Question

A client arrives at the ER exhibiting right-sided weakness and expressive aphasia of one hour duration. Several exams are ordered by the physician. Which exam should the nurse make sure is done first? A. CT scan B. \(\mathrm{CBC}\) C. Chest X-ray D. Carotid Doppler study

Short answer

Answer: A. CT scan

Step-by-step solution

Analyze the patient's symptoms

The patient has right-sided weakness and expressive aphasia, which are both sudden onset neurological symptoms. These symptoms could be indicative of a stroke, transient ischemic attack, or another neurological problem. The priority in this case is to determine the cause of these symptoms as quickly as possible in order for the appropriate treatment to be administered.

Evaluate the diagnostic value of each exam

A. CT scan: A CT (Computed Tomography) scan is a type of imaging study that can quickly provide detailed information about the structure of the brain and the presence of any abnormalities, such as bleeding, ischemia, or an infarct. In the case of a suspected stroke, a CT scan can help guide the appropriate treatment by differentiating between an ischemic (lack of blood flow) or hemorrhagic (bleeding) stroke. B. \(\mathrm{CBC}\) (Complete Blood Count): The complete blood count test is a routine blood test that measures various factors in the blood, such as red and white blood cell counts, and hemoglobin levels. While it provides valuable information about the patient's overall health, it won't help to determine the cause of the sudden onset neurological symptoms. C. Chest X-ray: A chest X-ray can help to identify lung and heart problems, such as pneumonia, heart failure, or lung cancer, but it will not provide any information about the cause of the neurological symptoms. D. Carotid Doppler study: A carotid Doppler study is an ultrasound imaging study that examines the blood flow through the carotid arteries, which supply blood to the brain. This test may help to identify carotid artery stenosis (narrowing) as a potential cause of the neurological symptoms, but it's a relatively time-consuming process and not useful in determining if the patient is having an acute stroke.

Determine the priority exam

Considering the potential causes of the patient's symptoms, as well as the diagnostic value and efficiency of each exam, the nurse should make sure that the CT scan is done first. This imaging study can quickly provide crucial information about the cause of the patient's neurological symptoms and guide appropriate treatment, especially in the case of a stroke, where time-sensitive interventions are critical to minimizing brain damage and improving the patient's outcome. Hence, the correct answer is: A. CT scan

Key concepts

Neurological Assessment

Neurological assessment is a critical process in evaluating the function and health of the nervous system to identify disorders early. For nursing professionals, a comprehensive neurological exam is crucial, especially when a patient presents symptoms like weakness on one side or speech difficulties. - They should observe and assess mental status, sensory abilities, balance, coordination, reflexes, and motor function. - Focus on gathering detailed patient history and observing the sudden onset of symptoms like aphasia (loss of ability to speak) which might suggest serious conditions like a stroke. Prompt and thorough neurological assessments provide essential information that healthcare teams need to decide on immediate interventions and appropriate treatments. This approach ensures rapid response, especially for conditions where time is critical to the patient's recovery.

Emergency Room Procedures

Emergency room procedures must be swift and efficient to ensure the best possible outcomes for patients. When someone like in our case scenario arrives with neurological symptoms, it triggers specific, prioritized protocols. - ER staff must quickly evaluate the patient's vital signs and symptoms. - Perform initial assessments and decide on the order of diagnostic tests. In cases like suspected strokes, where right-sided weakness and speech issues are observed, emergency room personnel prioritize tests that quickly distinguish between different types of conditions that require immediate intervention to prevent further damage. This coordination is key to the fast-paced environment of emergency care to deliver timely medical attention.

Stroke Diagnosis

Stroke diagnosis in ER settings is highly time-sensitive. Speedy diagnosis is critical due to the potential for significant neurological damage. - A CT scan is often the first test administered, as it can quickly reveal hemorrhagic or ischemic strokes. - Healthcare teams use CT scans to assess if there is any bleeding in the brain which determines the next steps in treatment. Understanding stroke symptoms like sudden weakness, especially on one side, or expressive aphasia allows healthcare workers to prioritize diagnostics and start treatments like thrombolysis. The sooner a stroke is diagnosed, the better the chances of reducing long-term impacts on patients.

Nursing Exam Questions

To prepare for nursing exams like the NCLEX-RN, students need to focus on a broad array of topics, including the integration of theory and practice in real-world scenarios. - Exam questions often test how well a nurse can prioritize and execute emergency procedures based on symptom presentation. - Practice with questions concerning urgent care situations, such as prioritizing a CT scan for suspected stroke cases. Studying scenarios, like those involving differential diagnosis of strokes, helps in understanding how to apply critical thinking under pressure. By simulating these exams, students can become adept at making quick, informed decisions in high-stakes environments, honing skills that are essential in both exams and their future careers.