A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting.
The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2 C (100.8 F). Which of the following neurologic disorders should the nurse suspect?
Embolic stroke.
Hemorrhagic stroke.
Transient ischemic attack (TIA).
Thrombotic stroke.
The Correct Answer is B
This scenario requires the application of neurovascular pathophysiology and clinical assessment skills. Understanding the distinct presentation of intracranial bleeding versus ischemic events is essential, specifically focusing on the relationship between sudden onset severe headache, projectile vomiting, and extreme hypertension in neurological emergencies.
Choice A rationale
Embolic strokes usually present with sudden focal deficits but rarely cause a thunderclap headache or significant vomiting unless brainstem involvement occurs. They result from a dislodged clot traveling to cerebral arteries, often during physical activity or exertion.
Choice B rationale
Hemorrhagic stroke involves the rupture of a blood vessel, leading to increased intracranial pressure. This pressure triggers the classic triad of sudden severe headache, vomiting, and altered consciousness, often accompanied by dangerously high blood pressure readings.
Choice C rationale
Transient ischemic attacks represent temporary blockages of blood flow that resolve within twenty-four hours without permanent damage. These episodes do not typically cause severe hypertension, vomiting, or prolonged unresponsiveness characteristic of a major intracranial event.
Choice D rationale
Thrombotic strokes are caused by gradual narrowing of an artery due to plaque, often manifesting during sleep or rest. The onset is typically slower than a hemorrhage and lacks the sudden, explosive headache and vomiting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Managing diabetic ketoacidosis involves addressing hyperglycemia, ketosis, and metabolic acidosis. Applying knowledge of insulin pharmacokinetics is essential, specifically identifying which insulin preparation is suitable for intravenous administration to rapidly reduce blood glucose and halt ketone production in emergencies.
Choice A rationale
Regular insulin is a short-acting preparation and the only insulin that can be administered intravenously. It rapidly lowers blood glucose and reverses ketoacidosis by inhibiting lipolysis. Onset is 30 to 60 minutes when given subcutaneously.
Choice B rationale
Insulin detemir is a long-acting basal insulin analog with a slow, steady release profile over 24 hours. It lacks a peak and cannot be given intravenously, making it inappropriate for the acute management of diabetic ketoacidosis.
Choice C rationale
NPH insulin is an intermediate-acting insulin containing protamine to delay absorption. It has an onset of 1 to 2 hours and is used for maintenance, not for the rapid correction of life-threatening metabolic acidosis.
Choice D rationale
Insulin glargine is a long-acting basal insulin that provides a constant concentration for 24 hours. It is used for long-term glycemic control and cannot be administered intravenously for emergent stabilization of diabetic ketoacidosis.
Correct Answer is C
Explanation
This clinical presentation requires applying knowledge of Monro-Kellie doctrine and neurological assessment. Understanding how space-occupying lesions like brain tumors affect intracranial dynamics is vital for identifying life-threatening shifts in pressure that manifest as headache, projectile vomiting, and mental status changes.
Choice A rationale
Migraine headaches typically present with unilateral throbbing pain and photophobia but rarely cause sudden, severe altered consciousness in this context. While painful, they do not explain the acute neurological decline associated with a known intracranial tumor.
Choice B rationale
Dehydration usually presents with tachycardia, poor skin turgor, and hypotension. While it can cause lightheadedness or confusion in extreme cases, it does not typically cause the sudden onset of a severe headache and vomiting seen in neurological emergencies.
Choice C rationale
Increased intracranial pressure results from the tumor mass or associated edema. It compresses brain tissue and blood vessels, leading to the classic triad of headache, vomiting, and altered consciousness, signaling a potential brain herniation and neurological crisis.
Choice D rationale
A gastric ulcer causes epigastric pain and potentially hematemesis if perforated. While vomiting may occur, it is unrelated to sudden neurological changes or severe headaches. This diagnosis fails to address the primary intracranial pathology and accompanying mental deficits.
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