SCRN Post-acute Care 3 — Questions and Answers
Question 1: A stroke patient in home health has a Barthel Index score of 60. What does this indicate?
- Fully independent in all ADLs
- Moderate dependence requiring significant assistance (Correct answer)
- Minimal dependence with only supervision needed
- Total dependence in all activities
Correct answer: Moderate dependence requiring significant assistance
A Barthel Index score of 60 out of 100 reflects moderate dependence, meaning the patient requires significant assistance with many ADLs.
Question 2: Which post-stroke complication is most commonly associated with shoulder pain in the hemiplegic upper extremity?
- Rotator cuff tear from overuse
- Glenohumeral subluxation (Correct answer)
- Bicipital tendonitis
- Acromioclavicular joint arthritis
Correct answer: Glenohumeral subluxation
Glenohumeral subluxation, caused by loss of muscle tone supporting the shoulder joint, is the most common cause of hemiplegic shoulder pain.
Question 3: A nurse is educating a post-stroke patient on secondary prevention. Which lifestyle modification has the greatest evidence for stroke risk reduction?
- Adopting a Mediterranean diet
- Blood pressure control (Correct answer)
- Regular aerobic exercise
- Smoking cessation
Correct answer: Blood pressure control
Hypertension is the single most modifiable risk factor for stroke recurrence, making blood pressure control the highest-priority secondary prevention measure.
Question 4: A post-stroke patient in outpatient rehab has spasticity limiting elbow extension. Botulinum toxin is administered. What is the expected onset of effect?
- Within 2–4 hours
- Within 24–48 hours
- Within 3–7 days (Correct answer)
- Within 2–4 weeks
Correct answer: Within 3–7 days
Botulinum toxin typically begins reducing spasticity within 3–7 days, with peak effect at 4–6 weeks.
Question 5: Which factor most strongly predicts a successful return to driving after stroke?
- Patient's self-reported confidence in driving
- Absence of visual field defects and adequate cognitive function (Correct answer)
- Time elapsed since stroke onset
- Family support and transportation availability
Correct answer: Absence of visual field defects and adequate cognitive function
Intact visual fields and adequate cognitive function — especially attention and processing speed — are the strongest predictors of safe return to driving.
Question 6: A patient with aphasia after stroke is frustrated during speech therapy. What is the most therapeutic nursing response?
- Complete sentences for the patient to reduce frustration
- Speak loudly and slowly to help comprehension
- Allow extra time and use augmentative communication supports (Correct answer)
- Recommend deferring speech therapy until the patient is emotionally ready
Correct answer: Allow extra time and use augmentative communication supports
Allowing extra response time and using AAC tools (picture boards, apps) respects the patient's effort and supports communication without fostering dependence.
Question 7: A post-stroke patient is prescribed aspirin and clopidogrel for dual antiplatelet therapy after a minor ischemic stroke. How long should dual therapy typically continue according to current guidelines?
- Indefinitely
- 21 days (Correct answer)
- 90 days
- 6 months
Correct answer: 21 days
Current AHA/ASA guidelines recommend dual antiplatelet therapy for 21 days after minor ischemic stroke or high-risk TIA, then single antiplatelet therapy.
SCRN Post-acute Care 3
A stroke patient in home health has a Barthel Index score of 60.
What does this indicate?