ASLS Post-test + New Questions

Question 1

1. The most common cause of intracerebral hemorrhage is:
   a. Vessel malformation
   b. Brain tumor
   c. Aneurysm rupture
   d. Chronic hypertension

Answer 1

d. Chronic hypertension

Question 2

2. The MEND Exam:
   a. Is the ideal on-scene assessment tool for prehospital personnel
   b. Is too time consuming for use as a routine assessment tool for nurses
   c. Enhances communication between prehospital and hospital personnel
   d. Is best used when assessing patients with diffuse brain dysfunction

Answer 2

c. Enhances communication between prehospital and hospital personnel

Question 3

3. Which one of the following statements is correct regarding the use of
   intravenous t-PA in ischemic stroke patients?
   a. Paramedics must be prepared to administer it in the field
   b. If used appropriately, it decreases risk of disability by 30%
   c. It is most beneficial within 3 hours, but may be given within 5 hours
   d. It is most beneficial if given to patients with minor symptoms

Answer 3

b. If used appropriately, it decreases risk of disability by 30%

Question 4

4. EMS arrives on scene to care for a 56-year-old woman who complained of
   sudden headache, dizziness, and falling to the left when trying to walk. On
   assessment, she is lethargic but responds appropriately to verbal stimuli.
   When asked to repeat a phrase, she says the words correctly without slurring.
   When asked to smile, she elevates both sides of her face without difficulty.
   When asked to hold out her arms extended, she raises both arms without
   drifting down, but the left arm moves awkwardly. The likely stroke syndrome is:
   a. Hemorrhage in cerebellum
   b. Ischemic stroke in right hemisphere
   c. Subarachnoid hemorrhage
   d. Ischemic stroke in left hemisphere

Answer 4

a. Hemorrhage in cerebellum

Question 5

A patient has sudden weakness of the left arm and leg. Paramedics find the
patient’s blood pressure (BP) to be 250/150 mm Hg. The appropriate action for
the paramedics is to monitor BP and:
a. Administer labetalol 15 mg IV
b. Administer nifedipine 10 mg SL
c. Administer nitroglycerine SL
d. Do not administer any antihypertensive agent

Answer 5

d. Do not administer any antihypertensive agent

Question 6

6. Symptoms of a cerebellar stroke include:
   a. Motor weakness
   b. Aphasia
   c. Dyscoordination
   d. Sensory loss

Answer 6

c. Dyscoordination

Question 7

7. Which pairing is correct?
   a. Left brain dysfunction – double vision
   b. Right brain dysfunction – neglect (left hemi-inattention)
   c. Subarachnoid hemorrhage – inappropriate speech
   d. Brainstem dysfunction – visual field deficit

Answer 7

b. Right brain dysfunction – neglect (left hemi-inattention)

Question 8

8. Paramedics arrive on scene to care for a 74-year-old woman. Examination
   reveals pulse 90, respirations 18, BP left arm 200/100, and BP right arm
   190/100. She is awake and alert, but says “dog tricks” when asked to repeat
   the phrase “You can’t teach an old dog new tricks.” When asked to smile, her
   right lower face does not elevate. When holding out both arms with her eyes
   closed, she can barely lift her right arm and it drifts down in a few seconds.
   The likely stroke syndrome is:
   a. Subarachnoid hemorrhage
   b. Left hemisphere
   c. Right hemisphere
   d. Brainstem

Answer 8

b. Left hemisphere

Question 9

9. The ischemic penumbra is:
   a. Brain tissue with permanent damage
   b. Unaffected by the use of t-PA
   c. Damaged by lowering blood pressure
   d. Visualized on CT scan of the brain

Answer 9

c. Damaged by lowering blood pressure

Question 10

10. Which of the following is true?
    a. Stroke is the leading cause of death in the USA
    b. It is best to start controlling stroke risk factors after age 40
    c. IV t-PA decreases the risk of death from stroke
    d. Stroke incidence increases with age

Answer 10

d. Stroke incidence increases with age

Question 11

11. Which of the following is NOT typical of subarachnoid hemorrhage?
    a. Neck stiffness
    b. Nausea and vomiting
    c. Depressed consciousness
    d. Gradual onset of symptoms

Answer 11

d. Gradual onset of symptoms

Question 12

12. Which of the following is most likely to present as depressed consciousness
without focal neurologic deficit?
a. Seizure
b. Brain tumor
c. Drug overdose
d. Migraine

Answer 12

c. Drug overdose

Question 13

13. The optimal IV solution for patients with acute stroke is:
    a. Lactated Ringers
    b. D5W
    c. Normal Saline
    d. ½ Normal Saline

Answer 13

c. Normal Saline

Question 14

14. The majority of ischemic strokes is caused by:
    a. Thromboembolism
    b. Atherosclerotic occlusion
    c. Aneurysmal rupture
    d. Acute hypertension

Answer 14

a. Thromboembolism

Question 15

15. In a patient suspected of having an acute stroke, which one of the following is
    the best way to differentiate between an ischemic or hemorrhagic cause?
    a. The history
    b. The neurologic examination
    c. Blood pressure values
    d. A CT scan of the brain

Answer 15

d. A CT scan of the brain

Question 16

16. Which of the following is NOT a risk factor for ischemic stroke?
    a. Cocaine use
    b. Brain tumor
    c. Excessive alcohol use
    d. Hypercoagulable state

Answer 16

b. Brain tumor

Question 17

17. Ischemic stroke accounts for approximately what percent of all strokes?
    a. 20%
    b. 50%
    c. 80%
    d. > 95%

Answer 17

c. 80%

Question 18

18. Contraindications for thrombolytic therapy in acute stroke patients include:
    a. History of TIA one week ago
    b. History of brain hemorrhage 5 years ago
    c. History of heart attack 1 year ago
    d. Taking warfarin with subtherapeutic INR of 1.2

Answer 18

b. History of brain hemorrhage 5 years ago

Question 19

19. Optimal management of patients with acute stroke in the prehospital and
    emergency-department (ED) settings includes:
    a. Keep patient NPO, including no oral liquids or medications
    b. Administer high-flow oxygen via face mask
    c. Keep patient’s head flat to improve blood flow to the penumbra
    d. Administer low-flow oxygen even if oxygen saturation is > 95%

Answer 19

a. Keep patient NPO, including no oral liquids or medications

Question 20

20. EMS transports a 64-year-old man to the hospital for complaint of sudden
    difficulty speaking and right-arm weakness that resolves after 20 minutes. In
    the emergency department (ED), his neurologic examination is normal. The
    appropriate action for ED personnel to take is:
    a. Discharge him with advice to call his doctor for an appointment as soon
    as possible.
    b. Admit him to the hospital for a rapid evaluation to determine the cause of
    his event
    c. Discharge him with advice to begin aspirin 325 mg per day for stroke
    prevention
    d. Advise him his risk of disability will be decreased if he receives IV t-PA
    therapy

Answer 20

b. Admit him to the hospital for a rapid evaluation to determine the cause of
his event

Question 21

What are one of the 8 D’s?

Answer 21

Delivery

Question 22

Your patient is an 85 y/o male in a nursing home complaining of left arm weakness and LOC 2 weeks after a fall… what is his condition?

Answer 22

Subdural Hematoma

Question 23

Stroke affects?

Answer 23

800,000 people a year

Question 24

What is the function of the cerebellum?

Answer 24

Its the Coordination Center

Question 25

What is the best way to determine if someone has a focal neurological deficit?

Answer 25

primary assessment