A patient arrives with sudden facial droop and slurred speech. To determine whether time-sensitive stroke treatments are still possible, which information does the nurse obtain from the family?
The time the patient was last known well
✓
The time the patient last ate a meal
The name of the patient's pharmacy
The date of the patient's last physical exam
Correct Answer
The time the patient was last known well
The time the patient was last known well is treated as the onset of the stroke, and it decides eligibility for clot-dissolving drugs and clot removal. The time the patient last ate a meal matters for aspiration risk but does not set the treatment window. The name of the patient's pharmacy can help with a medication list later but does not affect acute decisions. The date of the patient's last physical exam has no bearing on emergency treatment eligibility.
Category: Acute Stroke Care
Question 2
On arrival in the emergency department, which study is obtained first to tell an ischemic stroke from a hemorrhagic stroke?
Lumbar puncture
Noncontrast head CT scan
✓
Electroencephalogram
Carotid duplex ultrasound
Correct Answer
Noncontrast head CT scan
A noncontrast head CT scan quickly shows whether blood is present in or around the brain, which decides whether clot-dissolving treatment can be considered. Lumbar puncture is not the first step and is dangerous when intracranial pressure may be raised. Electroencephalogram records electrical activity to detect seizures and cannot show bleeding. Carotid duplex ultrasound looks at neck arteries for a cause of ischemic stroke but cannot detect bleeding inside the skull.
Category: Acute Stroke Care
Question 3
A patient with an acute stroke did not pass the bedside swallow screen, and oral medications are now due. What does the nurse do?
Crush the tablets and mix them into applesauce
Give the tablets with sips of thickened water
Hold the oral medications and ask the provider about another route
✓
Ask a family member to give the tablets slowly
Correct Answer
Hold the oral medications and ask the provider about another route
A failed swallow screen means nothing goes by mouth, including medications, until a full swallow evaluation is done, so the nurse holds oral doses and obtains orders for an alternate route such as IV or rectal. Crush the tablets and mix them into applesauce still requires a swallow the patient may not manage safely. Give the tablets with sips of thickened water uses a strategy that only a formal swallow evaluation can approve. Ask a family member to give the tablets slowly transfers the same aspiration risk to someone else.
Category: Rehabilitation and Safety
Question 4
The BE-FAST stroke screen adds which two checks to the FAST tool?
Blood pressure and electrolytes
Breathing and extremities
Bowel sounds and edema
Balance and eyes
✓
Correct Answer
Balance and eyes
BE-FAST adds balance (sudden trouble walking, standing or sitting upright) and eyes (sudden vision loss or double vision) to face, arm, speech and time, which helps catch strokes that FAST alone can miss. Blood pressure and electrolytes are part of the medical workup, not the screening tool. Breathing and extremities are not letters of the tool, although arm weakness is checked under arm. Bowel sounds and edema are unrelated to stroke recognition.
Category: Stroke Recognition
Question 5
Which patient report most strongly suggests a hemorrhagic stroke rather than an ischemic stroke?
A sudden, explosive headache described as the worst of the patient's life
✓
Clumsiness of one hand that developed gradually
Numbness of one arm that went away on its own
Mild lightheadedness when standing up quickly
Correct Answer
A sudden, explosive headache described as the worst of the patient's life
A sudden, severe headache that the patient calls the worst ever is the classic presentation of bleeding in or around the brain, especially a subarachnoid hemorrhage. Clumsiness of one hand that developed gradually fits a small-vessel ischemic process better than a bleed. Numbness of one arm that went away on its own suggests a transient ischemic attack. Mild lightheadedness when standing up quickly suggests orthostatic hypotension rather than a stroke.
Category: Hemorrhagic Stroke
Question 6
Which is the most common cause of a nontraumatic subarachnoid hemorrhage?
Embolus from the left atrium
Ruptured cerebral aneurysm
✓
Plaque in a small penetrating artery
Thrombus in a carotid artery
Correct Answer
Ruptured cerebral aneurysm
Rupture of a cerebral aneurysm, a weakened area of artery wall that balloons outward, is the most common cause of nontraumatic bleeding into the subarachnoid space. Embolus from the left atrium causes an ischemic stroke, not a bleed. Plaque in a small penetrating artery causes a lacunar ischemic stroke. Thrombus in a carotid artery blocks flow and causes ischemia rather than hemorrhage.
Category: Hemorrhagic Stroke
Question 7
Which condition is the most common cause of intracerebral hemorrhage?
Atrial fibrillation
Iron-deficiency anemia
Long-standing hypertension
✓
Low blood glucose
Correct Answer
Long-standing hypertension
Chronic high blood pressure weakens the walls of small arteries in the brain until they burst, making long-standing hypertension the leading cause of bleeding into brain tissue. Atrial fibrillation causes clots that travel to the brain and produce ischemic stroke. Iron-deficiency anemia lowers oxygen-carrying capacity but does not rupture cerebral vessels. Low blood glucose can mimic stroke signs but does not cause bleeding.
