stroke basics
A patient presents with right-sided weakness and slurred speech. The nurse suspects stroke. Which action is the priority?
A. Obtain blood glucose
B. Perform FAST assessment
C. Prepare for MRI
D. Administer oxygen
answer: B
rationale: FAST is the quickest way to identify stroke symptoms and initiate rapid response. Imaging comes after recognition.
A 72-year-old patient presents with sudden right-sided weakness and aphasia. Blood pressure is 182/96. The provider suspects an ischemic stroke. What is the nurse’s priority action?
A. Administer IV antihypertensives immediately
B. Prepare to lower BP rapidly
C. Maintain BP and prepare for imaging
D. Administer anticoagulants immediately
answer: C
rationale: in suspected ischemic stroke, permissive hypertension is allowed to maintain cerebral perfusion. BP should not be lowered aggressively until stroke type is confirmed with imaging.
A 49-year-old patient presents to the ED after suddenly developing a severe headache while exercising. They describe it as “the worst headache of my life” and report neck stiffness and sensitivity to light. What is the nurse’s priority concern?
A. Subarachnoid hemorrhage
B. Migraine
C. Tension headache
D. Sinus infection
answer: A
rationale:
a sudden, severe “worst headache of life” with nuchal rigidity and photophobia is classic for subarachnoid hemorrhage from a ruptured aneurysm.
B is incorrect because migraines are typically recurrent and not usually described this way.
C is incorrect because tension headaches are not sudden or severe.
D is incorrect because sinus headaches are associated with congestion, not neurologic symptoms.
A 66-year-old patient is admitted with an intracerebral hemorrhage. Four hours later, the nurse notes the patient is more confused and difficult to arouse. Vital signs show increasing blood pressure and a decreasing heart rate. What is the most likely cause of this change?
A. Infection
B. Hematoma expansion
C. Dehydration
D. Stroke resolution
answer: B
rationale:
hematoma expansion causes worsening neurologic status and signs of increasing ICP (worsening LOC, BP ↑, HR ↓).
A is incorrect because infection does not cause rapid neuro decline like this.
C is incorrect because dehydration would not cause these neurologic changes.
D is incorrect because recovery would improve symptoms, not worsen them.
A patient with subarachnoid hemorrhage is prescribed nimodipine. The nurse understands this medication is used to:
A. Lower intracranial pressure
B. Prevent cerebral vasospasm
C. Stop active bleeding
D. Dissolve clots
answer: B
rationale:
nimodipine is a calcium channel blocker used to prevent vasospasm after SAH.
A is incorrect because it does not directly reduce ICP.
C is incorrect because it does not stop bleeding.
D is incorrect because it is not a thrombolytic.
A nurse is assessing a patient for stroke using FAST. Which findings are consistent with stroke?
A. Facial droop
B. Arm drift
C. Slurred speech
D. Fever
E. Unequal pupils
answer: A, B, C
rationale: FAST = face droop, arm weakness, speech difficulty. Fever and pupils are not part of FAST screening.
SATA
A 60-year-old patient presents with sudden onset severe headache, vomiting, and decreased level of consciousness. Which findings support a hemorrhagic stroke?
A. Sudden symptom onset
B. Severe headache
C. Gradual progression over days
D. Vomiting
E. Decreased LOC
answer: A, B, D, E
rationale: hemorrhagic strokes present suddenly with severe headache, vomiting, and decreased LOC. gradual onset is more typical of other conditions.
SATA
A patient with a known cerebral aneurysm arrives with new symptoms. Which findings indicate a possible rupture?
A. Sudden severe headache
B. Gradual onset fatigue
C. Nuchal rigidity
D. Vomiting
E. Photophobia
answer: A, C, D, E
rationale:
aneurysm rupture leads to subarachnoid hemorrhage, causing sudden headache, meningeal irritation (neck stiffness), vomiting, and photophobia.
B is incorrect because fatigue is not a typical acute symptom and rupture is sudden, not gradual.
SATA
A patient is being monitored after a hemorrhagic stroke. Which findings indicate possible complications?
