A 67-year-old female was treated with IV alteplase (tPA) 12 … | MyMerci
More questions like thisTry ›
Physiological Adaptation

A 67-year-old female was treated with IV alteplase (tPA) 12 hours ago for acute left middle cerebral artery ischemic stroke. Review the chart and determine which assessment finding requires immediate provider notification.

Chart/Exhibit

Choose your responses, then check the answer.

History
Vitals
Labs
Orders
Notes
67yo female with HTN, AFib (on apixaban, held), hyperlipidemia. Last known well 14h ago. Symptom onset 13h ago — left MCA ischemic stroke, NIHSS 12 on arrival. IV alteplase given 12h ago within the 4.5h window.
BP 168/92 (1h ago 145/85), HR 88, RR 22, SpO2 95% RA, T 37.0C, GCS 13 (E3 V4 M6, down from 15 one hour ago).
INR 1.2, PT 14, aPTT 32, Plt 250K, Hgb 13.4, Glucose 132, Cr 1.0.
Post-tPA protocol: keep BP <180/105, q15min neuro x2h then q30min x6h then q1h x16h. NPO until swallow eval. No antiplatelets, anticoagulants, or invasive lines x24h. STAT non-contrast head CT if neuro decline.
Mild dysarthria and right arm/leg weakness present since stroke onset (baseline post-stroke, NIHSS 8 after tPA). At hour 12: patient reports worst headache of life, vomited once, eyelids heavy, GCS 13. Cardiology and neurology paged.
Explanation
Post-tPA patients are at highest risk for intracranial hemorrhage (ICH) within the first 24 hours. The triad of new severe headache, vomiting, and decreasing level of consciousness (GCS 15 to 13) is a classic presentation of ICH and requires immediate notification, emergent non-contrast head CT, and reversal protocols (cryoprecipitate, platelets, possible neurosurgery). BP 168/92 is within the post-tPA target (<180/105). Unchanged baseline deficits do not require immediate escalation.
Next question on this topicA 58-year-old patient with metastatic lung cancer is admitted with progressive dyspnea, hy…From this question bank[전통+신유형] NCLEX LEVEL UP 패키지KRW 79,000
Browse all questions No login required

Master the NCLEX-RN with MyMerci

Thousands of NCLEX-style questions with detailed rationale — in your language. Track your progress and study smarter.

Start for free
App Store Google Play
Read in another language: English한국어日本語繁體中文Tiếng Việt

For study reference only. Always follow current clinical guidelines and your institution’s protocols.

Next question Start for free