A 32-year-old woman with no vascular risk factors presents with a left MCA stroke. MRI shows a single cortical infarct. Echocardiogram shows a patent foramen ovale with a large right-to-left shunt on Valsalva. Telemetry is negative for atrial fibrillation. Lower extremity Doppler shows no deep vein thrombosis. Which laboratory evaluation is most important to complete before determining the definitive secondary prevention strategy?

A patient with global aphasia after a large left MCA stroke cannot complete a standard verbal depression screening tool. Over three days the nursing staff has observed persistent psychomotor slowing, decreased food intake, withdrawal from family visits, and increased tearfulness. What is the most appropriate clinical response?

A nurse is using transcranial Doppler to monitor a post-SAH patient. Which mean flow velocity in the middle cerebral artery is most strongly associated with severe vasospasm?

A patient who received IV alteplase develops symptomatic intracranial hemorrhage confirmed on CT. Cryoprecipitate and antifibrinolytic therapy are ordered. What is the primary rationale for administering cryoprecipitate in this scenario?

A patient with a large right MCA territory infarct is assessed serially. Initial GCS is 13 with eyes 3, verbal 4, motor 6. At two hours it is 9 with eyes 2, verbal 3, motor 4. At four hours it is 7 with eyes 1, verbal 2, motor 4. Which concern does this trajectory most strongly suggest, and what urgent assessment should accompany it?

A 70 kg patient with acute ischemic stroke needs blood pressure lowered before alteplase. An initial IV labetalol bolus of 10 mg is given over 1 to 2 minutes but is ineffective at 10 minutes. What is the typical next step?

An angiogram reveals occlusion of the anterior choroidal artery. Which combination of deficits is most characteristic of this occlusion?

A patient develops left-sided facial, arm, and leg weakness with no sensory loss, no aphasia, no visual field cut, and no neglect. MRI shows a 7 mm lesion in the right posterior limb of the internal capsule. Which lacunar syndrome does this represent?

Locked-in syndrome results from infarction of which structure, and what motor function is characteristically preserved?

A patient is being discharged from a skilled nursing facility to home after completing post-stroke rehabilitation. His wife reports he was prescribed three new medications during the SNF stay that she doesn’t recognize, and his primary care physician’s office says they have not received any discharge summary. What is the most comprehensive nursing response?

A nurse is coordinating discharge for a 55-year-old stroke survivor who has moderate right arm weakness, is uninsured, and lives in a rural county. He requires ongoing outpatient speech and occupational therapy. Which referral approach is most appropriate?

The adult daughter of a stroke survivor with left-sided hemiplegia insists on performing all of the patient’s self-care tasks, including tasks the patient can do independently. The patient appears passive and disengaged during therapy. What is the nurse’s most appropriate initial intervention?

A patient with a prior ischemic stroke on aspirin 81 mg daily presents with a recurrent TIA. Her physician is considering switching to clopidogrel monotherapy. Which factor from the patient’s history would most strongly support clopidogrel over continued aspirin monotherapy?

A patient with atrial fibrillation is being evaluated for long-term oral anticoagulation to prevent stroke. The clinician calculates a HAS-BLED score. What does this score estimate?

A patient is being discharged on a direct oral anticoagulant (DOAC) for stroke prevention in nonvalvular atrial fibrillation. Which education point is most important for the nurse to emphasize regarding DOAC therapy?