4 
27Preventive Care
QUESTIONS
1. Which is true of a male patient with atrial fibrillation (a-fib) who scores 3 on either the CHADS2 (congestive heart failure, hypertension history, age ≥75, diabetes, stroke history) or the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes, stroke history, vascular disease, age 65–74, sex category) scores?
A. He had a history of heart failure and diabetes
B. He should receive an oral anticoagulant
C. He only needs an oral antithrombotic
D. He is at high risk of bleeding with an anticoagulant
2. A primary care provider (PCP) who initiates a statin medication for a patient whose medical history includes type 2 diabetes and hypertension would be providing what type of stroke care?
A. Secondary prevention
B. Tertiary prevention
C. Primary prevention
D. Primordial prevention
3. Your 78-year-old transient ischemic attack (TIA) patient was told by the neurologist on rounds that the patient should consider carotid endarterectomy (CEA) for the left carotid artery stenosis of 80%. The patient is 28concerned because there were never any prior symptoms and does not like the idea of surgery on the neck. Your best response would be:
A. To provide education that research supports this intervention for patients with higher than 70% stenosis and risk factors for stroke (the recent TIA)
B. To provide active listening, and then offer a second opinion from another provider
C. To calculate the patient’s ABCD2 (age [≥60], blood pressure, clinical features of TIA, duration, and diabetes) score and notify the patient that the score is only 5
D. To reassure the patient that the neck incision is nearly invisible within 5 years
4. You have a family history of atrial fibrillation on your mother’s side. She is turning 60 in a few weeks, and asks you how she can do a self-assessment for atrial fibrillation. What will you include in your response?
A. The importance of regular visits to the neighborhood pharmacy for blood pressure (BP) checks
B. Instructions on checking a radial pulse for rate and rhythm regularity
C. Deep breathing strategies to regulate heart rhythm
D. Instructions on monitoring for persistent cough and dyspnea
5. You are providing discharge education for your 30-year-old female transient ischemic attack (TIA) patient. Her workup has not revealed a clear etiology for the TIA. Which of the following scenarios would be most concerning to you?
A. She indicates that she occasionally has 3 to 4 beers a day, especially on the weekend, and she is a 1 pack-per-day smoker
B. Her husband asks if he needs to stop smoking marijuana in the same room as her now
C. Her history includes that she takes a birth control pill and she is 1 pack-per-day cigarette smoker
D. She asks you if she will need to take aspirin for the rest of her life because she hates feeling like an old lady
6. In reviewing stroke risk factors at a community health fair, one of the audience members says he has a 20-year history of cigarette smoking. What will you include in your response to the group?
A. Smoking cessation may not help him anymore, but he has a responsibility to those around him
B. 29Smoking cessation will eliminate all risk of stroke
C. Smoking filtered cigarettes reduces the risk of stroke by 50%
D. Smoking cessation can result in rapid reduction in stroke risk
7. The international case-control study, the INTERSTROKE study, has found that 10 potentially modifiable risk factors account for what percent of stroke risk?
A. 90%
B. 80%
C. 70%
D. 60%
8. Stroke incidence has remained steady at 800,000 new and recurrent strokes/year, despite the decrease in stroke among people aged 65 to 84 years. Which age group has shown a 44% increase in stroke incidence?
A. Ages 85 to 98 years
B. Ages 50 to 64 years
C. Ages 12 to 18 years
D. Ages 25 to 44 years
9. Over the decade 1998 through 2008, the rate of first stroke among people over age 65 years decreased by 30% to 40%. Increased use of which two treatments has been credited with contributing to this decline?
A. Tissue plasminogen activator (tPA) and mechanical clot retrieval
B. Statins and antihypertensive medications
C. Statins and diabetes medications
D. Antithrombotics and statins
10. All of the following are nonmodifiable risk factors for stroke except which one?
A. Age
B. Gender
C. Atrial fibrillation
D. Race/ethnicity
11. Which racial group has a higher incidence of, and mortality from, stroke because of a higher prevalence of hypertension, obesity, and diabetes?
A. Hispanic/Latino Americans
B. Blacks
C. 30Whites
D. Native Americans
12. As a nurse providing community education about stroke risk, you hear a woman say that her father had a stroke at age 50 years and she wonders if this increases her risk of stroke. You base your response on what knowledge?
