NCLEX Practice Test

A client with right-sided paralysis and slurred speech cannot receive thrombolytic therapy due to which reason?

1. Client had gallbladder surgery 2 months ago

2. Client has experienced loss of the gag reflex

3. Client has platelet count of 130,000/mm³ (130 × 10⁹/L)

4. Client has symptoms that started 12 hours earlier

The correct answer is: Client had gallbladder surgery 2 months ago

The correct answer is related to the contraindications for thrombolytic therapy. In general, thrombolytic therapy is not recommended for clients with certain recent surgical histories, such as major surgeries, including gallbladder surgery, especially if they occurred within a specific time frame—typically within the last 3 months. This is due to the increased risk of bleeding complications that can arise from thrombolytic agents. In the case of this client, being 2 months post-gallbladder surgery raises concerns about potential bleeding, which is why this surgical history is a critical factor ruling out the use of thrombolytics. The other factors mentioned, such as having a low platelet count, experiencing loss of the gag reflex, or the onset of symptoms being 12 hours prior, do not align as primary contraindications for thrombolytic therapy in the same definitive way that recent surgery does. For instance, while a low platelet count and loss of the gag reflex can be concerning, they would need to be evaluated in conjunction with other clinical signs.