NURSl 5463/l NURS5463l Examl 5l –l Adultl
Gerontologyl Acutel Carel Guide|l UTAl
(Latestl 2026/l 2027l Update)l 100%l
Verifiedl Questionsl &l Answersl |l Gradel A
Q:l Cerebelluml Damage
Answer:
•l Impairedl grossl andl finel motorl movementsl
•l Unablel tol walk,l poorl posturall controll
•l Impairedl rapidl movementl
•l Tremorsl and/orl dizzinessl
•l Slurredl speech
Q:l Brainsteml Damage
Answer:
•l Impairedl regulationl ofl temperature,l heartl ratel andl respiratoryl ratel
•l Difficultyl swallowingl fluidsl andl foodl
•l Difficultyl withl balancel andl movementl
•l Nauseal andl dizzinessl —l vertigol
•l Impairedl arousall andl sleepl regulation
Q:l Levell ofl Stroke
Answer:
•l Basedl onl lastl knownl welll beforel s/sl onsetl
•l Levell 1:l onsetl tol 4.5hl
•l Levell 2:l 4.5hl tol 8hl
•l Levell 3:l 8hl tol 72h
,Q:l Managementl ofl Acutel Stroke
Answer:
•l BP:l nol t-PAl <220/120l afterl t-PAl 180/105l
•l Glucose:l <140l
•l IVF:l goall euvolemial
•l Cardiacl monitor:l watchl forl Afib,l ratel controll vsl conversionl
•l Treatl feverl T>38.3l
•l Baselinel labs,l CXR,l EKG,l echol TTE,l lipidsl
•l Statinl andl ASAl forl secondaryl strokel prevention
Q:l Acutel Ischemicl Strokel Interventionall Treatment
Answer:
•l CEA:l carotidl endarterectomyl
•l Angioplastyl andl stentingl
•l Mechanicall thrombectomy
Q:l NIHSSl Strokel Scale
Answer:
•l NIHSSl 0-10:l 2-3%l riskl ofl ICHl
•l NIHSSl 11-20:l 4-5%l riskl ofl ICHl
•l NIHSSl >20:l 17%l riskl ofl ICH
Q:l t-PAl Inclusionl Criteria
Answer:
•l DXl ofl cerebrall ischemial -l ischemial isl causingl measurablel deficitl
•l Thel onsetl withinl 4.5l hoursl froml presentationl
•l T-pal betweenl 3-4.5hl isl notl FDAl approvedl butl remainsl standardl ofl carel forl mostl
strokel ptl
•l >/=l 18l yearsl orl older
,Q:l t-PAl Absolutel Exclusionl Criteria
Answer:
•l Hemorrhagel onl headl CT:l SAHl orl ICHl
•l Activel internall bleedingl
•l Intracraniall neoplasm,l arteriovenousl malformation,l orl aneurysml mayl increasel bleedingl
•l Recentl withinl 3l mo:l seriousl headl trauma,l intracraniall orl intra-spinall surgery
•l Activel bleedingl diathesis,l oftenl definedl as:l
-l Plateletl countl <l 100,000,l elevatedl aPTTl
-l INRl >l 1.7l orl PTl >l 15l secondsl
-l DTIl withinl 48hl orl sensitivel labl testl remainsl elevatedl (e.g.,l aPTT,l INR,l ECT,l TT,l orl
factorl Xa)l
•l Currentl uncontrolledl HTN:l BPl >l 185/110l
•l Glucosel <50
*Canl givel t-PAl ifl BPl andl glucosel arel corrected*
Q:l t-PAl Relativel Exclusionl Criteria
Answer:
•l Pregnancyl •l Majorl surgeryl orl seriousl traumal withinl thel previousl 14l daysl
•l Recentl gastrointestinall orl urinaryl tractl hemorrhagel withinl 21l daysl
•l Minorl orl rapidlyl improvingl symptomsl (resolvingl spontaneously)l
•l Seizurel atl onsetl withl postictall residuall impairmentsl
•l Recentl acutel myocardiall infarctionl withinl 3l monthsl
•l Arteriall puncturel atl al noncompressiblel sitel withinl 7l daysl
•l Symptomsl suggestivel ofl subarachnoidl hemorrhage
Q:l t-PAl Dosing
Answer:
