In suspected cerebrovascular accident with facial paralysis and left-sided weakness, a spouse tries to give the patient water. What action should the nurse take first?

• A. Encourage the spouse to give fluids to prevent dehydration
• B. Ask the spouse to stop and assess the swallowing reflex
• C. Place the patient in a flat position and monitor vitals
• D. Call the physician for orders about hydration

Answer: (B)

After a suspected stroke, facial weakness and unilateral weakness raise the chance of dysphagia, meaning swallowing may be unsafe. Giving water by mouth at this moment could cause fluid to go into the airway and lead to choking or aspiration pneumonia. The first step is to pause any oral intake and assess whether the patient can swallow safely. This involves stopping the fluids and performing a quick swallow assessment or gag reflex check, while keeping the patient in an upright position to protect the airway. Only after confirming that swallowing is safe should oral fluids be resumed or a formal swallow evaluation be arranged.