A. Sudden increase in headache severity
B. New onset seizure activity
C. Stable neurologic status
D. Decreased level of consciousness
E. Ventricular enlargement on imaging
answer: A, B, D, E
rationale:
these findings indicate complications such as rebleeding, seizures, hydrocephalus, or worsening ICP.
C is incorrect because stable status does not indicate complication.
SATA
A patient with SAH is unable to swallow safely. Which actions should the nurse take regarding nimodipine administration?
A. Administer via feeding tube
B. Hold the medication
C. Request alternative enteral route
D. Administer IV formulation
E. Monitor for effectiveness
answer: A, C, E
rationale:
nimodipine must be given enterally, so feeding tube or alternate enteral route is appropriate, and effectiveness should be monitored.
B is incorrect because the medication should not be withheld if another route is available.
D is incorrect because nimodipine cannot be given IV.
A patient arrives 2 hours after symptom onset. What is the most important next step?
A. Administer aspirin
B. Lower blood pressure
C. Obtain CT scan
D. Start IV fluids
answer: C
rationale: CT must be done first to determine ischemic vs hemorrhagic before any treatment.
A patient taking warfarin presents with sudden neurologic deficits and severe headache. Which stroke type does the nurse suspect?
A. Ischemic stroke
B. Hemorrhagic stroke
C. Transient ischemic attack
D. Embolic stroke
answer: B
rationale: anticoagulants increase the risk of bleeding, making hemorrhagic stroke more likely.
A patient is diagnosed with a saccular aneurysm. Which explanation by the nurse is most accurate?
A. “There is a balloon-like pouch forming off a weakened blood vessel wall”
B. “A clot has completely blocked blood flow in the vessel”
C. “The vessel has become narrowed due to plaque buildup”
D. “The vessel wall has thickened and hardened”
answer: A
rationale:
a saccular (berry) aneurysm is a pouch-like bulge due to weakness in the vessel wall.
B is incorrect because that describes a thrombus.
C is incorrect because that describes atherosclerosis.
D is incorrect because that describes vessel wall thickening, not aneurysm formation.
A patient who had a subarachnoid hemorrhage 9 days ago develops new weakness on the left side and confusion. What is the nurse’s priority concern?
A. Rebleeding
B. Hydrocephalus
C. Vasospasm
D. Seizure activity
answer: C
rationale:
vasospasm typically occurs 7–10 days after SAH and causes decreased cerebral perfusion leading to new neurologic deficits.
A is incorrect because rebleeding usually occurs earlier.
B is incorrect because hydrocephalus presents more with LOC changes than focal weakness.
D is incorrect because seizures do not typically cause persistent focal deficits.
A patient with hemorrhagic stroke becomes unresponsive and is noted to have irregular respirations. What is the nurse’s priority action?
A. Administer antihypertensive medication
B. Notify the provider
C. Prepare for immediate airway management
D. Perform a full neurologic assessment
answer: C
rationale:
airway and breathing are the highest priority. irregular respirations indicate the patient cannot maintain their airway.
A is incorrect because BP control is not the immediate priority over airway.
B is incorrect because immediate action is required before notification.
D is incorrect because assessment comes after stabilization.
Which statements explain why time is critical in stroke? SATA
A. Brain cells die without oxygen
B. Perfusion can worsen over time
C. Symptoms always improve spontaneously
D. Delayed treatment increases damage
E. Blood flow is unaffected initially
answer: A, B, D
rationale: lack of oxygen kills brain cells and delayed treatment worsens damage. symptoms do not just improve on their own.
SATA
A nurse is reviewing risk factors in a patient admitted with hemorrhagic stroke. Which factors likely contributed?
A. Chronic hypertension
B. Arteriovenous malformation
C. Use of thrombolytics
D. History of aneurysm
E. Dehydration
answer: A, B, C, D
rationale: all listed increase bleeding risk. dehydration is not a direct cause of hemorrhagic stroke.
SATA
A patient is being educated on treatment options for an aneurysm. Which statements correctly describe clipping and coiling?
