Stroke Basics
A sudden loss of neurologic function due to disrupted cerebral blood flow.
Answer Stroke
Rationale A stroke is a sudden interruption of cerebral blood flow that leads to loss of neurologic function. Because brain tissue is highly sensitive to hypoxia, prompt recognition and treatment are critical to limit permanent damage.
Standardized tool used to assess stroke severity.
Answer: NIH Stroke Scale (NIHSS)
Rationale:
The NIHSS is a standardized tool used to quantify stroke severity, monitor neurologic changes, and guide treatment decisions such as eligibility for thrombolytic therapy.
Primary goal of IV tPA therapy.
Answer Restore Cerebral Blood Flow
Rationale:
The primary goal of IV tPA is to dissolve the clot and restore perfusion to ischemic brain tissue, limiting infarct size and improving functional outcomes.
Stroke caused by bleeding into brain tissue.
Answer: Hemorrhagic Stroke
Rationale:
Hemorrhagic stroke results from bleeding into brain tissue or surrounding spaces, leading to increased intracranial pressure and ischemia. Management differs significantly from ischemic stroke.
State of unarousable unresponsiveness
Answer: Coma
Rationale:
Coma is a state of unarousable unresponsiveness indicating severe brain dysfunction and requires total nursing care, including airway protection and neurologic monitoring.
The most common type of stroke.
Answer Ischemic strokes
Rationale Ischemic strokes account for approximately 87% of all strokes and are caused by thrombus or embolus formation. This distinction is essential because ischemic strokes may be treated with thrombolytic therapy, whereas hemorrhagic strokes may not.
Inability to express language due to Broca’s area damage.
Answer: Expressive Aphasia
Rationale:
Damage to Broca’s area impairs speech production while comprehension may remain intact. Recognizing aphasia types helps nurses tailor communication strategies and patient education.
Typical maximum time window for IV tPA administration.
Answer: Within 3 Hours
Rationale:
IV tPA is most effective when administered within 3 hours of symptom onset (with select patients eligible up to 4.5 hours). Delays increase bleeding risk and reduce benefit.
Most common modifiable risk factor for hemorrhagic stroke.
Answer: Hypertension
Rationale:
Uncontrolled hypertension weakens cerebral blood vessels and increases the risk of rupture, making it the leading modifiable risk factor for hemorrhagic stroke.
Patient awake but unable to move except eyes.
Answer: Locked-In Syndrome
Rationale:
Locked-in syndrome results from pontine lesions. Patients are conscious but unable to move or speak, making eye movement–based communication essential.
The most important modifiable risk factor for ischemic stroke.
Answer: Hypertension
Rationale HTN is the most significant modifiable risk factor for ischemic stroke because it causes chronic damage to blood vessels, promotes atherosclerosis, and increases the risk of clot formation.
Loss of the same half of the visual field in both eyes.
Answer: Homonymous Hemianopsia
Rationale:
Homonymous hemianopsia occurs when the same half of the visual field is lost in both eyes, typically due to occipital lobe involvement. This deficit increases fall and injury risk, requiring environmental safety interventions.
Diagnostic test required before giving tPA
Answer: CT Scan
Rationale:
A non-contrast CT scan is required before tPA administration to rule out hemorrhagic stroke, as thrombolytics would worsen bleeding and increase mortality.
Sudden severe headache with LOC suggests which stroke type?
Answer: Hemorrhagic Stroke
Rationale:
Sudden severe headache, rapid decline in level of consciousness, and vomiting are hallmark features of hemorrhagic stroke and require immediate intervention.
Early sign of increased intracranial pressure
Answer: Change in Level of Consciousness
Rationale:
Changes in LOC are the earliest and most sensitive indicator of increased intracranial pressure and must be reported immediately.
A transient neurologic deficit warning of future stroke.
Answer: TIA
Rationale TIA is a temporary neurologic deficit caused by brief interruption of cerebral blood flow. Although symptoms resolve, TIAs are a critical warning sign of impending stroke and require urgent diagnostic evaluation and secondary prevention.
Weakness affecting one side of the body after stroke.
Answer: Hemiparesis
Rationale:
Hemiparesis refers to weakness on one side of the body and is more common than complete paralysis. Differentiating paresis from plegia assists in rehabilitation planning and functional goal setting.
Appropriate head-of-bed position unless contraindicated.
Answer: Head of Bed at 30 Degrees
Rationale:
Elevating the head of the bed promotes venous drainage and reduces intracranial pressure while maintaining adequate cerebral perfusion, unless contraindicated.
Medication used to prevent vasospasm after SAH.
Answer: Nimodipine
Rationale:
Nimodipine is administered after subarachnoid hemorrhage to prevent cerebral vasospasm, which can cause delayed ischemia and worsen neurologic outcomes.
The three symptoms of Cushing's Triad
Answer: Bradycardia hypertension and irregular respirations
Rationale:
Cushing’s triad (bradycardia, hypertension, irregular respirations) is a late and ominous sign of increased ICP and brainstem compression, signaling impending herniation.
The nurse explains that stroke symptoms occur because neurons are particularly sensitive to interruption of this physiologic process.
Answer What is oxygen and glucose delivery to brain tissue?
Rationale:
Neurons rely almost exclusively on aerobic metabolism. Interruption of cerebral blood flow rapidly deprives brain cells of oxygen and glucose, leading to ischemia, infarction, and irreversible neurologic damage.
A stroke patient understands spoken language but responds with inappropriate or nonsensical words. This finding is most consistent with damage to which area?
Answer What is Wernicke’s area (receptive aphasia)?
Rationale:
Damage to Wernicke’s area impairs language comprehension. Patients may speak fluently but without meaningful content, which affects safety and education strategies.
After receiving IV tPA, which nursing assessment finding requires immediate intervention?
Answer: What is sudden severe headache or change in level of consciousness?
Rationale:
These findings may indicate intracranial hemorrhage, a serious complication of thrombolytic therapy that requires emergent evaluation and discontinuation of tPA.
The primary reason blood pressure is carefully controlled in a patient with hemorrhagic stroke is to prevent this complication.
Answer: What is rebleeding and worsening intracranial pressure?
Rationale:
Elevated blood pressure can increase ongoing bleeding, expand the hematoma, and worsen cerebral edema, leading to increased ICP and neurologic deterioration.
According to the Monro–Kellie hypothesis, an increase in brain tissue volume must be compensated for by a decrease in which components?
Answer: What are cerebrospinal fluid and/or cerebral blood volume?
Rationale:
Because the skull is a fixed space, increases in one component (brain tissue, blood, or CSF) must be offset by decreases in another to prevent increased ICP.