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Anna Bryant, a 65-year-old White female, is brought to the emergency department by her daughter, Pat. Ms. Bryant complains of right-sided weakness and a headache that started about 2 hours ago. Her daughter states she found her in bed early this morning and noticed she was having trouble speaking. Ms. Bryant has a history of type 2 diabetes mellitus, for which she takes metformin and rheumatoid arthritis, which she manages with naproxen. She used to smoke but quit 5 years ago. She does not drink alcohol or use illicit drugs.Â

Her vital signs are as follows: Temperature 99.0Â°F; heart rate 94 beats per minute and irregular; respirations 20 per minute; blood pressure 150/90 mmHg; pulse oximeter 95%. Upon assessment, Ms. Bryant is alert, but has trouble answering questions. Her speech is slurred, and she appears frightened.Â

Answer the following questions.

1. Based on her manifestations which cerebral artery is likely affected? Â

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Vertebral artery
Basilar artery
Posterior cerebral artery
Middle cerebral artery

2. Which type of stroke is Ms. Bryant likely having? Â

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Ischemic embolic stroke
Ischemic thrombotic stroke
Subarachnoid hemorrhage
Intracerebral hemorrhage

3. Where in the brain is the lesion? Â

Â
Right hemisphere
Left hemisphere

4. Based on her history and physical examination findings, what is a possible etiology for a stroke in Ms. Bryant? Â

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Endocarditis
Rheumatoid arthritis
Atrial fibrillation
Illicit drug use

5. This question is optional. What diagnostic tests should be ordered in the acute phase? Select all that apply. Â

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12-lead electrocardiogram
Hemoglobin A1c
Noncontrast CT
Lipid profile

6. This question is optional. What are treatment strategies for this acute stroke? Select all that apply. Â

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Intravenous thrombolytic therapy administration
Systemic cooling to decrease risk of cerebral edema
Antihypertensive agents to reduce mean arterial pressure to 80 (e.g., 100/70 mmHg)
Statin administration
SCIENCE
HEALTH SCIENCE
NURSING
NURSING RN 2372

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