ACLS Acute Stroke Care Practice Questions and
Answers (2026|2027)
Question 1
A 65-year-old patient presents with sudden right-sided weakness and slurred speech.
The last known well time was 90 minutes ago. What is the most appropriate next step?
A. Administer aspirin immediately
• B. Activate the stroke team and prepare for CT scan
C. Begin IV heparin
D. Monitor and reassess in 1 hour
Rationale: Early activation of the stroke team and rapid neuroimaging (CT/MRI) is
critical to differentiate ischemic vs. hemorrhagic stroke before initiating treatment.
Aspirin or anticoagulants should not be given until hemorrhage is excluded.
Question 2
Door-to-needle time for IV thrombolytic therapy (tPA) in eligible ischemic stroke patients
should be:
A. Within 120 minutes
B. Within 90 minutes
• C. Within 60 minutes
D. Within 30 minutes
Rationale: AHA guidelines emphasize a door-to-needle time ≤ 60 minutes for IV tPA
administration in eligible patients to maximize neurological recovery.
Question 3
Which prehospital stroke assessment tool is commonly used to identify potential stroke
patients?
A. Glasgow Coma Scale
• B. Cincinnati Prehospital Stroke Scale (CPSS)
C. APGAR Score
D. NIH Stroke Scale
Rationale: CPSS is a rapid prehospital screening tool assessing facial droop, arm drift,
and speech abnormalities. The NIH Stroke Scale is more detailed and used in hospital
settings.
Question 4
A patient with suspected stroke has a blood pressure of 210/120 mmHg. What is the
correct management before tPA administration?
A. Proceed with tPA immediately
• B. Lower BP to <185/110 mmHg before tPA
C. Give aspirin and monitor
D. Delay treatment until BP normalizes naturally
Rationale: Elevated BP must be controlled to <185/110 mmHg before tPA to reduce risk
of intracranial hemorrhage.
,Question 5
Which of the following is a contraindication for IV tPA in acute ischemic stroke?
A. Age > 80 years
B. NIH Stroke Scale > 15
• C. Recent intracranial hemorrhage
D. Hypertension controlled with medication
Rationale: A history of recent intracranial hemorrhage is an absolute contraindication for
thrombolytic therapy due to high bleeding risk.
Question 6
Which imaging modality is most commonly used first in suspected acute stroke?
A. MRI
• B. Non-contrast CT scan
C. PET scan
D. CT angiography
Rationale: Non-contrast CT is the fastest and most widely available tool to rule out
hemorrhage before thrombolytic therapy.
Question 7
For patients eligible for mechanical thrombectomy, the recommended time window from
last known well is:
A. 3 hours
B. 6 hours
• C. Up to 24 hours in select patients
D. 12 hours
Rationale: Mechanical thrombectomy can be performed up to 24 hours in carefully
selected patients based on imaging and perfusion studies.
Question 8
Which of the following is part of the Cincinnati Prehospital Stroke Scale?
A. Pupillary response
• B. Arm drift
C. Reflexes
D. Coordination
Rationale: CPSS evaluates facial droop, arm drift, and speech abnormalities.
Question 9
What is the most important determinant for IV tPA eligibility?
A. Patient’s age
• B. Time since symptom onset
C. Stroke severity
D. Past medical history
Rationale: IV tPA is time-sensitive, typically within 4.5 hours of symptom onset.
Question 10
Which medication should be avoided within 24 hours after tPA administration?
, A. Oxygen
• B. Anticoagulants and antiplatelets
C. IV fluids
D. Antihypertensives
Rationale: Anticoagulants and antiplatelets increase bleeding risk after thrombolysis.
Question 11
What is the target oxygen saturation in acute stroke patients?
A. 85–90%
• B. ≥94%
C. 100%
D. 90–92%
Rationale: Maintain oxygen saturation ≥94% to optimize cerebral perfusion.
Question 12
Which of the following is an absolute contraindication to IV tPA?
A. Age > 80 years
• B. Active internal bleeding
C. Diabetes mellitus
D. Hypertension controlled with medication
Rationale: Active bleeding is an absolute contraindication due to hemorrhage risk.
Question 13
What is the recommended blood glucose range during acute stroke management?
A. 40–60 mg/dL
B. 70–90 mg/dL
• C. 140–180 mg/dL
Rationale: Hyperglycemia worsens outcomes; maintain glucose between 140–180
mg/dL.
Question 14
Which stroke type is most common?
A. Hemorrhagic
• B. Ischemic
C. Subarachnoid
D. Lacunar
Rationale: Ischemic strokes account for ~85% of all strokes.
Question 15
Which artery is most often involved in ischemic stroke?
A. Posterior cerebral artery
• B. Middle cerebral artery (MCA)
C. Basilar artery
D. Anterior communicating artery
Rationale: MCA strokes are the most frequent, causing contralateral weakness and
aphasia.
