SCRN Preparation Guide: Stroke Nursing Decisions Across the Continuum Study Guide

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A patient awakens with disabling weakness. Rather than treating awakening as a known onset or assuming all tissue is lost, the nurse expedites the stroke team's imaging pathway to assess whether a reperfusion option remains available.

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Imaging shows a cerebral arterial occlusion and an ulcerated carotid plaque upstream. The nurse explains that material can travel from the neck artery into the brain; a cardiac source is not required for an embolic mechanism.

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A patient with a recent nondisabling ischemic event has severe carotid stenosis supplying the affected hemisphere. The nurse helps coordinate timely vascular evaluation and explains that the workup addresses a plausible source of recurrence.

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Left leg weakness with relative arm preservation suggests right ACA involvement. Right-sided weakness with aphasia instead suggests dominant left MCA involvement; left-sided weakness with marked left neglect suggests right MCA involvement.

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An alert patient cannot name a cup, writes unrelated words, and misunderstands a simple spoken request. These findings support a language impairment, prompting adapted communication and speech-language assessment rather than attributing the difficulty only to articulation.

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A patient consistently misses the left visual field when each eye is tested, supporting left homonymous loss. Another ignores the left arm while dressing and people approaching from the left, supporting neglect and a need for broader attention assessment.

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One patient's scan shows blood within brain tissue; another shows subarachnoid blood and an aneurysm. The nurse distinguishes parenchymal hemorrhage management from ruptured-aneurysm treatment planning and accurately names an AVM if vascular imaging instead identifies an abnormal vessel tangle.

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A patient has sudden vertigo, left facial numbness, right body numbness, hoarseness, and left ptosis with a small pupil. The nurse recognizes a left lateral medullary pattern, activates urgent stroke assessment, and maintains swallowing precautions.

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A patient reports abrupt arm weakness and word-finding difficulty that ended before arrival. The nurse preserves the symptom history, supports prompt diagnostic evaluation, and explains why feeling normal now does not remove the need for prevention planning.

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A patient has weakness after a witnessed seizure and a low glucose result. The nurse corrects hypoglycemia, monitors for ongoing seizure activity, and promptly reports persisting unilateral weakness so that stroke assessment continues.

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A patient gradually improves grasp during repeated functional practice and also learns to dress using an adaptive technique. The nurse recognizes both gains, records what the patient can actually do, and reinforces the agreed practice plan.

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A partner discovers weakness at 06:30 but spoke with the patient normally at 02:00. The nurse records 02:00 as last known well and 06:30 as discovery, retaining the partner's contact information for clarification.

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EMS reports a severe focal deficit and confirmed last known well. The receiving nurse activates the established pathway, alerts imaging and the stroke team, and verifies whether rapid transfer arrangements exist if advanced intervention is needed.

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A patient with a new focal deficit becomes poorly responsive and cannot maintain adequate ventilation. The nurse calls for airway support while another team member maintains the stroke timeline and prepares the diagnostic pathway.

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A patient has a low NIHSS total but cannot communicate meaningful sentences needed for independent daily life. The nurse documents the disabling language deficit and expedites eligibility review rather than describing the stroke as insignificant.

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A patient's initial CT excludes hemorrhage, but severe focal findings remain. The nurse supports prompt vascular imaging to assess for an occlusion rather than reassuring the family that a negative hemorrhage study excludes stroke.

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For a wake-up stroke, diffusion abnormality without marked matching FLAIR change supports an imaging estimate of recent onset. For a patient six hours after witnessed onset, a small estimated core within a larger hypoperfused region supports the perfusion-selected pathway. The nurse expedites the applicable assessment and gathers contraindication history.

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A family reports a blood thinner but cannot name it. The nurse promptly confirms the prescription and last administration while imaging proceeds, then communicates the specific anticoagulant history rather than documenting only an uncertain medication category.

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For an 80-kg adult, alteplase totals 72 mg: 7.2 mg over one minute, then 64.8 mg over 60 minutes. Exact-weight tenecteplase calculation gives 80 × 0.25 = 20 mg. Under the AHA/ASA and U.S. TNKase weight-band table, the same patient receives 22.5 mg, or 4.5 mL at 5 mg/mL. Verify the ordered method before preparation.

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A patient presenting eight hours after onset has NIHSS 1 from isolated numbness and retains normal walking, hand use, and communication. Imaging excludes hemorrhage, and the evaluation supports a noncardioembolic minor stroke without an indication for reperfusion. With low bleeding risk, this presentation can support early aspirin plus clopidogrel for a defined short course. If atrial fibrillation establishes a cardioembolic mechanism, the prevention assessment changes even though the deficit remains nondisabling.

