BLOK 19 MODUL 2

1. Pasien miastenia gravis, supaya ngga sampai kritis miastenia dan kolinergik, kita
edukasi apaa... (The nurse is teaching the female client with myasthenia gravis about
the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is
most effectively done by:)
A. Minta pasien untuk beraktifitas nya diawal hari saja
B. Latihan otot
C. Makan makannan yg bergizi
D. Pasien minum obat tepat waktu agar terapeutik kadar darah terjagaa
Feedback
Clients with myasthenia gravis are taught to space out activities over the day to
conserve energy and restore muscle strength. Taking medications correctly to maintain
blood levels that are not too low or too high is important. Muscle-strengthening
exercises are not helpful and can fatigue the client. Overeating is a cause of
exacerbation of symptoms, as is exposure to heat, crowds, erratic sleep habits, and
emotional stress.

5. Yang terkait dengan miastenia gravis .... (The nurse is caring for a client admitted
with suspected myasthenia gravis. Which finding is usually associated with a diagnosis
of myasthenia gravis?)
A. Tanda cogwheel … Cogwheel rigidity and loss of coordination
B. Paralysis ascenden... Ascending paralysis and loss of motor function
C. Fluktuatif gejala
D. Lupa Progressive weakness that is worse at the day’s end
E. Lupa Visual disturbances, including diplopia
Feedback
The client with myasthenia develops progressive weakness that worsens during the day.
Visual disturbances, including diplopia is incorrect because it refers to symptoms of
multiple sclerosis. Ascending paralysis and loss of motor function is incorrect because it
refers to symptoms of Guillain Barre syndrome. Cogwheel rigidity and loss of
coordination is incorrect because it refers to Parkinson’s disease.

7. Manakah dari berikut ini yang akurat terkait pemeriksaan GBS?

A. Autoantibodi serum secara rutin diukur dalam pemeriksaan GBS
B. Studi elektrodiagnostik ditemukan pemanjangan kecepatan hantar saraf pada
GBS
C. Protein cairan serebrospinal (CSF) dalam batas pasti GBS
D. MRI sensitif dan spesifik untuk diagnosis GBS
E. A dan B

8. Penatalaksanaan GBS?
A.
B.
C.
D. Plasmapharesis dan imunoglobulin iv
E.

9. Seorang pasien wanita dirujuk kerumah sakit dengan diagnosis sindrome guillain
barre. Yang perlu dokter jaga tanyakan selama wawancara adalah.. (Female client is
admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse
inquires during the nursing admission interview if the client has history of:)
A. Kejang atau trauma pada otak
B. Meningitis selama 5 tahun terakhir
C. Cedera punggung atau trauma pada sum sum tulang belakang
D. Inveksi saluran pernafasan atau gastrointestinal selama bulan sebelumnya
E. Semua benar
Feedback
Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial
and peripheral nerves. Many clients report a history of respiratory or gastrointestinal
infection in the 1 to 4 weeks before the onset of neurological deficits. Occasionally, the
syndrome can be triggered by vaccination or surgery.

13. Komplikasi stroke tersering adalah

A. Pneumonia
B. Decubitus
C. Infeksi saluran kemih
D. Phlebitis
E. Sinusitis

15. Penyebab iskemia otak pada pasien berusia 60 tahun adalah...

A. Hypoglicemia
B. Cardiac arrest
C. Seizure
D. Respiration arrest

17. Mau edukasi perawat tentang iskemi otak kiri, gejalanya apa aja?
You're educating a group of nursing students about left side brain damage. Select all
the signs and symptoms noted with this type of stroke:

 A. Aphasia
 B. Denial about limitations
 C. Impaired math skills
 D. Issues with seeing on the right side
 E. Disoriented
 F. Depression and anger
 G. Impulsive
 H. Agraphia
The answers are A, C, D, F, and H. Patients who have left side brain damage will have
aphasia, be AWARE of their limitations, impaired math skills, issues with seeing on the
right side, no deficit in memory, depression/anger, cautious, and agraphia. All the other
options are found in right side brain injury.

