Review Practice Exercise 1

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Practice Exercise 1

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Total Questions : 5

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Question 1:

A thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because:

A. The body can dissolve atherosclerotic plaques as they form B. Some tissues of the brain do not require constant blood supply to prevent damage C. Circulation via the circle of Willis may provide blood supply to the affected area of the brain D. Neurologic deficits occur only when major arteries are occluded by thrombus formation around atherosclerotic plaque

Answer and Explanation

Choice A:

The body can dissolve atherosclerotic plaques as they form. This is incorrect because plaques are permanent changes in the arterial wall and cannot be dissolved naturally by the body once formed.

Choice B:

Some tissues of the brain do not require constant blood supply to prevent damage. This is false since brain tissue is extremely dependent on continuous oxygen and glucose delivery; even short interruptions can result in injury.

Choice C:

Circulation via the circle of Willis may provide blood supply to the affected area of the brain. The circle of Willis serves as a natural bypass mechanism. When one artery becomes blocked, other arteries in the circle can compensate by delivering blood to the threatened region, which may prevent or limit ischemia.

Choice D:

Neurologic deficits occur only when major arteries are occluded by thrombus formation around atherosclerotic plaque. This is not accurate because small-vessel occlusions, such as those causing lacunar strokes, can also lead to neurologic deficits.

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Question 2:

A patient comes to the emergency department immediately after experiencing numbness of the face and an inability to speak. While awaiting examination, the symptoms disappear, and the patient requests discharge. Why should the nurse emphasize that it is important for the patient to be treated before leaving?

A. The patient has probably experienced an asymptomatic lacunar stroke B. The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours C. Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off D. The patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease

Answer and Explanation

Choice A:

The patient has probably experienced an asymptomatic lacunar stroke. This is incorrect because lacunar strokes are not transient and typically result in lasting neurologic deficits.

Choice B:

The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours. This is not always the case since TIA symptoms may not recur immediately, but the risk of stroke remains high.

Choice C:

Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off. This is inaccurate because hemorrhagic events usually produce sustained damage rather than symptoms that resolve completely.

Choice D:

The patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease. TIAs are caused by a brief interruption in cerebral blood flow that produces focal neurologic symptoms which fully resolve. Although temporary, they indicate underlying vascular pathology and serve as a predictor of future stroke.

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Question 3:

What are characteristics of a stroke caused by an intracerebral hemorrhage? Select all that apply

A. Carries a poor prognosis B. Caused by rupture of a vessel C. Strong association with hypertension D. Commonly occurs during or after sleep E. Creates a mass that compresses the brain

Answer and Explanation

Choice A:

Carries a poor prognosis. Intracerebral hemorrhage has high morbidity and mortality because of rapid neurologic deterioration and limited treatment options.

Choice B:

Caused by rupture of a vessel. Unlike ischemic strokes, ICH results from the rupture of a cerebral vessel, most often due to chronic hypertension or vascular malformations.

Choice C:

Strong association with hypertension. Long-standing hypertension weakens vessel walls and is the leading cause of intracerebral hemorrhage.

Choice D:

Commonly occurs during or after sleep. This is more characteristic of thrombotic ischemic strokes, not hemorrhagic strokes, which typically occur suddenly during activity.

Choice E:

Creates a mass that compresses the brain. The accumulation of blood forms a hematoma, which increases intracranial pressure and compresses adjacent tissue, worsening neurologic deficits.

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Question 4:

Which type of stroke is associated with endocardial disorders, has a rapid onset, and is unrelated to activity?

A. Embolic B. Thrombotic C. Intracerebral hemorrhage D. Subarachnoid hemorrhage

Answer and Explanation

Choice A:

Embolic. Embolic strokes are most commonly caused by clots originating from the heart, especially in patients with atrial fibrillation or valvular disease. They present with sudden neurologic symptoms due to immediate arterial obstruction, and onset is not linked to activity levels.

Choice B:

Thrombotic. Thrombotic strokes develop when an atherosclerotic plaque causes gradual vessel occlusion, often during sleep or rest, with symptoms that progress more slowly.

Choice C:

Intracerebral hemorrhage. This occurs due to ruptured blood vessels, often linked with hypertension, and is usually associated with exertion or activity.

Choice D:

Subarachnoid hemorrhage. This results from rupture of a cerebral aneurysm and typically presents with a sudden, severe headache often described as “the worst headache of my life.”

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Question 5:

What primarily determines the neurologic functions that are affected by a stroke?

A. The amount of tissue area involved B. The rapidity of the onset of symptoms C. The brain area perfused by the affected artery D. The presence or absence of collateral circulation

Answer and Explanation

Choice A:

The amount of tissue area involved. While the extent of damage can influence severity, the type of deficit depends more on the brain region affected than on size alone.

Choice B:

The rapidity of the onset of symptoms. This reflects the mechanism of stroke (ischemic vs hemorrhagic) but does not determine which functions are lost.

Choice C:

The brain area perfused by the affected artery. The brain has highly specialized regions, such as the occipital lobe for vision and the frontal lobe for motor control. Damage depends on which artery is obstructed and which brain region loses perfusion, making location the key determinant of clinical presentation.

Choice D:

The presence or absence of collateral circulation. Collateral circulation can influence stroke severity but does not determine which specific neurologic functions are impaired.

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Practice Exercise 1

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