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Acute Stroke Practice Test

Ischemic strokes are usually caused by an occlusion of an artery to a region of the brain. True False Ischemic strokes account for 87% of all strokes and are usually caused by an occlusion of an artery to a region of the brain. AHA Advanced Cardiovascular Life Support Provider Manual, p. 74 What is the critical decision point in the Adult Suspected Stroke algorithm? Immediate neurologic assessment by stroke team or designee Determine if the patient is still a candidate for fibrinolytic therapy Performance and assessment of a non-contrast CT to differentiate between hemorrhagic and ischemic stroke Establish time zero The performance and assessment of a non-contrast CT to differentiate between hemorrhagic and ischemic stroke is the critical decision point in the algorithm. The presence of hemorrhage versus no hemorrhage determines the next steps in treatment. AHA Advanced Cardiovascular Life Support Provider Manual, p. 84 Which of the following would exclude the use of fibrinolytic therapy in a patient confirmed to have had an ischemic stroke? Onset of symptoms less than 3 hours before beginning treatment Age greater than or equal to 18 Significant head trauma in the previous 3 months Seizure at the onset of stroke Exclusion criteria for fibrinolytic therapy include:
  • Significant head trauma or prior stroke in the previous 3 months
  • Symptoms suggest subarachnoid hemorrhage
  • Arterial puncture at noncompressible site in previous 7 days
  • History of previous intracranial hemorrhage
  • Elevated blood pressure (systolic greater than 185 mm Hg or diastolic greater than 110 mm Hg)
  • Active internal bleeding
  • Acute bleeding diathesis
  • Blood glucose concentration less than 50 mg/dL (2.7 mmol/L)
  • CT demonstrates multilobar infarction (hypodensity greater than 1/3 cerebral hemisphere)
AHA Advanced Cardiovascular Life Support Provider Manual, p. 86
Which of the following is not a sign or symptom of a stroke? Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body Temporary improvement in hand-eye coordination Sudden confusion Trouble speaking or understanding The signs and symptoms of a stroke may be subtle. They include:
  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body
  • Sudden confusion
  • Trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking
  • Dizziness or loss of balance and coordination
  • Sudden severe headache with no known cause
AHA Advanced Cardiovascular Life Support Provider Manual, p. 78
If the patient woke from sleep with symptoms of stroke, when is time zero? The time the patient woke up The time the patient went to sleep The last time the patient was seen to be normal The point halfway between when the patient went to sleep and woke up If the patient wakes from sleep with symptoms of stroke, time zero is the last time the patient was seen to be normal. AHA Advanced Cardiovascular Life Support Provider Manual, p. 81 Out-of-hospital acute stroke care focuses on: Initiation of the stroke pathway and patient admission to a stroke unit if available Ability to rapidly determine patient eligibility for fibrinolytic therapy Consideration of new treatment options Rapid transport to a facility capable of providing acute stroke care Out-of-hospital acute stroke care focuses on:
  • Rapid identification and assessment of patients with a stroke
  • Rapid transport (with pre-arrival notification) to a facility capable of providing acute stroke care
AHA Advanced Cardiovascular Life Support Provider Manual, p. 73
The 8 D's of Stroke Care include: Dispatch, Delivery, Death Door, Data, Defibrillation Detection, Dispatch, Dopamine Detection, Decision, Drug The 8 D's of Stroke Care are:
  • Detection: Rapid recognition of stroke symptoms
  • Dispatch: Early activation and dispatch of EMS by 911
  • Delivery: Rapid EMS identification, management and transport
  • Door: Appropriate triage to stroke center
  • Data: Rapid triage, evaluation, and management within the ED
  • Decision: Stroke expertise and therapy selection
  • Drug/Device: Fibrinolytic or endovascular therapy
  • Disposition: Rapid admission to the stroke unit of critical care unit
AHA Advanced Cardiovascular Life Support Provider Manual, p. 75
Fibrinolytic therapy should be initiated with how many hours of syptom onset? 3 8 1 12 Fibrinolytic therapy should be provided to eligible patients within 3 hours of symptom onset and 1 hour of hospital arrival. Door-to-admission time should be 3 hours. AHA Advanced Cardiovascular Life Support Provider Manual, p. 76 The Cincinnati Prehospital Stroke Scale identifies stroke based on which of the following three findings? Abnormal speech, abnormal gait and facial droop Arm drift, abnormal gait and abnormal speech One-sided weakness, facial droop and arm drift Facial droop, arm drift and abnormal speech The CPSS identifies stroke on the basis of 3 physical findings:
  • Facial droop (Have the patient smile or try to show teeth)
  • Arm drift (Have the patient close eyes and hold both arms up, with both palms up)
  • Abnormal speech (Have the patient say, "You can't teach an old dog new tricks")
AHA Advanced Cardiovascular Life Support Provider Manual, p. 78
Time zero is: The time when the patient was last known to be normal The time when the patient enters the ED (emergency department) The time when EMS is dispatched to see the patient The time when the patient is first assessed by the stroke team Time zero is when the patient was last known to be normal (i.e. symptom-free). If the patient wakes from sleep with stroke symptoms, time zero is the last time anyone saw the patient without symptoms. AHA Advanced Cardiovascular Life Support Provider Manual, p. 81