SCRN Acute Care 2

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?

Accepted Answer

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

Answer

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)?

Accepted Answer

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

Answer

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:

Accepted Answer

15–30°

Answer

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?

Accepted Answer

Hyperthermia expands the ischemic penumbra and worsens neurological outcomes

Answer

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?

Accepted Answer

Placing a nasogastric tube within the first 24 hours

Answer

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

(SCRN) Stroke Certified Registered Nurse Practice Test

(SCRN) Stroke Certified Registered Nurse Practice Test

SCRN Acute Care 2