External Fertilization in Aquatic Animals

Stroke A stroke occurs when the blood supply to part of your brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes. A stroke is a medical emergency, and prompt treatment is crucial. Early action can reduce brain damage and other complications. Effective treatments can also help prevent disability from stroke. Symptoms Blood supply to the brain? The blood supply to the brain comes for carotid the and vertebral arteries, which then branch into other arteries that feed the brain. If any of these areas of the artery become blocked or burst open it decreases the blood supply to the brain cells. Brain cells are very sensitive and within 5 minutes these cells start to become damaged, and the damage can become IRREVERSIBLE. If you or someone you're with may be having a stroke, pay particular attention to the time the symptoms began. Some treatment options are most effective when given soon after a stroke begins. Signs and symptoms of stroke include:      Trouble speaking and understanding what others are saying. You may experience confusion, slur your words or have difficulty understanding speech. Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often affects just one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile. Problems seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double. Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate that you're having a stroke. Trouble walking. You may stumble or lose your balance. You may also have sudden dizziness or a loss of coordination. Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to come and go or they disappear completely. Think "FAST" and do the following:     Face. Ask the person to smile. Does one side of the face droop? Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise? Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange? Time. If you observe any of these signs, call 911 or emergency medical help immediately. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. Causes There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms. Ischemic stroke This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.   Embolism: where a clot has left a part of the body (example the heart: this can happen due to a heart valve problem or atrial fibrillation). The clot develops in the heart and travels to the brain, which stops blood flow. Thrombosis: Clot forms within the artery wall within the neck or brain. This is seen in patients with hyperlipidemia or atherosclerosis Some initial research shows that COVID-19 infection may be a possible cause of ischemic stroke, but more study is needed. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Therefore, no blood will perfuse to the brain cells. In addition, this can lead to excessive swelling from the leakage of blood in the brain. Brain hemorrhages can result from many conditions that affect your blood vessels. Factors related to hemorrhagic stroke include:       Uncontrolled high blood pressure Overtreatment with blood thinners (anticoagulants) Bulges at weak spots in your blood vessel walls (aneurysms) Trauma (such as a car accident) Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy) Ischemic stroke leading to hemorrhage A less common cause of bleeding in the brain is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). Transient ischemic attack (TIA) A transient ischemic attack (TIA) — sometimes known as a ministroke — is a temporary period of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of your nervous system. Seek emergency care even if you think you've had a TIA because your symptoms got better. It's not possible to tell if you're having a stroke or TIA based only on your symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to your brain. Having a TIA increases your risk of having a full-blown stroke later. Risk factors Many factors can increase your stroke risk. Potentially treatable stroke risk factors include: Lifestyle risk factors     Being overweight or obese Physical inactivity Heavy or binge drinking Use of illegal drugs such as cocaine and methamphetamine Medical risk factors         High blood pressure Cigarette smoking or secondhand smoke exposure High cholesterol Diabetes Obstructive sleep apnea Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm, such as atrial fibrillation Personal or family history of stroke, heart attack or transient ischemic attack COVID-19 infection Other factors associated with a higher risk of stroke include:     Age — People age 55 or older have a higher risk of stroke than do younger people. Race — African Americans have a higher risk of stroke than do people of other races. Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. Hormones — Use of birth control pills or hormone therapies that include estrogen increases risk. Complications A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:       Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language, including speaking or understanding speech, reading, or writing. Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, reasoning, making judgments and understanding concepts. Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. Pain. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. Changes in behavior and self-care ability. People who have had strokes may become more withdrawn. They may need help with grooming and daily chores. Prevention Knowing your stroke risk factors, following your doctor's recommendations and adopting a healthy lifestyle are the best steps you can take to prevent a stroke. If you've had a stroke or a transient ischemic attack (TIA), these measures might help prevent another stroke. The follow-up care you receive in the hospital and afterward also may play a role. Many stroke prevention strategies are the same as strategies to prevent heart disease. In general, healthy lifestyle recommendations include:           Controlling high blood pressure (hypertension). This is one of the most important things you can do to reduce your stroke risk. If you've had a stroke, lowering your blood pressure can help prevent a subsequent TIA or stroke. Healthy lifestyle changes and medications are often used to treat high blood pressure. Lowering the amount of cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat and trans fats, may reduce the buildup in your arteries. If you can't control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication. Quitting tobacco use. Smoking raises the risk of stroke for smokers and nonsmokers exposed to secondhand smoke. Quitting tobacco use reduces your risk of stroke. Managing diabetes. Diet, exercise and losing weight can help you keep your blood sugar in a healthy range. If lifestyle factors don't seem to be enough to control your diabetes, your doctor may prescribe diabetes medication. Maintaining a healthy weight. Being overweight contributes to other stroke risk factors, such as high blood pressure, cardiovascular disease and diabetes. Eating a diet rich in fruits and vegetables. A diet containing five or more daily servings of fruits or vegetables may reduce your risk of stroke. The Mediterranean diet, which emphasizes olive oil, fruit, nuts, vegetables and whole grains, may be helpful. Exercising regularly. Aerobic exercise reduces your risk of stroke in many ways. Exercise can lower your blood pressure, increase your levels of good cholesterol, and improve the overall health of your blood vessels and heart. It also helps you lose weight, control diabetes and reduce stress. Gradually work up to at least 30 minutes of moderate physical activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week. Drinking alcohol in moderation, if at all. Heavy alcohol consumption increases your risk of high blood pressure, ischemic strokes and hemorrhagic strokes. Alcohol may also interact with other drugs you're taking. However, drinking small to moderate amounts of alcohol, such as one drink a day, may help prevent ischemic stroke and decrease your blood's clotting tendency. Talk to your doctor about what's appropriate for you. Treating obstructive sleep apnea (OSA). Your doctor may recommend a sleep study if you have symptoms of OSA — a sleep disorder that causes you to stop breathing for short periods repeatedly during sleep. Treatment for OSA includes a device that delivers positive airway pressure through a mask to keep your airway open while you sleep. Avoiding illegal drugs. Certain street drugs, such as cocaine and methamphetamine, are established risk factors for a TIA or a stroke. Preventive medications If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke. These include:  Anti-platelet drugs. Platelets are cells in your blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin. Your doctor can help you determine the right dose of aspirin for you. Your doctor might also consider prescribing Aggrenox, a combination of low-dose aspirin and the anti-platelet drug dipyridamole to reduce the risk of blood clotting. After a TIA or minor stroke, your doctor may give you aspirin and an anti-platelet drug such as clopidogrel (Plavix) for a period of time to reduce the risk of another stroke. If you can't take aspirin, your doctor may prescribe clopidogrel alone.  Anticoagulants. These drugs reduce blood clotting. Heparin is fast acting and may be used short-term in the hospital. Slower-acting warfarin (Coumadin, Jantoven) may be used over a longer term. Warfarin is a powerful blood-thinning drug, so you'll need to take it exactly as directed and watch for side effects. You'll also need to have regular blood tests to monitor warfarin's effects. Several newer blood-thinning medications (anticoagulants) are available for preventing strokes in people who have a high risk. These medications include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They're shorter acting than warfarin and usually don't require regular blood tests or monitoring by your doctor. These drugs are also associated with a lower risk of bleeding complications. Diagnosis Things will move quickly once you get to the hospital, as your emergency team tries to determine what type of stroke you're having. That means you'll have a CT scan or other imaging test soon after arrival. Doctors also need to rule out other possible causes of your symptoms, such as a brain tumor or a drug reaction. Some of the tests you may have include:  A physical exam. Your doctor will do a number of tests you're familiar with, such as listening to your heart and checking your blood pressure. You'll also have a neurological exam to see how a potential stroke is affecting your nervous system.       Blood tests. You may have several blood tests, including tests to check how fast your blood clots, whether your blood sugar is too high or low, and whether you have an infection. Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography). Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and magnets to create a detailed view of your brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography). Carotid ultrasound. In this test, sound waves create detailed images of the inside of the carotid arteries in your neck. This test shows buildup of fatty deposits (plaques) and blood flow in your carotid arteries. Cerebral angiogram. In this uncommonly used test, your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin, and guides it through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye into your blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in your brain and neck. Echocardiogram. An echocardiogram uses sound waves to create detailed images of your heart. An echocardiogram can find a source of clots in your heart that may have traveled from your heart to your brain and caused your stroke. The cells in the brain control how our body functions and depending on where the cells are located they are responsible for specific functions. Therefore, it is super important to be familiar with the function of each lobe and the difference between the right and left hemispheres of the brain. Let’s look at the lobes of the brain and their functions: Now strokes tend to affect ONE side of the body. So be familiar with the functions of the right side vs the left side: The right side of the brain is the CREATIVE side while the left side is the LOGICAL side. Right Side’s Functions:         Attention span Showing emotions Ability to solve every day problems by making decisions/plans Reasoning (understanding jokes…reading in between the lines) Making judgement calls Memory Music/art awareness Control the left side of the body If a patient has right side brain damage, what do you think the patient will experience?   Left side weakness: Hemiplegia Impairment in creativity: arts and music  Confused on date, time, place Cannot recognize faces or the person’s name Loss of depth perception Trouble staying on topic when talking Can’t see things on left side: LEFT SIDE NEGLECT (unilateral neglect)       o (Ignores left side of body) Trouble with maintaining proper grooming Emotionally: not going to think things through….very impulsive Poor ability to make decisions and assessing spatial qualities….shapes Denial about limitations Not able to read nonverbal language or understand the hidden meaning of things Very short attention span     Left Side’s Functions:       Speaking Writing Reading Math skills Analyzing info Planning If a patient has left side brain damage, what do you think the patient will experience?:         Right side Hemiplegia Aphasia (trouble formulating words and comprehending them) Aware of their limits…experiences depression, anger, frustration Trouble understanding written text Can’t write (agraphia) Impaired math skills Memory intact Issues with seeing on the right side Important Stroke Terms (remember these terms because exams love to ask you about them) Aphasia: unable to speak (comprehending or producing it)  Receptive Aphasia: unable to comprehend speech (Wernicke’s area)  Expressive Aphasia: comprehends speech but can’t respond back with the correct words, if at all (Broca’s area)  Mixed Aphasia: combination of the two types of aphasia.  Global Aphasia: complete inability to understand speech or produce it. Dysarthria: unable to hear speech clearly due to weak muscles (hard to understand the patient’s speech….it may be slurred) Apraxia: can’t perform voluntarily movements (winking/moving arm to scratch an itch) even though muscles function is normal. Agraphia: loss the ability to write Alexia: loss the ability to read…doesn’t understand or recognize the words Agnosia: doesn’t understand sensations or recognize known objects or people Dysphagia: issues swallowing (weak muscles) Hemianopia: limited vision in half of the visual field Treatment Emergency treatment for stroke depends on whether you're having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic). Ischemic stroke To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with:  Emergency IV medication. Therapy with drugs that can break up a clot has to be given within 4.5 hours from when symptoms first started if given intravenously. The sooner these drugs are given, the better. Quick treatment not only improves your chances of survival but also may reduce complications. An IV injection of recombinant tissue plasminogen activator (tPA) — also called alteplase (Activase) — is the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm with the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started. This drug restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.  Emergency endovascular procedures. Doctors sometimes treat ischemic strokes directly inside the blocked blood vessel. Endovascular therapy has been shown to significantly improve outcomes and reduce long-term disability after ischemic stroke. These procedures must be performed as soon as possible: o Medications delivered directly to the brain. