Stroke Certification Study Guide for Nurses: Q&A Review for Exam Success

63Stroke Diagnostics

QUESTIONS

1. What is the only blood test you must have results of in order to safely administer IV tissue plasminogen activator (tPA)—besides international normalized ratio (INR), which is required for patients on Coumadin?

A. Liver enzymes

B. Cardiac enzymes

C. Creatinine to know if CT angiography is safe

D. Blood sugar

2. Patient X presents to the emergency department (ED) with right-sided weakness and speech difficulty at 10:00 a.m., reporting onset at 8:30 a.m. The CT was unremarkable. The wife says the only medication her husband takes is Coumadin. The international normalized ratio (INR) result is 1.9. What can you expect to do next?

A. Mix and administer tissue plasminogen activator (tPA) according to the patient’s actual weight

B. Repeat the INR

C. Continue to monitor vital signs and neurologic checks according to ED policy

D. Prepare to discharge the patient from the ED

3. 64Identify the main reason why a CT scan is the first imaging study done in acute stroke.

A. Most hospitals only have CT scan capability

B. While not completely reliable, it is least expensive and the one insurance will cover

C. There is less radiation involved than MRI

D. CT is fast and reliable in ruling out cerebral hemorrhage

4. The consulting neurologist recommends vascular imaging in order to determine if there is a large vessel occlusion. What test would you expect to see done next?

A. PET scan

B. CT angiogram (CTA)

C. MRI

D. Transcranial Doppler (TCD)

5. Patient Y presents to your emergency department (ED) at 3:00 p.m. with left-sided weakness onset at 10:30 a.m. The CT software is out of service so a stat MRI/magnetic resonance angiography (MRA) package is done that shows a perfusion–diffusion mismatch. This indicates which of the following?

A. Presence of salvageable brain tissue, so thrombectomy should be considered

B. Absence of salvageable brain tissue, so thrombectomy is not an option

C. Technical error by imaging staff

D. Presence of an uncommon cerebral anomaly

6. Why is an echocardiogram done during acute hospital stays?

A. The cause of up to 30% of strokes is cardiac related

B. It is only required on patients older than 80 years

C. To rule out incidental cardiomyopathy

D. All patients with stroke are at risk for cardiomyopathy within 10 years

7. Why would the neurologist order a transesophageal echocardiogram (TEE) after the patient has already had a transthoracic echocardiogram (TTE)?

A. Patient would not lie still for the TTE

B. TEE offers superior visualization as there is no impedance from the chest muscles or rib cage

C. 65Latest guidelines recommend both be done for confirmed stroke patients

D. The neurologist made a mistake and should be reminded that an echocardiogram was already done

8. Your stroke patient has just been ordered to have a video fluoroscopic swallowing exam. What is the provider looking for?

A. Confirmation of successful bedside swallow screen

B. Evaluation of swallowing function

C. Evidence of aspiration

D. Both B and C

9. What further diagnostic tool might be used for a patient with cryptogenic stroke prior to or shortly after discharge from the hospital?

A. Serial cardiac enzymes

B. Genetic mapping

C. Repeat CT in 1 month

D. Implantable cardiac monitor to check for atrial fibrillation

10. Your patient was told that she had a stroke at some time in the past, but she insists she has never had symptoms. How did her neurologist know this?

A. Presence of encephalomacia on CT scan

B. Presence of positive Babinski’s sign during neurologic exam

C. Prolonged QT interval on 12-lead EKG

D. Information from the spouse during history taking

11. A patient is brought to the emergency department (ED) by emergency medical services (EMS) with an original complaint of the worst headache of the patient’s life, and is sleepy on arrival. You look to your ED colleague and say, “I’ll bet you it’s a _________.”

A. Left middle cerebral artery (MCA) stroke

B. Lacunar stroke in the right basal ganglia

C. Complex migraine

D. Subarachnoid hemorrhage

12. Your patient’s CT is negative for blood and there is high suspicion for subarachnoid hemorrhage (SAH). What other diagnostic test might you be told to set up for?

A. Lumbar puncture

B. Repeat CT

C. 66Blood cultures

D. Caloric testing

13. Which diagnostic tool has been proven to not only diagnose and monitor vasospasm in subarachnoid hemorrhage (SAH) but also to predict and enhance IV tissue plasminogen activator (tPA) outcomes?

A. EEG

B. Diffusion-weighted MRI

C. PET scan

D. Transcranial Doppler (TCD)

14. Your patient has just had a diagnostic cerebral angiography. What are the most common complications you will monitor over the next 24 hours?

A. Insertion site hematoma, stroke, and adverse reaction to contrast dye

B. Insertion site hematoma, deep vein thrombosis (DVT), and adverse reaction to contrast dye

C. Fever, headache, and insertion site hematoma

D. Vessel wall tear, stroke, and DVT

15. The Brain Attack Coalition set separate standards for door-to-CT scan initiation and results. Which of the following is correct?

