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Nursing:
doi: 10.1097/01.NURSE.0000350756.86301.87
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Acute ischemic stroke: Not a moment to lose

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INSTRUCTIONS Responding to acute ischemic stroke: Not a moment to lose

TEST INSTRUCTIONS

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* Registration deadline is May 31, 2011.

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PROVIDER ACCREDITATION

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Responding to acute ischemic stroke: Not a moment to lose

GENERAL PURPOSE To familiarize nurses with AHA guidelines for acute ischemic stroke. LEARNING OBJECTIVES After reading the preceding article and taking this test, you should be able to: 1. Identify timelines for assessing and treating a patient with acute ischemic stroke. 2. Discuss the treatment of acute ischemic stroke using rtPA. 3. Identify nursing interventions for patients with acute ischemic stroke.

1. Approximately what proportion of strokes result from ischemia?

a. 10%

b. 30%

c. 50%

d. 90%

2. After a patient arrives in the ED with stroke signs and symptoms, a noncontrast CT should be performed within

a. 10 minutes.

b. 25 minutes.

c. 45 minutes.

d. 60 minutes.

3. After onset of stroke signs and symptoms, rtPA infusion must be initiated within

a. 1 hour.

b. 2 hours.

c. 3 hours.

d. 4 hours.

4. One absolute contraindication to rtPA therapy is

a. a radial artery puncture 2 weeks ago.

b. a systolic BP of 175 mm Hg.

c. a platelet count of 200,000/mm3.

d. active internal bleeding.

5. Which is a relative contraindication to rtPA?

a. myocardial infarction 2 months ago

b. INR >1.7

c. diastolic BP >110 mm Hg despite treatment

d. history of intracranial hemorrhage

6. Which of these “7 D's of stroke care” is the first priority?

a. dispatch

b. detection

c. delivery

d. data

7. According to the acute ischemic stroke guidelines, the stroke team should be activated within what period of time of the patient's arrival to the ED?

a. 10 minutes

b. 20 minutes

c. 30 minutes

d. 40 minutes

8. For a patient experiencing an acute ischemic stroke, maintain an oxygen saturation of at least

a. 88%.

b. 90%.

c. 92%.

d. 94%.

9. Which is the best I.V. fluid for a patient admitted with an acute ischemic stroke?

a. D10W

b. D5W

c. 0.45% sodium chloride solution

d. 0.9% sodium chloride solution

10. After the patient arrives in the ED, confirm the onset of stroke symptoms within the first

a. 15 minutes.

b. 25 minutes.

c. 35 minutes.

d. 45 minutes.

11. To treat acute ischemic stroke, how much of the total rtPA dose should be given as an initial I.V. bolus over 1 minute?

a. 5%

b. 10%

c. 15%

d. 20%

12. After the initial I.V. bolus of rtPA, the remainder of the infusion should be administered over the next

a. 30 minutes.

b. 60 minutes.

c. 90 minutes.

d. 120 minutes.

13. During an rtPA infusion for acute ischemic stroke, assess the patient's BP and neurologic status every

a. 5 minutes.

b. 15 minutes.

c. 30 minutes.

d. 60 minutes.

14. During an rtPA infusion, measure the patient's BP using

a. a radial arterial line.

b. a femoral arterial line.

c. an automatic BP cuff.

d. a manual BP cuff.

15. To minimize the risk of hemorrhage during and after the rtPA infusion, keep the patient's systolic BP below

a. 170 mm Hg.

b. 175 mm Hg.

c. 180 mm Hg.

d. 185 mm Hg.

16. What drug should be considered to manage hypertension refractory to I.V. labetalol and nicardipine infusion in a patient receiving rtPA for acute ischemic stroke?

a. fenoldopam mesylate

b. sodium nitroprusside

c. nitroglycerin

d. enalaprilat

17. After administering rtPA, don't start heparin or aspirin for at least

a. 6 hours.

b. 12 hours.

c. 24 hours.

d. 48 hours.

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