A thrombus in a cerebral artery does not always result in loss of neurologic function because the circle of Willis provides an important collateral circulation system. This structure allows blood to be redistributed from other vessels when one artery is obstructed, which helps preserve perfusion to the brain and prevent significant damage.

Rationale for correct answer:
3. Circulation via the circle of Willis may provide blood supply to the affected area of the brain. The circle of Willis serves as a natural bypass mechanism. When one artery becomes blocked, other arteries in the circle can compensate by delivering blood to the threatened region, which may prevent or limit ischemia.

Rationale for incorrect answers:
1. The body can dissolve atherosclerotic plaques as they form. This is incorrect because plaques are permanent changes in the arterial wall and cannot be dissolved naturally by the body once formed.
2. Some tissues of the brain do not require constant blood supply to prevent damage. This is false since brain tissue is extremely dependent on continuous oxygen and glucose delivery; even short interruptions can result in injury.
4. Neurologic deficits occur only when major arteries are occluded by thrombus formation around atherosclerotic plaque. This is not accurate because small-vessel occlusions, such as those causing lacunar strokes, can also lead to neurologic deficits.

Take-home points:

• The circle of Willis provides vital collateral circulation that may prevent neurologic deficits when one artery is blocked.
• Brain tissue requires a continuous supply of oxygen and glucose, and interruptions quickly cause damage.
• Both major and minor vessel occlusions can produce stroke symptoms, depending on the affected area.

A transient ischemic attack (TIA) is a temporary episode of neurologic dysfunction caused by reduced blood flow to the brain. Even though the symptoms resolve, a TIA is a serious warning sign of progressive cerebrovascular disease. Patients who experience a TIA are at significantly increased risk of developing a stroke within days to weeks. Therefore, urgent evaluation and treatment are essential to prevent long-term complications.

Rationale for correct answer:
4. The patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease. TIAs are caused by a brief interruption in cerebral blood flow that produces focal neurologic symptoms which fully resolve. Although temporary, they indicate underlying vascular pathology and serve as a predictor of future stroke.

Rationale for incorrect answers:
1. The patient has probably experienced an asymptomatic lacunar stroke. This is incorrect because lacunar strokes are not transient and typically result in lasting neurologic deficits.
2. The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours. This is not always the case since TIA symptoms may not recur immediately, but the risk of stroke remains high.
3. Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off. This is inaccurate because hemorrhagic events usually produce sustained damage rather than symptoms that resolve completely.

Take-home points:

• A TIA is a critical warning sign of impending stroke that must not be ignored.
• Even if symptoms resolve, cerebrovascular disease persists and requires urgent management.
• Early intervention and treatment following a TIA can prevent a disabling or fatal stroke.

An intracerebral hemorrhage (ICH) occurs when a blood vessel ruptures and causes bleeding directly into the brain tissue. This event often creates a mass effect, leading to increased intracranial pressure and compression of surrounding brain tissue. The condition has a poor prognosis because of the severity of damage and complications such as herniation. Hypertension is the most significant risk factor, making it strongly linked to this type of stroke.

Rationale for correct answers:
1. Carries a poor prognosis. Intracerebral hemorrhage has high morbidity and mortality because of rapid neurologic deterioration and limited treatment options.
2. Caused by rupture of a vessel. Unlike ischemic strokes, ICH results from the rupture of a cerebral vessel, most often due to chronic hypertension or vascular malformations.
3. Strong association with hypertension. Long-standing hypertension weakens vessel walls and is the leading cause of intracerebral hemorrhage.
5. Creates a mass that compresses the brain. The accumulation of blood forms a hematoma, which increases intracranial pressure and compresses adjacent tissue, worsening neurologic deficits.

Rationale for incorrect answer:
4. Commonly occurs during or after sleep. This is more characteristic of thrombotic ischemic strokes, not hemorrhagic strokes, which typically occur suddenly during activity.

Take-home points:

• Intracerebral hemorrhage results from ruptured cerebral vessels and carries a poor prognosis.
• Hypertension is the strongest risk factor for this type of stroke.
• The hemorrhage creates a mass effect that compresses the brain and elevates intracranial pressure.

An embolic stroke occurs when a blood clot or other embolus travels from the heart or another source and lodges in a cerebral artery. This type of stroke is strongly associated with endocardial disorders such as atrial fibrillation, rheumatic heart disease, or prosthetic heart valves. Symptoms typically develop rapidly, often within minutes, because the embolus abruptly blocks blood flow. Unlike thrombotic strokes, embolic strokes are not related to activity and may occur suddenly at rest.

Rationale for correct answer:
1. Embolic. Embolic strokes are most commonly caused by clots originating from the heart, especially in patients with atrial fibrillation or valvular disease. They present with sudden neurologic symptoms due to immediate arterial obstruction, and onset is not linked to activity levels.

Rationale for incorrect answers:
2. Thrombotic. Thrombotic strokes develop when an atherosclerotic plaque causes gradual vessel occlusion, often during sleep or rest, with symptoms that progress more slowly.
3. Intracerebral hemorrhage. This occurs due to ruptured blood vessels, often linked with hypertension, and is usually associated with exertion or activity.
4. Subarachnoid hemorrhage. This results from rupture of a cerebral aneurysm and typically presents with a sudden, severe headache often described as “the worst headache of my life.”

Take-home points:

• Embolic strokes are caused by clots traveling from the heart or other sources.
• They have a rapid onset and produce immediate neurologic deficits.
• They are not related to activity, unlike hemorrhagic strokes that often occur during exertion.

The neurologic functions affected by a stroke are primarily determined by the brain area perfused by the affected artery. Each region of the brain controls specific motor, sensory, language, and cognitive functions. When an artery supplying a particular region is occluded or ruptures, the functions associated with that region are impaired. Therefore, the location of the stroke is the most important factor in predicting the type of neurologic deficits that occur.

