Section III follows the patient from the angiography suite or the emergency department to the stroke unit or neuro ICU, where the work is preventing the next problem: swelling, rebleeding, aspiration, clots and falls.
Plan of care, safety and daily living: team rounds, fall and aspiration prevention, positioning, sensory needs
Psychosocial care and education: family teaching, mood, goals of care
Quality measures, medications and discharge planning: the STK set, early rehab referral
18 acute care questions
0 of 18 attempted · 0 correct · 0 missed
Acute Care · 42 items
The nurse monitors a patient with a large hemispheric infarct for cerebral edema, which typically peaks
Answer and why, all 4 options
Early CT may show subtle swelling, but mass effect from edema takes a day or more to develop; a patient who looks fine early can still herniate later.
Cytotoxic edema after a large hemispheric infarct builds over the first days and peaks around days 2 to 5, which is when herniation risk and neuro checks matter most.
Weeks after the stroke the infarct is in the chronic phase and shrinking toward encephalomalacia, not swelling.
By the second week edema is usually resolving; a nurse who expects the peak this late would relax monitoring during the most dangerous days.
Item 419521
Acute Care · 42 items
A patient with left hemiparesis and apraxia after stroke needs help with dressing, grooming and bathing. The nurse should request a referral to
Answer and why, all 4 options
The SLP treats swallowing, speech and language; apraxia of limb tasks is not a communication problem.
A dietitian manages nutrition and texture-modified diets, not the motor planning needed for self-care.
Occupational therapy retrains dressing, grooming and bathing and teaches strategies for apraxia, so it matches the self-care deficits described.
Nothing in the scenario points to a breathing or airway need.
Item 420236
Acute Care · 42 items
A patient with ICH and signs of raised intracranial pressure needs IV BP control. Which ordered agent should the nurse question?
Answer and why, all 4 options
Nitroprusside dilates cerebral vessels, which raises cerebral blood volume and intracranial pressure; it is avoided when ICP is already high.
Labetalol lowers BP without dilating cerebral vessels much, so it is a standard choice in intracerebral hemorrhage.
Clevidipine is an ultra-short-acting calcium channel blocker suited to tight BP titration in ICH.
Nicardipine is a titratable calcium channel blocker widely used for BP control in ICH, with little effect on ICP.
Item 420450
Acute Care · 42 items
A patient with a moderate ischemic stroke is medically stable on day 1. Which mobilization plan is BEST supported by evidence?
Answer and why, all 4 options
Prolonged bed rest in a stable patient adds deconditioning, pneumonia and VTE risk without protecting the brain.
Lying flat for a day has not improved outcomes in trials and raises aspiration risk; it is not a mobilization plan.
This is the high-dose, very early mobilization that the AVERT trial linked to worse 3-month outcomes.
Trials of very early mobilization found that intensive out-of-bed activity in the first 24 hours worsened outcomes, while shorter, more frequent sessions after that were linked to better recovery.
Item 1876490
Acute Care · 42 items
A patient with a right hemisphere stroke and dense left hemiparesis insists there is no weakness and keeps trying to walk alone. This behavior is BEST explained by
Answer and why, all 4 options
Pseudobulbar affect is sudden crying or laughing out of step with mood, not denial of a deficit.
Unawareness of one's own deficit is typical of nondominant (usually right) parietal strokes and makes the patient try to walk alone, so falls are the main safety risk.
Apathy lowers effort and initiative; it does not make a patient deny an obvious weakness and attempt to walk.
Receptive aphasia affects understanding of language and comes from the dominant (usually left) hemisphere, which does not fit a right hemisphere stroke.
Item 1876492
Acute Care · 42 items
A patient with post-stroke dysphagia is fed by nasogastric tube. Which measure helps reduce the risk of pneumonia?
Answer and why, all 4 options
In the FOOD trial early PEG did not beat nasogastric feeding; a tube in the stomach does not stop aspiration of saliva.
Trials of preventive antibiotics after stroke did not reduce pneumonia or improve outcomes, and they add resistance and C. difficile risk.
Tube feeding does not protect against aspiration of oral secretions; regular structured oral care lowers the bacterial load in those secretions and reduces pneumonia.
Lying flat increases reflux and aspiration; tube-fed patients are kept with the head raised at least 30 degrees.
Item 1876531
Acute Care · 42 items
A 66-year-old with diabetes had 20 minutes of right arm weakness that has fully resolved. BP is 150/92 mm Hg. The patient's ABCD2 score is
Answer and why, all 4 options
ABCD2: age 60 or older 1, BP 140/90 or higher 1, unilateral weakness 2, duration 10 to 59 minutes 1, diabetes 1, for a total of 6.
This total usually leaves out diabetes or counts weakness as 1 point; unilateral weakness carries 2 points.