•l Dosingl isl wtl basedl 0.9mg/kgl withl al maxl ofl 90mgl infusedl overl 60l minutesl
•l 10%l ofl totall ofl dosel isl givenl asl anl initiall bolusl IVl overl 1l minutel
*Heparinl infusionl isl notl recommendedl forl acutel stroke*
, Q:l Subarachnoidl Hemorrhagel (SAH)
Answer:
Bleedingl intol thel subarachnoidl spacel —l thel areal betweenl thel arachnoidl membranel andl
thel pial materl surroundingl thel brain
•l Trauma,l aneurysml (75-85%)l andl AVMl (4-5%)
•l 10%l mortalityl withinl fewl daysl ofl bleed
•l *"Worstl headachel ofl myl life"*l orl *"Thunderclapl headache"*
Q:l Neurosurgicall Interventions
Answer:
*Craniotomy*:l Incisionl inl thel scalp,l withl removall ofl al piecel ofl thel skulll (bonel flap),l
whichl isl thenl re-inserted
*Craniectomy*:l Samel asl abovel butl thel bonel flapl isl notl re-inserted
Q:l Endovascularl Neurol Interventions
Answer:
•l *Coill embolization*:l platinuml coilsl combinedl withl liquidl embolicl agentl
•l *Stentl coiling*:l permanentl stentl placedl inl adjacentl vesselsl ,l providesl supportl tol keepl
coilsl inl placel
•l *Balloonl assistedl coiling*:l balloonl catheterl insertedl temporarilyl tol helpl supportl andl
keepl coilsl inl placel duringl procedurel
•l *Flowl diversion*:l doesl notl causel immediatel occlusion,l redirectsl bloodl flowl throughl
anotherl vessel
Q:l Complicationsl ofl SAH
Answer:
-l Rebleedl *50%l willl rebleedl inl 6l months*
-l EKGl changes
-l Hydrocephalus
-l Vasospasml *almostl neverl occursl <3dl postl bleed,l highestl frequencyl dayl 6-8,l lastingl
upl tol 20d*
Gerontologyl Acutel Carel Guide|l UTAl
(Latestl 2026/l 2027l Update)l 100%l
Verifiedl Questionsl &l Answersl |l Gradel A
Q:l Cerebelluml Damage
Answer:
•l Impairedl grossl andl finel motorl movementsl
•l Unablel tol walk,l poorl posturall controll
•l Impairedl rapidl movementl
•l Tremorsl and/orl dizzinessl
•l Slurredl speech
Q:l Brainsteml Damage
Answer:
•l Impairedl regulationl ofl temperature,l heartl ratel andl respiratoryl ratel
•l Difficultyl swallowingl fluidsl andl foodl
•l Difficultyl withl balancel andl movementl
•l Nauseal andl dizzinessl —l vertigol
•l Impairedl arousall andl sleepl regulation
Q:l Levell ofl Stroke
Answer:
•l Basedl onl lastl knownl welll beforel s/sl onsetl
•l Levell 1:l onsetl tol 4.5hl
•l Levell 2:l 4.5hl tol 8hl
•l Levell 3:l 8hl tol 72h
,Q:l Managementl ofl Acutel Stroke
Answer:
•l BP:l nol t-PAl <220/120l afterl t-PAl 180/105l
•l Glucose:l <140l
•l IVF:l goall euvolemial
•l Cardiacl monitor:l watchl forl Afib,l ratel controll vsl conversionl
•l Treatl feverl T>38.3l
•l Baselinel labs,l CXR,l EKG,l echol TTE,l lipidsl
•l Statinl andl ASAl forl secondaryl strokel prevention
Q:l Acutel Ischemicl Strokel Interventionall Treatment
Answer:
•l CEA:l carotidl endarterectomyl
•l Angioplastyl andl stentingl
•l Mechanicall thrombectomy
Q:l NIHSSl Strokel Scale
Answer:
•l NIHSSl 0-10:l 2-3%l riskl ofl ICHl
•l NIHSSl 11-20:l 4-5%l riskl ofl ICHl
•l NIHSSl >20:l 17%l riskl ofl ICH
Q:l t-PAl Inclusionl Criteria
Answer:
