Left versus Right
A patient has a stroke involving the left cerebral hemisphere. Which side of the body would you expect to be weak?
What is the right side?
A stroke caused by a blood clot blocking cerebral blood flow is called what?
What is an ischemic stroke?
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?
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?
A patient suddenly develops right-sided weakness and difficulty expressing words. Which side of the brain is most likely affected?
What is the left hemisphere?
A stroke caused by a ruptured blood vessel and bleeding into or around the brain is called what?
What is a hemorrhagic stroke?
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 patient with a severe stroke becomes increasingly difficult to arouse. What should the nurse do FIRST?
What is perform an immediate neurological assessment and notify the provider/stroke team of the acute change?
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?
A patient has a right-sided stroke. The nurse notices that the patient repeatedly ignores the food on the left side of the tray. What neurological deficit does this suggest?
What is left-sided neglect?
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?
A patient with suspected stroke has:
What should the nurse recognize?
What is an acute ischemic stroke requiring rapid evaluation for reperfusion therapy, while BP and thrombolysis eligibility are assessed?
Teaching point: Do not independently give BP-lowering medication simply because the BP is elevated; management depends on the treatment pathway and eligibility.
Which patient finding is MOST consistent with a right-brain stroke?
A. Expressive aphasia and right hemiplegia
B. Left-sided neglect and impulsive behavior
C. Difficulty understanding language and right-sided weakness
D. Slow, cautious behavior with impaired language
What is B — left-sided neglect and impulsive behavior?
A patient with suspected ischemic stroke arrives at the ED. The CT demonstrates an intracranial hemorrhage. The provider considers administering TNK. What should the nurse do?
What is question/hold the thrombolytic and immediately notify the stroke team/provider?
Rationale: Thrombolytic therapy is used for eligible acute ischemic stroke—not for an intracranial hemorrhage.
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?
"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.
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.
A patient was last known well at 0700.
What is the MOST important nursing priority?
What is immediately activating/continuing the stroke treatment pathway and preparing for rapid thrombolytic decision-making?
Why?
The patient is only 1 hour 40 minutes from last known well when CT is completed.
Hospitals should complete the initial brain scan rapidly; the 2026 AHA/ASA guidance highlights a target of within 25 minutes of arrival.
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.