Section V covers both kinds of prevention, before any stroke and after one; secondary prevention means matching the drug and the procedure to the cause of the stroke, then keeping the patient on them.
Medication education and management: antiplatelets, anticoagulants, statins, antihypertensives
Quality measures and community education: discharge teaching, public warning-sign campaigns
12 stroke prevention questions
0 of 12 attempted · 0 correct · 0 missed
Primary and Secondary Preventative Care · 19 items
A patient prescribed dabigatran asks about using a weekly pill organizer. The nurse explains that dabigatran capsules should be
Answer and why, all 4 options
Dabigatran capsules absorb moisture and lose potency, so they stay in the original container and the bottle is used within 4 months of opening, not transferred to a pill organizer.
Opening the capsule greatly increases absorption and bleeding risk; dabigatran is swallowed whole.
Capsules cannot be split, and halving an anticoagulant dose leaves the patient without stroke protection.
Refrigeration is not required and adds humidity; the drug is kept at room temperature in its original package.
Item 420421
Primary and Secondary Preventative Care · 19 items
A patient with type 2 diabetes and a recent ischemic stroke has an HbA1c of 8.6%. For most such patients, the SCRN teaches that the goal is an HbA1c of
Answer and why, all 4 options
For most adults with diabetes, including stroke survivors, an HbA1c of about 7% or lower lowers microvascular risk without the hypoglycemia of tighter targets; goals are individualized.
A looser target around 8% is reserved for people with limited life expectancy, frequent hypoglycemia or major comorbidity, not most patients.
An HbA1c near 9% reflects poor control and accepts high glucose exposure; it is not a treatment goal.
Pushing HbA1c toward normal raised hypoglycemia and, in one major trial, mortality without lowering stroke risk.
Item 419560
Primary and Secondary Preventative Care · 19 items
A nurse is asked to start a stroke prevention program in an underserved neighborhood. The FIRST step should be to
Answer and why, all 4 options
A campaign is an intervention, and picking a channel before assessing the audience risks missing it.
Brochures chosen without knowing literacy, language or needs often go unread; planning comes first.
Screening may turn out to be the right intervention, but choosing it before learning the community's needs skips the planning step.
A needs assessment finds the community's actual risk factors, barriers, languages and resources, so later interventions fit the people they are meant for.
Item 420056
Primary and Secondary Preventative Care · 19 items
Two months after a stroke, a patient stops taking clopidogrel and says, 'What's the point anymore?' The nurse's PRIORITY is to
Answer and why, all 4 options
Cost is a common barrier, but this patient's words point to hopelessness, not money.
Hiding the medicine does not address the cause and removes the patient's control without fixing adherence.
Reteaching assumes a knowledge gap; the patient knows the drug and has lost the will to take it.
Hopeless statements and stopping secondary prevention are warning signs of post-stroke depression, which affects about a third of survivors and also calls for asking about thoughts of self-harm.
Item 420424
Primary and Secondary Preventative Care · 19 items
During a routine exam of a 70-year-old with hypertension, the nurse hears a bruit over the left carotid artery. The nurse understands that this finding
Answer and why, all 4 options
A fully occluded artery has no flow and is often silent; a bruit implies flow through a narrowed segment.
A carotid bruit reflects turbulent flow, often from stenosis; it is neither sensitive nor specific, so duplex ultrasound is used to check the degree of narrowing.
A bruit may accompany significant stenosis; it cannot exclude it, and severe stenosis may even be silent.
A bruit is not a normal finding at any age and calls for evaluation in a patient with vascular risk factors.
Item 420479
Primary and Secondary Preventative Care · 19 items
At a clinic visit 3 months after an ischemic stroke, a patient's BP readings are 142/88 and 138/86 mm Hg. The long-term BP goal the SCRN reinforces is
Answer and why, all 4 options
The secondary prevention guideline sets an office BP goal below 130/80 mm Hg for most stroke survivors, so both readings still need treatment.
A goal of 150 is an older target for some older adults in primary prevention, not for secondary prevention after stroke.
This is lower than the guideline target and raises the risk of hypotension and falls without proven extra benefit after stroke.
This was the older target; current guidance aims lower because recurrence risk keeps falling below 140/90.
Item 1876520
Primary and Secondary Preventative Care · 19 items
A patient with a recurrent stroke is labeled 'noncompliant' with antihypertensives in the handoff report. The SCRN should FIRST
Answer and why, all 4 options
More warnings assume the problem is knowledge; if the barrier is cost or side effects, teaching will not change the behavior.
Recording the label without exploring it repeats the handoff and leaves the barrier in place.
Nonadherence often has a cause the patient can name, such as cost, side effects, pill burden or a misunderstanding; asking first replaces a label with a plan.
Raising the dose of a drug the patient is not taking does not lower BP and risks hypotension if adherence resumes.
Item 1876526
Primary and Secondary Preventative Care · 19 items
Before a DOAC is started after a cardioembolic stroke, the baseline lab MOST important for choosing the dose is
Answer and why, all 4 options
DOACs act within hours and need no heparin bridge; bridging belongs to warfarin starts in selected patients.
INR targets apply to warfarin; DOACs have fixed doses and no INR target.
Platelet function testing concerns antiplatelet drugs, not anticoagulant dosing.
