NRNP 6566 WEEK 6 KNOWLEDGE CHECK 2026/2027 |
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Acute Ischemic & Hemorrhagic Stroke
Q1: A 72-year-old male arrives via EMS with sudden onset right-sided weakness and
aphasia. Last known well was 90 minutes ago. CT head shows no hemorrhage. NIHSS
score is 18. Blood pressure is 185/110 mmHg. Which is the immediate priority?
A. Administer IV tPA immediately – the patient meets all criteria for thrombolysis
B. Lower blood pressure to <140/90 before any other intervention
C. Obtain CT angiography to identify large vessel occlusion while managing BP to
<185/110 for tPA eligibility [CORRECT]
D. Start aspirin 325mg immediately – antiplatelet therapy is first-line for acute ischemic
stroke
Correct Answer: C
Rationale: For tPA eligibility, blood pressure must be <185/110 mmHg. Current
guidelines allow treatment if BP can be lowered safely to this threshold. CT angiography
identifies large vessel occlusion candidates for mechanical thrombectomy (up to 6-24
hours with perfusion imaging). Immediate tPA (A) with this BP is contraindicated.
Aggressive BP lowering (B) can worsen ischemia. Aspirin (D) is appropriate but not until
after tPA decision (if no tPA, give within 24-48 hours; if tPA given, wait 24 hours).
,Q2: A 68-year-old female presents with left hemiparesis and neglect. NIHSS score
components include: level of consciousness (0), questions (1), commands (0), gaze (1),
visual fields (0), facial palsy (2), left arm (3), left leg (3), limb ataxia (0), sensory (1),
language (2), dysarthria (0), extinction/inattention (2). Total NIHSS score is:
A. 12 – moderate stroke severity
B. 15 – moderate to severe stroke [CORRECT]
C. 18 – severe stroke requiring immediate intervention
D. 9 – mild stroke with good prognosis
Correct Answer: B
Rationale: Adding the components: 0+1+0+1+0+2+3+3+0+1+2+0+2 = 15. NIHSS
scoring: 1-4 minor, 5-15 moderate, 16-20 moderate-severe, 21-42 severe. A score of 15
indicates significant stroke with potential for disability and need for comprehensive
acute intervention including consideration for tPA and/or thrombectomy.
Q3: A patient with acute ischemic stroke is being evaluated for IV tPA. Which finding is
an absolute exclusion criterion?
A. Age 82 years – advanced age increases risk but is not exclusion
B. Blood glucose 140 mg/dL – mild hyperglycemia is manageable
C. Current INR 2.5 on warfarin – anticoagulation with therapeutic INR is absolute
contraindication [CORRECT]
D. Prior stroke 4 months ago – recent stroke is relative exclusion, not absolute
Correct Answer: C
,Rationale: Therapeutic anticoagulation (INR >1.7) is an absolute contraindication to IV
tPA due to hemorrhagic transformation risk. Age >80 (A) was previously exclusion but
no longer in 3-4.5 hour window. Glucose (B) must be >400 or <50 for exclusion. Prior
stroke <3 months is exclusion; 4 months (D) is acceptable though higher risk.
Q4: A 58-year-old with acute ischemic stroke receives IV tPA. Blood pressure must be
maintained below which threshold for 24 hours post-treatment?
A. 140/90 mmHg – standard hypertensive target
B. 160/100 mmHg – moderate allowance for post-stroke perfusion
C. 180/105 mmHg – prevents hemorrhagic transformation [CORRECT]
D. 220/120 mmHg – permissive hypertension acceptable after tPA
Correct Answer: C
Rationale: Post-tPA BP must be maintained <180/105 mmHg for 24 hours to reduce
hemorrhagic transformation risk. Frequent monitoring (every 15 minutes initially) and
aggressive management with IV agents (labetalol, nicardipine) is required. Standard
targets (A, B) are too strict and may compromise penumbral perfusion. Permissive
hypertension (D) is dangerous after thrombolysis.
Q5: A patient with acute ischemic stroke has large vessel occlusion (ICA terminus) and
small core infarct on perfusion imaging. Last known well was 14 hours ago. Which
intervention is appropriate?
A. IV tPA only – beyond 4.5 hour window for thrombolysis
B. Mechanical thrombectomy up to 6 hours only – patient is outside window
, C. Mechanical thrombectomy up to 24 hours with perfusion imaging showing
salvageable brain (DAWN/DEFUSE 3 criteria) [CORRECT]
D. Supportive care only – no intervention possible beyond 6 hours
Correct Answer: C
Rationale: DAWN and DEFUSE 3 trials demonstrated benefit of mechanical
thrombectomy up to 16-24 hours in selected patients with clinical-imaging mismatch
(small core, large penumbra, significant deficit). This patient meets criteria for extended
window thrombectomy. IV tPA (A) is contraindicated >4.5 hours. Traditional 6-hour limit
(B, D) has been extended with advanced imaging.
Q6: A patient presents with thunderclap headache, vomiting, and meningismus. CT
shows subarachnoid hemorrhage. Hunt-Hess grade is III (drowsy, confused, mild focal
deficit). Which medication is essential for vasospasm prevention?
A. Nimodipine 60mg PO/NG every 4 hours for 21 days – reduces vasospasm-related
delayed cerebral ischemia [CORRECT]
B. Labetalol IV – blood pressure control only
C. Mannitol 1g/kg – hyperosmolar therapy for ICP
D. Heparin prophylaxis – prevents DVT in SAH patients
Correct Answer: A
Rationale: Nimodipine is the only agent proven to reduce delayed cerebral ischemia
from vasospasm in aneurysmal SAH, administered for 21 days regardless of
neurological status. It doesn't reverse vasospasm but improves outcomes. Blood
pressure management (B) is important but not specific for vasospasm prevention.