Rationale for correct answer:
3. The brain area perfused by the affected artery. The brain has highly specialized regions, such as the occipital lobe for vision and the frontal lobe for motor control. Damage depends on which artery is obstructed and which brain region loses perfusion, making location the key determinant of clinical presentation.

Rationale for incorrect answers:
1. The amount of tissue area involved. While the extent of damage can influence severity, the type of deficit depends more on the brain region affected than on size alone.
2. The rapidity of the onset of symptoms. This reflects the mechanism of stroke (ischemic vs hemorrhagic) but does not determine which functions are lost.
4. The presence or absence of collateral circulation. Collateral circulation can influence stroke severity but does not determine which specific neurologic functions are impaired.

Take-home points:

• The location of the stroke determines which neurologic functions are impaired.
• Different arterial territories correspond to specific brain regions and functional losses.
• Stroke severity may be influenced by tissue area and collateral flow, but the artery involved is the key factor.

A right-hemispheric stroke typically affects the left side of the body because each cerebral hemisphere controls the opposite side. Clients often exhibit impulse control difficulty, loss of depth perception, and lack of awareness (anosognosia) due to impaired spatial and perceptual abilities. Left hemiplegia is also a hallmark feature, resulting from motor deficits caused by right-sided brain damage. In contrast, aphasia is more strongly associated with left-hemispheric strokes, as language centers are usually located in the left hemisphere.

Rationale for correct answers:
1. Impulse control difficulty. Right-sided brain damage impairs judgment and self-control, often leading to impulsive behavior.
2. Left hemiplegia. The right hemisphere controls the left side of the body, so weakness or paralysis occurs on that side.
3. Loss of depth perception. Right-hemispheric strokes disrupt spatial-perceptual processing, leading to difficulty judging distances.
5. Lack of awareness. Patients may deny or ignore their deficits (anosognosia), a common finding in right-brain injury.

Rationale for incorrect answer:
4. Aphasia. This is primarily associated with left-hemispheric strokes, which affect language centers such as Broca’s and Wernicke’s areas.

Take-home points:

• Right-hemispheric strokes cause left-sided weakness/paralysis and spatial-perceptual deficits.
• Clients may demonstrate impulsivity and poor awareness of deficits (anosognosia).
• Aphasia is more typical of left-hemispheric strokes due to language center involvement.

A left-hemispheric stroke primarily affects language, analytical abilities, and recognition skills. Clients often experience aphasia, agnosia (inability to recognize familiar objects), and impaired right-side motor function. Unlike right-hemispheric strokes, which commonly affect judgment, impulse control, and spatial-perceptual abilities, left-sided strokes are more likely to cause language and recognition deficits. Therefore, the inability to recognize familiar objects is a classic finding in patients with left-brain damage.

Rationale for correct answer:
3. Inability to recognize familiar objects. Left-hemispheric damage impairs recognition and language processing, leading to agnosia, where the patient cannot identify known items.

Rationales for incorrect answers:
1. Impulse control difficulty. More commonly seen in right-hemispheric strokes due to altered judgment and poor inhibition.
2. Poor judgment. Typically associated with right-hemispheric strokes that affect executive and decision-making functions.
4. Loss of depth perception. This spatial-perceptual deficit is characteristic of right-brain injuries, not left-sided ones.

Take-home points:

• Left-hemispheric strokes affect language, recognition, and right-sided motor control.
• Agnosia (inability to recognize familiar objects) is a key expected finding.
• Right-hemispheric strokes are more linked to judgment, impulsivity, and spatial-perceptual deficits.

The secondary assessment of a stroke patient provides a more detailed evaluation once the initial life-threatening concerns have been addressed. This stage focuses on neurological functions and history that help guide further treatment and rehabilitation. Key elements such as sensation, proprioception, and distal motor function provide information about the extent of neurologic damage, while reviewing current medications ensures safe and effective care planning. Findings such as gaze and facial palsy are addressed earlier during the primary assessment, as they are essential for rapid stroke recognition and intervention.

Rationale for correct answers:
2. Sensation. Assessing sensation helps determine whether the patient has lost feeling in specific areas, which is critical for identifying the location and severity of brain injury. Sensory testing can reveal deficits that may not be immediately visible, such as numbness or altered touch perception. These findings are important for planning both acute management and long-term rehabilitation.

4. Proprioception. Proprioception refers to the awareness of body position in space, which can be impaired after a stroke. Evaluating this function helps detect subtle neurological deficits that may affect balance and coordination. Early recognition of proprioceptive deficits guides safety measures and therapy interventions to prevent falls.

5. Current medications. Reviewing the patient’s medication history is essential because drugs such as anticoagulants, antihypertensives, or antiplatelets significantly affect both the cause and management of stroke. For example, anticoagulant use may increase the risk of hemorrhagic stroke, while antiplatelets are common in ischemic stroke prevention. This information helps providers make safe decisions about acute treatment and secondary prevention strategies.

6. Distal motor function. Assessing fine motor strength and coordination in the extremities provides valuable insight into the degree of functional impairment. Weakness or loss of control in distal muscles often reflects cortical or corticospinal tract involvement. These findings are important in predicting disability and planning rehabilitation needs.

Rationale for incorrect answers:
1. Gaze. Abnormal gaze patterns, such as deviation of the eyes, are included in the primary assessment because they are quickly observed and indicate potential brain injury. This finding is evaluated early using tools such as the NIH Stroke Scale to guide urgent treatment. It does not fall under the more detailed secondary evaluation.

3. Facial palsy. Like gaze, facial weakness is part of rapid stroke screening tools such as FAST and is considered during the primary assessment. Detecting facial droop helps quickly establish the likelihood of a stroke in emergency situations. It is not typically reassessed in detail during the secondary evaluation unless needed for follow-up.

Take-home points:

• The secondary assessment includes sensation, proprioception, distal motor function, and medication history.
• Gaze and facial palsy belong to the primary assessment, focusing on rapid stroke recognition.
• A thorough secondary exam supports individualized treatment planning and rehabilitation.

