Stroke: Ischemic stroke, Hemorrhagic stroke, Transient ischemic attack (TIA)

Stroke: Ischemic stroke, Hemorrhagic stroke, Transient ischemic attack (TIA) ( 5 Questions)

A nurse is planning care for a client who has a hemorrhagic stroke. Which of the following interventions should the nurse include in the plan of care?


Correct Answer: C

Choice A reason:

This is an incorrect answer. Elevating the head of the bed to 30 degrees is not an appropriate intervention for a client who has a hemorrhagic stroke. Elevating the head of the bed can lower blood pressure and reduce cerebral perfusion pressure, which can worsen brain ischemia and injury.

Choice B reason:

This is an incorrect answer. Administering aspirin as prescribed is not an appropriate intervention for a client who has a hemorrhagic stroke. Aspirin is an antiplatelet agent that inhibits

the clotting of blood and increases the risk of bleeding in the brain or elsewhere. Aspirin is contraindicated for clients who have a hemorrhagic stroke and may worsen their condition.

Choice C reason:

This is a correct answer. Monitoring blood pressure and keeping it within normal range is an appropriate intervention for a client who has a hemorrhagic stroke. Blood pressure is a major factor that affects the severity and outcome of hemorrhagic stroke. High blood pressure can increase the bleeding and ICP, while low blood pressure can reduce cerebral perfusion and oxygenation. The nurse should monitor blood pressure frequently and administer antihypertensive or vasopressor medications as prescribed to maintain optimal blood pressure.

Choice D reason:

This is an incorrect answer. Performing passive range of motion exercises is not an appropriate intervention for a client who has a hemorrhagic stroke. Passive range of motion exercises can increase ICP and bleeding by stimulating the sympathetic nervous system, which increases blood pressure and cerebral blood flow. The nurse should avoid any activity that can increase ICP or bleeding in the acute phase of hemorrhagic stroke.




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