Which of the following core measures should the nurse implement for a client experiencing an acute stroke? Select four that apply.

Acute stroke management follows evidence-based core measures aimed at improving outcomes, reducing complications, and preventing recurrence. These measures include timely reperfusion therapy, prevention of venous thromboembolism (VTE), appropriate antithrombotic management, and patient education. Early implementation of standardized stroke protocols improves survival and functional recovery. Nursing care plays a central role in ensuring adherence to these time-sensitive and guideline-driven interventions. Rationale: A. Delaying rehabilitation assessments until after discharge is incorrect because early rehabilitation evaluation is an essential component of stroke care. Early mobilization and assessment help reduce complications such as contractures, pressure injuries, and functional decline. Rehabilitation planning begins during hospitalization to improve recovery outcomes. B. Reevaluating antithrombotic therapy on hospital day 2 is appropriate because stroke management includes reassessment of antiplatelet or anticoagulant therapy based on stroke type and clinical progression. This ensures optimal prevention of recurrent cerebrovascular events while balancing bleeding risk. Adjustments are made according to diagnostic findings and patient response. C. Documenting stroke education for the client is a core measure because patient and family education is essential for secondary prevention. Education includes risk factor modification, medication adherence, and recognition of stroke warning signs. Proper documentation ensures continuity of care and confirms that discharge teaching has been completed. D. Increasing the dosage of anticoagulants immediately is not a core stroke measure and may be unsafe without proper evaluation. Anticoagulant therapy must be carefully individualized based on stroke type (ischemic vs hemorrhagic) and bleeding risk. Empiric dose escalation could increase the risk of intracranial hemorrhage. E. Providing VTE prophylaxis is a key core measure because stroke clients are at high risk for immobility-related complications such as deep vein thrombosis and pulmonary embolism. Interventions may include pharmacologic prophylaxis (e.g., low-dose heparin) and mechanical devices like sequential compression devices. This reduces morbidity and mortality during hospitalization. F. Administering thrombolytic therapy as indicated is a critical acute stroke intervention for eligible clients with ischemic stroke. Timely administration of thrombolytics such as tissue plasminogen activator (tPA) can restore cerebral perfusion and minimize neurologic damage. This treatment must be given within a strict therapeutic time window and after exclusion of hemorrhagic stroke.