Review Practice Exercise 3

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A nurse is caring for a client who has left homonymous hemianopsia. Which of the following is an appropriate nursing intervention?

A. Teach the client to scan to the right to see objects on the right side of her body. B. Place the client’s bedside table on the right side of the bed. C. Orient the client to the food on her plate using the clock method. D. Place the client’s wheelchair on her left side.

Answer and Explanation

Choice A:

Teach the client to scan to the right to see objects on the right side of her body. This intervention would benefit a client with right homonymous hemianopsia, not left. Teaching scanning is helpful, but in this case, the deficit is on the left, so scanning should focus on that side. Using it incorrectly could result in continued neglect of the affected field.

Choice B:

Place the client’s bedside table on the right side of the bed. Since the client cannot see objects on the left side, placing the bedside table on the right would reinforce neglect of the affected field. Nursing interventions should encourage use of the impaired side to promote awareness and prevent accidents. This option does not support functional independence for left-sided visual loss.

Choice C:

Orient the client to the food on her plate using the clock method. This intervention allows the client to compensate for visual field loss by knowing the location of food items relative to a clock face. It enhances independence by reducing frustration and ensuring proper intake during meals. The clock method is a widely recommended strategy for patients with hemianopsia because it is both practical and safe.

Choice D:

Place the client’s wheelchair on her left side. Positioning mobility aids on the side of the visual deficit increases the risk of collisions or falls, since the patient may not notice them. Wheelchairs and other essential equipment should be placed on the unaffected (right) side for easier access and safety. This makes the option inappropriate for managing left homonymous hemianopsia.

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Question 2:

A nurse is planning care for a client who has dysphagia and has a new dietary prescription. Which of the following should the nurse include in the plan of care? Select all that apply

A. Have suction equipment available for use. B. Use thickened liquids. C. Place food on the client’s unaffected side of her mouth. D. Assign an assistive personnel to feed the client slowly. E. Teach the client to swallow with her neck flexed.

Answer and Explanation

Choice A:

Have suction equipment available for use. Clients with dysphagia may aspirate food or liquids despite careful precautions. Having suction readily available ensures the nurse can promptly clear the airway if obstruction occurs. This intervention is a critical safety measure and should always be part of dysphagia care.

Choice B:

Use thickened liquids. Thin liquids are the most difficult consistency to control when swallowing and can easily be aspirated. Thickened liquids travel more slowly and allow better airway protection. They are a standard recommendation for patients with swallowing difficulties.

Choice C:

Place food on the client’s unaffected side of her mouth. If the client has unilateral weakness from a stroke or neurological disorder, placing food on the strong side promotes safe chewing and swallowing. This helps the patient control the bolus and reduces the risk of food pocketing on the weak side. It also encourages more effective oral intake.

Choice D:

Assign an assistive personnel to feed the client slowly. Feeding a client with dysphagia requires specialized knowledge and skills to monitor for aspiration and ensure safe techniques are followed. This task is inappropriate to delegate to assistive personnel, as it requires nursing judgment and close observation. Feeding should be performed or supervised by the nurse or a speech-language pathologist.

Choice E:

Teach the client to swallow with her neck flexed. The chin-tuck technique helps close off the airway while opening the esophagus, making swallowing safer. Flexing the neck forward reduces aspiration risk by directing food away from the trachea. Teaching this maneuver empowers the client to participate in their care and improves independence.

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Question 3:

A nurse is caring for a client who has global aphasia (both receptive and expressive). Which of the following should the nurse include in the client’s plan of care? Select all that apply

A. Speak to the client at a slower rate. B. Look directly at the client when speaking. C. Allow extra time for the client to answer. D. Complete sentences that the client cannot finish. E. Give instructions one step at a time.

Answer and Explanation

Choice A:

Speak to the client at a slower rate. Speaking more slowly and using short, simple phrases gives the client extra processing time and increases the likelihood that receptive language will be understood. A slower rate also allows the nurse to observe nonverbal cues and confirm comprehension before proceeding. This approach reduces communication breakdowns and frustration for both the client and caregiver.

