The nurse is caring for a client who experienced a stroke in the right hemisphere of the brain. What should the nurse do to ensure the safety of the patient?

Support the right arm with a sling or pillow to prevent shoulder dislocation.

Anticipate the client will exhibit some degree of expressive or receptive aphasia.

Place the wheelchair on the client’s left side when transferring him into a wheelchair.

Provide close supervision because of the client’s impulsiveness and poor judgment.

Answer and Explanation

The Correct Answer is D

Choice A rationale
Supporting the right arm with a sling or pillow can help prevent shoulder dislocation, but it may not directly ensure the safety of a patient who has experienced a stroke in the right hemisphere of the brain.
Choice B rationale
While it is true that a patient who has experienced a stroke in the right hemisphere of the brain may exhibit some degree of expressive or receptive aphasia, anticipating this does not directly ensure the patient’s safety.
Choice C rationale

Placing the wheelchair on the client’s left side when transferring him into a wheelchair is a good practice, but it may not directly ensure the safety of a patient who has experienced a stroke in the right hemisphere of the brain.
Choice D rationale
Patients who have experienced a stroke in the right hemisphere of the brain often exhibit impulsiveness and poor judgment. Therefore, providing close supervision can help ensure the patient’s safety.

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Correct Answer is A

Explanation

Choice A rationale

Facial droop is a classic symptom of stroke. It occurs when there’s weakness or paralysis on one side of the face, which is caused by a disruption in the nerve signals due to a stroke. This can be easily observed in the person’s smile, as it will appear uneven.
Choice B rationale
While dysrhythmias can be associated with stroke, they are not the most indicative symptom. Dysrhythmias are more commonly associated with heart conditions.
Choice C rationale
Periorbital edema, or swelling around the eyes, is not typically a symptom of stroke. It can be caused by various conditions such as allergies, infections, or kidney problems.
Choice D rationale
Projectile vomiting is not typically a symptom of stroke. It can be caused by various conditions such as gastrointestinal issues, brain tumors, or increased intracranial pressure.

A. I should try to eat my food either very warm or very cold. B. I will have to start chewing on my unaffected side. C. I should rinse my mouth if tooth brushing is too painful. D. I will wash my face with cotton pads.

Correct Answer is A

Explanation

Choice A rationale

Eating food that is either very warm or very cold can trigger pain in individuals with trigeminal neuralgia. Therefore, if a client made this statement, it would indicate the need for further teaching.
Choice B rationale
Chewing on the unaffected side can help minimize episodes of pain in trigeminal neuralgia.
Choice C rationale
Rinsing the mouth if tooth brushing is too painful is a good strategy for managing trigeminal neuralgia.
Choice D rationale
Washing the face with cotton pads can help minimize episodes of pain in trigeminal neuralgia.

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The nurse is caring for a client who experienced a stroke in the right hemisphere of the brain. What should the nurse do to ensure the safety of the patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a patient with a suspected stroke. What assessment finding is most suggestive of a stroke?

Correct Answer is A

Explanation

A client with trigeminal neuralgia has been given suggestions to minimize episodes of pain. Which statement, if made by the client, would indicate the need for further teaching?

Correct Answer is A

Explanation

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