FAST stands for Facial droop, Arm drift/weakness, Speech difficulty, and Time to call 911 immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is suspected of having an acute ischemic stroke and arrives within the treatment window. Which assessment is the priority before thrombolytic therapy is considered?
Answer: A. Before thrombolytic (alteplase) therapy for ischemic stroke, a non-contrast CT scan must rule out hemorrhage, because giving a thrombolytic during a hemorrhagic stroke is contraindicated and dangerous. Establishing the last known well time and screening for contraindications are also essential, but confirming the absence of bleeding via imaging is the priority safety step.
Question 2 of 5
A client suddenly has facial droop, arm weakness, and slurred speech. The nurse's priority is to:
Answer: B. Suspect stroke (FAST). Note the exact time of symptom onset and activate the stroke protocol — eligibility for tPA depends on the time window (generally within 3–4.5 hours).
Question 3 of 5
A client recovering from a left-hemisphere stroke shows the expected behavioral pattern. Which finding is the nurse MOST likely to observe?
Answer: A. Left-hemisphere strokes commonly produce aphasia (the left side usually controls language) and a slow, cautious, anxious behavioral style, along with right-sided weakness. Right-hemisphere strokes more often cause impulsiveness, poor judgment of abilities, and left-sided neglect. Therefore slow, cautious behavior with language deficits is most consistent with a left-hemisphere stroke.
Question 4 of 5
A client is admitted with a hemorrhagic stroke. Which intervention should the nurse anticipate to help control intracranial pressure?
Answer: B. For hemorrhagic stroke, blood pressure is lowered carefully and the head of the bed is elevated to about 30 degrees with the head midline to promote venous drainage and reduce intracranial pressure. Thrombolytics and anticoagulants are contraindicated because they would worsen bleeding. Trendelenburg position increases intracranial pressure.
Question 5 of 5
A client with a right-hemisphere stroke neglects the left side of the body and bumps into objects on the left. Which term BEST describes this finding?
Answer: A. Unilateral neglect (hemineglect) is common with right-hemisphere strokes; the client ignores stimuli on the affected (left) side. Homonymous hemianopsia is loss of half the visual field, which may coexist but is a visual deficit. Agnosia is failure to recognize objects, and apraxia is inability to perform purposeful movement.
Keep the streak going with more questions like these, each with a full rationale.
What is acute stroke recognition (fast)?
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.
Key points to remember
- 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.
Nursing priorities
- 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.
Labs & values
Patient teaching
- 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.
Red flags: report now
- 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.
References
Clinical references for this topic
