Stroke (CVA) — NCLEX Cheat Sheet
FAST → time = brainAlso known as: stroke · brain attack · CVA · cerebrovascular accident
Use this quick-reference guide to spot, treat, and prevent Stroke (CVA) on the NCLEX. Keep it handy during review and on exam day!
🩺📒 The 1-minute cheat sheet
📌 Types
- Ischemic (87%) = clot/thrombus
- Hemorrhagic = bleed, worse HA
🩺 Signs
- Face droop, arm drift, speech
- Hemiparesis, aphasia, hemianopia
- Right brain → left side weakness
✅ Do
- CT FIRST → rule out bleed
- tPA within 3-4.5h if ischemic
- Swallow eval before food/meds
📌 Avoid
- tPA if hemorrhagic = fatal
- Affected-side IV/positioning
📚 Stroke (CVA) — 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.
Key points
Understand these first- Symptoms are usually sudden and one-sided: facial droop, arm/leg weakness, and slurred or garbled speech.
- Deficits appear on the side of the body OPPOSITE the affected brain hemisphere.
- Left-brain stroke commonly causes aphasia and a slow, cautious behavior style; right-brain stroke causes spatial-perceptual deficits and impulsiveness.
- Ischemic stroke is treated with tPA if within the window; hemorrhagic stroke must NEVER receive tPA or anticoagulants.
- Homonymous hemianopsia (loss of half the visual field) and unilateral neglect are common and increase fall and injury risk.
Nursing priorities
What to do, in order- Assess and protect the airway first; position to prevent aspiration and keep the head of bed elevated unless contraindicated.
- Determine the exact time of symptom onset (last known well) immediately, as it dictates tPA eligibility.
- Obtain a stat noncontrast CT scan to distinguish ischemic from hemorrhagic before any clot-busting therapy.
- Perform frequent neuro checks (NIH Stroke Scale, pupils, level of consciousness) and monitor blood pressure.
- Implement aspiration precautions and a dysphagia (swallow) screen before giving any food, fluids, or oral meds.
Red flags — report now
Escalate immediately- A sudden severe 'worst headache of my life,' decreasing LOC, or vomiting suggests hemorrhage or rising ICP, report immediately.
- Never give tPA, aspirin, or anticoagulants until a CT has ruled out bleeding.
- Bleeding from gums, IV sites, or in urine/stool after tPA signals hemorrhage, stop the infusion and notify the provider.
- A new decline in neuro status or fixed/dilated pupil is a neurologic emergency.
Labs & values
Numbers to know- Blood glucose (normal 70-110 mg/dL; rule out hypoglycemia mimicking stroke)
- INR (normal ~0.8-1.1; must be acceptable before tPA)
- Platelets (normal 150,000-400,000/mcL)
Patient teaching
What patients must know- Recognize stroke warning signs and call 911 immediately, do not wait or drive yourself.
- Control blood pressure, cholesterol, diabetes, and stop smoking to prevent recurrence.
- Approach a patient with neglect from the unaffected side and place objects within their intact visual field.
❓ Stroke (CVA): NCLEX FAQs
What are the priority nursing interventions for Stroke (CVA)?
Assess and protect the airway first; position to prevent aspiration and keep the head of bed elevated unless contraindicated. Determine the exact time of symptom onset (last known well) immediately, as it dictates tPA eligibility. Obtain a stat noncontrast CT scan to distinguish ischemic from hemorrhagic before any clot-busting therapy. Perform frequent neuro checks (NIH Stroke Scale, pupils, level of consciousness) and monitor blood pressure.
What are the warning signs of Stroke (CVA) a nurse must report?
A sudden severe 'worst headache of my life,' decreasing LOC, or vomiting suggests hemorrhage or rising ICP, report immediately. Never give tPA, aspirin, or anticoagulants until a CT has ruled out bleeding. Bleeding from gums, IV sites, or in urine/stool after tPA signals hemorrhage, stop the infusion and notify the provider. A new decline in neuro status or fixed/dilated pupil is a neurologic emergency.
What do I need to know about Stroke (CVA) for the NCLEX?
Symptoms are usually sudden and one-sided: facial droop, arm/leg weakness, and slurred or garbled speech. Deficits appear on the side of the body OPPOSITE the affected brain hemisphere. Left-brain stroke commonly causes aphasia and a slow, cautious behavior style; right-brain stroke causes spatial-perceptual deficits and impulsiveness. Ischemic stroke is treated with tPA if within the window; hemorrhagic stroke must NEVER receive tPA or anticoagulants.
What patient teaching is important for Stroke (CVA)?
Recognize stroke warning signs and call 911 immediately, do not wait or drive yourself. Control blood pressure, cholesterol, diabetes, and stop smoking to prevent recurrence. Approach a patient with neglect from the unaffected side and place objects within their intact visual field.
Quick Tip
Symptoms are usually sudden and one-sided: facial droop, arm/leg weakness, and slurred or garbled speech.
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