A. There has been no genetic link to stroke risk
B. A parental history of stroke before age 65 years increases stroke risk by 0.1%
C. A positive family history of stroke increases risk of stroke by 30%
D. A subtle connection has been found if stroke was due to hypertension
13. Which is true of stroke risk related to high cholesterol?
A. Each 1% reduction in total cholesterol is associated with a 0.8% reduction in risk of stroke
B. Only high-intensity therapy along with fibrates is effective in reducing stroke risk
C. The beneficial effect of statins is due to their capacity to double the blood–brain barrier
D. There is a direct correlation between the level of cholesterol and risk of mortality
14. The American Heart Association (AHA) guidelines for physical activity to reduce stroke risk include:
A. Moderate to vigorous aerobic activity daily for a minimum of 40 minutes/day
B. Moderate aerobic activity for a minimum of 60 min/day, twice a week
C. Vigorous aerobic activity for 20 minutes, twice a day, three times a week
D. Moderate to vigorous aerobic activity for a minimum of 40 minutes/day, three to four times a week
15. Which of the following combination therapies is thought to provide the most effective primary prevention of stroke among people with diabetes?
A. Tight control of hypertension and statin therapy
B. Glycemic control and antithrombotic therapy
C. 31Physical activity and glycemic control
D. Physical activity and antithrombotic therapy
16. Of the following patients with cryptogenic stroke, which would you suspect the etiology to be undiagnosed atrial fibrillation?
A. 45-year-old female
B. 85-year-old female
C. 64-year-old male
D. 40-year-old male
17. What is the distinction between secondary prevention strategies for stroke patients versus transient ischemic attack (TIA) patients?
A. Blood pressure control is not as critical for TIA patients
B. Intensive statin therapy is recommended for large vessel stroke patients only
C. TIA patients do not need follow-up
D. Prevention strategies are the same for both stroke and TIA
18. Your patient’s wife tells you that she dreads the time that he will be allowed to come home from the acute rehabilitation hospital. She says that all of the information she has been getting is overwhelming, and what she really thinks she will need is advice and support after he is home. How can you help her?
A. Communicate her concerns to the care team and ensure that a community resource guide is provided
B. Familiarize yourself with the resource guide in order to be able to reinforce the information and to supplement with other resources
C. Provide her with information about a local or online stroke support group
D. All of the above
19. Your multidisciplinary stroke oversight team has determined that community education about stroke will be a goal for the coming year. What information will be most helpful in developing a strategic plan for this outreach education?
A. Demographic information of the region, such as race, age, and socioeconomic status
B. The number of stroke flyers that can be produced
C. 32The number of nurses/health care members interested in participating
D. The number of stroke survivors in the region
20. In what circumstance would you expect a right-sided carotid artery stenosis to be treated with a stent rather than an endarterectomy?
A. When the degree of stenosis is less than 50% and the patient is over age 80 years
B. When the procedure needs to be performed within 2 weeks
C. When the degree of stenosis is higher than 70% and there are anatomic or medical conditions present that increase risk of surgery
D. When the provider who performs endarterectomy is not available
21. Which of the following is true about long-term monitoring for occult atrial fibrillation?
A. It has been credited with finding 11% more cases of atrial fibrillation than found during hospital stay
B. It is indicated only for females between 40 and 60 years with cryptogenic stroke
C. Of the cases found during long-term monitoring, only those with duration over 60 minutes pose risk of stroke
D. Long-term monitoring involves patients dialing into the control center once daily and holding their finger against the phone speaker for 2 minutes
22. Your transient ischemic attack (TIA) patient has had no other risk factors besides a patent foramen ovale (PFO) revealed on an echocardiogram. The patient expresses concern that the neurologist advised the patient that discharge would be with only aspirin to prevent a stroke. Your response would be:
A. To suggest a second opinion from another specialist such as a cardiologist
B. To reassure the patient that research evidence supports this as the best treatment because no deep vein thrombosis (DVT) was found
C. To explain that you have not kept up on the current evidence so you do not really know
D. To suggest that the patient ask the primary care provider about it at the follow-up visit
23. 33Mrs. Mills has intermittent atrial fibrillation and has been on Coumadin for 3 years. She is now your patient in the neuro intensive care unit with an intracerebral hemorrhage. What are the American Heart Association/American Stroke Association recommendations for safe resumption of anticoagulation in her case?
A. Oral anticoagulation is safe to start for all patients within 1 week
B. Anticoagulation resumption should be held for at least 1 week
C. Low-dose IV anticoagulation should be started within 48 hours
D. Perform an MRI at 24 hours after admission; if stable, initiate oral anticoagulation
24. As your multidisciplinary stroke team is reviewing your organization’s stroke education content and process, which of the following is important to keep in mind?
A. Daily reinforcement of education provides better chance for retention of information
B. A fifth- to sixth-grade reading level is recommended
C. Poststroke cognitive deficits or emotional distress will impair patients’ and families’ abilities to comprehend
D. All of the above
25. Your stroke center serves a community that is predominantly Black (44%), with Whites (32%) and Hispanics (21%) coming in second and third. You have limited personnel resources for community outreach. Which of the following would be the best use of your time/resources?
A. Risk factor screening at the local Crispus Attucks community center
B. Health fair at a local mall involving a dozen other community organizations
C. Health talk at the local senior center
D. Distributing F.A.S.T. cards at a local elementary school