Every DOAC is cleared in part by the kidneys, so creatinine clearance sets the dose and decides which agent can be used.
Item 1876549
Primary and Secondary Preventative Care · 19 items
Before discharge after an ischemic stroke, a 59-year-old who smokes, has a BMI of 32 and BP of 155/92 mm Hg on two drugs says, 'I know I need to change, but it's overwhelming.' The nurse's BEST response is to
Answer and why, all 4 options
Demanding total change at once increases resistance and sets the patient up to fail.
Handing over every topic at once adds to the overload the patient just described, so little of it is likely to be used.
Letting the patient choose the first step uses motivational interviewing: it respects the feeling of being overwhelmed and builds confidence with one achievable change.
Recurrence risk is highest early, and the patient is already open to change; waiting wastes that moment.
Item 1981242
Primary and Secondary Preventative Care · 19 items
A stroke survivor brings a home blood pressure log showing exactly 142/88 mm Hg every morning and evening for 10 days. The nurse's BEST action is to
Answer and why, all 4 options
Identical readings twice a day for 10 days are not physiologic; watching the patient measure and checking the cuff and log tells a device or technique problem from a recording problem.
Changing treatment on data that may not be real risks overtreatment and hypotension.
Home monitoring is valuable after stroke; fixing the technique beats giving it up.
Normal BP varies from reading to reading; accepting implausible numbers lets wrong data guide treatment.
Item 1981284
Primary and Secondary Preventative Care · 19 items
Three months after an ischemic stroke, a patient asks which dietary change has the strongest evidence for lowering the risk of another vascular event. The nurse recommends
Answer and why, all 4 options
B vitamins lower homocysteine but did not reduce recurrent stroke in secondary prevention trials, so a lab change is mistaken for clinical benefit.
Cutting all fat did not lower stroke risk, and fish oil capsules have not shown stroke benefit; the gain comes from the whole diet pattern, including healthy fats.
A Mediterranean-type pattern with olive oil, nuts, fish, legumes and vegetables lowered major vascular events including stroke in trials and is the eating pattern the stroke prevention guideline supports.
Antioxidant vitamin E did not prevent stroke in large trials and was linked to more hemorrhagic strokes.
Item 9710005
Primary and Secondary Preventative Care · 19 items
Two weeks after a TIA, a 63-year-old who takes aspirin is found to have 80% stenosis of the left middle cerebral artery. For the next 90 days, the nurse anticipates
Answer and why, all 4 options
In the WASID trial warfarin prevented no more strokes than aspirin and caused more bleeding and deaths.
For a recent TIA or stroke from 70 to 99% intracranial stenosis, adding clopidogrel to aspirin for up to 90 days, with aggressive BP, lipid and lifestyle targets, gave fewer strokes than stenting in the SAMMPRIS trial.
Bypass surgery did not reduce stroke in patients with MCA stenosis or occlusion and is not used for this indication.
Stenting seems a direct fix, but in SAMMPRIS it caused more early strokes and deaths than intensive medical therapy, so it is not first-line.
Item 9710007
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Antithrombotics after stroke or TIA
After a minor stroke or a high-risk TIA: aspirin plus clopidogrel started within 24 hours and given for about 21 days, then one antiplatelet. For this indication, continuing dual therapy well beyond about 3 weeks adds bleeding without adding protection (AHA/ASA secondary prevention guideline, 2021; 2026 acute guideline); other causes, such as severe intracranial stenosis, follow their own regimen.
Atrial fibrillation with a stroke: an oral anticoagulant, usually a direct oral anticoagulant in preference to warfarin when the valve status allows; antiplatelets are not a substitute.
Embolic stroke of undetermined source: no empiric anticoagulation; prolonged rhythm monitoring looks for atrial fibrillation.
Patent foramen ovale: closure is reasonable for selected patients aged 18 to 60 with no other cause found.
Rate and rhythm control of atrial fibrillation, and anticoagulation in a patient who has not had a stroke, are cardiac medicine: CMC cardiac pharmacology.
Prevention items that catch nurses
Aspirin for everyone. Routine aspirin for primary prevention is no longer recommended for most adults; it is a decision about bleeding risk, not a default (AHA/ASA primary prevention guideline, 2024).
Carotid surgery timing. For a symptomatic 70–99% stenosis, endarterectomy is best done within 2 weeks of the event, when recurrence risk is highest (2021 guideline).
ABCD2 measures TIA risk, not stroke severity; it does not replace imaging.
Exercise advice with numbers. The 2021 guideline suggests moderate activity at least 10 minutes four times a week or vigorous activity 20 minutes twice a week for survivors who can; older items quote other figures, so read the stem for the source it assumes.
Risk factors beyond the classic list. Preeclampsia, early menopause and gestational diabetes now count in women's stroke risk (2024 guideline).
Who owns the overlap
Starting antithrombotics in the hospital is shared with acute care; teaching that continues in rehab is post-acute care. Heart failure, coronary disease and arrhythmia management outside the stroke context belong to cardiac medicine.
Does the SCRN test primary prevention or only care after a stroke?
Both are in the outline. Community programs, risk factor screening and public education are primary prevention; antithrombotics, carotid procedures and adherence after a stroke are secondary.
Are drug doses tested in this section?
The outline names medication education and management; know which drug fits the cause, what to monitor and what to teach.