An adult client is brought to the emergency department (ED) and diagnosed with a thrombotic stroke. The team plans to administer alteplase (Activase)
The client makes the following comments to a nurse. Which information is critical for the nurse to relay to the health care provider?
1. "I can't believe this is happening. My baby is only a year old."
2. "I thought this was just my asthma acting up."
3. "I wonder if this was happening when I fell and hit my head last week."
4. "I had a blood clot in my leg last year after my baby was born."
Correct Answer: 3
Rationale 1: Childbirth a year ago is not a contraindication to alteplase (Activase).
Rationale 2: Asthma is not a contraindication to alteplase (Activase).
Rationale 3: The use of alteplase (Activase) increases the risk of severe bleeding. Clients with head injury can experience intracranial bleeding, which can cause brain damage and is potentially fatal.
Rationale 4: DVT is not a contraindication to the use of alteplase (Activase).
Global Rationale: The use of alteplase (Activase) increases the risk of severe bleeding. Clients with head injury can experience intracranial bleeding, which can cause brain damage and is potentially fatal. Childbirth a year ago, a history of asthma, and DVT are not contraindications to alteplase (Activase).
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