SCRN Acute Care 3 — Questions and Answers
Question 1: 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?
- To reduce cerebral metabolic rate
- To limit hematoma expansion and improve outcomes (Correct answer)
- To prevent vasospasm
- To increase cerebral perfusion pressure
Correct 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.
Question 2: Which neurological scale is used at the bedside to quantify stroke severity and guide acute treatment decisions?
- Glasgow Coma Scale (GCS)
- NIH Stroke Scale (NIHSS) (Correct answer)
- Hunt and Hess Scale
- Modified Rankin Scale (mRS)
Correct 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.
Question 3: A SCRN notices that a stroke patient has a new onset of atrial fibrillation on the cardiac monitor. Why is this finding especially significant?
- It lowers the risk of deep vein thrombosis
- It is a common cause of cardioembolic stroke and may indicate the stroke's etiology (Correct answer)
- It typically resolves without treatment
- It always requires immediate cardioversion
Correct 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.
Question 4: When performing dysphagia screening in an acute stroke patient, what is the safest initial step?
- Administer a 3-oz water swallow test immediately
- Keep the patient NPO and use a validated bedside screening tool before any oral intake (Correct answer)
- Offer soft foods to assess swallowing
- Perform a modified barium swallow study within the first hour
Correct 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.
Question 5: A patient with a posterior circulation stroke presents with vertigo, ipsilateral facial numbness, and contralateral limb ataxia. This constellation suggests involvement of which artery?
- Middle cerebral artery (MCA)
- Anterior cerebral artery (ACA)
- Posterior inferior cerebellar artery (PICA) (Correct answer)
- Basilar artery tip
Correct 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.
Question 6: Which laboratory value is most important to check BEFORE initiating IV alteplase in an acute ischemic stroke patient?
- Complete metabolic panel (CMP)
- Blood glucose level
- Prothrombin time (PT) and INR (Correct answer)
- Troponin I
Correct 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.
Question 7: 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?
- Within 3 hours of symptom onset only
- Up to 6 hours, and up to 24 hours in selected patients with favorable imaging (Correct answer)
- Only if tPA was given first
- Within 1 hour of symptom onset
Correct 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.
SCRN Acute Care 3
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?