All of the following are exclusion criteria for tPA (tissue plasminogen activator) therapy EXCEPT

ESIC Nursing Officer-7July 2024

Medical & Surgical Nursing

Medium

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

Ischemic stroke is the primary indication for administering tPA, not an exclusion criterion.
tPA is a thrombolytic ('clot-busting') drug used to dissolve the clot causing the ischemic stroke and restore blood flow to the brain.
The goal of therapy is to treat the ischemic stroke, so its presence is the reason for treatment.
All other options listed are conditions that increase the risk of adverse effects (primarily bleeding) and are therefore valid exclusion criteria.

Option A: Severe hyperglycemia (e.g., glucose > 400 mg/dL) is a relative exclusion criterion. It can mimic stroke symptoms and is associated with a higher risk of hemorrhagic transformation after tPA administration.
Option B: Coagulopathy (a bleeding disorder or elevated clotting times like an INR > 1.7) is an absolute exclusion criterion. Giving a thrombolytic to a patient who cannot form clots effectively poses a very high risk of life-threatening hemorrhage.
Option C: A history of major surgery within the past 14 days is a significant exclusion criterion. The surgical site is still healing and is highly vulnerable to severe bleeding if a thrombolytic drug is given.

Visual 1: Flowchart: tPA eligibility for acute ischemic stroke, showing the decision pathway from patient arrival to treatment, including time windows, imaging, and key exclusion criteria.
Visual 2: Table: A comprehensive list of absolute and relative contraindications for tPA therapy.
Visual 3: Infographic: 'Time is Brain' - illustrating the critical time window for tPA administration and the importance of rapid stroke recognition and transport.

Clinical Relevance

Nursing practice connection: Knowing Contraindications for tPA therapy in acute ischemic stroke helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a critical role in the stroke team, including accurately assessing the 'last known well' time, which is crucial for determining tPA eligibility.
Vigilant monitoring for signs of bleeding (e.g., new headache, change in LOC, oozing from IV sites) is a key nursing responsibility during and after tPA infusion.
What if? If the patient's blood pressure was 190/115 mmHg, it would also be a contraindication. The nurse's priority would be to administer antihypertensives (like labetalol or nicardipine) to lower the BP below 185/110 mmHg to make the patient eligible for tPA, assuming no other contraindications exist.

How to Approach the Question

First, identify the keywords in the stem: 'tPA', 'exclusion criteria', and especially 'EXCEPT'.
The word 'EXCEPT' signals that three of the options are true (they are exclusion criteria) and one is false (it is not an exclusion criterion). Your task is to find the false statement.
Think about the purpose of tPA. It's a thrombolytic, used to dissolve clots.
Evaluate each option: Is this a reason to AVOID giving a clot-busting drug?
Option A (High Glucose): High glucose can worsen brain injury. This is a risk. So, it's a likely exclusion.
Option B (Coagulopathy): A bleeding disorder plus a clot-buster is a recipe for disaster. This is a definite exclusion.

Concept Tested & Keywords

Concept Tested: Contraindications for tPA therapy in acute ischemic stroke.
Stem keywords: tPA, tissue plasminogen activator, exclusion criteria
Lead-in keywords: EXCEPT
Negative lead-in flag: The question asks for the option that is NOT an exclusion criterion.

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