18. Seorang pasien pasca stroke mengalami sindrome pengabaian (neglected

syndrome). Yang harus anda lakukan dalam rencana perawatan adalah..
A. Menyuruh pasien untuk menggunakan dan menyentuh kedua tangan setiap hari
B. Berikan terapi diet mekanik yang lembut dengan cairan tebal madu
C. Ajukan pertanyaan yang membutuhkan satu tanggapan kata
D. Tawarkan pispot dan tempat tidur disamping tempat tidur tiap 2 jam
E. Semua benar
A patient has experienced right side brain damage. You note the patient is experiencing
neglect syndrome. What nursing intervention will you include in the patient's plan of
care?
 A. Remind the patient to use and touch both sides of the body daily.
 B. Offer the patient a soft mechanical diet with honey thick liquids.
 C. Ask direct questions that require one word responses.
 D. Offer the bedpan and bedside commode every 2 hours.
The answer is A. It is important to watch for neglect syndrome. This tends to happen
in right side brain damage. The patient ignores the left side of the body in this
condition. The nurse needs to remind the patient to use and touch both sides of the
body daily and that the patient must make a conscious effort to do so.

19. Apakah pengobatan paling umum untuk stroke? [clot-preventing (antiplatelet)]

A. Terapi kejut
B. Olahrga aerob
C. Potasium
D. Pengencer darah
Blood thinners are the most common treatment for stroke. Blood thinners are used to
treat acute stroke. The ''clotbuster'' drug used in emergency settings is called alteplase
(Activase), also referred to as tPA (tissue plasminogen activator).
Blood thinners are also used to prevent or decrease the risk of stroke in conditions such
as heart disease, atrial fibrillation, heart valve disorders, hypercoagulable states, and
previous cerebral vascular disease.
20. Supply darah otak terganggu…(Blood supply to the brain that is briefly
interrupted describes a….)
A. Stroke
B. Mini stroke
C. TIA
D. B n C
E. Semua benar
A transient ischemic attack (TIA), also referred to as a mini-stroke, occurs when there
is a temporary interruption on the blood flow to an area of the brain. The symptoms of
a TIA generally last less than an hour, and always resolve within one day. They do not
usually cause brain damage and may not be seen on conventional stroke testing (CAT
scan). Mini-strokes are a warning that a damage-causing stroke may occur in the near
future.

22. Seorang pasien laki-laki, umur 37 tahun diantar keluarga ke IGD klinik BPJS
dengan kesadaran somnolen. Pemeriksaan yhang tidak perlu dilakukan pada pasien
tersebut adalah ...
A. pupil
B. Dolls eye
C. Reflex patologis
D. Motorik
E. Sensorik
23. Stroke dengan masalah pembicaran. Aphasia yang terkeba area otak apa?
A. Ekspresif, afea wernickle
B. Penerimaan, area broca
C. Ekspresif, area hipocampus
D. Penerinaan, area wernickle
E. B dan D
You're patient who had a stroke has issues with understanding speech. What type of
aphasia is this patient experiencing and what area of the brain is affected?
 A. Expressive; Wernicke's area
 B. Receptive, Broca's area
 C. Expressive; hippocampus
 D. Receptive; Wernicke's area
The answer is D.

24. Merupakan etiologi stroke hemoragic

A. Alkohol tidak terlalu pada hemoragic
B.
C. Aneurisma emboli
D
E

25.pemeriksaan stroke hemoragik didapatkan

A.aritmia
B.defisiensi neurologis
C.kejang
D.gejala mual muntah
E.bssd

27. Seorang pasien perempuan 48 thn, datang dibawa keluarganya ke IGD klinik
BPJS dengan kondisi koma, pemeriksaan pertama yang perlu dilakukan pada
pasien tsb utk menentukan kondisi batang otak adalah
A. Gerakan bola mata
B. Reflex kornea
C. Tes kalori
D. Doll eye
E. Bssd

29. Area otak.yang sering terkena stroke

A. Thalamus
B. Nucleus caudatus
C. Substansia nigra
D. olive inferior
Feedback
The caudate nucleus is the most sensitive among the listed structures in adult HIE.
30. Manakah dari obat berikut yang dibutuhkan sebagai terapi profilaksis sekunder
pada pasien stroke...
A. Antihipertensi
B. Statin
C. Aspirin
D. Warfarin
E. Semua benar
Feedback
The higher dose of aspirin, 325 mg, is an option; give within 24-48 hours of the stroke.
81 mg is also acceptable.

