Acute Care Flashcards

A patient with ischemic stroke is receiving IV alteplase. After 30 minutes, the nurse notes a blood pressure of 195/108 mmHg. What is the priority action?

Answer: Administer labetalol or nicardipine to lower BP below 180/105 mmHg

During IV alteplase infusion, BP must be maintained below 180/105 mmHg; antihypertensives such as labetalol or nicardipine should be given promptly.

Which finding in a stroke patient most urgently indicates elevated intracranial pressure (ICP)?

Answer: Cushing's triad: bradycardia, hypertension, and irregular respirations

Cushing's triad is a late, ominous sign of severely elevated ICP and impending brainstem herniation requiring immediate intervention.

A nurse is caring for a patient with a large hemispheric ischemic stroke. To reduce the risk of malignant cerebral edema, the head of the bed should be maintained at:

Answer: 15–30°

Head-of-bed elevation at 15–30° optimizes cerebral venous drainage and ICP without compromising cerebral perfusion pressure.

A patient post-stroke develops a fever of 38.5°C on day 2. Why is aggressive fever management critical in acute stroke care?

Answer: Hyperthermia expands the ischemic penumbra and worsens neurological outcomes

Hyperthermia increases metabolic demand in vulnerable penumbral tissue, enlarging infarct size and worsening outcomes.

Which intervention is CONTRAINDICATED in a patient receiving IV alteplase for acute ischemic stroke?

Answer: Placing a nasogastric tube within the first 24 hours

Invasive procedures such as nasogastric tube placement should be avoided for 24 hours after alteplase to minimize bleeding risk.

A stroke patient's serum glucose is 280 mg/dL on admission. How does hyperglycemia affect acute stroke outcomes?

Answer: It worsens infarct size by promoting lactic acidosis and cerebral edema

Hyperglycemia promotes anaerobic metabolism, lactic acidosis, and cerebral edema, all of which expand the ischemic injury.

A patient with acute ischemic stroke suddenly develops worsening neurological deficits and a MAP drop to 55 mmHg during hospitalization. What is the most likely cause?

Answer: Stroke-related cardiac arrhythmia causing hemodynamic compromise

Stroke patients are prone to cardiac arrhythmias and neurogenic cardiac dysfunction, which can precipitate hemodynamic instability and secondary neurological deterioration.