CNRN Neurovascular Disorders and Stroke Nursing 1 — Questions and Answers
Question 1: Which time window is the FDA-approved limit for IV alteplase (tPA) administration in eligible ischemic stroke patients?
- Within 2 hours of symptom onset
- Within 3 hours of symptom onset (up to 4.5 hours per extended guidelines) (Correct answer)
- Within 6 hours of symptom onset
- Within 12 hours of symptom onset
Correct answer: Within 3 hours of symptom onset (up to 4.5 hours per extended guidelines)
IV alteplase is FDA-approved within 3 hours of ischemic stroke onset, with AHA/ASA extending to 4.5 hours for select patients.
Question 2: The nurse is preparing a patient for IV tPA. Which finding is an absolute contraindication?
- Blood glucose of 60 mg/dL
- BP of 175/95 mmHg
- Active intracranial hemorrhage on CT (Correct answer)
- Age greater than 80
Correct answer: Active intracranial hemorrhage on CT
Active intracranial hemorrhage on CT is an absolute contraindication to IV tPA due to the risk of worsening hemorrhage.
Question 3: A patient with ischemic stroke is being monitored post-tPA. The nurse notes the patient's BP is 195/110 mmHg. The priority action is to:
- Continue monitoring per routine schedule
- Administer antihypertensive to keep BP below 180/105 mmHg (Correct answer)
- Stop the tPA infusion immediately
- Place the patient in Trendelenburg position
Correct answer: Administer antihypertensive to keep BP below 180/105 mmHg
Post-tPA guidelines require maintaining BP below 180/105 mmHg to reduce the risk of hemorrhagic transformation.
Question 4: Which artery occlusion typically produces the syndrome of contralateral hemiplegia, hemisensory loss, homonymous hemianopia, and aphasia (dominant hemisphere)?
- Posterior cerebral artery
- Middle cerebral artery (Correct answer)
- Anterior cerebral artery
- Basilar artery
Correct answer: Middle cerebral artery
Middle cerebral artery (MCA) occlusion produces contralateral hemiplegia, hemisensory loss, hemianopia, and aphasia if the dominant hemisphere is affected.
Question 5: The nurse is caring for a patient with a hemorrhagic stroke on anticoagulation. Which medication is used to reverse warfarin toxicity emergently?
- Protamine sulfate
- 4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
- Vitamin K only
- Fresh frozen plasma alone
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC)
4-factor prothrombin complex concentrate (4F-PCC) provides rapid, complete reversal of warfarin anticoagulation in hemorrhagic emergencies.
Question 6: Which neurological deficit is most characteristic of a cerebellar stroke?
- Expressive aphasia
- Ipsilateral limb ataxia and gait instability (Correct answer)
- Contralateral hemiplegia
- Neglect syndrome
Correct answer: Ipsilateral limb ataxia and gait instability
Cerebellar stroke produces ipsilateral limb ataxia, nystagmus, dysarthria, and gait instability due to incoordination of the ipsilateral side.
CNRN Neurovascular Disorders and Stroke Nursing 1
Which time window is the FDA-approved limit for IV alteplase (tPA) administration in eligible ischemic stroke patients?