CNA Basic Nursing Skills 15 2 — Questions and Answers

Question 1: Which statement BEST describes what causes a stroke (cerebrovascular accident)?

A rapid drop in blood pressure due to excessive fluid intake
Interrupted blood flow to part of the brain, causing brain cell death (Correct answer)
An electrical disturbance in the brain causing seizure activity
Inflammation of the brain tissue due to viral infection

Correct answer: Interrupted blood flow to part of the brain, causing brain cell death

A stroke occurs when blood flow to part of the brain is blocked (ischemic stroke) or a blood vessel ruptures (hemorrhagic stroke), causing brain cells to die from oxygen deprivation.

Strokes are the leading cause of serious long-term disability in adults. Ischemic stroke (approximately 87% of strokes) occurs when a blood clot or plaque occludes a brain artery, cutting off oxygenated blood to the downstream brain tissue. The affected brain cells begin dying within minutes. Hemorrhagic stroke occurs when a blood vessel ruptures (often due to uncontrolled hypertension or aneurysm), causing bleeding directly into brain tissue. Both types produce similar deficits depending on the brain region affected. Seizures involve electrical disturbances, not blood flow interruption. Encephalitis (brain inflammation from viruses) is a distinct condition.

Question 2: A resident suddenly cannot speak, has facial drooping on one side, and cannot lift one arm. The CNA should FIRST:

Help the patient to bed and monitor for improvement
Call a code or emergency response immediately — these are signs of an acute stroke (Correct answer)
Ask the patient to take deep breaths and try speaking again
Document the observations and notify the nurse at the next round

Correct answer: Call a code or emergency response immediately — these are signs of an acute stroke

Sudden speech loss, facial drooping, and arm weakness are the FAST warning signs of stroke — this is a time-critical emergency and the CNA must immediately activate emergency response.

Stroke is a time-critical medical emergency — every minute of delayed treatment causes approximately 1.9 million brain cells to die. The FAST acronym (Face drooping, Arm weakness, Speech difficulty, Time to call) identifies the most common stroke signs. The CNA must immediately: (1) activate the facility's emergency response system or call 911, (2) stay with the patient, (3) do not give anything by mouth, (4) monitor and document the time the symptoms were first noticed (crucial for tPA eligibility — must be within 4.5 hours of symptom onset), and (5) provide information to the responding nurse or emergency team. Delaying response for any reason is dangerous.

Question 3: A resident who had a stroke now has left-sided hemiplegia. When assisting the resident to walk with a gait belt, the CNA should position themselves:

Directly in front of the resident to pull them forward
On the resident's stronger (right) side, walking slightly behind
On the resident's weaker (left) side to support and protect against falls to that side (Correct answer)
Behind the resident and push them forward gently

Correct answer: On the resident's weaker (left) side to support and protect against falls to that side

The CNA stands on the patient's weaker side to provide physical support and protection against falls toward the hemiplegic side, which is the side at greatest risk.

In hemiplegia (one-sided paralysis or weakness), the affected side cannot bear weight reliably or protect against falls. The CNA positions themselves on the weak side with one hand gripping the gait belt at the back and the other hand ready to support the patient's weakened arm if needed. This placement means the CNA is between the patient and the direction they are most likely to fall. Walking slightly behind allows the CNA to see the patient's gait and react quickly. Standing in front would pull the patient forward (dangerous), and standing on the strong side leaves the weak side unprotected.

Question 4: A stroke patient has left-sided neglect (unilateral neglect). This means the patient:

Is refusing care on purpose and should be encouraged more firmly
Has difficulty perceiving or responding to stimuli on the left side of their body or environment (Correct answer)
Has complete paralysis on the left side with no sensation
Has visual problems that affect only nighttime vision

Correct answer: Has difficulty perceiving or responding to stimuli on the left side of their body or environment

Left-sided neglect is a perceptual deficit caused by right hemisphere stroke damage in which the patient fails to notice or respond to people, objects, or their own body on the left side.

Unilateral neglect (hemispatial neglect) occurs when a stroke damages the right hemisphere of the brain, which controls spatial awareness. The patient is not choosing to ignore their left side — their brain simply fails to register stimuli from that side. Clinical manifestations include: eating only food on the right side of the plate, bumping into objects or doorframes on the left, leaving the left arm in uncomfortable positions, applying makeup or shaving only one side of the face, and reading only the right side of text. CNA interventions: approach and place items from the neglected side to promote awareness, remind the patient to check their left side, and ensure safety by protecting the neglected limb from injury.

Question 5: Which activity should the CNA encourage to support rehabilitation after a stroke?

Complete bedrest until the patient regains full strength
Encouraging the patient to use the affected limb in functional tasks as much as possible (Correct answer)
Performing all activities for the patient to conserve their energy for healing
Restricting the patient to passive range of motion only until cleared by the physician

Correct answer: Encouraging the patient to use the affected limb in functional tasks as much as possible

Neuroplasticity research shows that using the affected limb in functional activities (task-specific training) promotes brain remapping and functional recovery after stroke.

Stroke rehabilitation is based on neuroplasticity — the brain's ability to reorganize and form new neural connections in response to practice and use. Complete bedrest or doing everything for the patient prevents this neural reorganization and leads to learned non-use (the brain stops trying to use the affected limb). Evidence-based principles from physical and occupational therapy require: active participation in ADLs using the affected side as much as possible, task-specific practice (e.g., practicing reaching with the affected arm during dressing), and gradual progression of challenge. The CNA reinforces therapy goals during ADL assistance by encouraging the patient to attempt movements with the affected limb before providing assistance.

Question 6: Which risk factor is MOST commonly associated with stroke?

Regular moderate exercise
Poorly controlled hypertension (high blood pressure) (Correct answer)
High dietary fiber intake
Regular aspirin use as prescribed by a physician

Correct answer: Poorly controlled hypertension (high blood pressure)

Uncontrolled hypertension is the single most important modifiable risk factor for both ischemic and hemorrhagic stroke, damaging blood vessel walls over time.

Hypertension is the leading modifiable stroke risk factor because chronically elevated blood pressure damages the inner lining (endothelium) of blood vessels, promotes atherosclerotic plaque formation (increasing clot risk), and weakens arterial walls (increasing aneurysm and hemorrhage risk). Other major modifiable risk factors include: atrial fibrillation, diabetes mellitus, smoking, dyslipidemia, obesity, physical inactivity, and excessive alcohol use. Regular exercise, dietary fiber, and physician-prescribed aspirin are protective factors. Understanding risk factors helps CNAs appreciate the importance of blood pressure monitoring and medication adherence in the patients they care for.

CNA Basic Nursing Skills 15 2

Which statement BEST describes what causes a stroke (cerebrovascular accident)?