Bladder training in a male patient who has urinary incontinence after a stroke includes:

tPA (tissue plasminogen activator) is a thrombolytic medication used only for ischemic strokes, where a clot obstructs blood flow. In a hemorrhagic stroke, the problem is bleeding rather than blockage, so administering tPA would worsen intracranial bleeding and increase the risk of death. The best response is to provide clear, accurate information in simple terms that reassure the wife and explain why her husband’s treatment is different. This promotes understanding, trust, and safety in care.

Rationale for correct answer:
4. “The medication you are talking about dissolves clots and could cause more bleeding in your husband’s brain.” This response directly addresses the wife’s concern while providing accurate education about why tPA is contraindicated. It is clear, compassionate, and avoids unnecessary medical jargon, helping the family understand the risk of worsening hemorrhage. Providing this explanation empowers the family with knowledge and helps prevent misconceptions about treatment.

Rationale for incorrect answers:
1. “He didn’t arrive within the timeframe for that therapy.” While time is critical for ischemic strokes, the main issue here is that the patient has a hemorrhagic stroke. This answer would be misleading and fail to address the real reason tPA was not given.

2. “Not everyone is eligible for this drug. Has he had surgery lately?” This is true for ischemic stroke patients, as recent surgery or bleeding risk may exclude them. However, it is not relevant in this case because the stroke is hemorrhagic, making tPA absolutely contraindicated.

3. “You should discuss the treatment of your husband with his doctor.” Although involving the doctor is appropriate, this answer avoids the nurse’s responsibility to provide accurate teaching. It may leave the wife feeling dismissed or more anxious.

Take-home points:

• tPA is only used for ischemic strokes, never for hemorrhagic strokes.
• In hemorrhagic stroke, giving tPA would worsen bleeding and increase mortality.
• Nurses must provide clear, honest explanations to families to build trust and understanding.

A stroke can be life-altering, not only physically but also psychologically. Patients often experience depression due to sudden loss of independence and changes in body function. Sleep disturbances are also common, often related to stress, anxiety, or altered brain physiology after the stroke. In addition, many patients initially respond with denial of severity, minimizing their deficits as a way of coping with overwhelming changes.

Rationale for correct answers:
1. Depression. Post-stroke depression is highly prevalent and may hinder rehabilitation, recovery, and quality of life. It results from both neurological changes in brain chemistry and the psychosocial impact of disability. Early screening and intervention are essential.

4. Sleep disturbances. Stroke patients frequently experience disrupted sleep patterns due to hospitalization, neurological injury, or psychological stress. Poor sleep further worsens recovery, mood, and overall health, making it a common psychosocial concern.

5. Denial of severity of stroke. Denial is a defense mechanism many patients use to cope with the sudden, overwhelming reality of disability. While temporary denial may help adjustment, prolonged denial can interfere with rehabilitation and safety awareness.

Rationale for incorrect answers:
2. Disassociation. This is not a common psychosocial reaction to stroke. Stroke patients are more likely to experience depression or denial than dissociative symptoms, which are more typical of trauma-related psychiatric conditions.

3. Intellectualization. Although some patients may use rationalization to cope, intellectualization is not considered a common or characteristic psychosocial response after a stroke. Emotional responses like depression and denial are more typical.

Take-home points:

• Depression is the most common psychosocial response after a stroke and requires early recognition and management.
• Sleep disturbances and denial are frequent coping responses that can impact rehabilitation outcomes.
• Support, counseling, and involvement of a multidisciplinary team are essential in addressing post-stroke psychosocial challenges.