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Vascular imaging identifies basilar artery occlusion eight hours after symptom onset in a patient with NIHSS 16. The nurse facilitates immediate endovascular consultation and transfer preparation rather than treating posterior circulation location as an exclusion.

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While alteplase is infusing, an interactive patient becomes drowsy with a severe new headache. The nurse stops the infusion immediately, alerts the stroke team, facilitates emergency CT and laboratory testing, and prepares ordered hemorrhage treatment.

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An otherwise potentially eligible patient has repeated pressure measurements of 194/116 mm Hg. The nurse facilitates ordered pressure management and repeat measurements before thrombolysis, preserving urgency while addressing the unresolved safety criterion.

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A patient with ischemic stroke and hyperglycemia is receiving treatment. The nurse questions a proposed intensive 80–130 mg/dL target, explains the hypoglycemia concern, and verifies the intended stroke glucose-management plan.

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A patient taking warfarin has CT-confirmed intracerebral hemorrhage and an elevated INR. The nurse urgently communicates the medication and result and prepares the ordered factor replacement and vitamin K rather than merely withholding the next dose.

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An alert patient has a 17-mL cerebellar ICH without documented hydrocephalus. The nurse urgently facilitates neurosurgical management because the volume criterion is already met, while continuing close surveillance for deterioration.

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A hospital identifies aneurysmal subarachnoid hemorrhage but lacks definitive treatment capability. The nurse coordinates the urgent transfer pathway, sends imaging and baseline findings, and explains why stabilization must be followed by prompt aneurysm treatment.

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Arrival is documented at 14:08 and thrombolysis begins at 14:46. Under the stated definition, door-to-needle time is 38 minutes. The nurse records imaging and order times separately to help locate any process delay.

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A patient who previously followed commands now responds only briefly and cannot lift an arm that moved earlier. The nurse confirms the change, checks vital signs and glucose, and urgently reports the specific findings and timing.

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After thrombolysis, pressure rises to 182/106 mm Hg. It exceeds the post-treatment boundary and requires prompt ordered management. The nurse continues the scheduled neurological checks and verifies that 24-hour follow-up imaging excludes hemorrhage before routine antithrombotic initiation, even if the patient appears improved.

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A patient with mild-to-moderate ICH presents at 186 mm Hg systolic. The nurse verifies a target of 140 with maintenance at 130–150 and promptly reports a treatment-related drop to 122 rather than interpreting the lower reading as better control.

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A patient with intraventricular blood becomes progressively less responsive, and imaging shows hydrocephalus. The nurse urgently facilitates neurosurgical evaluation for ventricular drainage rather than attributing the decline solely to the original hemorrhage.

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A patient develops repeated unexplained episodes of reduced responsiveness without limb shaking. The nurse reports the pattern and supports EEG evaluation while the team also assesses other causes of deterioration, rather than dismissing seizure because convulsions are absent.

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After aneurysm coiling, a family asks why nimodipine continues. The nurse explains its role in reducing delayed ischemic complications and reinforces that new weakness or language change still needs immediate assessment despite the completed procedure.

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A stable patient after aneurysm treatment is prescribed routine extra fluid loading solely to prevent delayed ischemia. The nurse requests review of the prophylactic hypervolemia rationale and confirms the team's goal-directed euvolemia plan.

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An alert patient with clear speech requests tablets with water before swallowing screening. The nurse withholds oral administration, arranges the validated screen, and checks whether prescribed medications need an alternative route while swallowing safety remains unconfirmed.

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A patient remains NPO after an abnormal screen and cannot perform oral hygiene independently. The nurse arranges assisted oral care and coordinates nutrition and hydration assessment, explaining that avoiding food does not make mouth care unnecessary.

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A newly admitted patient with ICH cannot walk and has no device-related contraindication. The nurse implements ordered intermittent pneumatic compression and checks its use and skin tolerance while the team evaluates later pharmacological prophylaxis.

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A patient develops temperature 38.4°C, new cough, and increased respiratory secretions. The nurse recognizes that the Canadian threshold is exceeded, increases observation, facilitates respiratory infection assessment, and administers prescribed temperature treatment.

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A patient passes frequent small amounts of urine and repeatedly wets the bed. The nurse assesses symptoms and postvoid residual rather than assuming adequate emptying, then works with the team on a targeted bladder-management plan.