Choice B:

Look directly at the client when speaking. Direct eye contact provides important nonverbal cues and helps focus the client’s attention on the speaker, which supports comprehension. Visual attention can augment limited auditory processing in receptive aphasia and helps the client pick up facial expressions and gestures. Maintaining eye contact also builds rapport and conveys that the nurse is engaged and patient.

Choice C:

Allow extra time for the client to answer. Clients with global aphasia often require prolonged time to comprehend questions and formulate responses, so allowing extra time prevents interruption and reduces anxiety. Rushing the client can increase errors, withdrawal, or agitation, and may obscure their true abilities. Patience during response time encourages attempts at communication and helps the nurse accurately assess function.

Choice D:

Complete sentences that the client cannot finish. Finishing the client’s sentences removes their opportunity to attempt expression and undermines autonomy and self-esteem. It also makes it difficult to assess the client’s residual language abilities and progress in therapy. Instead, the nurse should offer supportive cues (gestures, written words, yes/no choices) and allow the client to attempt completion with encouragement.

Choice E:

Give instructions one step at a time. One-step commands reduce cognitive load and make it more likely the client will understand and carry out directions safely. Multi-step instructions can overwhelm processing and lead to incomplete or incorrect responses. Providing a single, clear action at a time also allows the nurse to offer immediate feedback and reinforcement.

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Question 4:

A patient is admitted to the hospital with a left hemiplegia. To determine the size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates that the health care provider will request a:

A. Lumbar puncture B. Cerebral arteriogram C. Magnetic resonance imaging (MRI) D. Computed tomography (CT) scan with contrast

Answer and Explanation

Choice A:

Lumbar puncture. This procedure is not used to diagnose ischemic or hemorrhagic stroke. It may be indicated if a subarachnoid hemorrhage is suspected and not seen on imaging, but it does not determine stroke size, location, or type.

Choice B:

Cerebral arteriogram. While an arteriogram can visualize cerebral blood vessels and locate obstructions, it is invasive and not the first-line diagnostic tool. It is generally reserved for interventional planning, such as clot retrieval or aneurysm repair.

Choice C:

Magnetic resonance imaging (MRI). MRI is the most effective imaging modality for identifying the extent, location, and type of stroke. It is highly sensitive to ischemic changes within minutes of onset, allowing early recognition and intervention. MRI also provides detailed brain imaging, making it superior to CT in detecting small or posterior circulation infarcts.

Choice D:

Computed tomography (CT) scan with contrast. A non-contrast CT is typically performed first in suspected stroke to quickly rule out hemorrhage. Contrast-enhanced CT can identify vascular lesions but is less sensitive than MRI for early ischemia, so it is not the preferred diagnostic tool for determining stroke size and type.

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Question 5:

A carotid endarterectomy is being considered as treatment for a patient who has had several TIAs. What should the nurse explain to the patient about this surgery?

A. It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery B. It is used to restore blood circulation to the brain following an obstruction of a cerebral artery C. It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke D. It is used to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation

Answer and Explanation

Choice A:

It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery. This describes an extracranial-intracranial bypass, not a carotid endarterectomy. That procedure is rarely used and has not been shown to be as effective in preventing stroke in patients with TIAs.

Choice B:

It is used to restore blood circulation to the brain following an obstruction of a cerebral artery. This describes the goal of thrombolytic therapy or endovascular thrombectomy in acute ischemic stroke, not carotid endarterectomy. Carotid endarterectomy is a preventive surgery, not an emergency reperfusion treatment.

Choice C:

It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke. Carotid endarterectomy directly addresses the cause of TIAs by surgically removing plaque buildup in the carotid artery. This improves blood flow and prevents the progression to an ischemic stroke caused by thromboembolism or severe stenosis. It is specifically indicated for patients with symptomatic carotid stenosis of 70% or greater, or for selected patients with moderate stenosis.

Choice D:

It is used to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation. This describes carotid angioplasty with stenting, which is a less invasive alternative but not the same as endarterectomy. While both improve circulation, stenting involves dilation and mesh placement rather than surgical plaque removal.

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