SCRN Hyperacute Care 3 — Questions and Answers
Question 1: Which imaging modality is the gold standard for detecting acute hemorrhagic stroke in the emergency setting?
- Non-contrast CT of the head (Correct answer)
- MRI with diffusion-weighted imaging
- CT angiography
- Carotid duplex ultrasound
Correct answer: Non-contrast CT of the head
Non-contrast CT of the head rapidly identifies acute hemorrhage and is the gold standard first-line neuroimaging in emergency stroke evaluation.
Question 2: In a patient with large vessel occlusion (LVO), mechanical thrombectomy is recommended up to how many hours from last known well with favorable imaging?
- 24 hours (Correct answer)
- 6 hours
- 12 hours
- 48 hours
Correct answer: 24 hours
Based on DAWN and DEFUSE-3 trials, mechanical thrombectomy can be performed up to 24 hours in selected patients with favorable perfusion imaging.
Question 3: Which NIHSS item specifically assesses the patient's level of consciousness responsiveness?
- Item 1a – Level of Consciousness (Correct answer)
- Item 2 – Best Gaze
- Item 5 – Motor Arm
- Item 9 – Best Language
Correct answer: Item 1a – Level of Consciousness
NIHSS Item 1a assesses level of consciousness responsiveness, scored 0 (alert) to 3 (responds only with reflex).
Question 4: A stroke patient is found to have atrial fibrillation. Which anticoagulant is NOT appropriate for acute use in the hyperacute phase?
- Heparin infusion as acute bridging therapy (Correct answer)
- Aspirin for antiplatelet effect
- IV tPA if eligible
- CT imaging to rule out hemorrhage
Correct answer: Heparin infusion as acute bridging therapy
Full anticoagulation with heparin is generally avoided in the hyperacute phase due to increased risk of hemorrhagic transformation.
Question 5: Which finding on CT imaging is an absolute contraindication to IV tPA in acute ischemic stroke?
- Intracranial hemorrhage (Correct answer)
- Hypodensity involving less than one-third of the MCA territory
- Mild sulcal effacement
- Loss of gray-white differentiation in a small area
Correct answer: Intracranial hemorrhage
Any intracranial hemorrhage visible on CT is an absolute contraindication to IV tPA administration.
Question 6: During the hyperacute stroke window, glucose should be monitored because hyperglycemia worsens outcomes. What blood glucose level is generally recommended to treat in acute ischemic stroke?
- Greater than 180 mg/dL (Correct answer)
- Greater than 140 mg/dL
- Greater than 200 mg/dL
- Greater than 250 mg/dL
Correct answer: Greater than 180 mg/dL
Blood glucose above 180 mg/dL should be treated in acute ischemic stroke as hyperglycemia worsens infarct size and outcomes.
Question 7: What is the role of the stroke nurse during CT imaging for a hyperacute stroke patient?
- Accompany the patient, monitor vitals, and ensure imaging is completed without delay (Correct answer)
- Stay at the nursing station and await radiology report
- Administer sedation for the scan
- Document the scan results independently
Correct answer: Accompany the patient, monitor vitals, and ensure imaging is completed without delay
The stroke nurse accompanies the patient to CT, continuously monitors vitals and neurological status, and facilitates rapid turnaround to minimize delays.
SCRN Hyperacute Care 3
Which imaging modality is the gold standard for detecting acute hemorrhagic stroke in the emergency setting?