A patient has been admitted with an ischemic stroke The ...

[RYAN BANYAN]

A patient has been admitted with an ischemic stroke
 
  The patient received recombinant tissue plasminogen activator (rtPA) in the emergency department. The nurse checks the medication administration record to make sure the patient does not have which medications for the next 24 hours? (Select all that apply.)
 
  a. Aspirin
  b. Sodium nitroprusside
  c. Warfarin
  d. Labetalol
  e. Any antiplatelet drugs

Question 2

A patient who was an unrestrained driver in a high-speed, head-on motor vehicle collision presents with dyspnea, tachycardia, hypotension, jugular venous distention, tracheal deviation to the left, and decreased breath sounds on the right side
 
  What is the most likely diagnosis?
 
  a. Tension pneumothorax
  b. Cardiac tamponade
  c. Simple pneumothorax
  d. Ruptured diaphragm

[ambernicolefink]

Answer to Question 1

A, C, E
The major risk and complication of rtPA therapy is bleeding, especially intracranial hemorrhage. Unlike fibrinolytic protocols for acute myocardial infarction, subsequent therapy with anticoagulant or antiplatelet agents is not recommended after rtPA administration in ischemic stroke. Patients receiving fibrinolytic therapy for stroke should not receive aspirin, heparin, warfarin, ticlopidine, or any other antithrombotic or antiplatelet drugs for at least 24 hours after treatment. Sodium nitroprusside and labetalol are used to manage blood pressure after a stroke.

Answer to Question 2

A
Clinical manifestations of a tension pneumothorax include dyspnea, tachycardia, hypotension, and sudden chest pain extending to the shoulders. Patients with cardiac tamponade will not have unilateral decreased breath sounds. Neither a simple pneumothorax nor a ruptured diaphragm will result in hypotension, jugular venous distention, or tracheal deviation unless it goes untreated.

[RYAN BANYAN]

Thanks for the timely response, appreciate it

[xiazhe]

Excellent