Category: Hemorrhagic Stroke
Question 8
A patient has a small ischemic stroke deep in the brain caused by blockage of a tiny penetrating artery, a type closely linked to hypertension and diabetes. What is this type of stroke called?
Cardioembolic stroke
Large artery atherosclerotic stroke
Subarachnoid hemorrhage
Lacunar stroke
✓
Correct Answer
Lacunar stroke
A lacunar stroke occurs when a small penetrating branch artery deep in the brain is occluded, usually from damage caused by hypertension, diabetes and high cholesterol, and it tends to cause fewer deficits than a large vessel stroke. Cardioembolic stroke results from a clot that forms in the heart and travels to the brain. Large artery atherosclerotic stroke results from plaque and clot in a major artery such as the carotid, not a tiny penetrating branch. Subarachnoid hemorrhage is bleeding around the brain, not an arterial blockage.
Category: Ischemic Stroke
Question 9
A patient whose sudden arm weakness and slurred speech fully resolved is diagnosed with a transient ischemic attack and asks whether any follow-up is needed. What does the nurse explain?
A TIA is a warning of high stroke risk and needs prompt evaluation
✓
Because the symptoms resolved, no further care is needed
A TIA is caused by a small bleed that has now stopped
Follow-up is needed only if the symptoms return and last longer
Correct Answer
A TIA is a warning of high stroke risk and needs prompt evaluation
A transient ischemic attack has the same mechanism as an ischemic stroke but the clot clears on its own, and it signals a high risk of a full stroke, so the cause must be found and treated promptly. Because the symptoms resolved, no further care is needed ignores that risk. A TIA is caused by a small bleed that has now stopped is incorrect because a TIA is ischemic. Follow-up is needed only if the symptoms return and last longer delays care that should begin now.
Category: Ischemic Stroke
Question 10
A patient has right-sided weakness and numbness that affect the face and arm more than the leg, along with aphasia. Occlusion of which artery best explains these findings?
Right middle cerebral artery
Left middle cerebral artery
✓
Left anterior cerebral artery
Basilar artery
Correct Answer
Left middle cerebral artery
The left middle cerebral artery supplies the lateral left hemisphere, including the motor and sensory areas for the face and arm and, in most people, the language areas, so its occlusion causes right-sided face and arm deficits with aphasia. Right middle cerebral artery occlusion causes left-sided deficits. Left anterior cerebral artery occlusion affects the leg more than the arm. Basilar artery occlusion causes brainstem signs such as quadriplegia and can cause locked-in syndrome.
Category: Stroke Recognition
Question 11
In acute stroke care, which interval does the door-to-needle time measure?
Symptom onset to hospital arrival
Hospital arrival to the first head CT
Hospital arrival to the start of a thrombolytic
✓
Head CT to admission to a stroke unit
Correct Answer
Hospital arrival to the start of a thrombolytic
Door-to-needle time runs from the patient's arrival at the hospital to the start of an IV thrombolytic, and stroke programs track it because every delay costs salvageable brain tissue. Symptom onset to hospital arrival is the prehospital interval, which the hospital team does not control. Hospital arrival to the first head CT is the door-to-imaging interval, an earlier step on the way to treatment. Head CT to admission to a stroke unit is not the benchmark that door-to-needle time describes.
Category: Acute Stroke Care
Question 12
A patient with an intracerebral hemorrhage who was calm and oriented at the last check is now restless and pulling at the bed sheets. What does the nurse do first?
Apply soft wrist restraints for safety
Dim the lights and recheck at the next scheduled time
Give the as-needed sedative that is ordered
Perform a focused neurologic assessment and report the change
✓
Correct Answer
Perform a focused neurologic assessment and report the change
New restlessness in a patient with a brain bleed can be the first sign of rising intracranial pressure or an expanding hematoma, so the nurse first assesses level of consciousness, pupils and motor function and reports the change promptly. Apply soft wrist restraints for safety treats the behavior without finding its cause, and struggling against restraints can raise intracranial pressure. Dim the lights and recheck at the next scheduled time delays recognition of a bleed that may be growing. Give the as-needed sedative that is ordered would mask the neurologic changes the team needs to track.
Category: Intracranial Pressure
Question 13
Which teaching point helps a stroke survivor lower the risk of another ischemic stroke?
Stop smoking and keep blood pressure under control
✓
Avoid all physical activity to protect the brain
Add salt to meals to keep blood pressure up
Stop prescribed antiplatelet medicine once feeling well
Correct Answer
Stop smoking and keep blood pressure under control
Smoking and hypertension are major modifiable risk factors, so quitting smoking and controlling blood pressure, along with managing cholesterol, diabetes and atrial fibrillation, reduce the chance of another stroke. Avoid all physical activity to protect the brain is wrong because regular activity lowers stroke risk. Add salt to meals to keep blood pressure up raises blood pressure over time and increases risk. Stop prescribed antiplatelet medicine once feeling well removes protection against new clots.
