NPTE Practice Test 5

Scenario: left MCA stroke, acute care to inpatient rehabilitation

A 67-year-old right-handed woman was admitted to an acute stroke unit with sudden right-sided weakness and difficulty speaking. MRI showed an ischemic infarct in the superior division of the left middle cerebral artery territory, involving the left frontal and parietal cortex. She received IV thrombolysis on admission. History: hypertension and type 2 diabetes. She lives with her spouse in a single-level home.

Day 2 (acute care): The physician has cleared her for mobility. BP 162/88 mm Hg, HR 78 beats/min, SpO2 97% on room air. Her speech is nonfluent and effortful, and she follows simple commands. She has right lower facial weakness. Right UE: shoulder flexion 1/5, no active wrist or finger movement. Right LE: hip flexion 3-/5, knee extension 3/5, ankle dorsiflexion 1/5. The right glenohumeral joint has one fingerbreadth of inferior subluxation. She sits on the edge of the bed with minimal assist, leaning to the right, and needs moderate assist of 1 to stand.

Day 10: She was transferred to an inpatient rehabilitation facility. Day 14: She walks 10 m with a quad cane and a right ankle-foot orthosis with moderate assist of 1; comfortable gait speed is 0.22 m/s. Her goal is to return home and walk in the community.