SCRN Acute Care 5 — Questions and Answers
Question 1: A stroke patient with dysphagia fails a bedside swallow screen. Which nutritional strategy is most appropriate for the short term?
- Total parenteral nutrition (TPN) via central line
- Nasogastric (NG) tube feeding (Correct answer)
- Percutaneous endoscopic gastrostomy (PEG) tube placement within 24 hours
- Continue NPO status indefinitely
Correct answer: Nasogastric (NG) tube feeding
Nasogastric tube feeding is the first-line enteral route for short-term nutritional support in stroke patients who fail dysphagia screening.
Question 2: A patient with acute ischemic stroke has a serum sodium of 126 mEq/L on day 3. The most likely cause in the stroke population is:
- Diabetes insipidus
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Correct answer)
- Hyperaldosteronism
- Medication-induced diuresis
Correct answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
SIADH is the most common cause of hyponatremia following stroke due to inappropriate ADH release from hypothalamic disruption.
Question 3: Which assessment finding indicates successful reperfusion after mechanical thrombectomy?
- Persistent NIHSS score of 18
- Improvement in neurological deficits and TICI 2b/3 reperfusion on angiogram (Correct answer)
- Stable CT scan without hemorrhage
- Blood pressure within normal limits
Correct answer: Improvement in neurological deficits and TICI 2b/3 reperfusion on angiogram
Successful reperfusion is defined angiographically as TICI grade 2b or 3 and clinically as improvement in neurological deficits.
Question 4: A patient admitted with ischemic stroke has an LDL of 145 mg/dL. Per current stroke guidelines, what medication should be started during the acute hospitalization?
- Fibrate therapy
- High-intensity statin therapy (Correct answer)
- Niacin supplementation
- Ezetimibe monotherapy
Correct answer: High-intensity statin therapy
High-intensity statin therapy reduces recurrent stroke and cardiovascular events and should be initiated during acute hospitalization regardless of baseline LDL.
Question 5: During the first 24 hours after IV alteplase, a patient's blood pressure must be maintained below which threshold?
- 220/120 mmHg
- 185/110 mmHg
- 180/105 mmHg (Correct answer)
- 160/90 mmHg
Correct answer: 180/105 mmHg
After alteplase administration, blood pressure must be kept below 180/105 mmHg for at least 24 hours to minimize the risk of hemorrhagic transformation.
Question 6: A stroke patient is being discharged on apixaban for newly diagnosed atrial fibrillation. The SCRN's education should emphasize which critical point?
- Take apixaban only when symptomatic palpitations occur
- Never miss a dose, avoid NSAIDs, and report unusual bleeding immediately (Correct answer)
- Apixaban requires routine INR monitoring every week
- Grapefruit juice enhances apixaban's effectiveness
Correct answer: Never miss a dose, avoid NSAIDs, and report unusual bleeding immediately
Consistent dosing adherence, avoidance of NSAIDs that increase bleeding risk, and prompt reporting of bleeding signs are essential for safe DOAC therapy.
Question 7: A patient is transferred from the ICU to the stroke unit 48 hours after a large MCA infarct. Which complication requires ongoing prophylactic nursing intervention throughout hospitalization?
- Hyperthyroidism
- Deep vein thrombosis (DVT) (Correct answer)
- Hyperkalemia
- Polyuria
Correct answer: Deep vein thrombosis (DVT)
Immobility after stroke significantly increases DVT risk; prophylaxis with compression devices and pharmacological anticoagulation (when safe) must be maintained throughout the hospital stay.
SCRN Acute Care 5
A stroke patient with dysphagia fails a bedside swallow screen.
Which nutritional strategy is most appropriate for the short term?