SCRN Acute Care 2 — Questions and Answers
Question 1: 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?
- Administer labetalol or nicardipine to lower BP below 180/105 mmHg (Correct answer)
- Stop the alteplase infusion immediately
- Increase IV fluid rate to dilute the medication
- Notify the physician and document the reading
Correct 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.
Question 2: Which finding in a stroke patient most urgently indicates elevated intracranial pressure (ICP)?
- Complaint of headache rated 4/10
- Cushing's triad: bradycardia, hypertension, and irregular respirations (Correct answer)
- SpO2 of 94% on room air
- Temperature of 37.8°C
Correct 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.
Question 3: 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:
- Flat (0°)
- 15–30° (Correct answer)
- 45°
- 60–90°
Correct answer: 15–30°
Head-of-bed elevation at 15–30° optimizes cerebral venous drainage and ICP without compromising cerebral perfusion pressure.
Question 4: A patient post-stroke develops a fever of 38.5°C on day 2. Why is aggressive fever management critical in acute stroke care?
- Fever increases the risk of hemorrhagic transformation only
- Hyperthermia expands the ischemic penumbra and worsens neurological outcomes (Correct answer)
- Fever indicates successful reperfusion
- High temperature improves collateral blood flow
Correct answer: Hyperthermia expands the ischemic penumbra and worsens neurological outcomes
Hyperthermia increases metabolic demand in vulnerable penumbral tissue, enlarging infarct size and worsening outcomes.
Question 5: Which intervention is CONTRAINDICATED in a patient receiving IV alteplase for acute ischemic stroke?
- Continuous cardiac monitoring
- Placing an arterial line for blood pressure monitoring
- Placing a nasogastric tube within the first 24 hours (Correct answer)
- Frequent neurological checks every 15 minutes
Correct 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.
Question 6: A stroke patient's serum glucose is 280 mg/dL on admission. How does hyperglycemia affect acute stroke outcomes?
- It is neuroprotective by providing extra fuel to ischemic neurons
- It worsens infarct size by promoting lactic acidosis and cerebral edema (Correct answer)
- It has no significant effect on stroke outcomes
- It reduces hemorrhagic transformation risk
Correct 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.
Question 7: 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?
- Hyperperfusion syndrome
- Cerebral vasospasm
- Stroke-related cardiac arrhythmia causing hemodynamic compromise (Correct answer)
- Benign fatigue from rehabilitation
Correct 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.
SCRN Acute Care 2
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?