SCRN Hyperacute Care 5 — Questions and Answers
Question 1: After IV tPA administration, how frequently should neurological assessments and blood pressure be monitored in the first 2 hours?
- Every 15 minutes (Correct answer)
- Every 30 minutes
- Every hour
- Every 5 minutes
Correct answer: Every 15 minutes
During tPA infusion and for the first 2 hours after, neurological checks and BP should be performed every 15 minutes to detect hemorrhagic complications early.
Question 2: Which of the following laboratory values is MOST important to obtain before administering IV tPA in a patient on anticoagulation?
- INR and aPTT (Correct answer)
- Troponin and BNP
- Hemoglobin and hematocrit
- Serum sodium and potassium
Correct answer: INR and aPTT
INR and aPTT must be checked to rule out therapeutic anticoagulation, as an INR >1.7 is a contraindication to IV tPA.
Question 3: A patient is eligible for mechanical thrombectomy. What is the recommended door-to-puncture time goal at thrombectomy-capable stroke centers?
- 90 minutes or less (Correct answer)
- 60 minutes or less
- 30 minutes or less
- 120 minutes or less
Correct answer: 90 minutes or less
The AHA/ASA recommends a door-to-puncture time of 90 minutes or less for mechanical thrombectomy at capable centers.
Question 4: A hyperacute stroke patient with known DOAC use taken within the last 48 hours presents within the tPA window. What is the appropriate action?
- IV tPA is generally contraindicated; proceed with thrombectomy if LVO present (Correct answer)
- Administer tPA at half the standard dose
- Administer tPA at full dose after reversal agent
- Withhold all reperfusion therapy
Correct answer: IV tPA is generally contraindicated; proceed with thrombectomy if LVO present
DOACs taken within 48 hours are a contraindication to IV tPA; mechanical thrombectomy remains an option if LVO is confirmed on imaging.
Question 5: Which sign on non-contrast CT is associated with a proximal MCA occlusion in hyperacute ischemic stroke?
- Hyperdense MCA sign (Correct answer)
- Diffuse sulcal effacement
- Butterfly hemorrhage pattern
- Hypodense basal ganglia
Correct answer: Hyperdense MCA sign
The hyperdense MCA sign represents acute thrombus within the middle cerebral artery and indicates proximal occlusion requiring emergent intervention.
Question 6: Which temperature management strategy is recommended in the hyperacute phase of ischemic stroke?
- Treat fever aggressively with antipyretics to maintain normothermia (≤37.5°C) (Correct answer)
- Induce mild hypothermia to 35°C with cooling blankets
- Allow mild hyperthermia up to 38.5°C to improve cerebral metabolism
- Temperature has no impact on acute stroke outcomes
Correct answer: Treat fever aggressively with antipyretics to maintain normothermia (≤37.5°C)
Hyperthermia worsens ischemic brain injury, so fever should be treated aggressively with antipyretics to maintain a temperature ≤37.5°C.
Question 7: A patient declines IV tPA after being informed of risks and benefits. What is the nurse's appropriate response?
- Document the refusal, ensure the patient has decision-making capacity, and explore alternative therapies (Correct answer)
- Override the refusal and administer tPA as ordered
- Discharge the patient immediately
- Administer tPA while the patient is distracted
Correct answer: Document the refusal, ensure the patient has decision-making capacity, and explore alternative therapies
A patient with decision-making capacity has the right to refuse treatment; the nurse must document the refusal, assess capacity, and explore alternatives such as thrombectomy.
SCRN Hyperacute Care 5
After IV tPA administration, how frequently should neurological assessments and blood pressure be monitored in the first 2 hours?