# A 68-year-old arrives in the emergency department 35 minutes after suddenly developing facial asymmetry and difficulty speaking. The client is awake, and point-of-care glucose is 108 mg/dL. For each group, select all responses that apply.

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 68-year-old arrives in the emergency department 35 minutes after suddenly developing facial asymmetry and difficulty speaking. The client is awake, and point-of-care glucose is 108 mg/dL. For each group, select all responses that apply.

Findings that support immediate stroke activation

New left facial droop when asked to smile

New slurred speech while repeating a sentence

Bilateral knee pain that has worsened over 6 months

Point-of-care glucose of 108 mg/dL

Actions to complete without delaying the stroke pathway

Activate the facility stroke response immediately

Document the exact time the client was last known well

Offer oral fluids while waiting for symptoms to improve

Delay notification until symptoms have persisted for 1 hour

## Explanation

Sudden unilateral facial weakness and new speech difficulty are stroke warning signs. Activate the stroke pathway immediately and establish the last-known-well time; do not wait for persistence or give oral intake during the urgent evaluation.

## In-depth explanation

Quick answer
Stroke cues: new facial droop and slurred speech. Actions: activate the stroke response and record the last-known-well time.
Why this is the best response
The onset is sudden and focal, and a normal bedside glucose does not explain the deficit. Time-to-evaluation directly affects eligibility for time-sensitive treatment.
Why the alternatives do not fit
Chronic knee pain is not an acute focal neurologic cue. Waiting or giving oral fluids delays a time-critical evaluation and may add aspiration risk before swallowing safety is established.
**Sources**
- CDC — Signs and Symptoms of Stroke

- CDC — Treatment and Intervention for Stroke

## Key concepts

- **Last known well** — The last time the client was known to be at the neurologic baseline.
- **Stroke activation** — Immediate emergency evaluation because time-sensitive treatment depends on rapid recognition.

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