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A patient with severe stroke has fluctuating hemodynamics and recent arterial access. The nurse coordinates early rehabilitation assessment but confirms activity restrictions and stability before standing practice, while beginning discussion of assistance and discharge needs.

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After a neurovascular procedure, the nurse finds new access-site swelling and a change in distal circulation compared with baseline. The nurse immediately reports both findings and follows the procedural escalation pathway rather than documenting only neurological stability.

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During a care discussion, the nurse moves to a quiet space, presents one idea at a time, and gives the patient time to respond. Understanding is checked before the team proceeds with the proposed activity.

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A patient who previously engaged in therapy becomes withdrawn and repeatedly declines sessions without a new physical explanation. The nurse explores concerns, supports an accessible mood screen, and communicates findings for further evaluation and treatment planning.

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A family believes a high ICH score means all treatment must stop. The nurse clarifies the score's limits, identifies the patient's known wishes, and facilitates a discussion separating resuscitation preferences from other available treatments.

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A patient practices grasp to improve hand function and uses an adapted utensil to eat independently. The nurse identifies the first as restorative practice and the second as compensation, reinforcing both within the patient's mealtime goal.

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A medically stable patient who participates in therapy but needs substantial toileting and transfer help unavailable at home warrants inpatient rehabilitation assessment. Another with safe transfers and reliable help may receive supported home rehabilitation. An independently mobile patient needing focused hand therapy may attend outpatient services; persistent extensive nursing and daily-care needs may favor longer-term supported care.

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A patient's arm movement improves during testing, but they still need help preparing breakfast. The nurse records both findings and works with the team to add an activity goal that measures actual meal-preparation performance.

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An elbow resists a rapid passive extension more than a slow stretch, supporting spasticity. Another remains restricted at slow speed, raising concern for contracture. The nurse reports the difference and the effect on sleeve placement and palm hygiene for rehabilitation reassessment.

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A partner says a transfer seems easy after watching once. The nurse arranges a supervised return demonstration with the prescribed technique and equipment, then uses the observed performance to identify further training or additional help before discharge.

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Months after therapy discharge, a patient reports gradually increasing difficulty managing household activities. The nurse helps arrange reassessment for new rehabilitation targets while confirming that there has been no abrupt focal change suggesting another acute event.

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A patient taking apixaban describes black tarry stools as an expected effect. The nurse explains that this may indicate gastrointestinal bleeding and directs immediate medical contact for urgent assessment. The patient then states that severe bleeding that will not stop requires emergency help.

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A patient misses therapy because accessible transport is unavailable and feels isolated at home. The nurse explores an appropriate telehealth option and a stroke support group, then confirms the patient has the support needed to use each service.

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A patient believes aspirin makes smoking cessation and blood pressure follow-up unnecessary. The nurse explains the separate prevention targets, helps prioritize achievable changes, and confirms that medication and risk-factor follow-up are both included in the plan.

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After an ischemic stroke, monitoring documents atrial fibrillation and the team plans anticoagulation after assessing timing and safety. The nurse explains the identified embolic risk and checks the patient's understanding of use, follow-up, and bleeding precautions.

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A patient has an embolic-appearing infarct but no identified source and a normal admission ECG. The nurse explains the purpose of planned rhythm monitoring and reinforces the prescribed prevention plan while the diagnostic evaluation continues.

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A patient with a noncardioembolic stroke, NIHSS 2, no hemorrhage, and low bleeding risk starts aspirin plus clopidogrel 18 hours after onset. A prescribed 21-day course followed by aspirin alone provides an explicit transition: both agents through day 21, then aspirin alone beginning day 22. The nurse confirms those dates and teaches the patient to report bleeding. A proposed 90-day course requires confirmation of its specific indication, such as the separate symptomatic intracranial stenosis pathway.

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Two patients have severe arterial narrowing after ischemic events, one extracranial and one intracranial. The nurse checks the precise location before discussing the plan and avoids telling both patients that stenting is the standard first treatment.

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A patient reports a weekly exercise session but otherwise sits most waking hours. The nurse discusses feasible ways to interrupt sedentary time and adapt everyday meals, coordinating activity advice with the patient's rehabilitation safety plan.

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A patient skips medication because the prescription is unaffordable and misses visits because transport is unreliable. The nurse coordinates targeted assistance, verifies the revised plan through teach-back, and checks that the patient can describe the emergency response to new symptoms.