A client has ordered a thrombolytic medication for the treatment of CVA. Which type of stroke should not be treated with a thrombolytic?

Correct Answer: A

Rationale: ### **Comprehensive Rationale for the Correct Answer (A: Hemorrhagic Stroke)** **1. Correct Answer (A): Hemorrhagic Stroke** Thrombolytic medications (e.g., alteplase, tenecteplase) work by breaking down blood clots, which is beneficial in **ischemic strokes** (caused by blocked arteries). However, in a **hemorrhagic stroke**, bleeding occurs in or around the brain due to a ruptured blood vessel. Administering a thrombolytic in this scenario would **worsen bleeding** by inhibiting clotting mechanisms, leading to increased intracranial hemorrhage, higher morbidity, and potentially fatal outcomes. Thus, thrombolytics are **contraindicated** in hemorrhagic strokes, making **A the correct answer**. **2. Incorrect Answer (B): Thrombotic Stroke** A thrombotic stroke is a subtype of **ischemic stroke** caused by a clot obstructing blood flow in the brain. Thrombolytics are **first-line treatments** for ischemic strokes (if administered within the 3-4.5-hour window), as they dissolve clots and restore perfusion. Since this option incorrectly suggests that thrombotic strokes should **not** be treated with thrombolytics, it is **wrong**. **3. Incorrect Answer (C): Both Types Can Be Treated with a Thrombolytic** This choice falsely claims that thrombolytics are safe for **both** hemorrhagic and thrombotic strokes. While they are appropriate for **ischemic** (thrombotic/embolic) strokes, they **must never** be given in hemorrhagic strokes due to the risk of exacerbating bleeding. Thus, this option is **incorrect**. **4. Incorrect Answer (D): Neither Type Can Be Treated with a Thrombolytic** This option incorrectly asserts that **no strokes** should be treated with thrombolytics. While they are **contraindicated** in hemorrhagic strokes, they are **critical** in ischemic strokes when given promptly. Therefore, this choice is **false**. ### **Key Clinical Considerations:** - **Ischemic strokes (thrombotic/embolic)**: Thrombolytics are **lifesaving** if administered early (ideally within 3 hours, up to 4.5 hours in select cases). - **Hemorrhagic strokes**: Thrombolytics are **dangerous** and increase mortality—management focuses on controlling bleeding (e.g., BP control, surgical intervention). - **Imaging confirmation (CT/MRI)** is **essential** before thrombolytic administration to rule out hemorrhage. ### **Conclusion:** The **only correct answer is A (Hemorrhagic stroke)** because thrombolytics are **absolutely contraindicated** in bleeding strokes. The other options either misrepresent the use of thrombolytics in ischemic strokes (B, D) or incorrectly include hemorrhagic strokes as candidates (C). Proper stroke subtype diagnosis is **critical** before initiating therapy.

Correct Answer: C

Rationale: Hyponatremia is not a common side effect associated with nitroglycerin use. Nitroglycerin typically causes side effects such as reflex tachycardia, dizziness, and hypotension due to its vasodilatory effects. Therefore, it is important for the nurse to educate the client about these potential side effects to promote understanding and appropriate management.

Correct Answer: D

Rationale: Diltiazem (Cardizem) belongs to the class of drugs known as calcium channel blockers. These medications work by blocking calcium from entering the muscle cells of the heart and blood vessels, leading to relaxation of the blood vessels and reduced workload on the heart. This helps in lowering blood pressure and improving blood flow. It is crucial for the nurse to provide accurate information to the client about the type of drug prescribed to ensure understanding and compliance with the treatment plan.

Correct Answer: A

Rationale: Atenolol (Tenormin) is a beta blocker commonly used to treat conditions like hypertension and angina by blocking the action of adrenaline on the heart. Verapamil is a calcium channel blocker, Captopril is an ACE inhibitor, and Clopidogrel is an antiplatelet medication. Therefore, the correct answer is Atenolol (Tenormin) as it belongs to the beta blocker class of medications.

Correct Answer: B

Rationale: The correct answer instructs the client on the appropriate use of nitroglycerin. Nitroglycerin is used to relieve chest pain or angina. If the chest pain does not subside after taking one tablet, the client should take a maximum of three tablets at 5-minute intervals. If the pain persists after three tablets, it could indicate a heart attack, and emergency medical help should be sought. This education is crucial to ensure the client knows when to seek immediate medical attention.