The Nurse Is Assessing a Client with a Possible Stroke

question 10

Multiple Choice

The nurse is assessing a client with a possible stroke and finds that the client's aphasia started 3.5 hours previously and the blood pressure is 170/92 mm Hg. Which of these prescriptions by the health care provider should the nurse question?

• A)Infuse normal saline at 75 mL/hour.
• B)Keep head of bed elevated at least 30 degrees.
• C)Administer tissue plasminogen activator (tPA) per protocol.
• D)Titrate labetalol drip to keep BP less than 140/90 mm Hg.

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Definitions:

Developmental Aphasia

A neurological condition characterized by difficulties with language skills acquired during childhood due to brain development issues.

Learning Disabilities

Neurologically-based processing problems that can interfere with learning basic skills such as reading, writing, or math.

Disadvantaged Environment

A setting that lacks the basic resources and opportunities required for individuals to achieve their full potential.

Incremental

Describes gradual, step-by-step changes or improvements over time.