A patient in the emergency department with sudden-onset ...

[Evvie72]

A patient in the emergency department with sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider?
 
  a. The patient's speech is difficult to understand.
  b. The patient's blood pressure is 144/90 mm Hg.
  c. The patient takes a diuretic because of a history of hypertension.
  d. The patient has atrial fibrillation and takes warfarin (Coumadin).

Question 2

A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?
 
  a. Complete blood count (CBC)
  b. Chest radiograph (Chest x-ray)
  c. 12-Lead electrocardiogram (ECG)
  d. Noncontrast computed tomography (CT) scan

[sailorcrescent]

Answer to Question 1

ANS: D
The use of warfarin probably contributed to the intracerebral bleeding and remains a risk factor for further bleeding. Administration of vitamin K is needed to reverse the effects of the warfarin, especially if the patient is to have surgery to correct the bleeding. The history of hypertension is a risk factor for the patient but has no immediate effect on the patient's care. The BP of 144/90 indicates the need for ongoing monitoring but not for any immediate change in therapy. Slurred speech is consistent with a left-sided stroke, and no change in therapy is indicated.

Answer to Question 2

ANS: D
Rapid screening with a noncontrast CT scan is needed before administration of tissue plasminogen activator (tPA), which must be given within 4.5 hours of the onset of clinical manifestations of the stroke. The sooner the tPA is given, the less brain injury. The other diagnostic tests give information about possible causes of the stroke and do not need to be completed as urgently as the CT scan.