Left versus Right
This side of the brain is the side most likely to be affected with aphasia, alexia and agraphia.
What is the left side?
aphasia is problems speaking
alexia problems reading
agraphia problems writing
A stroke caused by a blood clot blocking cerebral blood flow is called what?
What is an ischemic stroke?
Embolic stroke from possible afib
thrombotic stroke from atherosclerosis
A patient's spouse says, "I noticed her speech was abnormal at 1430." What critical time should the nurse immediately establish?
What is the last known well time?
Which finding is an early warning sign of increasing intracranial pressure
A. Decreased level of consciousness
B. Increased appetite
C. Bradycardia only
D. Increased urine output
What is A — decreased level of consciousness?
Normal level of ICP is 5 to 15 mm HG
A patient arrives with sudden right-sided weakness and expressive aphasia. What is the nurse's priority?
What is activate the stroke protocol/rapid stroke evaluation?
This type of aphasia is in the broca's area of the brain and has trouble speaking.
What is expressive aphasia?
The other is receptive aphasia in the wernickie's area of the brain. This condition has problems with understanding or receiving the spoken language.
A stroke caused by a ruptured blood vessel and bleeding into or around the brain is called what?
What is a hemorrhagic stroke?
SSX include thunder clap headache
vomiting without nausea.
Potential complications include increasing ICP and Brain herniation.
A patient arrives at 1515 with stroke symptoms. The spouse reports the patient was last known normal at 1400. How long has it been since the patient was last known well?
What is 1 hour and 15 minutes?
A craniotomy is
what is surgical removal of part of the skull
A patient with suspected stroke asks for water. The patient has not yet had a swallow screen. What should the nurse do?
What is keep the patient NPO until a swallow screen is completed?
If a person has aphasia from stroke, these are some nursing interventions to consider when communicating with client.
What is look at client, allow time to respond and allow time to speak. Speak slow and clear.
A patient arrives with sudden facial drooping, arm weakness, and slurred speech. What diagnostic study must be obtained urgently to determine whether the patient has an ischemic or hemorrhagic stroke?
What is a noncontrast CT of the head?
A patient was last known well at 0900 and arrives at the ED at 1100. The CT scan is completed at 1120 and shows no hemorrhage. Is the patient still within the standard 4.5-hour IV thrombolysis window?
What is yes?
The patient is 2 hours and 20 minutes from last known well at the time of CT completion.
The 2026 guideline supports IV thrombolysis with alteplase or TNK in eligible patients within 4.5 hours.
Which combination is classically associated with Cushing's triad, a late and ominous sign of increased ICP?
What are hypertension with widened pulse pressure, bradycardia, and irregular respirations?
Cranial nerve 3 controls
Example DOLLS EYES, Blown pupils
Cranial nerve 2 is optic nerve, a sensory nerve that transmits visual information, governs vision.
If a person has dysphagia this means they have trouble with
What is swallowing?
Interventions may include assisting with meals, thicken liquids, allow time to eat, don't rush, put food in mouth on the unaffected side, chin tuck to swallow.
Signs and symptoms of basilar artery stroke include
balance issues or ataxia which is jerky, unsteady and staggering
nausea, dysphagia and dysarthria (slurred speech due to impaired muscles)
A patient arrives at 1300 with stroke symptoms. Last known well was 0900. CT is completed at 1320 and shows no hemorrhage. The patient is otherwise eligible for IV thrombolysis.
How much time has elapsed since last known well?
What is 4 hours and 20 minutes?
Clinical judgment: This patient remains within the 4.5-hour window, so the team must act immediately rather than assuming the patient is "too late."
A patient with an acute stroke develops increasing ICP. Which position is generally appropriate to promote venous drainage?
A. Flat with neck flexed
B. Head of bed elevated with head/neck in neutral alignment
C. Trendelenburg
D. Prone
What is B — head of bed elevated with the head and neck in neutral alignment?
also hyperoxygenate prior to any suctioning
HOB 30 degrees
Don't flex knees
Client teaching for a stroke patient in recovery may include...
What is diet, exercise, ssx to report, medication teaching
anticoagulations (afib) to dissolve clots
antihypertensives
antiplatelets (atherosclerosis) prevents plts from clumping
Lipid lowering cholesterol meds
A patient suddenly develops left-sided paralysis, poor spatial awareness, impulsive behavior, and denies that anything is wrong. Which brain hemisphere is most likely involved?
What is the right cerebral hemisphere?
The patient's CT shows no intracranial hemorrhage. The patient has a disabling neurological deficit and symptoms began 2 hours ago. What treatment may be considered if the patient meets all eligibility criter
What are IV thrombolytic therapy with alteplase or tenecteplase (TNK)?
Rationale: The 2026 AHA/ASA guideline endorses either alteplase or tenecteplase for eligible acute ischemic stroke patients within the 4.5-hour thrombolysis window.
If a patient presents with increasing intracranial pressure with signs of decortication you may see.....
What is adduction of arms and lower extremities toward core of body.
decerebrate is rigid extension and pronation of arms and legs.
A patient with a large stroke becomes increasingly somnolent. The nurse observes vomiting, worsening headache, unequal pupils, and a declining level of consciousness. What complication should the nurse suspect?
What is increasing intracranial pressure with possible cerebral herniation?
Clinical priority: This is an emergency requiring immediate escalation.
"WHICH PATIENT FIRST?"
Which patient should the nurse assess FIRST?
A. Left-sided weakness for 8 hours, stable neurological assessment
B. Right-sided weakness for 2 hours, awaiting CT
C. Stroke patient who suddenly becomes difficult to arouse and develops unequal pupils
D. Stroke patient requesting assistance with lunch
What is C?
Rationale: Acute deterioration in LOC and unequal pupils may indicate increasing ICP/herniation and requires immediate intervention.
If a client has homonymous hemianopia after a right brain stroke they may have visual loss that includes....
What is both sides of the left visual field in both eyes.
Interventions include teaching client to scan the affected side.
Also when setting things up for client set things up on the unaffected side so they can better see and get to their items.
Risk factors for stroke include
high blood pressure
afib
DM
high cholesterol
smoking
excessive alcohol
previous strokes
age
family history
Thrombolytics are used to...
What is dissolve clots.
Contraindications include bleeding in brain, pregnancy, recent surgery, warfarin or other blood thinners, symptoms onset more than 4.5 hours.
BEFAST
what is balance, eyes, facial drooping, arm, speech, time
what is ssx stroke
also any TIA's like numbness, tingling.