Acute Care Flashcards

A patient with hemorrhagic stroke is on a nicardipine infusion. The target systolic blood pressure is less than 140 mmHg per protocol. What is the primary rationale?

Answer: To limit hematoma expansion and improve outcomes

Aggressive blood pressure lowering in intracerebral hemorrhage reduces ongoing hematoma expansion, which is a key driver of early neurological deterioration.

Which neurological scale is used at the bedside to quantify stroke severity and guide acute treatment decisions?

Answer: NIH Stroke Scale (NIHSS)

The NIHSS provides a standardized, reproducible measure of acute stroke deficits and is used to determine tPA eligibility and monitor response to treatment.

A SCRN notices that a stroke patient has a new onset of atrial fibrillation on the cardiac monitor. Why is this finding especially significant?

Answer: It is a common cause of cardioembolic stroke and may indicate the stroke's etiology

Atrial fibrillation is the most common cardiac source of emboli in cardioembolic stroke, and its detection informs anticoagulation decisions.

When performing dysphagia screening in an acute stroke patient, what is the safest initial step?

Answer: Keep the patient NPO and use a validated bedside screening tool before any oral intake

The patient should remain NPO until a validated bedside dysphagia screen is passed; aspiration pneumonia is a leading preventable complication of acute stroke.

A patient with a posterior circulation stroke presents with vertigo, ipsilateral facial numbness, and contralateral limb ataxia. This constellation suggests involvement of which artery?

Answer: Posterior inferior cerebellar artery (PICA)

PICA occlusion causes Wallenberg (lateral medullary) syndrome, characterized by ipsilateral facial and contralateral body sensory loss, vertigo, dysphagia, and ataxia.

Which laboratory value is most important to check BEFORE initiating IV alteplase in an acute ischemic stroke patient?

Answer: Prothrombin time (PT) and INR

Elevated INR (>1.7) is a contraindication to alteplase; checking PT/INR is critical to rule out coagulopathy before thrombolysis.

A nurse is preparing a patient for mechanical thrombectomy. The patient's NIHSS score is 18 and CT angiography confirms large vessel occlusion. What time window is generally accepted for thrombectomy in eligible patients?

Answer: Up to 6 hours, and up to 24 hours in selected patients with favorable imaging

Current guidelines support thrombectomy up to 6 hours for standard eligibility and up to 24 hours for selected patients with perfusion imaging mismatch.