ASC Acute Stroke Care & Treatment 2

Question 1

A patient with acute ischemic stroke presents 2 hours after symptom onset with NIHSS of 18 and large vessel occlusion on CTA. What is the preferred reperfusion strategy?

Accepted Answer

Mechanical thrombectomy with or without IV tPA

Answer

Large vessel occlusion with high NIHSS and presentation within the thrombectomy window warrants mechanical thrombectomy, which can be combined with IV tPA if eligible.

Question 2

Which blood pressure target is recommended for eligible patients BEFORE administration of IV alteplase?

Accepted Answer

< 185/110 mmHg

Answer

Blood pressure must be below 185/110 mmHg before alteplase administration to reduce hemorrhagic transformation risk.

Question 3

A patient receives IV tPA and 30 minutes later develops a severe headache with 20-point NIHSS increase. What is the FIRST action?

Accepted Answer

Stop the tPA infusion and obtain STAT CT head

Answer

Sudden neurological deterioration during tPA infusion suggests symptomatic intracranial hemorrhage; stop infusion immediately and obtain emergent CT.

Question 4

What is the maximum dose of IV alteplase for an 85 kg patient with acute ischemic stroke?

Accepted Answer

90 mg

Answer

The maximum dose of IV alteplase is capped at 90 mg regardless of body weight, even though the dose is 0.9 mg/kg.

Question 5

Tenecteplase (TNK) compared to alteplase for acute ischemic stroke has which pharmacological advantage?

Accepted Answer

Single IV bolus administration with higher fibrin specificity

Answer

Tenecteplase is administered as a single IV bolus and has greater fibrin specificity than alteplase, simplifying administration logistics.

(ASC) Advanced Stroke Coordinator Certification Practice Test

(ASC) Advanced Stroke Coordinator Certification Practice Test

ASC Acute Stroke Care & Treatment 2