Progressive Care Nursing Certification (PCCN) Practice Exam

What is the most important immediate concern in managing a patient with an acute ischemic stroke?

1. Preventing pressure ulcers from limited mobility

2. Avoiding hypertension while maintaining cerebral perfusion

3. Performing a CT scan to evaluate for bleeding

4. Intubation and mechanical ventilation for airway protection

The correct answer is: Avoiding hypertension while maintaining cerebral perfusion

The most important immediate concern in managing a patient with an acute ischemic stroke is avoiding hypertension while maintaining cerebral perfusion. In the context of acute ischemic stroke, the cerebral circulation must be managed carefully. High blood pressure can exacerbate damage to the already compromised brain tissue and potentially lead to hemorrhagic transformation of the ischemic area. It’s critical to maintain sufficient cerebral perfusion pressure to ensure that oxygen and nutrients continue to reach brain cells that might still be viable but at risk of further ischemic damage. On the other hand, while preventing pressure ulcers is important for patients with limited mobility, it is a secondary concern in the acute phase of a stroke. Additionally, performing a CT scan to evaluate for bleeding is essential for differentiating between ischemic and hemorrhagic strokes, but the immediate management should focus on blood pressure control, as rapid intervention can mitigate further brain injury. Intubation and mechanical ventilation for airway protection may be necessary in certain situations, particularly if the patient is unable to protect their airway, but it is not the primary concern unless the patient exhibits signs of respiratory distress or impaired consciousness that threatens airway integrity. Thus, managing blood pressure while ensuring adequate cerebral perfusion remains the priority in the acute phase of ischemic stroke care