The emergency department nurse is preparing an infusion of IV alteplase for a client who suffered a cerebrovascular accident (CVA). Which of the following statements is accurate about the administration of alteplase?
The drug is not given to clients who are taking anticoagulant or antiplatelet therapy.
The drug is given in a bolus over the first 3 minutes followed by a continuous infusion.
The recommended time for drug administration is within 90 minutes after admission to the emergency department.
The maximum dosage of the drug, including the bolus, is 120 mg intravenously.
The Correct Answer is B
A. While there are strict inclusion and exclusion criteria for alteplase administration, this statement is overly broad. There are certain situations where anticoagulant or antiplatelet therapy can be managed to allow for alteplase use.
B. Alteplase is administered as a bolus over 1 minute, followed by an infusion over 60 minutes.
C. While time is critical in stroke treatment, the recommended window for alteplase administration is typically within 3-4.5 hours of symptom onset.
D. The maximum dose of alteplase is actually 0.9 mg/kg, up to a maximum of 90 mg.
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Correct Answer is A
Explanation
A. Lorazepam is a benzodiazepine used as the first-line treatment for status epilepticus. It rapidly terminates seizures.
B. A beta-blocker, atenolol is used for conditions like hypertension and angina, not for seizures.
C. While phenytoin is an anti-seizure medication, it has a slower onset of action compared to lorazepam. It's used as a second-line agent in status epilepticus.
D. Levetiracetam is an anti-epileptic drug, but not the first choice for acute seizure management like status epilepticus.
Correct Answer is B
Explanation
A. This is a late sign of shock. It occurs when the body's compensatory mechanisms fail to maintain blood pressure.
B. This is one of the earliest signs of shock. The body tries to compensate for decreased oxygen delivery by increasing the respiratory rate.
C. This is a very late sign of shock, indicating severe kidney damage due to decreased blood flow.
D. This is also a late sign of shock, occurring when the brain is deprived of oxygen.
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