31. Indikasi yang diperbolehkan untuk terapi fibrinolitik pada stroke hemoragik
adalah.. (Which of the following are exclusion criteria for receiving fibrinolytic
therapy?)
- Active internal bleeding
- Blood pressure >185/110 mmHg
- INR>1.7
- Stroke within 3 months
A. INI > 1,7
B. Riwayat stroke 3 bln yg lalu
C. GDS 90?
D. Tekanan Darah 185/110
Feedback
Any indications of increased risk of bleeding preclude the use of a fibrinolytic, which
can cause life-threatening bleeding. Blood glucose should be normoglycemic: above 50
mg/dL. Of note is if the patient had a stroke within the past 3 months, then the patient is
precluded from receiving a fibrinolytic. Also, blood pressure must be lower than
185/110 mmHg.

32. Antihipertensi perlu diberikan pada pasien stroke yang tidak mendapat fibrinolitik,
jika tekanan darah (For patients who do not receive fibrinolytic therapy, utilize blood
pressure medications to lower blood pressure by 15% during the first 24 hours of stroke
onset only if the patient's blood pressure is above what threshold?)
A. >130/90
B. >185/110
C. >140/90
D. >220/120
E. >160/90
Feedback
As mentioned in the previous question, high blood pressure during a stroke is key for
preserving perfusion to the brain. Therefore, only utilize medications to lower blood
pressure if the patient's blood pressure is greater than 220/120 mmHg.

33. Antihipertensi pada pasien stroke yang mendapat fibrinolisis jika (For patients
who do not receive fibrinolytic therapy, utilize blood pressure medications to lower
blood pressure by 15% during the first 24 hours of stroke onset only if the patient's
blood pressure is above what threshold?)
A. TD > 130/90
B. TD > 185/110
C. TD > 140/90
D. TD >220/120
E. TD > 160/90
Feedback
The blood pressure goal for a patient receiving fibrinolytic therapy is less than 185/110
mmHg. The high blood pressure is keeping the blood supply to the brain, so
antihypertensive medications should not be given unless the blood pressure is greater
than 185/110 mmHg and fibrinolytic therapy is desired. For the 24 hours following tPA,
the blood pressure should be maintained at less than 185/105 mmHg.

34. pemeriksaan tambahan setelah CT scan/MRI yang perlu dilakukan pada pasien
stroke untuk memberikan terapi fibrinolitik (Besides the tests such as CT scans or MRI
that are necessary for establishing the diagnosis of ischemic stroke, which is the one test
that may preclude the initiation of IV tPA, if IV tPA is appropriate?)
a. CRP
b. CKMB
c. Gula darah
d. troponin
e. semua benar
Blood glucose is the only assessment that must precede the initiation of IV tPA.

35. edema otak pada iskemia serebri diakibatkan oleh pelepasan

a. asam arakhidonat
b. asam laktat
c. A+B benar
d. BSSD
Feedback
Cerebral edema in HIE is caused by both, arachidonic acid and lactic acid. Arachidonic
acid increases vascular permeability and lactic acid damages blood vessels and acts as
an osmotic agent.

36. Terapi stroke

38. Yang bukan merupakan hasil pemeriksaan N. VII adalah ...

A. Kelemahan pada dahi
B. Kelemahan pada pipi satu sisi
C. Kelemahan pada bahu
D. Kelemahan pada satu sisi wajah
E. Bssd

41. Apa penanganan pasien pasca stroke tanpa ekspresif?

A. Isi kata-kata kosong yang ditulis pasien
B. Taruh benda yng dapat dilihat
C. Gunakan papan tulis kecil
D. Jangan biarkan pasien berbicara
You're patient has expressive aphasia. Select all the ways to effectively communicate
with this patient?
 A. Fill in the words for the patient they can't say.
 B. Don't repeat questions.
 C. Ask questions that require a simple response.
 D. Use a communication board.
 E. Discourage the patient from using words.
The answers are C and D. Patients with expressive aphasia can understand spoken
words but can't respond back effectively or at all. Therefore be patient, let them speak,
be direct and ask simple questions that require a simple response, and communicate
with a dry erase board etc.