The time at which stroke symptoms first appeared is one of the most critical pieces of information for suspected stroke patients. This is because the use of time-sensitive treatments, such as tissue plasminogen activator (tPA), depends on knowing the exact onset of symptoms. If symptoms began within the therapeutic window, the patient may be eligible for thrombolytic therapy, which can significantly improve outcomes. Missing or inaccurate timing could result in either unsafe treatment or missed opportunities for intervention.

Rationale for correct answer:
2. Time at which stroke symptoms first appeared. This information determines whether the patient is within the treatment window for interventions such as thrombolytic therapy. The benefits of treatments like tPA are time-dependent, and delays beyond 4.5 hours from symptom onset generally exclude patients from eligibility. Accurate knowledge of onset also helps guide decisions about imaging and other urgent interventions.

Rationales for incorrect answers:
1. Time of the patient’s last meal. Although relevant if surgical or procedural interventions are planned, the last meal does not influence immediate treatment decisions in suspected stroke. Nutritional history is secondary and should be gathered later in the assessment process. It is not as time-sensitive as symptom onset.

3. Patient’s hypertension history and management. Hypertension is an important risk factor for stroke, but its history does not guide immediate treatment decisions in the acute setting. Blood pressure control will be addressed after stabilization and imaging. Therefore, while relevant for long-term management, it is not the most urgent information to obtain during the initial stroke evaluation.

4. Family history of stroke and other cardiovascular diseases. Family history can provide background on genetic and lifestyle-related risks for stroke. However, it has no immediate impact on acute treatment options or eligibility for therapies like thrombolysis. It is considered later in the care process, not during the urgent phase of evaluation.

Take-home points:

• The time of symptom onset is the single most important detail in suspected stroke cases.
• Thrombolytic therapy and other interventions depend on strict time windows.
• Family history, hypertension, and diet history are important but not critical during the initial emergency assessment.

A stroke involving the left middle cerebral artery (MCA) is the most likely cause of right-sided hemiplegia and aphasia. The left hemisphere of the brain controls the motor and sensory function of the right side of the body and is also the dominant hemisphere for language in most individuals. Damage in this region often leads to contralateral motor deficits and language disturbances such as aphasia. This combination of findings is characteristic of left MCA involvement and distinguishes it from other vascular territories.

Rationale for correct answer:
3. Left middle cerebral artery. The left MCA supplies the lateral portion of the left cerebral hemisphere, including areas responsible for motor control of the right side and speech centers such as Broca’s and Wernicke’s areas. Stroke in this artery commonly results in right hemiplegia due to contralateral motor pathway involvement. Aphasia occurs because the dominant hemisphere’s language centers are disrupted, making this the best explanation for the patient’s findings.

Rationales for incorrect answers:
1. Brainstem. Brainstem strokes often cause bilateral deficits, cranial nerve involvement, and problems with vital functions such as respiration and consciousness. They do not usually produce isolated aphasia, since language centers are located in the cerebral hemispheres, not the brainstem. Therefore, this location is inconsistent with the patient’s presentation.

2. Vertebral artery. The vertebral arteries supply the posterior circulation, including the brainstem, cerebellum, and occipital lobes. Deficits from vertebral artery strokes usually involve balance, coordination, visual disturbances, or cranial nerve dysfunction. Aphasia and contralateral hemiplegia are not typical findings of vertebral artery involvement.

4. Right middle cerebral artery. The right MCA supplies the lateral right cerebral hemisphere, leading to left-sided motor and sensory deficits when damaged. It can also produce spatial-perceptual deficits and neglect but does not typically cause aphasia, since the right hemisphere is usually non-dominant for language. This makes it an incorrect choice for this patient’s symptoms.

Take-home points:

• Left MCA strokes commonly result in right-sided hemiplegia and aphasia due to contralateral motor and dominant language area involvement.
• Brainstem and vertebral artery strokes present with cranial nerve and posterior circulation deficits, not aphasia.
• Right MCA strokes cause left-sided deficits and neglect but generally do not affect language.

Clients with left homonymous hemianopsia lose vision in the left half of the visual field of both eyes, making it difficult for them to perceive objects on that side. An effective nursing intervention is to orient the client to food using the clock method, which provides a structured way for them to identify items despite visual field loss. This technique promotes independence, safety, and adequate nutrition. While other strategies may assist clients with visual deficits, the clock method directly compensates for hemianopsia during meals.

Rationale for correct answer:
3. Orient the client to the food on her plate using the clock method. This intervention allows the client to compensate for visual field loss by knowing the location of food items relative to a clock face. It enhances independence by reducing frustration and ensuring proper intake during meals. The clock method is a widely recommended strategy for patients with hemianopsia because it is both practical and safe.

Rationales for incorrect answers:
1. Teach the client to scan to the right to see objects on the right side of her body. This intervention would benefit a client with right homonymous hemianopsia, not left. Teaching scanning is helpful, but in this case, the deficit is on the left, so scanning should focus on that side. Using it incorrectly could result in continued neglect of the affected field.

2. Place the client’s bedside table on the right side of the bed. Since the client cannot see objects on the left side, placing the bedside table on the right would reinforce neglect of the affected field. Nursing interventions should encourage use of the impaired side to promote awareness and prevent accidents. This option does not support functional independence for left-sided visual loss.

4. Place the client’s wheelchair on her left side. Positioning mobility aids on the side of the visual deficit increases the risk of collisions or falls, since the patient may not notice them. Wheelchairs and other essential equipment should be placed on the unaffected (right) side for easier access and safety. This makes the option inappropriate for managing left homonymous hemianopsia.

Take-home points:

• Left homonymous hemianopsia causes loss of vision in the left visual field of both eyes.
• The clock method is a practical and effective way to improve independence during meals.
• Nursing interventions must encourage safe compensation for visual field loss and prevent neglect of the affected side.

Clients with dysphagia are at high risk for aspiration, malnutrition, and pneumonia, so interventions must focus on safety and effective swallowing. Having suction equipment available ensures quick response if choking or aspiration occurs. Thickened liquids move more slowly and are easier to control, reducing the risk of aspiration. Placing food on the unaffected side maximizes chewing ability, while teaching the client to swallow with the neck flexed (chin-tuck technique) helps protect the airway. These strategies support both safety and independence during meals.

Rationale for correct answers:
1. Have suction equipment available for use. Clients with dysphagia may aspirate food or liquids despite careful precautions. Having suction readily available ensures the nurse can promptly clear the airway if obstruction occurs. This intervention is a critical safety measure and should always be part of dysphagia care.

2. Use thickened liquids. Thin liquids are the most difficult consistency to control when swallowing and can easily be aspirated. Thickened liquids travel more slowly and allow better airway protection. They are a standard recommendation for patients with swallowing difficulties.

3. Place food on the client’s unaffected side of her mouth. If the client has unilateral weakness from a stroke or neurological disorder, placing food on the strong side promotes safe chewing and swallowing. This helps the patient control the bolus and reduces the risk of food pocketing on the weak side. It also encourages more effective oral intake.

5. Teach the client to swallow with her neck flexed. The chin-tuck technique helps close off the airway while opening the esophagus, making swallowing safer. Flexing the neck forward reduces aspiration risk by directing food away from the trachea. Teaching this maneuver empowers the client to participate in their care and improves independence.

Rationale for incorrect answer:
4. Assign an assistive personnel to feed the client slowly. Feeding a client with dysphagia requires specialized knowledge and skills to monitor for aspiration and ensure safe techniques are followed. This task is inappropriate to delegate to assistive personnel, as it requires nursing judgment and close observation. Feeding should be performed or supervised by the nurse or a speech-language pathologist.

Take-home points:

• Clients with dysphagia need safety-focused interventions to prevent aspiration.
• Effective strategies include suction readiness, thickened liquids, strong-side feeding, and chin-tuck swallowing.
• Feeding should be managed by trained nursing staff or specialists, not delegated to assistive personnel.

Clients with global aphasia have both receptive (understanding) and expressive (speaking) language impairments, so communication strategies must address both comprehension and expression. Interventions should emphasize clear, simple language, supportive nonverbal cues, and techniques that reduce processing demands. Techniques such as speaking at a slower rate, maintaining direct eye contact, allowing extra time for responses, and providing one-step instructions help the client understand and participate. Approaches that take over the client’s speech or finish statements for them can increase frustration and reduce their sense of autonomy.

Rationale for correct answers:
1. Speak to the client at a slower rate. Speaking more slowly and using short, simple phrases gives the client extra processing time and increases the likelihood that receptive language will be understood. A slower rate also allows the nurse to observe nonverbal cues and confirm comprehension before proceeding. This approach reduces communication breakdowns and frustration for both the client and caregiver.

2. Look directly at the client when speaking. Direct eye contact provides important nonverbal cues and helps focus the client’s attention on the speaker, which supports comprehension. Visual attention can augment limited auditory processing in receptive aphasia and helps the client pick up facial expressions and gestures. Maintaining eye contact also builds rapport and conveys that the nurse is engaged and patient.

3. Allow extra time for the client to answer. Clients with global aphasia often require prolonged time to comprehend questions and formulate responses, so allowing extra time prevents interruption and reduces anxiety. Rushing the client can increase errors, withdrawal, or agitation, and may obscure their true abilities. Patience during response time encourages attempts at communication and helps the nurse accurately assess function.

5. Give instructions one step at a time. One-step commands reduce cognitive load and make it more likely the client will understand and carry out directions safely. Multi-step instructions can overwhelm processing and lead to incomplete or incorrect responses. Providing a single, clear action at a time also allows the nurse to offer immediate feedback and reinforcement.

Rationale for incorrect answer:
4. Complete sentences that the client cannot finish. Finishing the client’s sentences removes their opportunity to attempt expression and undermines autonomy and self-esteem. It also makes it difficult to assess the client’s residual language abilities and progress in therapy. Instead, the nurse should offer supportive cues (gestures, written words, yes/no choices) and allow the client to attempt completion with encouragement.

Take-home points:

• Use slow, simple speech, direct eye contact, and one-step instructions to maximize comprehension and participation.
• Allow extra time for responses and avoid finishing the client’s sentences to preserve autonomy and accurately assess ability.
• Involve speech-language pathology and consider alternative communication aids when needed to support long-term communication.

A stroke requires rapid and precise diagnostic imaging to guide treatment and reduce permanent disability. The most important goal is to determine whether the stroke is ischemic or hemorrhagic and to identify the size and location of the lesion. Among available tests, MRI is the most sensitive method for detecting acute ischemic injury, small infarcts, and subtle changes not visible on CT. This makes MRI a crucial tool in both early diagnosis and treatment planning.

Rationale for correct answer:
3. Magnetic resonance imaging (MRI). MRI is the most effective imaging modality for identifying the extent, location, and type of stroke. It is highly sensitive to ischemic changes within minutes of onset, allowing early recognition and intervention. MRI also provides detailed brain imaging, making it superior to CT in detecting small or posterior circulation infarcts.

Rationale for incorrect answers:
1. Lumbar puncture. This procedure is not used to diagnose ischemic or hemorrhagic stroke. It may be indicated if a subarachnoid hemorrhage is suspected and not seen on imaging, but it does not determine stroke size, location, or type.

2. Cerebral arteriogram. While an arteriogram can visualize cerebral blood vessels and locate obstructions, it is invasive and not the first-line diagnostic tool. It is generally reserved for interventional planning, such as clot retrieval or aneurysm repair.

4. Computed tomography (CT) scan with contrast. A non-contrast CT is typically performed first in suspected stroke to quickly rule out hemorrhage. Contrast-enhanced CT can identify vascular lesions but is less sensitive than MRI for early ischemia, so it is not the preferred diagnostic tool for determining stroke size and type.

