SCRN Post-acute Care 4 — Questions and Answers
Question 1: A patient in subacute rehabilitation after ischemic stroke suddenly develops a severe headache, vomiting, and declining level of consciousness. The nurse suspects hemorrhagic transformation. What is the priority action?
- Administer acetaminophen for headache and reassess
- Activate rapid response and obtain emergent CT head (Correct answer)
- Elevate head of bed to 45° and continue monitoring
- Hold all antiplatelet medications and notify physician
Correct answer: Activate rapid response and obtain emergent CT head
New neurological deterioration after stroke requires emergent imaging to rule out hemorrhagic transformation, which demands immediate intervention.
Question 2: Which outcome measure is specifically designed to assess activity limitations in stroke survivors and is commonly used in post-acute research?
- Rankin Scale
- NIHSS
- Stroke Impact Scale (SIS) (Correct answer)
- GCS
Correct answer: Stroke Impact Scale (SIS)
The Stroke Impact Scale is a patient-reported outcome measure assessing multiple domains of stroke recovery including strength, memory, emotion, communication, and social participation.
Question 3: A home health nurse assesses a stroke survivor 4 weeks post-discharge and finds the patient sitting alone, not participating in hobbies, and expressing hopelessness. Which intervention is the priority?
- Encourage the patient to exercise daily
- Refer to outpatient speech therapy
- Conduct depression screening and notify the provider (Correct answer)
- Increase home health visit frequency
Correct answer: Conduct depression screening and notify the provider
Symptoms of hopelessness and social withdrawal suggest post-stroke depression, which requires formal screening and timely provider notification for treatment.
Question 4: A post-stroke patient has urinary incontinence. The nurse recognizes that which type is most common after stroke?
- Stress incontinence
- Urge incontinence (overactive bladder) (Correct answer)
- Overflow incontinence
- Functional incontinence
Correct answer: Urge incontinence (overactive bladder)
Urge incontinence due to disrupted cortical inhibition of detrusor activity is the most common type of urinary incontinence following stroke.
Question 5: Which patient behavior after stroke best indicates readiness for inpatient rehabilitation transfer?
- Patient denies disability and refuses therapy
- Patient tolerates 3 hours of therapy per day and is medically stable (Correct answer)
- Patient requires continuous IV medication titration
- Patient is nonverbal with no response to commands
Correct answer: Patient tolerates 3 hours of therapy per day and is medically stable
Inpatient rehabilitation requires medical stability and ability to participate in at least 3 hours of therapy per day.
Question 6: A SCRN is reviewing a post-stroke patient's home medication list and notes the patient is taking warfarin for atrial fibrillation. The INR today is 1.4. What is the appropriate interpretation?
- The INR is therapeutic for stroke prevention in AF
- The INR is supratherapeutic and warfarin should be held
- The INR is subtherapeutic and requires dose adjustment (Correct answer)
- No action is needed as the INR is within normal lab range
Correct answer: The INR is subtherapeutic and requires dose adjustment
The therapeutic INR range for stroke prevention in atrial fibrillation is 2.0–3.0; an INR of 1.4 is subtherapeutic and warrants a dose adjustment.
Question 7: Which nursing intervention best prevents post-stroke shoulder-hand syndrome (complex regional pain syndrome type 1)?
- Applying a sling to keep the arm immobilized
- Gentle ROM, proper positioning, and avoiding trauma to the hand (Correct answer)
- Restricting arm movement until spasticity resolves
- Applying ice to the hand twice daily
Correct answer: Gentle ROM, proper positioning, and avoiding trauma to the hand
Preventing joint trauma, maintaining joint mobility with gentle ROM, and proper positioning prevent the cascade that leads to shoulder-hand syndrome.
SCRN Post-acute Care 4
A patient in subacute rehabilitation after ischemic stroke suddenly develops a severe headache, vomiting, and declining level of consciousness.
The nurse suspects hemorrhagic transformation.
What is the priority action?