# Situation: A 64-year-old man is on the rehabilitation ward 10 days after an ischemic stroke in the left cerebral hemisphere. He has right-sided weakness and aphasia. He takes aspirin 80 mg and atorvastatin 40 mg once daily. When asked what he wants for breakfast, he answers in short, effortful phrases and grows frustrated. He correctly follows the request "Pick up the cup, then give it to me." Which approach BEST fits his communication problem?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630516  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 64-year-old man is on the rehabilitation ward 10 days after an ischemic stroke in the left cerebral hemisphere. He has right-sided weakness and aphasia. He takes aspirin 80 mg and atorvastatin 40 mg once daily.

When asked what he wants for breakfast, he answers in short, effortful phrases and grows frustrated. He correctly follows the request "Pick up the cup, then give it to me." Which approach BEST fits his communication problem?

## 보기

1. Finish his sentences for him to spare him the frustration
2. Have him repeat words slowly to strengthen his lips and tongue
3. Use mainly gestures and pictures, since spoken words confuse him
4. Ask one yes-or-no question at a time and wait for his reply **✔ 정답**

**정답: 4**

## 해설

Effortful, halting speech with intact understanding of a two-step request is expressive (Broca) aphasia, typical of a left-hemisphere stroke. Because comprehension is preserved, short yes-or-no questions asked one at a time, with time to respond, reduce the demand on word production. Finishing his sentences or rushing him increases frustration and removes practice.

## 심화 해설

Identifying expressive aphasia
He speaks in short, effortful phrases and becomes frustrated, yet he correctly follows a two-step spoken request. This combination, impaired speech production with preserved comprehension, is expressive (Broca) aphasia. It results from damage to the language production area in the frontal lobe of the dominant hemisphere, which is usually the left hemisphere, consistent with his left-sided ischemic stroke and right-sided weakness. Because his understanding is intact, communication should reduce the demand on word production rather than on comprehension.

The best communication approach
Asking one yes-or-no question at a time and waiting for his reply allows him to answer with a single word, a nod, or a gesture. It respects his intact understanding, lowers frustration, and still gives him practice. The nurse speaks normally rather than loudly or in a childish way, gives him time, avoids interrupting, and may use communication boards or writing if helpful. Speech-language therapy guides further rehabilitation.

| Feature | Expressive (Broca) aphasia | Receptive (Wernicke) aphasia |
| --- | --- | --- |
| Speech | Slow, effortful, short phrases | Fluent but often meaningless |
| Comprehension | Largely intact | Impaired |
| Awareness of errors | Usually aware, frustrated | Often unaware |
| Helpful approach | Yes-or-no questions, time to answer | Gestures, pictures, simple cues |

Why the other approaches are wrong
Finishing his sentences may seem kind but removes his opportunity to practice and may misstate what he wants. Repeating words slowly to strengthen the lips and tongue targets dysarthria, a motor speech problem, not a language disorder. Relying mainly on gestures and pictures because words confuse him suits receptive aphasia; he clearly understood the spoken request. Watch out! Distinguish aphasia (language) from dysarthria (speech muscles), and expressive from receptive aphasia, by checking comprehension.

Exam takeaway
Assess both expression and comprehension before choosing a communication strategy. Key point! For expressive aphasia, ask simple yes-or-no questions one at a time, allow time, and avoid finishing the client's sentences.

## 임상 시나리오

Communicating with Expressive AphasiaLeft-hemisphere stroke
Short, effortful phrases with intact comprehension indicate expressive (Broca) aphasia, typical of a left-hemisphere stroke.

Ask one yes-or-no question at a time, wait for the reply, speak normally, and avoid interrupting.

Use communication boards or writing if helpful; speech-language therapy guides rehabilitation.

CautionFinishing sentences for the client increases frustration and removes practice.

## 핵심 개념

- **Expressive aphasia** — Broca aphasia, difficulty producing language with relatively preserved comprehension.
- **Receptive aphasia** — Wernicke aphasia, impaired understanding with fluent but often meaningless speech.
- **Dysarthria** — A motor speech disorder caused by weakness or incoordination of speech muscles.
- **Dominant hemisphere** — The cerebral hemisphere, usually the left, that controls language.

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