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Acute Ischemic & Hemorrhagic Stroke
Q1: A 72-year-old male arrives via EMS with sudden onset right-sided weakness and
aphasia. Last known well was 90 minutes ago. CT head shows no hemorrhage. NIHSS
score is 18. Blood pressure is 185/110 mmHg. Which is the immediate priority?
A. Administer IV tPA immediately – the patient meets all criteria for thrombolysis
B. Lower blood pressure to <140/90 before any other intervention
C. Obtain CT angiography to identify large vessel occlusion while managing BP to
<185/110 for tPA eligibility [CORRECT]
D. Start aspirin 325mg immediately – antiplatelet therapy is first-line for acute ischemic
stroke
Correct Answer: C
Rationale: For tPA eligibility, blood pressure must be <185/110 mmHg. Current
guidelines allow treatment if BP can be lowered safely to this threshold. CT angiography
identifies large vessel occlusion candidates for mechanical thrombectomy (up to 6-24
hours with perfusion imaging). Immediate tPA (A) with this BP is contraindicated.
Aggressive BP lowering (B) can worsen ischemia. Aspirin (D) is appropriate but not until
after tPA decision (if no tPA, give within 24-48 hours; if tPA given, wait 24 hours).
,Q2: A 68-year-old female presents with left hemiparesis and neglect. NIHSS score
components include: level of consciousness (0), questions (1), commands (0), gaze (1),
visual fields (0), facial palsy (2), left arm (3), left leg (3), limb ataxia (0), sensory (1),
language (2), dysarthria (0), extinction/inattention (2). Total NIHSS score is:
A. 12 – moderate stroke severity
B. 15 – moderate to severe stroke [CORRECT]
C. 18 – severe stroke requiring immediate intervention
D. 9 – mild stroke with good prognosis
Correct Answer: B
Rationale: Adding the components: 0+1+0+1+0+2+3+3+0+1+2+0+2 = 15. NIHSS
scoring: 1-4 minor, 5-15 moderate, 16-20 moderate-severe, 21-42 severe. A score of 15
indicates significant stroke with potential for disability and need for comprehensive
acute intervention including consideration for tPA and/or thrombectomy.
Q3: A patient with acute ischemic stroke is being evaluated for IV tPA. Which finding is
an absolute exclusion criterion?
A. Age 82 years – advanced age increases risk but is not exclusion
B. Blood glucose 140 mg/dL – mild hyperglycemia is manageable
C. Current INR 2.5 on warfarin – anticoagulation with therapeutic INR is absolute
contraindication [CORRECT]
D. Prior stroke 4 months ago – recent stroke is relative exclusion, not absolute
Correct Answer: C
,Rationale: Therapeutic anticoagulation (INR >1.7) is an absolute contraindication to IV
tPA due to hemorrhagic transformation risk. Age >80 (A) was previously exclusion but
no longer in 3-4.5 hour window. Glucose (B) must be >400 or <50 for exclusion. Prior
stroke <3 months is exclusion; 4 months (D) is acceptable though higher risk.
Q4: A 58-year-old with acute ischemic stroke receives IV tPA. Blood pressure must be
maintained below which threshold for 24 hours post-treatment?
A. 140/90 mmHg – standard hypertensive target
B. 160/100 mmHg – moderate allowance for post-stroke perfusion
C. 180/105 mmHg – prevents hemorrhagic transformation [CORRECT]
D. 220/120 mmHg – permissive hypertension acceptable after tPA
Correct Answer: C
Rationale: Post-tPA BP must be maintained <180/105 mmHg for 24 hours to reduce
hemorrhagic transformation risk. Frequent monitoring (every 15 minutes initially) and
aggressive management with IV agents (labetalol, nicardipine) is required. Standard
targets (A, B) are too strict and may compromise penumbral perfusion. Permissive
hypertension (D) is dangerous after thrombolysis.
Q5: A patient with acute ischemic stroke has large vessel occlusion (ICA terminus) and
small core infarct on perfusion imaging. Last known well was 14 hours ago. Which
intervention is appropriate?
A. IV tPA only – beyond 4.5 hour window for thrombolysis
B. Mechanical thrombectomy up to 6 hours only – patient is outside window
, C. Mechanical thrombectomy up to 24 hours with perfusion imaging showing
salvageable brain (DAWN/DEFUSE 3 criteria) [CORRECT]
D. Supportive care only – no intervention possible beyond 6 hours
Correct Answer: C
Rationale: DAWN and DEFUSE 3 trials demonstrated benefit of mechanical
thrombectomy up to 16-24 hours in selected patients with clinical-imaging mismatch
(small core, large penumbra, significant deficit). This patient meets criteria for extended
window thrombectomy. IV tPA (A) is contraindicated >4.5 hours. Traditional 6-hour limit
(B, D) has been extended with advanced imaging.
Q6: A patient presents with thunderclap headache, vomiting, and meningismus. CT
shows subarachnoid hemorrhage. Hunt-Hess grade is III (drowsy, confused, mild focal
deficit). Which medication is essential for vasospasm prevention?
A. Nimodipine 60mg PO/NG every 4 hours for 21 days – reduces vasospasm-related
delayed cerebral ischemia [CORRECT]
B. Labetalol IV – blood pressure control only
C. Mannitol 1g/kg – hyperosmolar therapy for ICP
D. Heparin prophylaxis – prevents DVT in SAH patients
Correct Answer: A
Rationale: Nimodipine is the only agent proven to reduce delayed cerebral ischemia
from vasospasm in aneurysmal SAH, administered for 21 days regardless of
neurological status. It doesn't reverse vasospasm but improves outcomes. Blood
pressure management (B) is important but not specific for vasospasm prevention.