This total drops two items, often the BP point and the diabetes point; both thresholds are met here.
Seven is the maximum and needs symptoms lasting 60 minutes or longer for 2 points; 20 minutes earns only 1.
Item 1876602
Acute Care · 42 items
A nonambulatory patient with an ischemic stroke is admitted on Monday. Which intervention, started on Tuesday, meets TJC measure STK-1 (VTE prophylaxis)?
Answer and why, all 4 options
Graduated stockings did not prevent DVT after stroke and caused skin breakdown, so they are not recommended and do not meet the measure.
An ambulation order does not count as prophylaxis, and a nonambulatory patient could not follow it.
STK-1 counts pharmacologic or mechanical VTE prophylaxis started by the end of hospital day 2; intermittent pneumatic compression qualifies and also lowers DVT risk in immobile stroke patients.
Aspirin is antithrombotic therapy for the stroke itself; it does not count as VTE prophylaxis.
Item 1876690
Acute Care · 42 items
Four patients with atrial fibrillation are candidates for oral anticoagulation. Which patient would generally start anticoagulation EARLIEST?
Answer and why, all 4 options
Even petechial hemorrhagic change pushes the start later than in a patient with no infarct at all.
A large infarct that has already bled is the case where the start is delayed longest.
A large infarct with edema carries the highest risk of hemorrhagic transformation, so anticoagulation is started later than in smaller strokes.
With no infarcted tissue there is no risk of hemorrhagic transformation, so anticoagulation can start almost at once; timing is set by infarct size and bleeding.
Item 1876787
Acute Care · 42 items
After a large cortical ischemic stroke, a patient has had no seizures. The family asks whether a drug should be started to prevent seizures. The nurse explains that
Answer and why, all 4 options
Guidelines advise against prophylactic antiseizure drugs after ischemic stroke without seizures; they have not prevented seizures and may impair recovery.
A short preventive course is not a recommended practice; levetiracetam is used only if a seizure occurs.
Focal slowing over an infarct is expected; it is not epileptiform activity and does not call for treatment.
Cortical location raises seizure risk, but no stroke is an indication for prophylaxis, and phenytoin has been linked to worse outcomes.
Item 1876929
Acute Care · 42 items
The Joint Commission comprehensive stroke measure CSTK-06 tracks whether patients with aneurysmal subarachnoid hemorrhage receive
Answer and why, all 4 options
Routine tranexamic acid did not improve outcomes after SAH, so it is not tracked as a quality measure.
Phenytoin has been linked to worse outcomes after SAH and is not a quality measure.
CSTK-06 measures whether aneurysmal SAH patients get nimodipine, the drug that improves outcome after aneurysm rupture.
Hypervolemia, hypertension and hemodilution as prophylaxis is no longer advised; the goal is euvolemia.
Item 1981430
Acute Care · 42 items
A therapist documents a Modified Ashworth Scale score of 2 for a stroke patient's elbow flexors. This scale measures
Answer and why, all 4 options
The Modified Ashworth Scale grades the resistance felt when a limb is moved passively, that is, muscle tone or spasticity; a 2 is a marked increase through most of the range.
Strength is graded 0 to 5 with manual muscle testing during active effort; the Ashworth scale is scored while the patient relaxes.
Sensation is tested with touch, pinprick and position sense; the Ashworth scale does not assess it.
Independence in self-care is measured with tools such as the Barthel Index or Section GG, not by tone.
Item 1981443
Acute Care · 42 items
A patient with a left MCA stroke passed the bedside swallow screen and is on a modified diet. Which finding MOST suggests silent aspiration?
Answer and why, all 4 options
Wanting more flavor is common with bland modified diets and altered taste; it says nothing about airway protection.
Coughing with meals is overt aspiration; the protective reflex is working, which is the opposite of silent aspiration.
Pocketing on the weak side reflects poor oral control and sensation; it is an oral-phase problem that calls for mouth checks, not a sign of silent aspiration.
Silent aspiration causes no cough, so it often shows up only as pneumonia, typically in the right lower lobe because the right main bronchus is more vertical.
Item 1981501
Acute Care · 42 items
A patient with aneurysmal subarachnoid hemorrhage has an external ventricular drain (EVD) for hydrocephalus. The nurse should level the drain's zero point at the
Answer and why, all 4 options
Leveling well above the ventricles makes the drain read low and changes how much CSF drains.
The tragus approximates the foramen of Monro, the reference point for intracranial pressure, so the EVD zero is leveled there and releveled with every position change.
The phlebostatic axis is the reference for hemodynamic lines such as arterial and CVP monitoring, which sits at the level of the right atrium.
The mattress is far below the ventricles; zeroing there would over-drain CSF and risk ventricular collapse or rebleeding.