Take-home points:

• MRI is the most sensitive tool for detecting the size, location, and type of stroke.
• Non-contrast CT is performed initially in emergencies to exclude hemorrhage quickly.
• Accurate imaging guides timely stroke management, improving outcomes and reducing disability

A carotid endarterectomy is a surgical procedure performed to remove atherosclerotic plaque from the carotid artery, thereby improving cerebral blood flow. This procedure is often recommended for patients with transient ischemic attacks (TIAs) or significant carotid stenosis to prevent the development of a stroke. By eliminating the obstruction, the surgery reduces the risk of embolism or reduced perfusion to the brain. It is considered one of the most effective surgical interventions for secondary stroke prevention in appropriately selected patients.

Rationale for correct answer:
3. It involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke. Carotid endarterectomy directly addresses the cause of TIAs by surgically removing plaque buildup in the carotid artery. This improves blood flow and prevents the progression to an ischemic stroke caused by thromboembolism or severe stenosis. It is specifically indicated for patients with symptomatic carotid stenosis of 70% or greater, or for selected patients with moderate stenosis.

Rationale for incorrect answers:
1. It involves intracranial surgery to join a superficial extracranial artery to an intracranial artery. This describes an extracranial-intracranial bypass, not a carotid endarterectomy. That procedure is rarely used and has not been shown to be as effective in preventing stroke in patients with TIAs.

2. It is used to restore blood circulation to the brain following an obstruction of a cerebral artery. This describes the goal of thrombolytic therapy or endovascular thrombectomy in acute ischemic stroke, not carotid endarterectomy. Carotid endarterectomy is a preventive surgery, not an emergency reperfusion treatment.

4. It is used to open a stenosis in a carotid artery with a balloon and stent to restore cerebral circulation. This describes carotid angioplasty with stenting, which is a less invasive alternative but not the same as endarterectomy. While both improve circulation, stenting involves dilation and mesh placement rather than surgical plaque removal.

Take-home points:

• Carotid endarterectomy removes atherosclerotic plaque to reduce stroke risk in patients with TIAs or significant carotid stenosis.
• It is a preventive surgery, not an emergency treatment for acute stroke.
• Other options like stenting or bypass differ in technique and indications but may be considered in selected patients.

A stroke is strongly associated with age, race, and hypertension, making certain individuals more vulnerable. African Americans have nearly twice the risk of a first stroke compared to whites, and hypertension is the single most important modifiable risk factor. Older adults with uncontrolled blood pressure are therefore at the highest risk among the listed groups. Early recognition of risk helps guide preventive interventions to reduce morbidity and mortality.

Rationale for correct answer:
4. 65-year-old African American man with hypertension. Hypertension is the leading cause of stroke because it damages arterial walls, accelerates atherosclerosis, and increases the likelihood of vessel rupture or occlusion. African American men not only have higher rates of hypertension but also higher rates of severe complications from it, including ischemic and hemorrhagic strokes. Age greater than 60 further increases risk, making this patient the most vulnerable.

Rationale for incorrect answers:
1. Obese 45-year-old Native American. While obesity is a significant risk factor for cardiovascular disease and stroke, this patient is younger and does not have a higher-risk comorbidity like hypertension. Although Native Americans do experience higher rates of diabetes and obesity, these factors alone do not surpass the combined risks of age, race, and hypertension in the correct choice.

2. 35-year-old Asian American woman who smokes. Smoking increases clot formation and accelerates atherosclerosis, raising stroke risk. However, this patient is relatively young, and her overall risk remains lower compared to an older hypertensive African American man. The protective factor of younger age offsets her smoking risk.

3. 32-year-old white woman taking oral contraceptives. Oral contraceptives slightly increase the risk of thrombotic stroke, especially in women who also smoke or have migraines with aura. Still, this patient is the youngest in the group and lacks additional high-risk conditions like hypertension or advanced age.

Take-home points:

• Hypertension is the single most important modifiable risk factor for stroke.
• African Americans are at higher risk of both incidence and complications from stroke.
• Age combined with chronic conditions such as hypertension significantly elevates stroke risk.

The severity of a stroke depends not only on the type and location of the vessel involved but also on the degree of collateral circulation. Collateral circulation refers to the development of alternative blood flow pathways when a main artery becomes obstructed. If these collateral vessels are well-developed, the brain may still receive enough blood to reduce the extent of ischemic damage. In contrast, poor collateral circulation leads to more extensive and permanent neurological deficits.

Rationale for correct answer:
3. Degree of collateral circulation. Collateral circulation determines how much oxygenated blood reaches brain tissue when an artery is blocked. Strong collateral networks can limit infarct size and improve outcomes by maintaining perfusion in at-risk areas. This is why two patients with similar arterial occlusions can have very different clinical outcomes.

Rationale for incorrect answers:
1. Amount of cardiac output. While overall cardiac output affects systemic blood flow, the brain has autoregulatory mechanisms that maintain relatively constant perfusion unless there is severe heart failure or shock. Stroke severity is not primarily determined by cardiac output but by localized cerebral circulation.

2. Oxygen content of the blood. Low oxygen levels, such as in severe anemia or hypoxemia, can worsen brain injury but are not the primary factor in determining stroke damage. Most stroke patients have normal oxygenation, and localized blood supply plays a bigger role in infarct size.

4. Level of carbon dioxide in the blood. Carbon dioxide levels do influence cerebral blood flow through vasodilation and vasoconstriction, but this effect is transient. It does not determine the extent of permanent stroke damage as much as collateral circulation does.

Take-home points:

• Collateral circulation is the key determinant of stroke damage, as it provides alternate routes for blood flow.
• Patients with strong collateral vessels often have less severe deficits despite major occlusions.
• Stroke outcomes vary widely depending on both vascular anatomy and collateral blood supply.

