Neurologic Case Study

Patient Profile:

Age: 68 years

Gender: Male

Medical History: Hypertension, Type 2 Diabetes Mellitus

Medications: Lisinopril, Metformin

Allergies: None

Chief Complaint: The patient presents to the emergency department (ED) with sudden onset of right-sided weakness and difficulty speaking that began approximately 1 hour prior to arrival.

Exhibits

Which condition is the patient most likely experiencing?

Hypoglycemia

Hemorrhagic stroke

Ischemic stroke

Multiple sclerosis

Answer and Explanation

The Correct Answer is C

Choice A reason: Hypoglycemia typically presents with symptoms such as sweating, trembling, hunger, confusion, and in severe cases, loss of consciousness. The patient's symptoms of sudden right-sided weakness and difficulty speaking are more consistent with a neurological event rather than low blood sugar levels.

Choice B reason: Hemorrhagic stroke involves bleeding within the brain. Although it can present with similar symptoms to ischemic stroke, the diagnostic tests indicate no evidence of hemorrhage. This makes a hemorrhagic stroke less likely.

Choice C reason: Ischemic stroke occurs when a blood clot blocks a blood vessel in the brain, leading to reduced blood flow and oxygen to a part of the brain. The patient's symptoms of sudden right-sided weakness and expressive aphasia are classic signs of an ischemic stroke, and the absence of hemorrhage on the head CT scan supports this diagnosis.

Choice D reason: Multiple sclerosis (MS) is a chronic, progressive disease that affects the central nervous system. It usually presents with episodic neurological symptoms rather than the sudden onset seen in this patient. MS symptoms develop over time and can vary widely, whereas the patient's acute presentation is more indicative of a stroke.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason: Hypertension, often called the "silent killer," is usually asymptomatic until significant target organ damage has occurred. This means that many people with hypertension do not experience symptoms until their blood pressure has been high for a long time, leading to damage in organs such as the heart, kidneys, brain, and eyes. Therefore, it's crucial for patients to understand the importance of regular blood pressure monitoring and management even in the absence of symptoms.

Choice B reason: While annual BP checks are useful for monitoring treatment effectiveness, more frequent monitoring may be necessary for newly diagnosed patients or those with poorly controlled hypertension. This information is important but not the most critical point compared to understanding the asymptomatic nature of hypertension.

Choice C reason: Increasing physical activity can help control blood pressure for many individuals, but it is not universally effective for everyone. While important, this information is part of a broader lifestyle modification plan rather than the single most critical point to emphasize.

Choice D reason: Dietary changes can play a significant role in controlling blood pressure, but not all individuals can control their BP through diet alone. Emphasizing this may give a false sense of control without highlighting the importance of medication and other interventions when needed.

A. Fluid volume overload B. Hyperglycemia C. Nocturia D. Generalized edema

Correct Answer is C

Explanation

Choice A reason: Fluid volume overload is not typically associated with diabetes insipidus. Instead, patients with diabetes insipidus often experience fluid volume deficit due to excessive urine output.

Choice B reason: Hyperglycemia is not a characteristic problem of diabetes insipidus. This condition involves an imbalance in water regulation due to insufficient production or response to antidiuretic hormone (ADH), rather than issues related to blood glucose levels.

Choice C reason: Nocturia, or frequent urination at night, is a common problem in diabetes insipidus. Patients with this condition produce large amounts of dilute urine, which can lead to frequent nighttime urination.

Choice D reason: Generalized edema is not a typical problem in diabetes insipidus. Edema is more commonly associated with conditions involving fluid retention, such as heart failure or kidney disease, rather than the excessive fluid loss seen in diabetes insipidus.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which information is most important for the nurse to include when teaching a patient newly diagnosed with hypertension?

Correct Answer is A

Explanation

Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?

Correct Answer is C

Explanation

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