Answers (2026|2027)
Question 1
A 65-year-old patient presents with sudden right-sided weakness and slurred speech.
The last known well time was 90 minutes ago. What is the most appropriate next step?
A. Administer aspirin immediately
• B. Activate the stroke team and prepare for CT scan
C. Begin IV heparin
D. Monitor and reassess in 1 hour
Rationale: Early activation of the stroke team and rapid neuroimaging (CT/MRI) is
critical to differentiate ischemic vs. hemorrhagic stroke before initiating treatment.
Aspirin or anticoagulants should not be given until hemorrhage is excluded.
Question 2
Door-to-needle time for IV thrombolytic therapy (tPA) in eligible ischemic stroke patients
should be:
A. Within 120 minutes
B. Within 90 minutes
• C. Within 60 minutes
D. Within 30 minutes
Rationale: AHA guidelines emphasize a door-to-needle time ≤ 60 minutes for IV tPA
administration in eligible patients to maximize neurological recovery.
Question 3
Which prehospital stroke assessment tool is commonly used to identify potential stroke
patients?
A. Glasgow Coma Scale
• B. Cincinnati Prehospital Stroke Scale (CPSS)
C. APGAR Score
D. NIH Stroke Scale
Rationale: CPSS is a rapid prehospital screening tool assessing facial droop, arm drift,
and speech abnormalities. The NIH Stroke Scale is more detailed and used in hospital
settings.
Question 4
A patient with suspected stroke has a blood pressure of 210/120 mmHg. What is the
correct management before tPA administration?
A. Proceed with tPA immediately
• B. Lower BP to <185/110 mmHg before tPA
C. Give aspirin and monitor
D. Delay treatment until BP normalizes naturally
Rationale: Elevated BP must be controlled to <185/110 mmHg before tPA to reduce risk
of intracranial hemorrhage.
,Question 5
Which of the following is a contraindication for IV tPA in acute ischemic stroke?
A. Age > 80 years
B. NIH Stroke Scale > 15
• C. Recent intracranial hemorrhage
D. Hypertension controlled with medication
Rationale: A history of recent intracranial hemorrhage is an absolute contraindication for
thrombolytic therapy due to high bleeding risk.
Question 6
Which imaging modality is most commonly used first in suspected acute stroke?
A. MRI
• B. Non-contrast CT scan
C. PET scan
D. CT angiography
Rationale: Non-contrast CT is the fastest and most widely available tool to rule out
hemorrhage before thrombolytic therapy.
Question 7
For patients eligible for mechanical thrombectomy, the recommended time window from
last known well is:
A. 3 hours
B. 6 hours
• C. Up to 24 hours in select patients
D. 12 hours
Rationale: Mechanical thrombectomy can be performed up to 24 hours in carefully
selected patients based on imaging and perfusion studies.
Question 8
Which of the following is part of the Cincinnati Prehospital Stroke Scale?
A. Pupillary response
• B. Arm drift
C. Reflexes
D. Coordination
Rationale: CPSS evaluates facial droop, arm drift, and speech abnormalities.
Question 9
What is the most important determinant for IV tPA eligibility?
A. Patient’s age
• B. Time since symptom onset
C. Stroke severity
D. Past medical history
Rationale: IV tPA is time-sensitive, typically within 4.5 hours of symptom onset.
Question 10
Which medication should be avoided within 24 hours after tPA administration?
, A. Oxygen
• B. Anticoagulants and antiplatelets
C. IV fluids
D. Antihypertensives
Rationale: Anticoagulants and antiplatelets increase bleeding risk after thrombolysis.
Question 11
What is the target oxygen saturation in acute stroke patients?
A. 85–90%
• B. ≥94%
C. 100%
D. 90–92%
Rationale: Maintain oxygen saturation ≥94% to optimize cerebral perfusion.
Question 12
Which of the following is an absolute contraindication to IV tPA?
A. Age > 80 years
• B. Active internal bleeding
C. Diabetes mellitus
D. Hypertension controlled with medication
Rationale: Active bleeding is an absolute contraindication due to hemorrhage risk.
Question 13
What is the recommended blood glucose range during acute stroke management?
A. 40–60 mg/dL
B. 70–90 mg/dL
• C. 140–180 mg/dL
Rationale: Hyperglycemia worsens outcomes; maintain glucose between 140–180
mg/dL.
Question 14
Which stroke type is most common?
A. Hemorrhagic
• B. Ischemic
C. Subarachnoid
D. Lacunar
Rationale: Ischemic strokes account for ~85% of all strokes.
Question 15
Which artery is most often involved in ischemic stroke?
A. Posterior cerebral artery
• B. Middle cerebral artery (MCA)
C. Basilar artery
D. Anterior communicating artery
Rationale: MCA strokes are the most frequent, causing contralateral weakness and
aphasia.