Item 1981682
Acute Care · 42 items
A patient is started on aspirin plus extended-release dipyridamole after a noncardioembolic ischemic stroke. The nurse teaches that the MOST common early side effect is
Answer and why, all 4 options
Dry cough is a class effect of ACE inhibitors, not of antiplatelet drugs.
Dipyridamole dilates vessels, and headache is the most common early side effect and a frequent reason patients stop the drug; it often eases after the first weeks.
Ankle edema is typical of dihydropyridine calcium channel blockers such as amlodipine.
Dipyridamole tends to cause diarrhea and stomach upset rather than constipation.
Item 1981488
Acute Care · 42 items
A 52-year-old patient had a left decompressive hemicraniectomy for a malignant MCA infarct. Which nursing measure is MOST important for the skull defect?
Answer and why, all 4 options
A flat position hinders venous drainage and raises aspiration risk; the head is usually raised about 30 degrees.
Without the bone flap the brain under the left scalp has no protection, so the patient is not positioned on that side, and a helmet is used once out of bed.
Pressure over a craniectomy site presses directly on the brain beneath it; the dressing is kept light and dry.
A head ring concentrates pressure on the edges and center of the defect; any support under the open side presses on unprotected brain.
Item 419848
Acute Care · 42 items
A patient 36 hours after an ischemic stroke is neurologically stable, failed the bedside swallow screen, and has moderate left hemiparesis. Regarding activity, the SCRN should
Answer and why, all 4 options
The SLP decides diet, not activity; waiting for that consult delays safe mobilization for no gain.
This ties mobility to swallowing, which are separate decisions; bed rest adds deconditioning, VTE and pneumonia risk.
Mobilizing is right, but a patient who failed the swallow screen stays NPO, including sips of water, until the SLP clears oral intake.
A failed swallow screen restricts oral intake, not movement; a neurologically stable patient is mobilized with assistance while staying NPO until the SLP clears intake.
Item 1981403
Acute Care · 42 items
Two hours after thrombectomy fully reopened a left M1 occlusion, a patient's BP is 168/92 mm Hg and the neurologic exam is improving. No lytic was given. Regarding BP, the nurse anticipates
Answer and why, all 4 options
After successful thrombectomy BP is kept at or below 180/105 mm Hg, and trials of intensive lowering below 140 after full reperfusion found worse outcomes, so a reading of 168/92 needs no drug.
Induced hypertension has no proven benefit, and once the artery is open the risk shifts to reperfusion injury and bleeding.
220/120 is the permissive ceiling for ischemic stroke without reperfusion; after thrombectomy the limit is 180/105 to lower hemorrhage risk.
Intensive lowering after successful reperfusion seemed logical to protect against reperfusion bleeding, but trials found more disability, and the current guideline advises against it.
Item 9710001
Your score: – fills in as you answer; nothing is saved.Doubt a key? Note the item number — how corrections work →
Noncontrast CT comes first; a lumbar puncture is for a negative CT with a suggestive history. Older items call the LP the gold standard, which is no longer the order of testing.
Rebleeding risk is highest before the aneurysm is secured, which the guideline wants done early, ideally within 24 hours.
Delayed cerebral ischemia is most likely from about day 3 to day 14, and serial neuro exams by trained nurses are one of the ways to catch it. Nimodipine improves outcome but does not reverse vasospasm.
Keep the patient euvolemic. Prophylactic hypervolemia and the old triple-H regimen are not recommended.
Low sodium after SAH is often cerebral salt wasting, so restricting fluids can make it worse.
Intracerebral hemorrhage after the first hours: keep pressure control smooth and avoid large swings, and watch for hematoma growth, which is most likely early (AHA/ASA guideline, 2022).
Ischemic stroke on the unit: settled answers
Oral medications wait for the swallow screen too. A pill by mouth before the screen is passed is a common unit error; a patient who fails the screen gets a speech-language pathology assessment, not a softer diet by default.
Glucose 140–180 mg/dL. Tight control at 80–130 brought no benefit in SHINE (2019), and the 2026 guideline keeps 140–180; treatment starts below 60.
Oxygen only for hypoxia, to keep saturation above 94%.
Aspirin waits 24 hours after a lytic. Giving it early raised bleeding in the trial that tested it.
Lying flat helps nobody routinely. Keeping every patient at 0° for the first day brought no benefit in the HeadPoST trial.
No routine urinary catheter and no prophylactic antibiotics (2026 guideline).
Fever matters. Find and treat it; induced hypothermia has no proven benefit and is not routine care.
Yes, as they apply to stroke. The outline lists hemorrhagic interventions in this section, and drains for hydrocephalus after subarachnoid or intraventricular hemorrhage are part of that.
Does the exam ask about Joint Commission stroke measures?
The outline names quality stroke metrics in both hyperacute and acute care. Know what each STK measure counts, not its number alone.