A hemorrhagic stroke occurs when a cerebral blood vessel ruptures, often due to long-standing hypertension or aneurysm rupture. Unlike thrombotic strokes, which typically have a more gradual onset of symptoms, hemorrhagic strokes are characterized by the sudden onset of a severe headache often described as “the worst headache of my life.” This acute presentation, sometimes accompanied by nausea, vomiting, or decreased consciousness, helps distinguish hemorrhagic from thrombotic causes. Rapid recognition is critical because treatment approaches differ significantly between the two.

Rationale for correct answer:
4. Sudden onset of severe headache. A severe, abrupt headache is a hallmark of hemorrhagic stroke because bleeding increases intracranial pressure and irritates meningeal tissues. This symptom occurs suddenly and is usually much more intense than headaches associated with other conditions. The dramatic presentation provides an important clue that the stroke is hemorrhagic rather than thrombotic.

Rationale for incorrect answers:
1. Sensory disturbance. Sensory changes such as numbness, tingling, or altered sensation can occur in both thrombotic and hemorrhagic strokes. They do not help distinguish between the two types, since both involve interruption of neural pathways.

2. A history of hypertension. Although hypertension is a major risk factor for hemorrhagic stroke, it is also the most significant risk factor for ischemic strokes. Therefore, its presence cannot differentiate between thrombotic and hemorrhagic events.

3. Presence of motor weakness. Motor weakness, such as hemiparesis, is a common symptom in both types of stroke. It results from decreased blood supply or damage to motor areas of the brain, so it does not specifically indicate hemorrhage.

Take-home points:

• Hemorrhagic strokes often present with a sudden, severe headache due to vessel rupture and increased intracranial pressure.
• Symptoms like motor weakness or sensory loss can occur in both ischemic and hemorrhagic strokes.
• Careful assessment of onset and symptom characteristics is essential to guide immediate diagnostic testing and treatment.

Urinary incontinence is a common complication after a stroke, often due to impaired mobility, cognitive changes, or loss of sphincter control. Effective bladder training focuses on restoring normal habits and encouraging voluntary voiding. For male patients, assisting the patient to stand to void uses natural body mechanics and gravity to promote bladder emptying. This strategy supports rehabilitation and helps the patient regain independence in urinary function.

Rationale for correct answer:
3. Assisting the patient to stand to void. Standing helps a male patient more effectively empty the bladder because it is the most natural and physiologic position for urination. This approach promotes muscle memory, encourages normal voiding patterns, and reduces the risk of urinary retention. It is an important component of rehabilitation and bladder retraining following stroke.

Rationale for incorrect answers:
1. Limiting fluid intake. Restricting fluids can lead to dehydration, urinary tract infections, and concentrated urine, which worsens bladder irritation. Adequate hydration is essential for urinary health and overall stroke recovery, making fluid restriction inappropriate for bladder training.

2. Keeping a urinal in place at all times. While convenient, leaving a urinal in place encourages dependence and does not retrain the bladder. The goal is to help the patient regain normal voiding habits rather than rely on a permanent external device.

4. Catheterizing the patient every 4 hours. Intermittent catheterization may be needed in cases of urinary retention, but routine catheterization increases the risk of infection and does not support retraining. It should not be used as a standard method for managing post-stroke incontinence.

Take-home points:

• Bladder training after stroke emphasizes restoring normal voiding patterns and independence.
• Standing to void is the best method for male patients, as it uses natural physiology to promote bladder emptying.
• Avoid strategies like fluid restriction, routine urinal use, or unnecessary catheterization, which do not support rehabilitation.

Cerebral angiography is an imaging test that uses contrast dye and X-rays to visualize blood vessels in the brain. For patients with suspected or confirmed stroke, it is primarily used to assess the patency, location, and extent of narrowing or blockage in cerebral arteries. This information guides decisions about interventions such as endarterectomy, stent placement, or thrombolytic therapy.

Rationale for correct answer:
3. Patency of the cerebral blood vessels. Angiography directly visualizes the cerebral vasculature, allowing providers to identify stenosis, occlusion, aneurysms, or other vascular abnormalities. By determining which vessels are open, narrowed, or blocked, the test provides critical data for planning treatment and preventing further ischemic damage. It is the gold standard for assessing vascular anatomy in stroke evaluation.

Rationale for incorrect answers:
1. Presence of increased ICP. Increased intracranial pressure is diagnosed clinically and with imaging such as CT or MRI, not with angiography. Angiography does not measure intracranial pressure levels.

2. Site and size of the infarction. The site and extent of brain tissue damage are better identified using CT or MRI scans, which show actual infarcted or hemorrhagic areas. Angiography only shows blood flow, not tissue damage.

4. Presence of blood in the cerebrospinal fluid. This is assessed by a lumbar puncture, which directly samples CSF, not by angiography. Angiography is not used to diagnose subarachnoid hemorrhage through CSF analysis.

Take-home points:

• Cerebral angiography assesses blood vessel patency and vascular abnormalities in stroke patients.
• It is not used to determine ICP, infarct size, or CSF bleeding.
• The results help guide interventional or surgical treatment planning.

A carotid endarterectomy is a surgical procedure in which the surgeon removes atherosclerotic plaque from the inner lining of the carotid artery. This improves cerebral blood flow and reduces the risk of future stroke, particularly in patients who have experienced TIAs or have significant carotid artery stenosis. By directly removing the obstruction, the surgery helps prevent ischemic events caused by plaque rupture or embolization.

Rationale for correct answer:
3. Prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow. This is the main goal of carotid endarterectomy. By physically eliminating the plaque, the artery is widened, restoring blood flow to the brain and significantly reducing the chance of ischemic stroke. It is considered for patients with moderate to severe stenosis and recurrent TIAs.

Rationale for incorrect answers:
1. Decrease cerebral edema. Carotid endarterectomy does not treat cerebral swelling. Cerebral edema is managed medically with osmotic diuretics, corticosteroids (in some cases), or surgical decompression, not with vascular surgery.

2. Reduce the brain damage that occurs during a stroke in evolution. Once a stroke is actively occurring, endarterectomy is not indicated because it cannot reverse acute ischemic brain damage. It is a preventive, not acute, intervention.

