SCRN Post-acute Care 5 — Questions and Answers
Question 1: A stroke patient with homonymous hemianopia is being discharged home. Which safety teaching is most important?
- Avoid all driving permanently regardless of recovery
- Scan toward the blind side when walking and in traffic (Correct answer)
- Wear an eye patch over the unaffected eye during activities
- Request a lower bed to minimize fall risk from visual loss
Correct answer: Scan toward the blind side when walking and in traffic
Teaching the patient to consciously scan toward the affected visual field compensates for the deficit and is the highest-priority safety strategy.
Question 2: A post-stroke patient in a skilled nursing facility refuses morning care and says 'there's no point.' The nurse's best first response is:
- Document the refusal and respect the patient's autonomy
- Notify the physician and request a psychiatric consult immediately
- Sit with the patient, use open-ended questions, and explore the statement (Correct answer)
- Remind the patient of their therapy schedule to refocus attention
Correct answer: Sit with the patient, use open-ended questions, and explore the statement
A therapeutic communication approach — sitting with the patient and exploring hopeless statements — assesses for suicidality and depression before escalating.
Question 3: When educating a family about stroke recurrence risk, the nurse correctly states that the highest risk period for a second stroke after a TIA or minor stroke is:
- Within the first 90 days (Correct answer)
- Between 6 and 12 months
- At the 1-year mark
- Risk remains constant over 5 years
Correct answer: Within the first 90 days
The risk of stroke after TIA or minor stroke is highest in the first 90 days, with the greatest risk in the first 48 hours.
Question 4: A patient 6 weeks post-stroke has right-sided hemiplegia and is learning to dress independently. The occupational therapist recommends dressing the affected side first. Why?
- It builds strength in the affected limb through repetition
- It is easier to thread the affected arm/leg through clothing before mobility is limited (Correct answer)
- It prevents contracture of the shoulder joint
- It follows the natural sequence of morning routine
Correct answer: It is easier to thread the affected arm/leg through clothing before mobility is limited
Dressing the affected side first allows easier garment placement when range of motion is less impaired by surrounding fabric.
Question 5: Which post-stroke complication is the leading cause of death in the first month after stroke?
- Hemorrhagic transformation
- Aspiration pneumonia (Correct answer)
- Deep vein thrombosis
- Recurrent ischemic stroke
Correct answer: Aspiration pneumonia
Aspiration pneumonia is the most common cause of death in the early post-stroke period due to dysphagia and impaired protective reflexes.
Question 6: A post-stroke patient with spastic foot drop is being evaluated for an ankle-foot orthosis (AFO). The nurse understands the primary goal of an AFO in this patient is to:
- Prevent heterotopic ossification
- Improve gait safety by holding the foot in a neutral position (Correct answer)
- Stretch spastic calf muscles overnight
- Reduce lymphedema in the paretic limb
Correct answer: Improve gait safety by holding the foot in a neutral position
An AFO holds the ankle in a neutral dorsiflexed position to prevent foot drop during the swing phase of gait, improving safety and efficiency.
Question 7: The Modified Rankin Scale (mRS) score of 3 is best described as:
- No symptoms at all
- Slight disability but able to carry out all usual duties and activities
- Moderate disability requiring some help but able to walk without assistance (Correct answer)
- Moderately severe disability requiring constant nursing care
Correct answer: Moderate disability requiring some help but able to walk without assistance
An mRS score of 3 indicates moderate disability: the patient requires some help with daily activities but is able to walk without assistance.
SCRN Post-acute Care 5
A stroke patient with homonymous hemianopia is being discharged home.
Which safety teaching is most important?