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Nurse Practitioner:
doi: 10.1097/01.NPR.0000421419.34400.94
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Ischemic stroke: The first 24 hours

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INSTRUCTIONS Ischemic stroke: The first 24 hours

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Ischemic stroke: The first 24 hours

General Purpose: To provide NPs with an overview of ischemic stroke and its treatment. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Discuss the risk factors, etiology, and clinical manifestations of stroke. 2. Describe diagnostic and treatment protocols for ischemic stroke.

1. Which statement about the occurrence of stroke is accurate?

a. Stroke is more common in younger males than in younger females.

b. Stroke is more common in older males than in older females.

c. Whites have twice the risk of stroke compared with Blacks.

d. Blacks have strokes twice as frequently as Hispanics.

2. The three most common risk factors for stroke are obesity, hypertension, and

a. diabetes.

b. smoking.

c. history of TIA.

d. inactivity.

3. The most common type of stroke is

a. hemorrhagic.

b. subarachnoid hemorrhage.

c. ischemic.

d. multifocal.

4. Smoking can lead to stroke because it

a. has toxins that damage the lining of the vessels leading to atherosclerosis.

b. is a potent vasodilator causing cerebral aneurysms.

c. prevents platelet aggregation causing intracranial bleeds.

d. has toxins that interfere with the exchange of oxygen and nutrients in cerebral cells.

5. The ischemic cascade is a low level of perfusion resulting in

a. conversion from anaerobic to aerobic cell respiration.

b. production of lactic acid that alters the pH level.

c. production of an increased volume of ATP.

d. decreased accumulation of calcium.

6. The penumbra region is a/an

a. area of maximally perfused cells surrounding the infarct.

b. clear area around the infarct in radiographic studies.

c. area of the body where stroke symptoms first appear.

d. area of dead or dying tissue in the vicinity of the infarction.

7. Facial hemiparesis and upper/lower extremity paresis or paralysis are the most common symptoms of which type of stroke?

a. hemorrhagic

b. ischemic

c. subarachnoid hemorrhage

d. intracranial aneurysm

8. A middle cerebral artery stroke may present with all of the following symptoms except

a. contralateral hemiparesis.

b. hemianopsia with gaze preference away from the side of the lesion.

c. receptive aphasia.

d. agnosia.

9. Language loss, right hemiparesis, and left gaze preference are consistent with stroke in which artery?

a. posterior cerebral

b. right middle cerebral

c. anterior cerebral

d. left middle cerebral

10. Primitive reflexes such as grasping and sucking are consistent with stroke in which artery?

a. posterior cerebral

b. right middle cerebral

c. anterior cerebral

d. left middle cerebral

11. Visual agnosia and alterations in thought are consistent with stroke in which artery?

a. posterior cerebral

b. right middle cerebral

c. anterior cerebral

d. left middle cerebral

12. For best outcomes, treatment must be initiated within how many minutes after the onset of symptoms?

a. 30

b. 60

c. 90

d. 120

13. For patients to be eligible for fibrinolytic therapy, BP should be maintained below

a. 220/120.

b. 210/115.

c. 195/110.

d. 185/110.

14. Temperature evaluation is critical because an elevated temperature can

a. cause a secondary stroke.

b. delay surgical intervention.

c. expand the ischemic injury.

d. precipitate a comatose state.

15. A skin assessment is necessary to evaluate for

a. malnutrition.

b. indicators of coagulopathies.

c. pressure damage.

d. elasticity.

16. Current guidelines recommend which neuroimaging to be done within 24 hours?

a. CT

b. MRI

c. CT angiography

d. CT perfusion

17. A major risk of fibrinolytic therapy is

a. bleeding.

b. secondary stroke.

c. coma.

d. coagulopathies.

18. Which of the following would exclude a patient from receiving t-PA?

a. age of 24 years

b. BP of 150/90

c. seizure activity at onset of stroke

d. stroke onset 2 hours ago

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