A 72-year-old presents to the ED with sudden right-sided weakness and aphasia. Family states symptoms began 2 hours ago. BP 168/92. The nurse anticipates which priority next step in the stroke pathway?
1Administer aspirin 325 mg orally without delay to inhibit platelet function and prevent clot propagation while awaiting further imaging studies.
2Initiate an IV labetalol infusion immediately to lower the blood pressure to a goal of less than 120/80 mm Hg before proceeding to head CT.
3Schedule a diffusion-weighted MRI scan to be obtained within the first hour to confirm the presence of an acute infarction and guide subsequent management.
4Activate the stroke team and obtain a non-contrast head CT within 25 minutes of arrival to rule out hemorrhage before any thrombolytic decision.✓ Correct answer
Explanation
Acute ischemic stroke pathway: activate stroke team, obtain non-contrast head CT within 25 minutes (must rule out hemorrhage before thrombolytics), and target door-to-needle for IV alteplase ≤ 60 minutes from arrival when within the 4.5-hour window. Aspirin is NOT given before tPA decision (1) — it would delay or contraindicate alteplase. BP is permissive in ischemic stroke up to ~185/110 BEFORE tPA (3 — overaggressive lowering can extend the infarct). MRI is not the initial study (4) — non-contrast CT is faster and adequate to rule out hemorrhage.
Time is brain. Door-to-needle target ≤ 60 minutes for alteplase. Permissive hypertension is allowed up to 185/110 BEFORE tPA — only above that is BP lowered. Aspirin is held until 24 hours AFTER tPA. The classic NCLEX trap is rushing to give aspirin or push BP down — both worsen outcomes.
72-year-old, sudden onset right-sided weakness and aphasia 2 hours ago. BP 168/92, HR 88, BG 110. Family confirms last-known-well at 2 hours ago. Suspected acute ischemic stroke; tPA window still open.
FAST assessment — Face droop, Arm weakness, Speech difficulty, Time of last known well — community and EMS stroke screen.
tPA / alteplase window — IV alteplase eligible up to 4.5 hours from last known well (extended criteria 3-4.5 h have additional exclusions).
Permissive hypertension (pre-tPA) — Allow BP up to ~185/110 prior to alteplase; aggressive lowering can extend the ischemic penumbra.