Any returning or worsening deficit may be an evolving stroke, report immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client reports a brief episode of right arm weakness and vision loss that fully resolved within 30 minutes. The nurse recognizes this is MOST consistent with which condition?
Answer: A. A transient ischemic attack (TIA) causes focal neurologic deficits, such as transient weakness or vision loss, that resolve completely, typically within an hour and without permanent infarction. It is a warning sign of future stroke and requires evaluation. A completed ischemic stroke causes lasting deficits, a hemorrhagic stroke usually causes a severe headache and persistent deficits, and a migraine aura is a different process.
Question 2 of 5
A nurse is assessing a client suspected of having a transient ischemic attack (TIA). Which statement best describes a TIA?
Answer: B. A TIA is a temporary episode of neurologic dysfunction caused by focal ischemia without acute infarction; symptoms resolve, typically within an hour, but it is a strong warning sign for future stroke.
Question 3 of 5
A nurse measures a client's blood pressure during the acute phase of an ischemic stroke who did not receive tPA. The provider allows permissive hypertension. What is the rationale?
Answer: B. Permissive (mildly elevated) blood pressure helps maintain cerebral perfusion pressure to the ischemic penumbra. Aggressively lowering BP can extend the infarct, so moderate elevation is often tolerated.
Question 4 of 5
A client with gout is admitted with an acutely painful, red, swollen great toe. Which dietary instruction should the nurse provide to help prevent future attacks?
Answer: B. Gout results from hyperuricemia and urate crystal deposition. Clients should limit purine-rich foods such as organ meats, red meat, shellfish, and alcohol (especially beer), and increase fluid intake to promote uric acid excretion. High-purine diets worsen attacks.
Question 5 of 5
A client with a traumatic brain injury is being monitored for increased intracranial pressure (ICP). Which value indicates a normal adult ICP?
Answer: A. Normal adult ICP is 5 to 15 mm Hg (often cited as 5-15, with up to 20 transiently tolerated). Sustained pressures above 20 mm Hg require treatment. Values of 25 and 30 are clearly elevated; a negative value is not physiologic for a supine adult.
Keep the streak going with more questions like these, each with a full rationale.
What is transient ischemic attack?
It produces no permanent damage but is a critical warning sign that a full stroke may follow. Causes include carotid stenosis, atrial fibrillation, and small emboli.
Key points to remember
- Symptoms mimic a stroke (one-sided weakness, slurred speech, visual loss, dizziness) but resolve completely.
- Temporary monocular blindness (amaurosis fugax), described as a curtain coming down over one eye, is classic.
- A TIA is a strong predictor of impending ischemic stroke, with the highest risk in the first 48 hours.
- Atrial fibrillation, carotid artery disease, hypertension, and diabetes are major underlying risk factors.
- Because symptoms have resolved by arrival, the history of onset and resolution is the key diagnostic clue.
Signs & symptoms
- Transient weakness, slurred speech
- Amaurosis fugax (vision loss)
- Numbness, dizziness, resolve
Nursing priorities
- Treat every TIA as a medical emergency and complete a full neuro assessment, even if the patient now feels normal.
- Anticipate diagnostic workup including carotid ultrasound, ECG/telemetry for atrial fibrillation, and brain imaging.
- Administer prescribed antiplatelet therapy (aspirin or clopidogrel) or anticoagulation for atrial fibrillation as ordered.
- Manage modifiable risk factors: monitor blood pressure, glucose, and lipids and reinforce lifestyle changes.
- Keep the patient safe from falls until the cause is identified and deficits are confirmed resolved.
Labs & values
Patient teaching
- A TIA is a warning, take it seriously and seek emergency care for any stroke-like symptom.
- Take antiplatelet or anticoagulant medication exactly as prescribed and do not stop it on your own.
- Control blood pressure, manage diabetes, eat a low-fat diet, exercise, and quit smoking to lower stroke risk.
Red flags: report now
- Any returning or worsening deficit may be an evolving stroke, report immediately.
- Do not dismiss resolved symptoms; failure to act on a TIA can lead to a disabling stroke.
- New onset of irregular pulse may indicate atrial fibrillation requiring urgent anticoagulation decisions.
References
Clinical references for this topic
