👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Pharmacological Therapies🔖 Free to read, print, and share
Also known as: tPA · Activase · clot buster · tissue plasminogen activator · thrombolytic
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Use this quick-reference guide to spot, treat, and prevent Alteplase (tPA) on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Uses
Acute ischemic stroke, STEMI, PE
Converts plasminogen → lyses clot
✅ Window
Stroke: within 3-4.5 hrs onset
Must r/o hemorrhage on CT first
📌 Avoid
Recent surgery, bleed, head trauma
Active bleed, BP > 185/110
🚩 Report
↓ LOC, severe HA → intracranial bleed
Bleeding gums, blood in urine/stool
✅ Do
Neuro checks, avoid IM/punctures
Bedrest, minimal handling
📚 Alteplase (tPA) — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Alteplase is a thrombolytic (tissue plasminogen activator) that dissolves existing clots by converting plasminogen to plasmin. It is used for acute ischemic stroke, acute myocardial infarction, and massive pulmonary embolism within strict time windows. Bleeding, including intracranial hemorrhage, is the most serious risk, so candidate screening is rigorous.
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Key points
Understand these first
Dissolves existing thrombi and must be given within tight time windows (generally within 3-4.5 hours of ischemic stroke symptom onset).
A hemorrhagic stroke must be ruled out by CT before administration for stroke.
Absolute contraindications include active internal bleeding, recent intracranial hemorrhage, recent stroke, and recent major surgery or head trauma.
Intracranial hemorrhage is the most feared complication.
Blood pressure must be controlled (commonly below 185/110 mmHg for stroke) before and during therapy.
Invasive procedures, IM injections, and unnecessary venipunctures are minimized to prevent bleeding.
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Nursing priorities
What to do, in order
Verify time of symptom onset and confirm the patient meets strict inclusion criteria before giving.
Perform frequent neurologic and vital sign checks and continuous bleeding assessment.
Minimize venipunctures, injections, and invasive lines; apply prolonged pressure to puncture sites.
Control blood pressure within ordered parameters before and during infusion.
Keep emergency equipment available and avoid concurrent anticoagulants or antiplatelets during the acute window unless ordered.
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Red flags — report now
Escalate immediately
Report sudden severe headache, decreased level of consciousness, or new neurologic deficits, which signal intracranial hemorrhage, and stop the infusion.
Report any signs of internal or external bleeding immediately.
Never give if the patient is outside the time window or has any absolute contraindication.
Report uncontrolled hypertension before or during therapy.
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Labs & values
Numbers to know
Platelet count (normal 150,000-400,000/mm3)
aPTT (normal about 30-40 seconds)
PT/INR (normal INR about 0.8-1.1)
Fibrinogen (normal about 200-400 mg/dL)
Hemoglobin and hematocrit (monitored for bleeding)
❓ Alteplase (tPA): NCLEX FAQs
What are the priority nursing interventions for Alteplase (tPA)?
Verify time of symptom onset and confirm the patient meets strict inclusion criteria before giving. Perform frequent neurologic and vital sign checks and continuous bleeding assessment. Minimize venipunctures, injections, and invasive lines; apply prolonged pressure to puncture sites. Control blood pressure within ordered parameters before and during infusion.
What are the warning signs of Alteplase (tPA) a nurse must report?
Report sudden severe headache, decreased level of consciousness, or new neurologic deficits, which signal intracranial hemorrhage, and stop the infusion. Report any signs of internal or external bleeding immediately. Never give if the patient is outside the time window or has any absolute contraindication. Report uncontrolled hypertension before or during therapy.
What do I need to know about Alteplase (tPA) for the NCLEX?
Dissolves existing thrombi and must be given within tight time windows (generally within 3-4.5 hours of ischemic stroke symptom onset). A hemorrhagic stroke must be ruled out by CT before administration for stroke. Absolute contraindications include active internal bleeding, recent intracranial hemorrhage, recent stroke, and recent major surgery or head trauma. Intracranial hemorrhage is the most feared complication.
What lab values are associated with Alteplase (tPA)?
Platelet count (normal 150,000-400,000/mm3). aPTT (normal about 30-40 seconds). PT/INR (normal INR about 0.8-1.1). Fibrinogen (normal about 200-400 mg/dL).
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Quick Tip
Dissolves existing thrombi and must be given within tight time windows (generally within 3-4.5 hours of ischemic stroke symptom onset).