The nurse is caring for a client with an ischemic stroke who has apraxia. Which of the following deficits would the nurse expect the client to have?

Inability to see objects on one side of the visual field

Inability to perform a previously learned action

Inability to repeat a simple sentence

Inability to hear from the ear on the affected side

Answer and Explanation

The Correct Answer is B

A. Inability to see objects on one side of the visual field: This describes hemianopsia, not apraxia.

B. Inability to perform a previously learned action: Apraxia is the loss of the ability to perform skilled movements or gestures despite having the desire and physical ability to do so.

C. Inability to repeat a simple sentence: This describes aphasia, specifically expressive or receptive aphasia.

D. Inability to hear from the ear on the affected side: This describes hearing loss, which is unrelated to apraxia.

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Correct Answer is D

Explanation

A. Ventricular aneurysm. Ventricular aneurysms are a complication that typically develops weeks or months after an MI.

B. Heart failure. While heart failure is a risk following an MI, it is more of a concern in the longer term after the acute phase.

C. Pulmonary embolism. Pulmonary embolism is not a direct complication of MI and is less common in the immediate post-MI period.

D. Dysrhythmia: Within the first 24 hours following a myocardial infarction, dysrhythmias, particularly ventricular arrhythmias, are common and can be life-threatening. This is the highest risk during the early period after MI.

A. Maintain hyperventilation to a PaCO2 of 15 to 20mm Hg. B. Routinely suction to prevent accumulation of respiratory secretions C. Encourage visitation to prevent feelings of isolation. D. Avoid positioning the client with neck and hip flexion.

Correct Answer is D

Explanation

A. Maintain hyperventilation to a PaCO2 of 15 to 20 mm Hg. Hyperventilation can reduce ICP by causing vasoconstriction of cerebral blood vessels; however, a PaCO2 as low as 15–20 mmHg may lead to excessive vasoconstriction, reducing cerebral blood flow and causing cerebral ischemia. A PaCO2 target closer to 30–35 mmHg is typically recommended, and even this is used cautiously.

B. Routinely suction to prevent accumulation of respiratory secretions. Suctioning can increase ICP due to stimulation of the cough reflex. It should be performed only as needed and in a way that minimizes stimulation, such as preoxygenation and limiting suction duration.

C. Encourage visitation to prevent feelings of isolation. While social support is important, minimizing environmental stimuli (including limiting visitation) is crucial for clients with increased ICP to prevent overstimulation and further increases in ICP.

D. Avoid positioning the client with neck and hip flexion. Maintaining proper alignment of the head and neck is essential to promote venous drainage and reduce intracranial pressure (ICP). Flexion of the neck or hips can impede venous outflow, exacerbate ICP, and compromise cerebral perfusion.

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The nurse is caring for a client with an ischemic stroke who has apraxia. Which of the following deficits would the nurse expect the client to have?

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