ACLS Acute Stroke Care 3 — Questions and Answers
Question 1: What is the recommended glucose target range in acute ischemic stroke patients to prevent worsening outcomes?
- 60–100 mg/dL
- 140–180 mg/dL (Correct answer)
- 180–220 mg/dL
- 100–120 mg/dL
Correct answer: 140–180 mg/dL
Hyperglycemia worsens stroke outcomes; AHA/ASA guidelines recommend treating glucose > 180 mg/dL and maintaining levels of 140–180 mg/dL.
Question 2: A patient with acute ischemic stroke has a temperature of 38.6°C. Which intervention is most appropriate?
- Active cooling blanket to achieve hypothermia
- Acetaminophen to reduce fever toward normothermia (Correct answer)
- No treatment; fever is a normal stress response
- Ice packs to the neck only
Correct answer: Acetaminophen to reduce fever toward normothermia
Fever increases cerebral metabolic demand and worsens ischemic injury; antipyretics (e.g., acetaminophen) should be used to achieve normothermia.
Question 3: Which of the following is the MOST sensitive early imaging modality for detecting acute ischemic stroke within the first few hours of onset?
- Non-contrast CT head
- CT angiography
- Diffusion-weighted MRI (DWI) (Correct answer)
- CT perfusion
Correct answer: Diffusion-weighted MRI (DWI)
DWI-MRI detects cytotoxic edema within minutes of ischemia onset and is far more sensitive than CT in the hyperacute phase.
Question 4: A patient is eligible for IV tPA. The dose of alteplase for acute ischemic stroke is:
- 0.6 mg/kg IV, max 60 mg
- 0.9 mg/kg IV, max 90 mg (Correct answer)
- 1.1 mg/kg IV, max 110 mg
- 0.9 mg/kg IV, max 80 mg
Correct answer: 0.9 mg/kg IV, max 90 mg
The standard dose is 0.9 mg/kg (maximum 90 mg), with 10% given as an IV bolus over 1 minute and the remainder over 60 minutes.
Question 5: What oxygen saturation target should be maintained in acute ischemic stroke patients without hypoxia?
- SpO₂ > 94%; do not give supplemental O₂ if already ≥ 94% (Correct answer)
- SpO₂ 100%; always provide high-flow O₂
- SpO₂ > 88%; permissive hypoxia is acceptable
- SpO₂ > 80%; avoid O₂ to prevent vasoconstriction
Correct answer: SpO₂ > 94%; do not give supplemental O₂ if already ≥ 94%
Supplemental oxygen is indicated only if SpO₂ < 94%; routine hyperoxia provides no benefit and may be harmful.
Question 6: Which statement about permissive hypertension in acute ischemic stroke is CORRECT?
- BP should be aggressively lowered to < 140/90 mmHg immediately
- BP up to 220/120 mmHg may be tolerated in non-tPA candidates to maintain penumbral perfusion (Correct answer)
- IV labetalol must be given for any BP > 160/90 mmHg
- Calcium channel blockers are first-line for any BP elevation
Correct answer: BP up to 220/120 mmHg may be tolerated in non-tPA candidates to maintain penumbral perfusion
In non-tPA-eligible patients, BP up to 220/120 mmHg is generally tolerated to preserve collateral flow to the ischemic penumbra.
Question 7: The Cincinnati Prehospital Stroke Scale (CPSS) assesses three findings. Which set is correct?
- Pupil asymmetry, arm drift, slurred speech
- Facial droop, arm drift, speech abnormality (Correct answer)
- Gaze deviation, facial droop, leg weakness
- Level of consciousness, arm drift, visual field cut
Correct answer: Facial droop, arm drift, speech abnormality
The CPSS evaluates facial droop, arm drift, and speech abnormality — any one abnormal finding indicates high stroke probability.
ACLS Acute Stroke Care 3
What is the recommended glucose target range in acute ischemic stroke patients to prevent worsening outcomes?