44. Hal yang dapat membantu pasien stroke agar mandiri adalah...
A. Membicarakan hal-hal yg nyata (foto, lukisan)
B. Meletakkan benda-benda yang dibutuhkan yg nudah dilihat
C. Menjauhkan benda-benda yang membahayakan
D. Membicarakan hal--hal yg menyenangkan
E. Lingkungan rumah yang kondusif.

45. Seorang anak yang mengalami afasia, maksudnya inability to speak

A. Tidak bisa mengerti bacaan
B. Sulit dalam melakukan gerakan
C. Gerakan yang tidak sesuai
Lupa wkwkw

47. Yang salah mengenai stroke adalah

A. Silent stroke dan warning stroke adalah sama
F: “Silent strokes” and “warning strokes” are the same thing.

A “warning stroke,” or transient ischemic attack (TIA), happens when a clot briefly
keeps blood from getting to part of the brain. Unlike a true stroke, it doesn't cause
permanent damage.
TIAs come and go fast, lasting about a minute on average. If you have a TIA, you’re
more likely to have a full stroke in the months that follow
B. Lupa
T: You can have a stroke without knowing it.

C. Risiko stroke meningkat pada orang pemarah

T: If you're angry a lot, you may be more likely to have a stroke.
Having an angry personality can cause your blood vessels to narrow and your blood
pressure to rise. People with short tempers have more thickening of the neck arteries,
which boosts the odds of having a stroke.
If you have trouble controlling your anger, talk to your doctor about how to handle it.
C. Lupa
F: You can reverse the damage caused by a stroke.

E. Stroke tersering adalah stroke hemoragik

F: Bleeding in the brain causes most strokes.
Brain bleeds, which happen when a blood vessel bursts, make up only 13% of strokes.
It's much more common for a clot to block a blood vessel that leads to the brain. This
can happen when blood vessels narrow from fatty buildup along their walls.

48. Stroke 1 bulan. Masalah pendengaran, masalah belajar, menunjukkan emosi.

Pada pemeriksaan MRI menunjukkan lobus yang terkena
A. Lobus frontal
B. Lobus Pariental
C. Lobus oksipital
D. Temporal
E. A+B
A patient who suffered a stroke one month ago is experiencing hearing problems along
with issues learning and showing emotion. On the MRI what lobe in the brain do you
expect to be affected?
 A. Frontal lobe
 B. Occipital lobe
 C. Parietal lobe
 D. Temporal
The answer is D. The temporal lobe is responsible for hearing, learning, and
feelings/emotions.

49. Faktor resiko stroke yang utama adalah

A. Obesitas
B. Diabetes
C. Hipertensi
D. Riwayat stroke keluarga
E. Merokok (younger adults)
The leading cause of stroke is high blood pressure (hypertension), making it the highest
risk factor for stroke. Other risk factors for stroke include:
- Smoking
- Diabetes
- High cholesterol
- Physical inactivity
- Obesity
- Artery disease
- Age over 65

50. Yang paling berisiko stroke hemoragik

A. 60an tahun ke atas dengan stenosis carotis
B. 89 tahun dengan aterosklerosis
C. 55 tahun dengan atrial flutter
D. 88 tahun dengan riwayat hipertensi dan riwayat aneurisma
Which patient below is at most risk for a hemorrhagic stroke?
A. A 65 year old male patient with carotid stenosis.
B. A 89 year old female with atherosclerosis.
C. A 88 year old male with uncontrolled hypertension and a history of brain aneurysm
repair 2 years ago.
D. A 55 year old female with atrial flutter.
The answer is C. A hemorrhagic stroke occurs when bleeding in the brain happens due
to a break in a blood vessel. Risk factors for a hemorrhagic stroke is uncontrolled
hypertension, history of brain aneurysm, old age (due to aging blood vessels.) All the
other options are at risk for an ischemic type of stroke.

