA, a range of 130-135 mm Hg may still be acceptable based on individual patient factors and risk assessments.

The client should maintain systolic BP between 136 and 140 mm Hg.
This is above the recommended range. Systolic BP between 136 and 140 mm Hg may be considered elevated and should be managed to lower levels to reduce the risk of recurrent TIA or stroke.

The client should maintain systolic BP between 141 and 145 mm Hg.This is above the recommended range. Systolic BP above 140 mm Hg is generally considered elevated and should be managed to lower levels to reduce the risk of recurrent TIA or stroke.

Difficulty understanding the written and spoken wordThis symptom is not typically associated with expressive aphasia. Instead, difficulty understanding language, both written and spoken, is more commonly seen in receptive aphasia, also known as Wernicke's aphasia.

Total inability to communicate
While expressive aphasia can severely impair verbal communication, it does not result in a total inability to communicate. Individuals with expressive aphasia may still be able to communicate to some extent using nonverbal means, gestures, or writing.

Stuttering and spittingStuttering and spitting are not characteristic symptoms of expressive aphasia. Stuttering is a speech disorder characterized by interruptions in the flow of speech, while spitting is not typically associated with aphasia.

"You should talk to your physician about things of that nature."This response may come across as dismissive or evasive. While it is true that the physician ultimately determines the patient's prognosis, the family may be seeking reassurance and guidance from the nurse as well.

"No. Significant recovery of function should occur in a few days."
This response is overly optimistic and potentially misleading. While some improvement may occur in the days following a spinal cord injury, significant recovery of function within a few days is unlikely, especially in cases of flaccid paralysis of all extremities.

This response is overly pessimistic and lacks sensitivity. It may unnecessarily distress the family and extinguish hope for the patient's recovery.

Dizziness and problems with balanceWhile dizziness and problems with balance can occur more frequently in older adults due to age-related changes in the vestibular system and other factors, persistent or severe dizziness or balance issues should be evaluated further as they could indicate underlying neurological or medical conditions.

Slow papillary response to lightThis finding may be considered abnormal, especially if it represents a significant change from the individual's baseline. While age-related changes in pupil function can occur, a slow or sluggish pupillary response to light may indicate dysfunction of the oculomotor nerve or other neurological issues and should be investigated further.

Jerky eye movements
Jerky eye movements, such as nystagmus, can be abnormal and may indicate dysfunction of the vestibular system or other neurological conditions. While some degree of nystagmus can occur with age, persistent or severe jerky eye movements should be evaluated further.

Lie on left side:This option involves instructing the patient to lie on their left side. While lying on the left side may provide some relief by reducing pressure on the lumbar puncture site, it is not typically recommended immediately after the procedure to prevent PLPH. Lying flat is generally preferred to minimize changes in CSF pressure and reduce the risk of headache.

Stay in semi-Fowler position:
The semi-Fowler position involves elevating the head of the bed at a 30-45 degree angle. This position is not typically recommended immediately after a lumbar puncture because it may increase CSF leakage and pressure changes, potentially exacerbating the risk of developing a headache.

Ambulate in the room with assistance:Ambulating shortly after a lumbar puncture is not typically recommended as it may increase the risk of developing a headache. Movement and changes in posture can exacerbate CSF leakage and pressure changes at the puncture site, leading to the development of post-lumbar puncture headaches.

Widening pulse pressure, headache, and seizureWhile headache and seizure may occur in patients with increased ICP, widening pulse pressure alone is not sufficient to meet the criteria of Cushing's triad. The presence of bradycardia and hypertension, along with widening pulse pressure, is more indicative of Cushing's triad.

Hypertension, tachycardia, and headache
Hypertension and headache may occur in patients with increased ICP, but the absence of bradycardia and widening pulse pressure makes this option less characteristic of Cushing's triad.

Hypotension, tachycardia, and narrowing pulse pressureHypotension (low blood pressure) and narrowing pulse pressure are not typically associated with Cushing's triad. Tachycardia (rapid heart rate) may occur in response to increased ICP, but it is usually accompanied by bradycardia rather than hypotension.

Semicomatose:This term suggests a state between consciousness and coma. A patient who is semicomatose may exhibit some level of responsiveness but is typically unresponsive or only responds to intense stimuli.

Somnolent:Somnolence refers to a state of drowsiness or sleepiness. A somnolent patient may appear sleepy, have difficulty staying awake, and may be slow to respond to stimuli. However, the withdrawal from painful stimuli described in the scenario suggests a higher level of responsiveness than what would typically be expected in a somnolent state.

Comatose:Coma refers to a state of profound unconsciousness where the patient is unresponsive to all stimuli, including painful stimuli. A comatose patient does not demonstrate any purposeful movement or response to stimuli. Since the patient in the scenario exhibits some response to painful stimuli by withdrawing, they do not meet the criteria for being comatose.

Intellectual capacity is not affected:This statement refers to the fact that ALS primarily affects motor neurons, leading to muscle weakness and paralysis, but it typically does not directly impact cognitive function or intellectual capacity. While cognitive impairment is not a hallmark feature of ALS, some individuals may experience changes in cognitive function or behavior, such as executive dysfunction or frontotemporal dementia, in later stages of the disease. However, depression in ALS is not primarily linked to changes in intellectual capacity but rather to other factors such as altered communication, physical limitations, and loss of autonomy.

Mobility is limited:ALS causes progressive muscle weakness and paralysis, which can significantly impair mobility over time. As the disease advances, individuals with ALS may become increasingly dependent on mobility aids such as wheelchairs or may require assistance with mobility tasks. Limited mobility can lead to feelings of loss of independence, decreased participation in activities, and increased dependence on caregivers, all of which can contribute to depression.

Nutritional intake is poor:ALS can affect the muscles involved in swallowing and chewing, leading to difficulties with eating and drinking. Dysphagia, or difficulty swallowing, is a common symptom in ALS and can result in poor nutritional intake and weight loss. Malnutrition and weight loss are associated with increased morbidity and mortality in ALS, and they can also contribute to feelings of weakness, fatigue, and overall decline in quality of life, which may exacerbate depression