•l DXl ofl cerebrall ischemial -l ischemial isl causingl measurablel deficitl
•l Thel onsetl withinl 4.5l hoursl froml presentationl
•l T-pal betweenl 3-4.5hl isl notl FDAl approvedl butl remainsl standardl ofl carel forl mostl
strokel ptl
•l >/=l 18l yearsl orl older
,Q:l t-PAl Absolutel Exclusionl Criteria
Answer:
•l Hemorrhagel onl headl CT:l SAHl orl ICHl
•l Activel internall bleedingl
•l Intracraniall neoplasm,l arteriovenousl malformation,l orl aneurysml mayl increasel bleedingl
•l Recentl withinl 3l mo:l seriousl headl trauma,l intracraniall orl intra-spinall surgery
•l Activel bleedingl diathesis,l oftenl definedl as:l
-l Plateletl countl <l 100,000,l elevatedl aPTTl
-l INRl >l 1.7l orl PTl >l 15l secondsl
-l DTIl withinl 48hl orl sensitivel labl testl remainsl elevatedl (e.g.,l aPTT,l INR,l ECT,l TT,l orl
factorl Xa)l
•l Currentl uncontrolledl HTN:l BPl >l 185/110l
•l Glucosel <50
*Canl givel t-PAl ifl BPl andl glucosel arel corrected*
Q:l t-PAl Relativel Exclusionl Criteria
Answer:
•l Pregnancyl •l Majorl surgeryl orl seriousl traumal withinl thel previousl 14l daysl
•l Recentl gastrointestinall orl urinaryl tractl hemorrhagel withinl 21l daysl
•l Minorl orl rapidlyl improvingl symptomsl (resolvingl spontaneously)l
•l Seizurel atl onsetl withl postictall residuall impairmentsl
•l Recentl acutel myocardiall infarctionl withinl 3l monthsl
•l Arteriall puncturel atl al noncompressiblel sitel withinl 7l daysl
•l Symptomsl suggestivel ofl subarachnoidl hemorrhage
Q:l t-PAl Dosing
Answer:
•l Dosingl isl wtl basedl 0.9mg/kgl withl al maxl ofl 90mgl infusedl overl 60l minutesl
•l 10%l ofl totall ofl dosel isl givenl asl anl initiall bolusl IVl overl 1l minutel
*Heparinl infusionl isl notl recommendedl forl acutel stroke*
, Q:l Subarachnoidl Hemorrhagel (SAH)
Answer:
Bleedingl intol thel subarachnoidl spacel —l thel areal betweenl thel arachnoidl membranel andl
thel pial materl surroundingl thel brain
•l Trauma,l aneurysml (75-85%)l andl AVMl (4-5%)
•l 10%l mortalityl withinl fewl daysl ofl bleed
•l *"Worstl headachel ofl myl life"*l orl *"Thunderclapl headache"*
Q:l Neurosurgicall Interventions
Answer:
*Craniotomy*:l Incisionl inl thel scalp,l withl removall ofl al piecel ofl thel skulll (bonel flap),l
whichl isl thenl re-inserted
*Craniectomy*:l Samel asl abovel butl thel bonel flapl isl notl re-inserted
Q:l Endovascularl Neurol Interventions
Answer:
•l *Coill embolization*:l platinuml coilsl combinedl withl liquidl embolicl agentl
•l *Stentl coiling*:l permanentl stentl placedl inl adjacentl vesselsl ,l providesl supportl tol keepl
coilsl inl placel
•l *Balloonl assistedl coiling*:l balloonl catheterl insertedl temporarilyl tol helpl supportl andl
keepl coilsl inl placel duringl procedurel
•l *Flowl diversion*:l doesl notl causel immediatel occlusion,l redirectsl bloodl flowl throughl
anotherl vessel
Q:l Complicationsl ofl SAH
Answer:
-l Rebleedl *50%l willl rebleedl inl 6l months*
-l EKGl changes
-l Hydrocephalus
-l Vasospasml *almostl neverl occursl <3dl postl bleed,l highestl frequencyl dayl 6-8,l lastingl
upl tol 20d*