Neurons damaged by hypoxia or trauma discharge:

A. NO
B. Free radicals
C. Glutamate
D. GABA
Injured neurons discharge glutamate which acts on the same neurons (autoexcitotoxin)
as well as adjacent ones initiating a destructive cascade.

Free radicals are generated in the:

A. Lysosomes
B. Cytosol
C. Mitochondria
D. Golgi apparatus
Feedback
Free radicals are generated in mitochondria, the power producing organelles of
neurons and all cells.

While conversing with a patient who had a stroke six months ago, you note their speech
is hard to understand and slurred. This is known as:
 A. Dysarthria
 B. Apraxia
 C. Alexia
 D. Dysphagia
The answer is A.

You're reading the physician’s history and physical assessment report. You note the
physician wrote that the patient has apraxia. What assessment finding in your morning
assessment correlates with this condition?
 A. The patient is unable to read.
 B. The patient has limited vision in half of the visual field.
 C. The patient is unable to wink or move his arm to scratch his skin.
 D. The patient doesn't recognize a pencil or television.
The answer is C.

You need to obtain informed consent from a patient for a procedure. The patient
experienced a stroke three months ago. The patient is unable to sign the consent form
because he can't write. This is known as what:
 A. Agraphia
 B. Alexia
 C. Hemianopia
 D. Apraxia
 The answer is A.

You're assessing your patient's pupil size and vision after a stroke. The patient says they
can only see half of the objects in the room. You document this finding as:
 A. Hemianopia
 B. Opticopsia
 C. Alexia
 D. Dysoptic
The answer is A.

A patient who has hemianopia is at risk for injury. What can you educate the patient to
perform regularly to prevent injury?
 A. Wearing anti-embolism stockings daily
 B. Consume soft foods and tuck in chin while swallowing
 C. Scanning the room from side to side frequently
 D. Muscle training
The answer is C. Hemianopia is limited vision in half of the visual field. The patient
needs to scan the room from side to side to prevent injury.

You receive a patient who is suspected of experiencing a stroke from EMS. You conduct
a stroke assessment with the NIH Stroke Scale. The patient scores a 40. According to
the scale, the result is:
 A. No stroke symptoms
 B. Severe stroke symptoms
 C. Mild stroke symptoms
 D. Moderate stroke symptoms
The answer is B. Scores on the NIH stroke scale range from 0 to 42, with 0 (no stroke
symptoms) and 21-42 (severe stroke symptoms).

In order for tissue plasminogen activator (tPA) to be most effective in the treatment of
stroke, it must be administered?
 A. 6 hours after the onset of stroke symptoms
 B. 3 hours before the onset of stroke symptoms
 C. 3 hours after the onset of stroke symptoms
 D. 12 hours before the onset of stroke symptoms
The answer is C. tPA dissolves the clot causing the blockage in stroke by activating
the protein that causes fibrinolysis. It should be given within 3 hours after the onset
of stroke symptoms. It can be given 3 to 4.5 hours after onset IF the patient meets
strict criteria. It is used for acute ischemia stroke, NOT hemorrhagic!!

Which patients are NOT a candidate for tissue plasminogen activator (tPA) for the
treatment of stroke?
 A. A patient with a CT scan that is negative.
 B. A patient whose blood pressure is 200/110.
 C. A patient who is showing signs and symptoms of ischemic stroke.
 D. A patient who received Heparin 24 hours ago.
 The answers are B and D. Patients who are experiencing signs and symptoms of a
hemorrhagic stroke, who have a BP for >185/110, and has received heparin or any
other anticoagulants etc. are NOT a candidate for tPA. tPA is only for an ischemic
stroke.

You're assisting a patient who has right side hemiparesis and dysphagia with eating. It
is very important to:
 A. Keep the head of bed less than 30'.
 B. Check for pouching of food in the right cheek.
 C. Prevent aspiration by thinning the liquids.
 D. Have the patient extend the neck upward away from the chest while eating.
The answer is B. Because the patient has weakness on the right side and dysphagia
the nurse should regularly check for pouching of food in the right cheek. Pouching of
food in the cheek can lead to aspiration or choking. The HOB should be >30', liquids
thickened per MD order, and the patient should tuck in the chin to the chest while
swallowing.