ATI Detailed Answer Key SS.N4581 Stroke and Intracranial Problems 2024 (NEWEST) Graded A+.
Detailed Answer Key
SS.N4581 Stroke and Intracranial
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1. A nurse is caring for a client who who has had a stroke involving the right hemisphere. Which of the following
alterations in function should the nurse expect?
A. Difficulty reading
Rationale: The left hemisphere is the center for language, mathematic skills and thinking analytically. A
client who is unable to read following a stroke would have involvement of the left hemisphere.
B. Inability to recognize his family members
Rationale: The right hemisphere is involved with visual and spatial awareness. A client who is unable to
recognize faces would have involvement with the right hemisphere.
C. Right hemiparesis
Rationale: The motor nerve fibers of the brain cross in the medulla, and a motor deficit on one side of the
body reflects damage to the upper motor neurons on the opposite side of the brain. A client who
has right hemiparesis would have involvement of the left hemisphere.
D. Aphasia
Rationale: The left hemisphere is the center for language, mathematic skills and thinking analytically. A
client who is unable to speak or understand language following a stroke would have involvement
of the left hemisphere.
2. A nurse is teaching about risk factors of developing a stroke with a group of older adult clients. Which of the
following nonmodifiable risk factors should the nurse include in the teaching?
A. History of smoking
Rationale: Smoking is a modifiable risk factor, because the client has an ability to change via cessation.
B. Obesity
Rationale: Obesity is a modifiable risk factor, because the client should have the ability to change via diet.
C. History of hypertension
Rationale: Hypertension is a modifiable risk factor, because the client should have the ability to change via
medication, exercise, and diet.
D. Race
Rationale: Race is a nonmodifiable risk factor, which the client is unable to control.
3. A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for
which of the following findings?
A. Poor impulse control
Rationale:
Created on: 02/18/2024 Page 1
Detailed Answer Key
SS.N4581 Stroke and Intracranial Problems
A client who had a stroke involving the right cerebral hemisphere is likely to have personality
changes, which can include impulsiveness, confabulation, and poor judgment.
B. Unable to discriminate words and letters
Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have deficits that
involve language, mathematical skills, and thinking. The nurse should expect the client who had
a stroke involving the right cerebral hemisphere to have deficits that include loss of sense of
humor, inability to recognize faces, and disorientation to time, place and person.
C. Deficits in the right visual field
Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have deficits in the
right visual field. The nurse should expect the client who had a stroke involving the right cerebral
hemisphere to have deficits that include neglect of the left visual field and loss of depth
perception.
D. Motor retardation
Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have motor
retardation, cautiousness and possibly depression. The nurse should expect the client who had
a stroke involving the right cerebral hemisphere to have deficits that include euphoria,
overestimation of abilities and lack of awareness of neurologic deficits.
4. A nurse is caring for a client who had a stroke involving the left cerebral hemisphere. The nurse should monitor for
which of the following findings?
A. Impaired sense of humor
Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have language
deficits, which include difficult using or comprehending language and difficulty writing. The nurse
should expect a client who had a stroke involving the right cerebral hemisphere to have an
impaired sense of humor.
B. Loss of depth perception
Rationale: A client who had a stroke involving the left cerebral hemisphere is more likely to have visual
deficits which include inability to discriminate words and letters, reading problems and deficits in
the right visual field. The nurse should expect a client who had a stroke involving the right
cerebral hemisphere to have loss of depth perception, visual spatial deficits and neglect of the
left visual field.
C. Poor judgment
Rationale: A client who had a stroke involving the left cerebral hemisphere is more likely to have behavior
changes that include cautiousness, depression and anxiety. The nurse should expect a client
who had a stroke involving the right cerebral hemisphere to have personality changes which can
include impulsiveness, confabulation and poor judgment.
D. Intellectual impairment
Rationale: A client who had a stroke involving the left cerebral hemisphere is likely to have deficits that
involve language, mathematical skills, and thinking.
Created on: 02/18/2024 Page 2
Detailed Answer Key
SS.N4581 Stroke and Intracranial Problems
5. A nurse is caring for a client who has had a hemorrhagic stroke following a ruptured cerebral aneurysm. Which of
the following manifestations should the nurse expect?
A. Gradual onset of several hours
Rationale: A client who has a thrombotic (ischemic) stroke will have a gradual onset of manifestations
occurring over several minutes to hours. A client who has had a hemorrhagic stroke tends to
have an acute onset.
B. Manifestations preceded by a severe headache
Rationale: A hemorrhagic stroke is caused by bleeding into the brain tissues, ventricles, or subarachnoid
space. It can be caused by hypertension, an aneurysm, or an arteriovenous malformation. A
sudden, severe headache is an expected initial manifestation of a hemorrhagic stroke.
C. Maintains consciousness
Rationale: A client who has an ischemic stroke maintains a level of consciousness. A client who has a
hemorrhagic stroke has a decreased level of consciousness, extending from stupor to coma.
D. History of neurologic deficits lasting less than 1 hr
Rationale: A client who has an ischemic stroke might have experienced transient ischemic attacks that
caused neurologic deficits lasting for short periods of time before. These transient attacks are
not present in a client who has had a hemorrhagic stroke. [Show Less]