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Stroke Alert
Brain Attack — Think TPA!
by Anna Ver Hage, MSN, AGACNP, CCRN, CNRN
CE461 | 1.00 contact hrs

Please review the required clinical vignette below and answer the quiz questions.
You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.

Once you successfully completed the short test associated with the clinical vignette, proceed to the multiple-choice exam.
To earn contact hours, you must achieve a score of 75% on your exam. You may retake the test as many times as necessary to pass the test.

Mrs. Warren, age 65, has a history of hypertension, hypercholesterolemia and atrial fibrillation. She returns to the telemetry unit at 9:30 a.m. after a diagnostic cardiac catheterization. At 10 a.m., she develops a right facial droop, garbled speech and right-sided paralysis of her upper extremity. Her vital signs are BP 200/110, T 98.4, P 86, R 22. She weighs 56 kg. The nurse notifies the stroke team. At 10:40 a.m., a stat CT scan of the brain shows no evidence of an ICH. Lab values are Hgb 13.4 and Hct 39.6, platelet count 180,000, PT 13.6, INR 1.1, PTT 25 and glucose 210. She is given labetalol 10 mg IV. At 11 a.m., Mrs. Warren’s BP is 170/90 and she receives IV rtPA.

1 ) Mrs. Warren’s stroke is most likely due to:

2 ) If the neurologist orders IV rtPA of 0.9 mg/kg for Mrs. Warren, the bolus dose would be:

3 ) Which should be administered to Mrs. Warren to reduce the risk of developing an ICH associated with rtPA administration for an acute ischemic stroke?

4 ) After rtPA administration, the RN should monitor Mrs. Warren for: