A nurse is assessing a patient who has had an ischemic stroke. The nurse hands the patient a comb, and the patient attempts to write with it. This inability to perform a previously learned action is known as:

1. A

   Dysarthria

2. B

   Aphasia

3. C

   Apraxia

4. D

   Homonymous hemianopsia

Appeared in: NORCET 1 - 2020

Explanation

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• Apraxia is the inability to execute a voluntary motor movement or task despite being able to understand the command and having the physical ability to move.
• The specific type described is ideational apraxia, where the conceptual knowledge of how to use an object is lost.
• The patient attempting to write with a comb is a classic example of this deficit, as they are misusing a familiar object because they cannot recall its proper function.

Why Other Options Were Wrong

• Option A: Dysarthria is a motor speech disorder. It affects the muscles used for speech, causing slurred or slow speech. It does not involve the inability to use objects correctly.
• Option B: Aphasia is a language disorder that impairs a person's ability to process language, either expressively (speaking) or receptively (understanding). It does not directly affect the ability to perform non-verbal tasks.
• Option D: Homonymous hemianopsia is a visual field deficit where the patient loses sight in the same half of the visual field in both eyes. It is a problem with vision, not motor planning or object use.

Related Visual

• Visual 1: Diagram: Brain regions affected in stroke, highlighting the parietal lobe which is often associated with apraxia.
• Visual 2: Illustration: A patient demonstrating ideational apraxia, such as trying to brush teeth with a pen, to visually reinforce the concept.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Neurological Deficits Following Stroke to guide bedside assessment, documentation, and the next nursing action.
• Nurses must assess for apraxia as it significantly impacts a patient's ability to perform activities of daily living (ADLs) like dressing, eating, and grooming, which increases their need for assistance and supervision.
• Apraxia poses a significant safety risk. A patient might misuse potentially dangerous objects, so environmental safety checks are crucial.
• Nursing interventions for apraxia include breaking down tasks into simple, single steps, using short, clear instructions, and utilizing non-verbal cues or hand-over-hand guidance to help the patient complete tasks.

How to Approach the Question

• First, identify the core clinical sign presented in the scenario. Here, the key action is the patient misusing a common object (a comb for writing).
• Analyze the nature of the deficit. The patient has the motor ability to hold and move the comb but is failing to use it for its intended purpose. This points to a problem with motor planning or conceptual knowledge of the object.
• Evaluate the given options based on their standard medical definitions.
• Eliminate options that do not match the clinical sign. Dysarthria (speech muscle issue), Aphasia (language issue), and Homonymous hemianopsia (vision issue) are not primarily about the misuse of objects.
• Select the option that directly describes the inability to perform a learned, purposeful action. Apraxia is the correct term for this deficit.

Concept Tested & Keywords

• Concept Tested: Neurological Deficits Following Stroke
• Stem keywords: ischemic stroke, inability to perform learned action, write with a comb
• Lead-in keywords: known as
• Clinical cues: The patient's action of attempting to write with a comb is the key diagnostic clue, pointing to a deficit in purposeful motor planning, not a primary motor, sensory, or language issue.

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