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited. o Removing the clot with a stent retriever. Doctors can use a device attached to a catheter to directly remove the clot from the blocked blood vessel in your brain. This procedure is particularly beneficial for people with large clots that can't be completely dissolved with tPA. This procedure is often performed in combination with injected tPA. The time window when these procedures can be considered has been expanding due to newer imaging technology. Doctors may order perfusion imaging tests (done with CT or MRI) to help determine how likely it is that someone can benefit from endovascular therapy. To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Options vary depending on your situation, but include:   Carotid endarterectomy. Carotid arteries are the blood vessels that run along each side of your neck, supplying your brain (carotid arteries) with blood. This surgery removes the plaque blocking a carotid artery, and may reduce your risk of ischemic stroke. A carotid endarterectomy also involves risks, especially for people with heart disease or other medical conditions. Angioplasty and stents. In an angioplasty, a surgeon threads a catheter to your carotid arteries through an artery in your groin. A balloon is then inflated to expand the narrowed artery. Then a stent can be inserted to support the opened artery. Hemorrhagic stroke Emergency treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid. Treatment options include:   Emergency measures. If you take blood-thinning medications to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower the pressure in your brain (intracranial pressure), lower your blood pressure, prevent spasms of your blood vessels and prevent seizures. Surgery. If the area of bleeding is large, your doctor may perform surgery to remove the blood and relieve pressure on your brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes. Your doctor may recommend one of these procedures after a stroke or if an aneurysm, arteriovenous malformation (AVM) or other type of blood vessel problem caused your hemorrhagic stroke:     Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can keep an aneurysm that has recently hemorrhaged from bleeding again. Coiling (endovascular embolization). Using a catheter inserted into an artery in your groin and guided to your brain, your surgeon will place tiny detachable coils into the aneurysm to fill it. This blocks blood flow into the aneurysm and causes blood to clot. Surgical AVM removal. Surgeons may remove a smaller AVM if it's located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM if it's located deep within the brain, it's large, or its removal would cause too much of an impact on brain function. Stereotactic radiosurgery. Using multiple beams of highly focused radiation, stereotactic radiosurgery is an advanced minimally invasive treatment used to repair blood vessel malformations. Nursing Interventions for Stroke Monitor vital signs and neuro status:  especially blood pressure (notify MD is hypertensive)  airway (difficulty swallowing….at risk for aspiration HOB 30’ with suction at bedside)  turn every 2 hours with proper alignment and watch for increased ICP (intracranial pressure) during acute stage o headache, nausea and vomiting, increased blood pressure and decreased HR and decreased RR, decrease in mental status from baseline, pupils don’t respond Assess with NIH Stroke Scale  Score ranges from 0 to 42  0: no stroke symptoms  21-42: severe symptoms Assesses: o Level of consciousness, gaze, visual, facial palsy, motor function of extremities, sensory, best language, dysarthria, extinction/inattention Check cranial nerves: pupil responses, motor function, gag reflex Monitor bowel and bladder function (may be incontinent or retaining) Stroke recovery and rehabilitation After emergency treatment, you'll be closely monitored for at least a day. After that, stroke care focuses on helping you recover as much function as possible and return to independent living. The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. If your stroke affected the right side of your brain, your movement and sensation on the left side of your body may be affected. If your stroke damaged the brain tissue on the left side of your brain, your movement and sensation on the right side of your body may be affected. Brain damage to the left side of your brain may cause speech and language disorders. Most stroke survivors go to a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. Stroke NCLEX Questions  1. A patient is admitted with uncontrolled atrial fibrillation. The patient’s medication history includes vitamin D supplements and calcium. What type of stroke is this patient at MOST risk for? o A. Ischemic thrombosis o B. Ischemic embolism o C. Hemorrhagic o D. Ischemic stenosis  2. Which patient below is at most risk for a hemorrhagic stroke? o A. A 65 year old male patient with carotid stenosis. o B. A 89 year old female with atherosclerosis. o o  o C. A 88 year old male with uncontrolled hypertension and a history of brain aneurysm repair 2 years ago. D. A 55 year old female with atrial flutter. 3. You're educating a patient about transient ischemic attacks (TIAs). Select all the options that are incorrect about this condition: A. TIAs are caused by a temporary decrease in blood flow to the brain. o B. TIAs produce signs and symptoms that can last for several weeks to months. o C. A TIAs is a warning sign that an impending stroke may occur. o D. TIAs don't require medical treatment.  4. A patient who suffered a stroke one month ago is experiencing hearing problems along with issues learning and showing emotion. On the MRI what lobe in the brain do you expect to be affected? o A. Frontal lobe o B. Occipital lobe o C. Parietal lobe o D. Temporal  5. A patient's MRI imaging shows damage to the cerebellum a week after the patient suffered a stroke. What assessment findings would correlate with this MRI finding? o A. Vision problems o B. Balance impairment o C. Language difficulty o D. Impaired short-term memory  6. A patient is demonstrating signs and symptoms of stroke. The patient reports loss of vision. What area of the brain do you suspect is affected based on this finding? o A. Brain stem o B. Hippocampus o C. Parietal lobe o D. Occipital lobe  7. A patient has right side brain damage from a stroke. Select all the signs and symptoms that occur with this type of stroke: o A. Right side hemiplegia o B. Confusion on date, time, and place o C. Aphasia o D. Unilateral neglect o E. Aware of limitations o F. Impulsive o G. Short attention span o H. Agraphia  8. You're educating a group of nursing students about left side brain damage. Select all the signs and symptoms noted with this type of stroke: o A. Aphasia o B. Denial about limitations o C. Impaired math skills o D. Issues with seeing on the right side o E. Disoriented o F. Depression and anger o G. Impulsive o H. Agraphia  o 9. During discharge teaching for a patient who experienced a mild stroke, you are providing details on how to eliminate risk factors for experiencing another stroke. Which risk factors below for stroke are modifiable? A. Smoking o B. Family history o C. Advanced age o D. Obesity o E. Sedentary lifestyle  10. Your patient who had a stroke has issues with understanding speech. What type of aphasia is this patient experiencing and what area of the brain is affected? o A. Expressive; Wernicke's area o B. Receptive, Broca's area o C. Expressive; hippocampus o D. Receptive; Wernicke's area  11. Your patient has expressive aphasia. Select all the ways to effectively communicate with this patient? o A. Fill in the words for the patient they can't say. o B. Don't repeat questions. o C. Ask questions that require a simple response. o D. Use a communication board. o E. Discourage the patient from using words.  12. While conversing with a patient who had a stroke six months ago, you note their speech is hard to understand and slurred. This is known as: o A. Dysarthria o B. Apraxia o C. Alexia o D. Dysphagia  13. You're reading the physician’s history and physical assessment report. You note the physician wrote that the patient has apraxia. What assessment finding in your morning assessment correlates with this condition? o A. The patient is unable to read. o B. The patient has limited vision in half of the visual field. o C. The patient is unable to wink or move his arm to scratch his skin. o D. The patient doesn't recognize a pencil or television.  14. You need to obtain informed consent from a patient for a procedure. The patient experienced a stroke three months ago. The patient is unable to sign the consent form because he can't write. This is known as what: o A. Agraphia o B. Alexia o C. Hemianopia o D. Apraxia  15. You're assessing your patient's pupil size and vision after a stroke. The patient says they can only see half of the objects in the room. You document this finding as: o A. Hemianopia o B. Opticopsia o C. Alexia o D. Dysoptic  16. A patient who has hemianopia is at risk for injury. What can you educate the patient to perform regularly to prevent injury? o A. Wearing anti-embolism stockings daily o B. Consume soft foods and tuck in chin while swallowing o C. Scanning the room from side to side frequently o  D. Muscle training 17. You receive a patient who is suspected of experiencing a stroke from EMS. You conduct a stroke assessment with the NIH Stroke Scale. The patient scores a 40. According to the scale, the result is: o A. No stroke symptoms o B. Severe stroke symptoms o C. Mild stroke symptoms o D. Moderate stroke symptoms  18. In order for tissue plasminogen activator (tPA) to be most effective in the treatment of stroke, it must be administered? o A. 6 hours after the onset of stroke symptoms o B. 3 hours before the onset of stroke symptoms o C. 3 hours after the onset of stroke symptoms o D. 12 hours before the onset of stroke symptoms  19. Which patients are NOT a candidate for tissue plasminogen activator (tPA) for the treatment of stroke? o A. A patient with a CT scan that is negative. o B. A patient whose blood pressure is 200/110. o C. A patient who is showing signs and symptoms of ischemic stroke. o D. A patient who received Heparin 24 hours ago.  20. You're assisting a patient who has right side hemiparesis and dysphagia with eating. It is very important to: o A. Keep the head of bed less than 30'. o B. Check for pouching of food in the right cheek. o C. Prevent aspiration by thinning the liquids. o D. Have the patient extend the neck upward away from the chest while eating.  21. A patient has experienced right side brain damage. You note the patient is experiencing neglect syndrome. What nursing intervention will you include in the patient's plan of care? o A. Remind the patient to use and touch both sides of the body daily. o B. Offer the patient a soft mechanical diet with honey thick liquids. o C. Ask direct questions that require one word responses. o D. Offer the bedpan and bedside commode every 2 hours.