Stroke Certification Study Guide for Nurses: Q&A Review for Exam Success

101Medications

QUESTIONS

1. Of the following antiplatelet agents, one is indicated for primary prevention, while others are indicated for secondary prevention. Which is the primary prevention agent?

A. Dipyridamole/aspirin (Aggrenox)

B. Aspirin

C. Clopidogrel (Plavix)

D. Ticlopidine (Ticlid)

2. The term “antiplatelet” agent is used because the mechanism of action is to

A. Increase platelet resistance of the blood–brain barrier

B. Inhibit platelet production in the liver

C. Decrease platelet passage through the cell membrane

D. Decrease platelet aggregation in the bloodstream

3. Your patient with atrial fibrillation has just been started on warfarin. What will be part of your medication education for them?

A. Eliminate salads and foods rich in vitamin K

B. Intake of salads and foods rich in vitamin K should be consistent

C. 102Never take medication on an empty stomach

D. Avoid physical activity to limit bruising risk

4. Your patient has just had a nasogastric (NG) tube inserted for enteral feeding. You have received confirmation of correct placement in the stomach, and initiated feeding 2 hours ago. Which of the following is now safe to administer via this route?

A. Rivaroxaban (Xarelto)

B. Dabigatran (Pradaxa)

C. Apixaban (Eliquis)

D. Abciximab (ReoPro)

5. Which of the statements below best describes the action of alteplase?

A. Promotes fibrinolysis of fibrin clots

B. Directly inhibits free and fibrin-bound thrombin

C. Directly inhibits free and clot-bound factor Xa

D. Inhibits activation of vitamin K–dependent clotting factors

6. In the emergency department (ED), alteplase has been ordered for Mr. Paine. The following is the patient’s home medication list. Which of the medications would make you more alert for orolingual angioedema?

A. Metformin

B. Simvastatin

C. Lisinopril

D. Aspirin

7. For Mr. Paine, which of these home medications might be responsible for his dry, nonproductive cough?

A. Metformin (Glucophage)

B. Simvastatin (Zocor)

C. Lisinopril (Prinivil, Zestril)

D. Aspirin

8. Which of these lipid-lowering agents has the best primary and secondary risk reduction?

A. Atorvastatin (Lipitor)

B. Gemfibrozil (Lopid)

C. 103Fenofibrate (Tricor)

D. Niacin

9. Your patient has been ordered to receive 23.4% saline, 30 mL, over 20 minutes. What do you tell the patient and the family about this treatment?

A. The patient will need to be transferred to the long-term acute care (LTAC) unit in order for insurance to cover this therapy

B. Reducing blood viscosity reduces risk of seizure

C. Saline is equivalent to blood viscosity and it helps to hydrate

D. Concentrated saline helps to reduce brain swelling

10. For which of the lipid-lowering agents would you include education about a possible side effect of flushing?

A. Atorvastatin (Lipitor)

B. Niacin

C. Cholestyramine (Questran)

D. Simvastatin (Zocor)

11. Your patient’s list of home medications includes a long-acting insulin. Which of the following would that be?

A. Insulin lispro (Humalog)

B. Insulin aspart (NovoLog)

C. Insulin glargine (Lantus)

D. Insulin glulisine (Apidra)

12. Your patient just returned from having a CT angiogram. You might have an order to hold which of the following medications for 48 hours?

A. Simvastatin (Zocor)

B. Metformin (Glucophage)

C. Aspirin

D. Cardizem (Diltiazem)

13. During the morning assessment, Mr. Smith tells you that he does not think recovery will be sufficient to make him want to keep living. What is your responsibility? Choose all that apply.

A. Reassure Mr. Smith that his feelings are not unusual, and that he will have help to deal with these feelings

B. Report this conversation to the provider

C. 104Realize that stroke patients often say things like this and it is best to let it pass quietly to avoid embarrassing them

D. Monitor Mr. Smith’s mood and behavior for further changes

14. Which medication do you anticipate to be ordered for a patient with signs of depression?

A. Escitalopram (Lexapro)

B. Paroxetine (Paxil)

C. Sertraline (Zoloft)

D. Any of the above

15. When you bring the first dose of antidepressant to your patient, and she says she does not want to take “crazy people pills,” what is your best response?

A. Antidepressants may enhance neurogenesis and thus functional recovery

B. Antidepressants facilitate pain management and will make therapy less painful

C. Antidepressants inhibit appetite which may result in weight loss

D. If you do not take this medication, your doctor will be angry

16. Your 20-year-old right–middle cerebral artery (MCA) territory stroke patient is awake and complaining of left shoulder pain. He has a history of a severe back injury from a snow boarding accident last year. He asks for his lollipop. What is he referring to?

A. Fentanyl buccal route

B. Dilaudid oral solution frozen

C. Oxycontin oral solution frozen

D. MS Contin buccal route

17. Which antipyretic could be given to your febrile, postoperative patient without concern for antiplatelet effect?

A. Ibuprofen (Advil, Motrin)

B. Aspirin

C. Acetaminophen (Tylenol)

D. None, they all impact platelet aggregation

18. 105Which of the following medications dissolves blood clots?

A. Warfarin (Coumadin)

B. Alteplase (Activase)

C. IV heparin

D. Rivaroxaban (Xarelto)

19. Your emergency department (ED) patient has arrived at 2 hours 30 minutes from symptom onset and Dr. Jones says to get the IV alteplase ready stat. The patient’s weight is 250 lbs. How much of the dose will be given as a bolus?

A. 10 mg

B. 14 mg

C. 9 mg

D. 20 mg

20. In the sign-off report at 7 p.m., the nurse tells you that the patient arrived at 2 p.m. to the stroke unit with a diagnosis of middle cerebral artery (MCA) stroke. Aspirin 81 mg orally was ordered, but was held owing to the patient failing the dysphagia screen. How do you respond?

A. Antithrombotics are to be administered by end of hospital day 2 or the length of stay will be extended

B. Antithrombotics need to be given early for best patient outcomes, so you will get an order for suppository right away

C. Antithrombotics are really only important in lacunar strokes, so a delay is not a problem

D. If this patient got alteplase, antithrombotics need to be given within 24 hours of alteplase dose

21. In the emergency department (ED), a patient became somnolent after complaining of a headache. After reviewing the CT and labs (intracerebral hemorrhage and international normalized ratio [INR] 2.5), the provider orders stat fresh frozen plasma (FFP). Which oral anticoagulant was the patient taking prior to admission?

A. Apixaban (Eliquis)

B. Dabigatran (Pradaxa)

C. Rivaroxaban (Xarelto)

D. Warfarin (Coumadin)

22. 106In the stroke clinic, Mr. Small and his wife are arguing when you enter the room. He has recently been started on warfarin and they cannot agree about whether it is important to mention the following item. When you hear what it is, you tell them that it is important.

A. He started taking gingko for memory help

B. He has developed an appetite for peaches

C. He is regaining sensation in his left thumb

D. He has been having unusual dreams about cats

23. Headache occurs in up to 40% of patients taking which medication?

A. Dipyridamole/aspirin (Aggrenox)

B. Metoprolol (Lopressor)

C. Rivaroxaban (Xarelto)

D. Nicardipine (Cardene)

24. The neuroscience ICU nurse notified the intensivist team that the patient just had three seizures, each of 50 seconds’ duration. Which medication is the first-line agent for this situation?

A. Levetiracetam (Keppra)

B. Valproic acid (Depakote)

C. Lorazepam (Ativan)

D. Pentobarbital (Nembutal)

25. How often should patients with insulin drips have their blood glucose checked?

A. Every 3 to 6 hours

B. Every 2 to 4 hours

C. Every 1 to 2 hours

D. Every other day

26. Which is true of the U.S. Food and Drug Administration’s (FDA) approval of alteplase (Activase)?

A. It was based on the National Institute of Neurological Disorders and Stroke (NINDS) recombinant tissue plasminogen activator (rt-PA) Stroke Trial of 1995

B. It was approved despite a 12% intracerebral hemorrhage rate

C. It was approved for 3 to 4.5 hours from onset in select populations

D. It was approved for 3 hours from onset

27. 107The appropriate administration of alteplase includes which of the following?

A. It should be given with an 18-gauge or larger needle

B. 10% is given as a bolus over 1 minute

C. Shaking the vial vigorously enhances the dissolution of the powder

D. If anaphylaxis is suspected, the rate should be reduced by 50% and the provider notified

28. Which medication is Class I, Level of Evidence A for use in aneurysmal subarachnoid hemorrhage?

A. IV magnesium sulfate

B. Oral nimodipine

C. Oral papaverine

D. Oral amlodipine

29. On what schedule will a patient who receives alteplase have vital signs and neurologic checks monitored?

A. Every 15 minutes for 2 hours, then every 30 minutes for 6 hours, then hourly for 16 hours

B. Every 15 minutes for 1 hour, then every 30 minutes for 3 hours, then hourly for 20 hours

C. Every 15 minutes for 2 hours, then every 30 mins for 2 hours, then hourly for 8 hours

D. Every 15 minutes for 3 hours, then every 30 minutes for 3 hours, then hourly for 3 hours

30. Which medication is not indicated for the control of shivering during therapeutic cooling?

A. Buspirone

B. Magnesium

C. Meperidine

D. Botulinum toxin