Category: Ischemic Stroke
Question 14
Which aneurysm treatment threads a catheter into the aneurysm and packs it with tiny platinum devices so the blood inside it clots?
Surgical clipping
Endovascular coiling
✓
Decompressive craniectomy
Carotid endarterectomy
Correct Answer
Endovascular coiling
Endovascular coiling places small coils inside the aneurysm through a catheter; clot forms around them and blocks blood from entering the sac. Surgical clipping requires opening the skull to place a clip across the base of the aneurysm. Decompressive craniectomy removes part of the skull to relieve swelling and does not seal an aneurysm. Carotid endarterectomy removes plaque from a carotid artery in the neck.
Category: Hemorrhagic Stroke
Question 15
A patient who had part of the skull removed to relieve brain swelling is beginning to walk with physical therapy. Which safety measure is needed?
A cervical collar during transfers
An abdominal binder while walking
A protective helmet whenever out of bed
✓
Soft wrist restraints while in bed
Correct Answer
A protective helmet whenever out of bed
After a decompressive craniectomy, the brain under the missing bone flap is unprotected, so the patient wears a helmet when up and walking until the bone is replaced. A cervical collar during transfers protects the cervical spine, which is not the issue. An abdominal binder while walking supports an abdominal incision, not the brain. Soft wrist restraints while in bed restrict movement and do not protect the exposed area of the brain.
Category: Rehabilitation and Safety
Question 16
After a right hemisphere stroke, a patient shaves only the right side of the face and ignores the left arm as if it were not there. Which deficit does the nurse document?
Homonymous hemianopsia
Dysarthria
Ataxia
Unilateral neglect
✓
Correct Answer
Unilateral neglect
Unilateral neglect is a lack of awareness of one side of the body and the space on that side, most often the left side after a right hemisphere stroke. Homonymous hemianopsia is loss of half of the visual field, and a patient who knows about it can compensate by turning the head. Dysarthria is slurred speech from weak speech muscles and does not explain ignoring one side. Ataxia is uncoordinated movement and gait.
Category: Rehabilitation and Safety
Question 17
A patient after a stroke speaks fluently, but the words make little sense and the patient cannot follow simple directions. Which deficit is present?
Receptive aphasia
✓
Expressive aphasia
Dysarthria
Dysphagia
Correct Answer
Receptive aphasia
Receptive aphasia impairs understanding of language, so speech may flow easily but carries little meaning and spoken directions are not understood. Expressive aphasia makes producing words hard while understanding is relatively preserved. Dysarthria is slurred speech from weak muscles with language intact. Dysphagia is difficulty swallowing, not a language problem.
Category: Rehabilitation and Safety
Question 18
Which strategy helps the nurse communicate with a patient who has expressive aphasia?
Speak loudly and quickly to hold attention
Ask yes-or-no questions and allow time to answer
✓
Finish the patient's sentences to save effort
Give several instructions at the same time
Correct Answer
Ask yes-or-no questions and allow time to answer
A patient with expressive aphasia understands more than they can say, so simple yes-or-no questions, gestures or picture boards, and plenty of time to respond reduce frustration. Speak loudly and quickly to hold attention does not help because hearing is not the problem. Finish the patient's sentences to save effort takes away practice and can cause frustration. Give several instructions at the same time adds confusion; one step at a time works better.
Category: Rehabilitation and Safety
Question 19
Before a thrombolytic is considered for a suspected stroke, the nurse checks which value because an abnormal result can produce stroke-like signs?
Serum cholesterol
Hemoglobin A1C
Blood glucose
✓
Thyroid-stimulating hormone
Correct Answer
Blood glucose
Hypoglycemia can cause confusion, weakness on one side and speech changes that mimic a stroke, so blood glucose is checked and corrected before clot-dissolving treatment. Serum cholesterol is a long-term risk factor that does not explain acute symptoms. Hemoglobin A1C reflects average glucose over time and cannot reveal an acute low. Thyroid-stimulating hormone helps find a cause of atrial fibrillation but does not mimic a stroke.
Category: Acute Stroke Care
Question 20
Mechanical removal of a clot with a catheter is an option for which type of stroke?
Ischemic stroke in a tiny penetrating artery
Intracerebral hemorrhage from hypertension
Subarachnoid hemorrhage from an aneurysm
Ischemic stroke from a large artery occlusion
✓
Correct Answer
Ischemic stroke from a large artery occlusion
Mechanical thrombectomy pulls a clot out of a large artery such as the middle cerebral or carotid artery and can be done with or without a thrombolytic. Ischemic stroke in a tiny penetrating artery cannot be treated this way because the vessel is too small to reach. Intracerebral hemorrhage from hypertension is a bleed, so there is no clot to remove from an artery. Subarachnoid hemorrhage from an aneurysm is treated by securing the aneurysm, not by clot retrieval.
Category: Ischemic Stroke