Report sudden severe headache, decreased level of consciousness, or new neurologic deficits, which signal intracranial hemorrhage, and stop the infusion.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client is being evaluated for alteplase (tPA) for acute ischemic stroke. Which finding would be a contraindication to administration?
Answer: C. Active internal bleeding or a recent history of significant bleeding is an absolute contraindication to alteplase because the drug dissolves clots and dramatically increases hemorrhage risk.
Question 2 of 3
A nurse is caring for a client receiving alteplase for an acute ischemic stroke. Which assessment finding is the priority concern?
Answer: A. Alteplase is a thrombolytic (fibrinolytic) that dissolves clots and carries a major risk of hemorrhage, including intracranial bleeding. A sudden severe headache with decreasing level of consciousness suggests intracranial hemorrhage and is the priority. Mild gum oozing, transient nausea, and a slight pulse increase are less urgent.
Question 3 of 3
A client is started on a thrombolytic (alteplase) for an acute ST-elevation myocardial infarction. Which finding would the nurse identify as an absolute contraindication to this therapy?
Answer: B. Thrombolytics dissolve clots but greatly increase bleeding risk, so a recent intracranial hemorrhage or active internal bleeding is an absolute contraindication. The nurse must verify the absence of such conditions before administration. Chest pain of 2 hours, a blood pressure of 150/90, and an elevated troponin are expected or manageable findings in acute MI, not contraindications to thrombolysis.
Keep the streak going with more questions like these, each with a full rationale.
What is alteplase (tpa)?
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.
Key points to remember
- 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.
Nursing priorities
- 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.
Labs & values
Red flags: report now
- 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.
References
Clinical references for this topic
