Post Test Questions - Stroke Abstraction Training

1. If a patient is admitted as an ischemic stroke and was treated with IV tPA and developed a complication such as an intra-cerebral hemorrhage what should the final clinical diagnosis related to stroke be?
2. A nursing home resident began experiencing signs and symptoms of a stroke while on a day trip with the family. There were transported to the ED. What would you choose for the question “where was the patient located when signs and symptoms were discovered?”
3. If documentation in the medical record indicates that therapy has been prescribed an antithrombotic but patient has not filled the prescription, has not taken the medication in the past week or is otherwise noncompliant, you would select “No” to prior medications to admission.
4. There are three circumstances in which an abstractor can infer why t-PA was not given. Select the one instance in which you can NOT infer.
5. If the NIH Sroke Scale is preformed after a patient is given t-PA or 48 hours after patient arrival for patients that do not receive thrombolytic treatment, what should the abstractor select for the question “Was the NIH Stroke Scale Completed”?
6. If there are multiple times of "last known well" documented in the patient record by various medical professionals reflecting different sources, should you use the Neurologist note over the admitting physician’s note?
7. If a Patient arrived in ED via EMS on 12/10/2013 at 14:43 accompanied by the daughter. And the daughter stated that patient was found at 2:00 pm in her chair slumped over, stating “I couldn't understand what she was saying and she was drooling from her mouth and her face just didn't look right." On further questioning by the neurologist, the daughter says her mother ate lunch at 12:30 pm and then went to sit in her chair where she was later found as noted above. What would you determine the Date/ Time of last known well to be?
8. In the same scenario above, what would you determine to be the Date and Time of discovery of stroke systems?
9. The patient who arrived in your ED at 14:43 in question #5 went directly to the CT scanner because the EMS professionals called the hospital in advance. The brain imaging was initiated at 14:55, completed at 15:25 and read by the ER physician at 15:30. What time should be abstracted for Date/Time Brain imaging initiated?
10. When looking for t-PA contraindications, the abstractor can take documentation written by the Emergency Room nurse.
11. Do the lipid measurements have to be a fasting value within-in the first 48 hours of arrival to the hospital?
12. Stroke patients require a documented reason for not administering another form of prophylaxis when graduated compression stockings (GCS) are the ONLY form of VTE prophylaxis administered. TRUE OR FALSE?
13. What is the recommendation of who may be qualified to perform the Modified Rankin Scale?
14. When abstracting the education component, which elements are required to select “YES” to the question Patient and/or caregiver received education and/or resource materials regarding all of the following?
15. According to the guidelines, assessing a stroke patient for rehabilitation is a Class I, Level of Evidence A recommendation. Which of the following is NOT considered a Rehab Discipline?
16. Which patients are EXCLUDED from the Get With The Guidelines-Stroke tool?
17. A patient is admitted to the in-patient unit with right hemiparesis and dysarthria. His pre-admission medications were lisinopril, aspirin, metformin and furosemide. His metformin is held but all other medications are continued. LDL is noted to be 180 and he has a recent non-q wave MI. He is discharged on day 5 on his original pre-admission medications and pravastatin plus a low-cholesterol diet. Data entry will be to select:
18. In the above scenario, if a fibrate was prescribed instead of a statin, would the patient be in compliance with the guideline?
19. The 2008 Update to the AHA/ASA Recommendations for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack contains the following Class I recommendation: "On the basis of the SPARCL trial, administration of statin therapy with intensive lipid-lowering effects is recommended for patients with atherosclerotic ischemic stroke or TIA and without known CHD to reduce the risk of stroke and cardiovascular events." All but which medications/dosages are considered Intensive Statin Therapy?
20. A Patient is admitted with new onset atrial fibrillation and a minor stroke. He is discharged on dalteparin 100 IU/kg sq twice a day along with a plan to start warfarin in 7 days. For the question “Antithrombotic Medication(s) at Discharge” what would your response be?
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