👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: stroke · brain attack · cva · cerebrovascular accident · fast warning signs
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Use this quick-reference guide to spot, treat, and prevent Acute Stroke Recognition (FAST) on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Fast
Face droop, Arm drift
Speech slurred, Time to call
✅ Do
Note LAST KNOWN WELL time
Stat non-contrast CT head
Check glucose, swallow screen
📌 Tpa
tPA window ≤ 3-4.5h ischemic
Rule out bleed FIRST
📌 Avoid
No food/fluids till swallow OK
tPA if hemorrhagic stroke
📚 Acute Stroke Recognition (FAST) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Stroke is sudden interruption of cerebral blood flow from a clot (ischemic) or bleed (hemorrhagic), causing rapid, often irreversible brain injury. Time is brain: fast recognition and treatment preserve neurologic function. The FAST mnemonic (Face droop, Arm weakness, Speech difficulty, Time to call 911) speeds identification.
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Key points
Understand these first
FAST stands for Facial droop, Arm drift/weakness, Speech difficulty, and Time to call 911 immediately.
Sudden unilateral weakness, numbness, vision loss, confusion, severe headache, and trouble speaking are classic warning signs.
A noncontrast head CT is the first priority to distinguish ischemic from hemorrhagic stroke before treatment.
Thrombolytics (tPA/alteplase) are given for ischemic stroke within the window (about 3 to 4.5 hours of last known well) only after hemorrhage is ruled out.
Thrombolytics are absolutely contraindicated in hemorrhagic stroke and recent bleeding/surgery.
Establishing the last-known-well time determines treatment eligibility.
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Nursing priorities
What to do, in order
Recognize FAST signs and note the exact time of symptom onset (last known well).
Activate the stroke alert/code and expedite a noncontrast head CT.
Maintain airway, give oxygen if hypoxic, and check blood glucose to rule out mimics.
Perform frequent neuro checks with NIH Stroke Scale and monitor blood pressure.
Withhold food and oral medications until a swallow screen confirms it is safe.
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Red flags — report now
Escalate immediately
Sudden facial droop, arm weakness, or slurred speech requires immediate stroke alert activation.
Never give tPA before a head CT rules out hemorrhage.
The worst headache of life with neuro changes suggests hemorrhagic stroke - report now.
Do not give food or oral meds before the swallow screen due to aspiration risk.
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Labs & values
Numbers to know
Blood glucose to exclude hypoglycemia mimic (normal 70-110 mg/dL)
PT/INR and aPTT before thrombolytics
Platelets greater than 100,000/mcL for tPA eligibility
Noncontrast head CT differentiates ischemic vs hemorrhagic
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Patient teaching
What patients must know
Call 911 immediately for any FAST symptom; do not wait to see if it passes.
Note the time symptoms started, as it determines treatment options.
Control blood pressure, diabetes, atrial fibrillation, and cholesterol and stop smoking to reduce risk.
Take prescribed anticoagulants or antiplatelets as directed for prevention.
❓ Acute Stroke Recognition (FAST): NCLEX FAQs
What are the priority nursing interventions for Acute Stroke Recognition (FAST)?
Recognize FAST signs and note the exact time of symptom onset (last known well). Activate the stroke alert/code and expedite a noncontrast head CT. Maintain airway, give oxygen if hypoxic, and check blood glucose to rule out mimics. Perform frequent neuro checks with NIH Stroke Scale and monitor blood pressure.
What are the warning signs of Acute Stroke Recognition (FAST) a nurse must report?
Sudden facial droop, arm weakness, or slurred speech requires immediate stroke alert activation. Never give tPA before a head CT rules out hemorrhage. The worst headache of life with neuro changes suggests hemorrhagic stroke - report now. Do not give food or oral meds before the swallow screen due to aspiration risk.
What do I need to know about Acute Stroke Recognition (FAST) for the NCLEX?
FAST stands for Facial droop, Arm drift/weakness, Speech difficulty, and Time to call 911 immediately. Sudden unilateral weakness, numbness, vision loss, confusion, severe headache, and trouble speaking are classic warning signs. A noncontrast head CT is the first priority to distinguish ischemic from hemorrhagic stroke before treatment. Thrombolytics (tPA/alteplase) are given for ischemic stroke within the window (about 3 to 4.5 hours of last known well) only after hemorrhage is ruled out.
What patient teaching is important for Acute Stroke Recognition (FAST)?
Call 911 immediately for any FAST symptom; do not wait to see if it passes. Note the time symptoms started, as it determines treatment options. Control blood pressure, diabetes, atrial fibrillation, and cholesterol and stop smoking to reduce risk. Take prescribed anticoagulants or antiplatelets as directed for prevention.
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Quick Tip
FAST stands for Facial droop, Arm drift/weakness, Speech difficulty, and Time to call 911 immediately.