4. Provide a circulatory bypass around thrombotic plaques obstructing cranial circulation. Carotid endarterectomy does not involve bypassing blocked arteries; instead, it involves direct removal of the obstruction (plaque) from the carotid artery.

Take-home points:

• Carotid endarterectomy is a preventive surgery aimed at reducing stroke risk in patients with significant carotid stenosis or TIAs.
• It works by removing plaques that impair cerebral blood flow, not by treating active strokes or bypassing arteries.
• Careful patient selection is essential to balance the benefits with surgical risks.

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.

Patients with TIAs are at increased risk of developing an ischemic stroke due to transient but recurrent interruptions in cerebral blood flow. Administration of daily low-dose aspirin, an antiplatelet medication, reduces platelet aggregation and prevents clot formation in cerebral arteries. This prophylactic therapy significantly decreases the likelihood of progression from TIA to stroke in high-risk individuals. Because of its proven effectiveness, aspirin is the most widely recommended first-line medication for secondary stroke prevention.

Rationale for correct answer:
3. Daily low-dose aspirin. Aspirin works by irreversibly inhibiting platelet aggregation, thereby reducing the risk of thrombus formation in cerebral arteries. Multiple studies have shown that aspirin decreases the incidence of ischemic stroke in patients with TIAs and other vascular risk factors. It is a cornerstone therapy in secondary prevention of ischemic stroke.

Rationale for incorrect answers:
1. Furosemide (Lasix). This is a loop diuretic used to manage fluid overload in conditions like heart failure or renal disease. It has no role in preventing thrombus formation or reducing stroke incidence in TIA patients.

2. Lovastatin (Mevacor). Statins help reduce cholesterol and are useful in long-term prevention of atherosclerotic disease. However, their role is more in reducing cardiovascular risk over time rather than immediate prevention of stroke following TIAs.

4. Nimodipine (Nimotop). This calcium channel blocker is specifically used to prevent cerebral vasospasm after subarachnoid hemorrhage, not in the prevention of ischemic stroke after TIAs.

Take-home points:

• Low-dose aspirin is the most effective and widely recommended medication to reduce stroke risk in patients with TIAs.
• Antiplatelet therapy plays a central role in secondary prevention of ischemic stroke.
• Medications like diuretics, statins, and calcium channel blockers have roles in cardiovascular care but do not replace aspirin for TIA-related stroke prevention.

In the emergency management of a stroke, the first priority is ensuring airway patency and adequate oxygenation, since the brain is highly sensitive to oxygen deprivation. Without sufficient oxygen delivery, neurologic injury progresses rapidly, worsening deficits and increasing the risk of mortality. While fluid balance, edema control, and neuroprotection are important, they are secondary to immediate respiratory support. Maintaining oxygenation preserves cerebral perfusion and minimizes irreversible ischemic injury.

Rationale for correct answer:
4. Maintenance of respiratory function with a patent airway and oxygen administration. This is the highest priority because brain tissue cannot survive without oxygen, and hypoxemia can worsen neurologic injury within minutes. Supporting the airway and ensuring oxygen delivery prevents secondary brain injury and allows time for diagnostic imaging and definitive treatment. This intervention forms the foundation of acute stroke management.

Rationale for incorrect answers:
1. Intravenous fluid replacement. Although fluids may be required for hemodynamic stability, aggressive replacement is not the first priority. Overhydration can worsen cerebral edema, and fluids should be carefully balanced after airway and breathing are stabilized.

2. Administration of osmotic diuretics to reduce cerebral edema. Osmotic diuretics like mannitol are sometimes used in the management of increased intracranial pressure, but this is not the first-line emergency intervention. Their use comes later, guided by imaging and clinical findings, not before airway stabilization.

3. Initiation of hypothermia to decrease the oxygen needs of the brain. Therapeutic hypothermia is not a standard initial treatment for stroke in the emergency setting. It may be explored in research or specialized contexts, but it does not replace basic airway and oxygen management.

Take-home points:

• Airway and oxygenation are the first priorities in acute stroke management to prevent secondary brain injury.
• Other interventions, such as fluid balance and ICP control, follow only after respiratory stability is established.
• Early stabilization allows for rapid diagnostic imaging and initiation of stroke-specific treatments (e.g., thrombolysis or surgical intervention).

After a stroke, patients are at high risk for aspiration due to impaired swallowing function. The first nursing action is to check the gag reflex before offering any food, fluids, or medications orally. Ensuring airway protection is critical, since aspiration can lead to pneumonia and further complications. Early assessment of swallowing safety guides dietary decisions and prevents potentially life-threatening respiratory issues.

Rationale for correct answer:
1. Check the patient’s gag reflex. This assessment provides crucial information about the safety of oral intake and helps prevent aspiration. A weak or absent gag reflex indicates the need for swallowing studies or alternate feeding methods until the patient’s airway protection is assured. Performing this check first ensures patient safety before advancing to diet orders or swallowing trials.

Rationale for incorrect answers:
2. Order a soft diet for the patient. Ordering food before assessing the patient’s gag reflex or swallow ability is unsafe. If the patient aspirates, it may lead to pneumonia or airway obstruction, which worsens outcomes after a stroke.

3. Raise the head of the bed to a sitting position. While this position is helpful in reducing aspiration risk and aiding breathing, it should not be the very first action. Without confirming the gag reflex, even upright positioning cannot fully protect against aspiration during oral intake.

4. Evaluate the patient’s ability to swallow small amounts of crushed ice or ice water. Swallow trials should never be attempted before confirming a gag reflex. Testing swallowing too early may directly expose the patient to aspiration risks.

Take-home points:

• Always assess gag reflex first in stroke patients before offering food, fluids, or medications orally.
• Airway protection takes priority over comfort or nutrition in the immediate phase of care.
• Safe feeding decisions must be guided by swallowing assessments and may involve referral to speech-language pathology.

