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The client is a 63-year-old female who arrived via emergency services with right-sided weakness, right facial droop, and slurred speech.  History and Physical Client with a history of Diabetes Mellitus type II, hypertension, and rheumatoid arthritis. Spouse is answering questions for her at the bedside. Per spouse, the client has experienced recent increased stress and does not monitor her blood pressure. The client was in her usual health the night prior. She woke up around 0500 and having a typical morning until approximately 0630 when she noticed that she wasn’t able to hold her brush with her right hand. Spouse states he noticed that her face was also drooping at that time and called 911. Nurses Note: 07/05/20XX 0712: Client assessed quickly at the ambulance bay doors and stroke alert initiated. Client is alert and oriented x 3 with slurred speech and some word finding difficulty. Client is unable to lift or maintain gravity in right arm and right leg. Drooping to the right side of the face noted. Healthcare provider at bedside.  Vitals: Temp: 98.6*F Pulse 99 Respirations: 22 Blood Pressure: 180/118 Oxygen Saturation: 98% on Room Air.  NIHSS: 10   Nurses Notes 7/5/20XX 0745:  The client is able to speak a few words and states that she has a history of atrial fibrillation and her gallbladder removed 4 months ago. The client begins to moan, hold her head, and complains of extreme pain in the back of her head. The lab has called with the stat laboratory results:   Lab  Result Reference Range White blood cell  6.4 4.5-11 per microliter Hemoglobin 13.3 12-16 g/dL Hematocrit 39 38-46% Platelet 180,000 150,000-45000/microliter PT 11 11-13.5 seconds INR 1.1 0.8-1.2  07/05/20XX 0810 – Client to radiology for CT without contrast. CT results: no evidence of hemorrhage.    07/05/20XX 0820: Client returns from Radiology and placed on bedside telemetry monitoring. Client remains in Atrial fibrillation. Heathcare provider at the bedside and orders to lower the blood pressure before administering thrombolytic to reduce the risk of hemorrhage.   Vitals: Temp: 98.6*F Pulse 99 Respirations: 22 Blood Pressure: 180/118 Oxygen Saturation: 98% on Room Air.  NIHSS: 10 07/05/XX 0830 – Client resting quietly. Right side remains weak, unable to maintain gravity in right arm and right leg, speech is slurred with some word finding difficulty. Client is frustrated and tearful. Remains in A-fib on the monitor with a rate of 90. Healthcare provider orders to administer thrombolytic – Tenecteplase 20 mg IV. Vitals: Temp: 98.6*F Pulse 90 Respirations: 20 Blood Pressure: 141/89 Oxygen Saturation: 98% on Room Air.  07/05/XX 0910 – Client is now able to maintain gravity in all extremities, slurred speech continues with dysarthria noted.  Client denies pain or discomfort, lungs are clear with no shortness of breath, has urinated with assistance on bedpan, urine clear and yellow. Orders for admission to ICU for further monitoring. Vitals: Temp: 98.6*F Pulse 88 Respirations: 20 Blood Pressure: 138/82 Oxygen Saturation: 98% on Room Air.  NIHSS: 4 The client is steadily improving and will likely stay for 3-4 days depending upon her continued improvement.  During her hospital stay, which diagnostic tests does the nurse anticipate to be ordered in effort to determine the cause of the stroke? Select all that apply.

The nurse is caring for four clients on a neuromuscular unit. Which client should the nurse see first?

A therapist plans to perform high intensity gait training with a patient during their session today.  The therapist asks the patient if they would prefer to do the training outside or inside.  Which core tenet of the OPTIMAL theory is this therapist employing?

A physical therapist is treating a patient 6 months post-stroke whose goal is to improve walking endurance.  According to the Locomotor Function CPG, which treatment approach SHOULD BE performed?

A physical therapist is working with a patient who appears extremely upset.  The patient says “I just want to see my husband.  He hasn’t visited me in a week!”  The patient’s husband is observing the therapy session from across the room, but the patient does not recognize his face.  What perceptual deficit is this an example of?

When considering environment during intervention planning, what is the benefit of gait training in an open environment?

Based on the imaging below, what primary deficit would you expect this individual to have?

Which of the following positions will BEST break up a flexion synergy in the left upper extremity:

A physical therapist is working with a patient who has a non-fluent aphasia.  What adjunct intervention best targets speech production and can be incorporated easily into a PT plan of care?

External competitiveness refers to: