Review Practice Exercise 2

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A nurse is caring for a client who has experienced a right-hemispheric stroke. Which of the following are expected findings? Select all that apply

A. Impulse control difficulty B. Left hemiplegia C. Loss of depth perception D. Aphasia E. Lack of awareness

Answer and Explanation

Choice A:

Impulse control difficulty. Right-sided brain damage impairs judgment and self-control, often leading to impulsive behavior.

Choice B:

Left hemiplegia. The right hemisphere controls the left side of the body, so weakness or paralysis occurs on that side.

Choice C:

Loss of depth perception. Right-hemispheric strokes disrupt spatial-perceptual processing, leading to difficulty judging distances.

Choice D:

Aphasia. This is primarily associated with left-hemispheric strokes, which affect language centers such as Broca’s and Wernicke’s areas.

Choice E:

Lack of awareness. Patients may deny or ignore their deficits (anosognosia), a common finding in right-brain injury.

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Question 2:

A nurse is assessing a client who has experienced a left-hemispheric stroke. Which of the following is an expected finding?

A. Impulse control difficulty B. Poor judgment C. Inability to recognize familiar objects D. Loss of depth perception

Answer and Explanation

Choice A:

Impulse control difficulty. More commonly seen in right-hemispheric strokes due to altered judgment and poor inhibition.

Choice B:

Poor judgment. Typically associated with right-hemispheric strokes that affect executive and decision-making functions.

Choice C:

Inability to recognize familiar objects. Left-hemispheric damage impairs recognition and language processing, leading to agnosia, where the patient cannot identify known items.

Choice D:

Loss of depth perception. This spatial-perceptual deficit is characteristic of right-brain injuries, not left-sided ones.

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Question 3:

During the secondary assessment of the patient with a stroke, what should be included? Select all that apply

A. Gaze B. Sensation C. Facial palsy D. Proprioception E. Current medications F. Distal motor function

Answer and Explanation

Choice A:

Gaze. Abnormal gaze patterns, such as deviation of the eyes, are included in the primary assessment because they are quickly observed and indicate potential brain injury. This finding is evaluated early using tools such as the NIH Stroke Scale to guide urgent treatment. It does not fall under the more detailed secondary evaluation.

Choice B:

Sensation. Assessing sensation helps determine whether the patient has lost feeling in specific areas, which is critical for identifying the location and severity of brain injury. Sensory testing can reveal deficits that may not be immediately visible, such as numbness or altered touch perception. These findings are important for planning both acute management and long-term rehabilitation.

Choice C:

Facial palsy. Like gaze, facial weakness is part of rapid stroke screening tools such as FAST and is considered during the primary assessment. Detecting facial droop helps quickly establish the likelihood of a stroke in emergency situations. It is not typically reassessed in detail during the secondary evaluation unless needed for follow-up.

Choice D:

Proprioception. Proprioception refers to the awareness of body position in space, which can be impaired after a stroke. Evaluating this function helps detect subtle neurological deficits that may affect balance and coordination. Early recognition of proprioceptive deficits guides safety measures and therapy interventions to prevent falls.

Choice E:

Current medications. Reviewing the patient’s medication history is essential because drugs such as anticoagulants, antihypertensives, or antiplatelets significantly affect both the cause and management of stroke. For example, anticoagulant use may increase the risk of hemorrhagic stroke, while antiplatelets are common in ischemic stroke prevention. This information helps providers make safe decisions about acute treatment and secondary prevention strategies.

Choice F:

Distal motor function. Assessing fine motor strength and coordination in the extremities provides valuable insight into the degree of functional impairment. Weakness or loss of control in distal muscles often reflects cortical or corticospinal tract involvement. These findings are important in predicting disability and planning rehabilitation needs.

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Question 4:

For a patient who is suspected of having a stroke, one of the most important pieces of information that the nurse can obtain is the:

A. Time of the patient’s last meal B. Time at which stroke symptoms first appeared C. Patient’s hypertension history and management D. Family history of stroke and other cardiovascular diseases

Answer and Explanation

Choice A:

Time of the patient’s last meal. Although relevant if surgical or procedural interventions are planned, the last meal does not influence immediate treatment decisions in suspected stroke. Nutritional history is secondary and should be gathered later in the assessment process. It is not as time-sensitive as symptom onset.

Choice B:

Time at which stroke symptoms first appeared. This information determines whether the patient is within the treatment window for interventions such as thrombolytic therapy. The benefits of treatments like tPA are time-dependent, and delays beyond 4.5 hours from symptom onset generally exclude patients from eligibility. Accurate knowledge of onset also helps guide decisions about imaging and other urgent interventions.

Choice C:

Patient’s hypertension history and management. Hypertension is an important risk factor for stroke, but its history does not guide immediate treatment decisions in the acute setting. Blood pressure control will be addressed after stabilization and imaging. Therefore, while relevant for long-term management, it is not the most urgent information to obtain during the initial stroke evaluation.

Choice D:

Family history of stroke and other cardiovascular diseases. Family history can provide background on genetic and lifestyle-related risks for stroke. However, it has no immediate impact on acute treatment options or eligibility for therapies like thrombolysis. It is considered later in the care process, not during the urgent phase of evaluation.

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Question 5:

A patient with right-sided hemiplegia and aphasia resulting from a stroke most likely has involvement of the:

A. Brainstem B. Vertebral artery C. Left middle cerebral artery D. Right middle cerebral artery

Answer and Explanation

Choice A:

Brainstem. Brainstem strokes often cause bilateral deficits, cranial nerve involvement, and problems with vital functions such as respiration and consciousness. They do not usually produce isolated aphasia, since language centers are located in the cerebral hemispheres, not the brainstem. Therefore, this location is inconsistent with the patient’s presentation.

Choice B:

Vertebral artery. The vertebral arteries supply the posterior circulation, including the brainstem, cerebellum, and occipital lobes. Deficits from vertebral artery strokes usually involve balance, coordination, visual disturbances, or cranial nerve dysfunction. Aphasia and contralateral hemiplegia are not typical findings of vertebral artery involvement.

Choice C:

Left middle cerebral artery. The left MCA supplies the lateral portion of the left cerebral hemisphere, including areas responsible for motor control of the right side and speech centers such as Broca’s and Wernicke’s areas. Stroke in this artery commonly results in right hemiplegia due to contralateral motor pathway involvement. Aphasia occurs because the dominant hemisphere’s language centers are disrupted, making this the best explanation for the patient’s findings.

Choice D:

Right middle cerebral artery. The right MCA supplies the lateral right cerebral hemisphere, leading to left-sided motor and sensory deficits when damaged. It can also produce spatial-perceptual deficits and neglect but does not typically cause aphasia, since the right hemisphere is usually non-dominant for language. This makes it an incorrect choice for this patient’s symptoms.

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Practice Exercise 2

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