Practice Question
Which of the following is not an anticipated finding for a client that experienced a stroke?
Answer Choices:
Correct Answer:
Clubbing of fingers
Rationale:
💎 Clubbing of the fingers is typically associated with chronic hypoxia, such as in chronic lung disease or cyanotic heart disease, not with acute stroke.
💎 Stroke primarily affects the central nervous system, leading to motor, sensory, cognitive, and speech deficits, rather than changes in the nail beds.
💎 The pathophysiology of clubbing involves long-standing low oxygen levels and vascular/connective tissue changes in the distal digits, which does not match the acute vascular event of a cerebrovascular accident (CVA).
💎 Because it is unrelated to cerebral blood flow interruption, clubbing is not considered an anticipated neurologic finding following a stroke.
💎 When a client with stroke presents with clubbing, the nurse should instead consider underlying pulmonary or cardiac disease as the likely cause.
Aphasia
💎 Aphasia is a classic and anticipated finding after a stroke, especially when the dominant hemisphere (often the left) is affected.
💎 It represents impaired language function, including difficulty speaking, understanding, reading, or writing, depending on the area of brain injury.
💎 Damage to Broca’s area causes expressive aphasia, while injury to Wernicke’s area causes receptive aphasia.
💎 Because stroke often injures specific cortical language centers, aphasia is a key neurologic deficit the nurse should monitor for and anticipate.
💎 Therefore, aphasia is not the correct choice for “not anticipated”; it is a common stroke manifestation.
Dysphagia
💎 Dysphagia—difficulty swallowing—is a well-known and expected complication following stroke, especially with brainstem or cranial nerve involvement.
💎 Stroke can impair the coordination of muscles involved in swallowing, increasing risk for aspiration, pneumonia, and malnutrition.
💎 Because of this, a swallowing assessment and possible speech therapy consult are routine after stroke.
💎 Nurses anticipate dysphagia and implement aspiration precautions, such as thickened liquids and upright positioning.
💎 Thus, dysphagia is an anticipated finding, not the correct answer to what is “not anticipated.”
Sensory loss
💎 Sensory loss is a common neurologic deficit after stroke due to damage in the sensory pathways or sensory cortex.
💎 Clients may experience numbness, decreased sensation, altered pain or temperature perception, often on one side of the body.
💎 This is frequently seen in hemiparesis or hemiplegia, where motor and sensory deficits occur together.
💎 The nurse should expect, assess, and document changes in sensation as part of a comprehensive stroke assessment.
💎 Therefore, sensory loss is an anticipated post-stroke finding and not the correct choice.
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This question is from Examplify NR304 Quiz 3 BSNOL NOV25 which contains 10 questions.
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The nurse is assessing the client. Which findings are indicative of the need for further neurological assessment? (Select all that apply.)
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Which outcome is most appropriate for a client being discharged to a long-term care facility after a stroke?
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Which findings in this client's health history should the nurse associate with an increased risk for neurological impairment? (Select all that apply.)
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A nurse has four clients who have all had a stroke. Which of the clients should the nurse see first?
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Health Assessment
- Answer Choices: 4