Which of the following is not a contraindication for the use of tissue plasminogen activator (PA) in the treatment of stroke?

Recent thoracic surgery within the past week

Uncontrolled hypertensive crisis

Age over 65 years

Head trauma with active cerebral hemorrhage

Answer and Explanation

The Correct Answer is C

A. Recent thoracic surgery within the past week:
Recent surgery, especially in the thoracic region, is a contraindication for the use of tissue plasminogen activator (tPA) in stroke treatment. tPA is a thrombolytic agent that dissolves clots, but it also increases the risk of bleeding, including in areas where surgery has recently occurred. Using tPA in this situation can potentially lead to life-threatening bleeding complications.

B. Uncontrolled hypertensive crisis:
Uncontrolled hypertension is a contraindication for tPA. High blood pressure can increase the risk of hemorrhagic transformation (bleeding into the brain) when using thrombolytic therapy like tPA. A hypertensive crisis (typically systolic BP > 185 mmHg or diastolic BP > 110 mmHg) must be managed and brought under control before administering tPA to minimize the risk of bleeding complications.

C. Age over 65 years:
While age over 65 years may increase the risk of complications from tPA, it is not an absolute contraindication for its use. Guidelines for tPA administration in stroke patients typically focus more on factors like time from symptom onset (usually within 4.5 hours), the presence of contraindications like recent surgery or uncontrolled hypertension, and the overall clinical condition. Age itself is not a reason to withhold tPA unless other risk factors are present.

D. Head trauma with active cerebral hemorrhage:
Head trauma with active cerebral hemorrhage is a definitive contraindication for tPA. Since tPA is a clot-busting drug, it can worsen bleeding in the brain, especially in cases where there is ongoing hemorrhage from trauma. This significantly increases the risk of severe neurological damage and even death, so tPA should not be administered in such situations.

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Correct Answer is ["8"]

Explanation

Given:

Total volume to infuse: 150 mL

Infusion time: 3 hours

Drop factor of tubing: 10 gtt/mL

To find:

Drip rate (gtt/min)

Step 1: Convert infusion time to minutes

3 hours x 60 minutes/hour = 180 minutes

Step 2: Calculate the total number of drops

Total drops = Total volume x Drop factor

Total drops = 150 mL x 10 gtt/mL = 1500 gtt

Step 3: Calculate the drip rate

Drip rate = Total drops / Infusion time in minutes

Drip rate = 1500 gtt / 180 minutes = 8.33 gtt/min

Step 4: Round to the nearest whole number

Since the question asks for the drip rate rounded to the nearest whole number, we round 8.33 to 8 gtt/min.

A. Patient's refusal to cough, deep breathe, and use their incentive spirometer due to pain B. Urine output of 40 mL/hr and clear yellow after having their Foley catheter removed C. Patient ambulating short distances and performing range of motion exercises alter pain is controlled D. Hypoactive bowel sounds 2 hours post-operative.

Correct Answer is A

Explanation

A) Patient's refusal to cough, deep breathe, and use their incentive spirometer due to pain:
The patient’s refusal to perform these respiratory exercises could lead to serious complications such as atelectasis, pneumonia, and other respiratory issues. Coughing, deep breathing, and using the incentive spirometer are essential to prevent postoperative respiratory complications, especially if the patient is at higher risk for lung issues due to immobility or anesthesia. This needs immediate intervention to ensure the patient understands the importance of these activities and to address the pain issue, potentially with additional pain management or support.

B) Urine output of 40 mL/hr and clear yellow after having their Foley catheter removed:
A urine output of 40 mL/hr is within normal limits for a post-operative patient, and the clear yellow color indicates that the urine is not concentrated or indicative of infection. While monitoring urine output is important postoperatively, this finding suggests adequate renal function and does not indicate an immediate risk for long-term complications.

C) Patient ambulating short distances and performing range of motion exercises after pain is controlled:
Early ambulation and range of motion exercises are encouraged after surgery to promote circulation, prevent blood clots, and support overall recovery. It indicates that the patient is progressing in their recovery and actively participating in post-operative rehabilitation, which is a positive sign and does not need urgent intervention.

D) Hypoactive bowel sounds 2 hours post-operatively:
This is expected immediately after surgery, especially if the patient underwent abdominal surgery or received general anesthesia, which can temporarily reduce bowel motility. Hypoactive bowel sounds within the first few hours post-surgery are a normal response to anesthesia and do not require urgent intervention. The nurse should continue to monitor the patient’s bowel function, but this finding is not a priority in the immediate postoperative period.

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Which of the following is not a contraindication for the use of tissue plasminogen activator (PA) in the treatment of stroke?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["8"]

Explanation

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Correct Answer is A

Explanation

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