A. Clipping involves open surgery to place a clip at the aneurysm neck
B. Coiling requires opening the skull to access the aneurysm
C. Coiling is performed using a catheter inserted through a blood vessel
D. Clipping prevents blood from entering the aneurysm
E. Coiling promotes clotting within the aneurysm
answer: A, C, D, E
rationale:
clipping blocks blood flow from the outside, while coiling fills the aneurysm from the inside and promotes clotting.
B is incorrect because coiling is not open surgery, it is endovascular.
SATA
A nurse suspects a patient is experiencing cerebral vasospasm. Which findings support this?
A. New neurologic deficits
B. Decreased cerebral blood flow
C. Increased oxygen delivery
D. Narrowing of cerebral vessels
E. Increased perfusion
answer: A, B, D
rationale:
vasospasm leads to vessel constriction, decreased blood flow, and neurologic decline.
C and E are incorrect because oxygen delivery and perfusion decrease, not increase.
SATA
A patient is receiving triple H therapy following a subarachnoid hemorrhage. Which findings indicate the therapy is effective?
A. Increased cerebral perfusion
B. Decreased intravascular volume
C. Improved neurologic status
D. Decreased blood viscosity
E. Lower blood pressure
answer: A, C, D
rationale:
triple H therapy works by increasing perfusion and improving neurologic function while decreasing blood viscosity.
B is incorrect because volume should increase, not decrease.
E is incorrect because BP is maintained or increased, not lowered.
A 68-year-old patient arrives to the emergency department with left-sided weakness and slurred speech that started 5 hours ago. The family reports they waited to see if symptoms would improve before coming in. The nurse anticipates that which intervention will most likely be withheld?
A. Noncontrast CT scan
B. Oxygen therapy
C. IV tPA administration
D. Neurologic assessment
A 68-year-old patient arrives to the emergency department with left-sided weakness and slurred speech that started 5 hours ago. The family reports they waited to see if symptoms would improve before coming in. The nurse anticipates that which intervention will most likely be withheld?
A. Noncontrast CT scan
B. Oxygen therapy
C. IV tPA administration
D. Neurologic assessment
A patient arrives with stroke symptoms. The nurse notes BP is 198/104, the patient is vomiting, and has a decreased level of consciousness. Which type of stroke is most likely?
A. Ischemic stroke
B. Hemorrhagic stroke
C. Transient ischemic attack
D. Embolic stroke
answer: B
rationale: high BP, vomiting, and decreased LOC strongly suggest hemorrhagic stroke due to increased ICP and bleeding.
A patient with an unruptured aneurysm says, “I don’t have any symptoms, why is treatment necessary?” What is the best response?
A. “The aneurysm can rupture suddenly and cause life-threatening bleeding”
B. “It will likely shrink and go away without treatment”
C. “It mainly causes blockage of blood flow over time”
D. “It increases your risk for infection in the brain”
answer: A
rationale:
aneurysms are often asymptomatic but can rupture suddenly, leading to subarachnoid hemorrhage, which is life-threatening.
B is incorrect because aneurysms do not resolve on their own.
C is incorrect because the primary issue is rupture, not blockage.
D is incorrect because infection is not the main concern.
A patient with SAH becomes increasingly lethargic, and CT imaging shows enlarged ventricles. Which complication is most likely occurring?
A. Vasospasm
B. Rebleeding
C. Seizure activity
D. Hydrocephalus
answer: D
rationale:
blood blocks CSF reabsorption, leading to hydrocephalus and increased ICP.
A is incorrect because vasospasm affects blood flow, not ventricular size.
B is incorrect because rebleeding would not specifically cause ventricular enlargement.
C is incorrect because seizures do not cause ventricular dilation.
A patient with hemorrhagic stroke has a BP of 192/100. Which intervention should the nurse perform first?
A. Increase IV fluid rate
B. Administer thrombolytic therapy
C. Place the patient flat
D. Administer IV antihypertensive medication
answer: D
rationale:
high BP increases risk of rebleeding and must be controlled carefully in hemorrhagic stroke.
A is incorrect because fluids do not address hypertension and may worsen ICP.
B is incorrect because thrombolytics are contraindicated in hemorrhagic stroke.
C is incorrect because positioning flat can increase ICP.