Patients with mild dysphagia require foods that are soft, easily chewed, and cohesive, reducing the risk of aspiration. Scrambled eggs are an excellent choice because they are soft, moist, and can be swallowed with minimal effort. They also provide good nutritional value while being less likely to fragment or cause choking compared to thin liquids or dry foods. Selecting the correct food texture is critical in preventing aspiration and ensuring adequate nutrition.

Rationale for correct answer:
3. Scrambled eggs. These are soft, moist, and easy to manipulate in the mouth, making them safer for patients with mild dysphagia. They hold together well, reducing the risk of food particles entering the airway. Scrambled eggs also provide a high-protein, nutrient-dense option that supports recovery.

Rationale for incorrect answers:
1. Fruit juices. Thin liquids like juice are among the most difficult to swallow for patients with dysphagia. They move too quickly through the oropharynx, increasing the risk of aspiration. Thickened liquids are preferred instead.

2. Pureed meat. While pureed foods are appropriate for moderate to severe dysphagia, they are unnecessarily restrictive for mild dysphagia. They may also be unappealing, leading to poor oral intake and reduced nutrition.

4. Fortified milkshakes. Like fruit juices, milkshakes are thin liquids unless thickened. These can increase aspiration risk in patients with impaired swallowing function. Even though they are nutrient-rich, they are unsafe without consistency modification.

Take-home points:

• Soft, moist, and cohesive foods like scrambled eggs are safest for mild dysphagia.
• Avoid thin liquids (juices, milkshakes) as they pose a high risk of aspiration.
• Dietary adjustments should always be individualized based on swallow assessment and speech-language pathology recommendations.

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 thorough rehabilitation assessment evaluates not only the patient’s physical status and remaining function but also the family’s ability to support recovery. Understanding body strength, affected systems, and the patient and caregiver’s expectations allows the nurse to design a rehabilitation program that is realistic, safe, and tailored to the patient’s needs. Including the family’s cognitive status ensures they can participate effectively in care and support the patient during rehabilitation.

Rationale for correct answers:
1. Cognitive status of the family. Assessing the family’s cognitive ability ensures they can understand instructions, provide appropriate support, and participate safely in rehabilitation activities.

4. Body strength remaining after the stroke. Knowing which muscles and movements are still functional guides physical therapy goals and interventions.

5. Physical status of body systems affected by the stroke. Stroke can impact cardiovascular, respiratory, neurological, and musculoskeletal systems; a complete assessment ensures interventions are safe and comprehensive.

6. Patient and caregiver expectations of the rehabilitation. Aligning expectations with achievable goals improves motivation, adherence, and satisfaction with the rehabilitation program.

Rationale for incorrect answers:
2. Patient resources and support. While support is important, it is not prioritized in this assessment if the focus is on the patient’s physical function and the family’s ability to participate in rehabilitation.

3. Rehabilitation potential of the patient. The client should be considered without limitation on their potential hence predicting their outcomes would not be appropriate.

Take-home points:

• Rehabilitation assessment should evaluate the patient’s current physical abilities and affected body systems.
• Family cognitive status and patient/caregiver expectations are essential to plan safe and achievable goals.
• Tailoring the program to strengths and needs improves recovery outcomes and supports long-term independence.

For patients with aphasia, communication is often more effective when it relates to familiar and meaningful topics, such as daily routines or personal interests. Discussing ADLs helps the patient understand, recall, and participate in conversation more easily, which improves engagement and supports cognitive-linguistic rehabilitation. Using familiar contexts reduces frustration and strengthens connections between language and functional activities.

Rationale for correct answer:
2. Talk about activities of daily living (ADLs) that are familiar to the patient. Familiar topics make comprehension easier and provide a context for the patient to practice expressive and receptive language. This approach enhances confidence, promotes interaction, and facilitates rehabilitation of everyday communication skills. It also reinforces independence and meaningful engagement in daily life.

Rationale for incorrect answers:
1. Use gestures, pictures, and music to stimulate patient responses. Gestures, pictures, and simple statements are more appropriate in the acute phase,

3. Structure statements so that the patient does not have to respond verbally. Avoiding verbal responses limits opportunities for the patient to practice and regain language skills. Rehabilitation aims to encourage active communication.

4. Use flashcards with simple words and pictures to promote recall of language. Flashcards are often perceived by the patient as childish and meaningless. Not responding verbally does not promote communication.

Take-home points:

• Focus on familiar topics like ADLs to enhance comprehension and participation.
• Encouraging conversation about meaningful activities supports functional communication and confidence.
• Complementary strategies (gestures, visual aids) can be used as needed, but contextual conversation is primary.

Unilateral neglect occurs when a patient ignores the side of the body opposite the brain lesion—in this case, the left side after a right hemisphere stroke. Rehabilitation focuses on increasing awareness of and engagement with the neglected side, since avoidance worsens functional loss. Teaching the patient to consciously attend to and care for the affected side promotes recovery and independence.

Rationale for correct answer:
3. Teach the patient to care consciously for the affected side. This intervention helps retrain the brain by encouraging use and recognition of the neglected side. Techniques may include scanning the environment, turning the head toward the affected side, and actively involving the limb in care tasks. These strategies reduce injury risk and improve functional recovery.

Rationale for incorrect answers:
1. Avoid positioning the patient on the affected side. Avoidance reinforces neglect and increases the risk of pressure injuries and contractures by not using or monitoring the affected side.

2. Place all objects for care on the patient’s unaffected side. While convenient, this worsens neglect by limiting opportunities to interact with the affected side. Rehabilitation requires stimulation of the neglected field.

4. Protect the affected side from injury with pillows and supports. Positioning aids are useful but insufficient as the primary intervention. Without retraining awareness, the patient remains at high risk for long-term neglect and dependency.

Take-home points:

• Unilateral neglect requires active retraining, not avoidance.
• Encourage patients to scan, attend, and use the neglected side to prevent injury and promote independence.
• Safety strategies like positioning aids are supportive but must be combined with conscious engagement training.