Which assessment data would indicate to the nurse that the client would be at risk for a hemorrhagic stroke?
A. A blood glucose level of 480 mg/dl.
B. A right-sided carotid bruit.
C. A blood pressure of 220/120 mmHg.
D. The presence of bronchogenic carcinoma.
Correct Answer: C. A blood pressure of 220/120 mmHg.
Uncontrolled hypertension is a risk factor for hemorrhagic stroke, which is a ruptured blood vessel in the cranium. Hypertension is the most common cause of hemorrhagic stroke. Long standing hypertension produces degeneration of media, breakage of the elastic lamina, and fragmentation of smooth muscles of arteries.
Option A: High blood glucose levels could predispose a patient to ischemic stroke, but not hemorrhagic. Decreased low-density lipoprotein cholesterol and low triglycerides are also considered to be risk factors. Cerebral microbleeds (CMBs) associated with hypertension, diabetes mellitus, and cigarette smoking increase the risk of ICH.
Option B: Bruit in the carotid artery would predispose a client to an embolic or ischemic stroke. Hypertensive change causes non-lobar intracranial hemorrhage (ICH). Acute hypertension, as seen in eclampsia, also can cause ICH, known as postpartum ICH.
Option D: Cancer is not a precursor to stroke. The common sites of origin of hypertension-induced intracerebral hemorrhage are the small penetrating arteries that originate from basilar arteries or the anterior, middle, or posterior cerebral arteries.
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