SCRN Hyperacute Care 4 — Questions and Answers
Question 1: A patient with acute ischemic stroke has a blood glucose of 42 mg/dL. What is the nurse's immediate intervention?
- Administer IV dextrose (D50) and recheck glucose (Correct answer)
- Proceed with tPA assessment without intervention
- Hold all interventions and notify neurology
- Administer oral glucose tablets
Correct answer: Administer IV dextrose (D50) and recheck glucose
Hypoglycemia (≤60 mg/dL) can mimic stroke and must be corrected immediately with IV dextrose before stroke workup proceeds.
Question 2: Which symptom pattern is most consistent with a posterior circulation (vertebrobasilar) stroke?
- Vertigo, diplopia, and ataxia (Correct answer)
- Unilateral arm weakness and facial droop
- Expressive aphasia with right hemiplegia
- Neglect and left-sided weakness
Correct answer: Vertigo, diplopia, and ataxia
Posterior circulation strokes commonly present with vertigo, diplopia, dysphagia, and cerebellar ataxia due to brainstem and cerebellar involvement.
Question 3: During hyperacute stroke care, the head of the bed is typically positioned flat (0°) for which reason?
- To maximize cerebral perfusion pressure in the ischemic penumbra (Correct answer)
- To prevent aspiration pneumonia
- To reduce intracranial pressure
- To facilitate IV access
Correct answer: To maximize cerebral perfusion pressure in the ischemic penumbra
Flat positioning improves cerebral perfusion to the ischemic penumbra, though it is contraindicated if the patient has elevated ICP or aspiration risk.
Question 4: What is the correct dose of IV alteplase (tPA) for acute ischemic stroke in adults?
- 0.9 mg/kg IV (max 90 mg), 10% bolus then 90% over 60 minutes (Correct answer)
- 1.0 mg/kg IV (max 100 mg) bolus
- 0.6 mg/kg IV over 30 minutes
- 0.9 mg/kg IV all as a bolus over 2 minutes
Correct answer: 0.9 mg/kg IV (max 90 mg), 10% bolus then 90% over 60 minutes
The standard dose is 0.9 mg/kg (max 90 mg) with 10% given as an IV bolus and the remaining 90% infused over 60 minutes.
Question 5: A patient who received IV tPA 2 hours ago requires urgent surgery for an unrelated emergency. What is the primary concern?
- Increased bleeding risk due to active fibrinolytic effect (Correct answer)
- Risk of rebound hypertension
- Potential for allergic reaction to anesthesia
- Risk of stroke recurrence during surgery
Correct answer: Increased bleeding risk due to active fibrinolytic effect
IV tPA has an active fibrinolytic effect for several hours, significantly increasing surgical bleeding risk and generally requiring delay of elective or semi-urgent procedures.
Question 6: Which of the following is a relative contraindication to IV tPA in acute ischemic stroke?
- Major surgery within the past 14 days (Correct answer)
- Blood pressure of 170/100 after two doses of labetalol
- Onset of symptoms 3.5 hours ago
- NIHSS score of 8
Correct answer: Major surgery within the past 14 days
Major surgery within 14 days is a relative contraindication to tPA due to the risk of serious bleeding at the surgical site.
Question 7: In a patient with suspected large vessel occlusion, which clinical finding most strongly suggests the need for emergent CT angiography?
- NIHSS ≥6 with gaze deviation or dense hemiplegia (Correct answer)
- Isolated headache without focal deficits
- NIHSS of 2 with mild facial droop only
- Transient symptoms that have fully resolved
Correct answer: NIHSS ≥6 with gaze deviation or dense hemiplegia
An NIHSS ≥6 with gaze deviation or dense hemiplegia suggests large vessel occlusion (LVO), warranting emergent CTA to identify thrombectomy candidacy.
SCRN Hyperacute Care 4
A patient with acute ischemic stroke has a blood glucose of 42 mg/dL.
What is the nurse's immediate intervention?