A. Door to CT in 35 minutes, results in 45 minutes

B. Door to CT in 25 minutes, results in 45 minutes

C. Door to CT in 10 minutes, results in 45 minutes

D. No completion standard timeframe; just results within 60 minutes

16. You are a stroke unit nurse and your new stroke patient has arrived from the emergency department (ED) without having a carotid ultrasound done. You call the provider to order one stat. Which would be the correct response by the provider?

A. “Get a carotid ultrasound done stat”

B. “A CT angiogram was done that provided carotid imaging”

C. “The patient has an allergy to contrast dye, so a carotid ultrasound cannot be done”

D. “Carotid disease is so rare that it is not necessary to do carotid imaging in stroke patients”

17. 67More sensitive brain imaging has contributed to the change in definition of which of the following?

A. Cerebral edema

B. Acute ischemic stroke

C. Subarachnoid hemorrhage

D. Transient ischemic attack (TIA)

18. You are working on a stroke unit with an assignment of four patients today. On which of them would you expect to see a hypercoagulable work-up?

A. An 80-year-old male with right basal ganglia stroke

B. A 45-year-old female with subarachnoid hemorrhage (SAH)

C. A 28-year-old male with right middle cerebral artery (MCA) stroke

D. A 58-year-old female with lock-in syndrome

19. Which of the following is true of CT imaging?

A. Bone and blood appear white and cerebrospinal fluid (CSF) appears black

B. Substances with increased density appear darker, while substances of less density appear lighter

C. It uses same radiologic technology as MRI imaging

D. Subarachnoid hemorrhage (SAH) classically has a white diamond shape in the center of the brain

20. Which of the following is the recommended initial imaging for suspected subarachnoid hemorrhage (SAH)?

A. MRI scan with contrast

B. Cerebral angiography

C. Noncontrast CT scan

D. CT angiogram

21. Early neurologic deterioration with a decrease in the Glasgow Coma Scale (GCS) score of 2 or more points is a hallmark of which type of stroke?

A. Spontaneous intracerebral hemorrhage (ICH)

B. Infratentorial shift

C. Vertebrobasilar syndrome

D. Basal ganglia stroke

22. 68The presence of a “spot sign” on a CT angiogram (CTA) and contrast-enhanced CT likely indicates which of the following?

A. Incidental additional pathology

B. Presence of contrast within a hematoma and increased risk of expansion

C. Absence of contrast within a large vessel clot

D. None of the above

23. Which of the following are early CT imaging predictors of cerebral edema?

A. Frank hypodensity within the first 6 hours

B. Involvement of one third or more of the middle cerebral artery (MCA) territory

C. Early midline shift

D. All of the above

24. Transcranial Doppler (TCD) ultrasonography has proven to be useful in detecting intracranial vessel abnormalities. Which of the following circumstances will produce the most useful results?

A. Posterior circulation strokes

B. Middle cerebral artery (MCA) strokes

C. Patients with poor bony windows

D. Moya Moya disease

25. In the hyperacute workup of acute ischemic stroke, what priority would you place on completion of a chest x-ray for most patients?

A. Immediately following noncontrast CT of brain

B. Immediately following lab work, prior to EKG

C. Following CT, lab work, and EKG

D. Following lab work, prior to EKG

26. The emergency medical services (EMS) personnel report that a 70-year-old male with new onset left-sided weakness is taking dabigatran, an oral anticoagulant. Which blood test will be helpful in determining the effect of this medication?

A. Prothrombin time (PT)/INR

B. Partial thromboplastin time (PTT)

C. Platelet count

D. None of the above

27. 69Dr. West, the stroke neurologist, mentions that a malignant middle cerebral artery (MCA) sign was noted on Mrs. Bender’s CT. What did the neurologist see?

A. Malignant tumor in the area of the MCA territory causing mass effect

B. Ischemic infarct involving more than 50% of the MCA territory with a midline shift

C. Hemorrhagic infarct involving more than 30% of the MCA territory with a midline shift

D. Vasospasm of the proximal MCA resulting in 50% reduced perfusion to territory

28. When President Dwight D. Eisenhower had a stroke in 1957, his diagnosis was left middle cerebral artery (MCA) infarct. Which diagnostic test would have contributed to his stroke diagnosis?

A. Noncontrast CT

B. MRI

C. Echocardiogram

D. None of the above

29. A patient who had a cerebral angiogram this morning has become diaphoretic and is complaining of lower abdominal pain and back pain. You suspect which of the following?

A. Arterial thrombosis with restricted perfusion pattern

B. Muscle spasm from prolonged immobility

C. Arterial dissection with retroperitoneal hemorrhage

D. Unintentional migration of the closure device

30. Your patient is headed to radiology for a CT angiogram and you do a quick review of reported allergies knowing that the patient will be getting contrast. Which of the following allergies will you immediately report?

A. Shellfish

B. Red dye #5

C. Eggs

D. Nickel alloy