A high school teacher who has been diagnosed with epilepsy after having a generalized tonic- clonic seizure tells the nurse, "I cannot teach anymore. It will be too upsetting if I have a seizure at work." How should the nurse respond to specifically address the patient's concern?

A. The patient has dysphasia: Dysphasia (difficulty with speech) is a common symptom of stroke but does not contraindicate the use of aspirin for acute ischemic stroke management. Aspirin is routinely administered in the acute phase of ischemic stroke to prevent further clot formation.

B. The patient has atrial fibrillation: Atrial fibrillation increases the risk of embolic strokes, and aspirin may be used for stroke prevention in certain cases. However, the presence of atrial fibrillation alone does not indicate a contraindication to aspirin administration in the acute setting of a suspected stroke.

C. The patient has a history of brief episodes of right-sided hemiplegia: A history of transient ischemic attacks (TIAs) or brief episodes of hemiplegia suggests a risk factor for stroke but does not necessarily contraindicate the use of aspirin in the acute phase of stroke
management. Aspirin is commonly used for secondary prevention after TIAs or minor strokes.

D. The patient reports that symptoms began with a severe headache: Severe headache as the initial symptom of stroke raises concerns about a possible hemorrhagic stroke rather than an ischemic stroke. Administration of aspirin in the setting of a hemorrhagic stroke can worsen bleeding and increase morbidity and mortality. Therefore, the nurse should consult with the healthcare provider before giving aspirin to determine the appropriate course of action based on the patient's presentation and diagnostic evaluation.

Intracranial hemorrhage: Given the client's history of falling out of bed, subsequent head injury, headache, seizure, and neurological deterioration (weakness on the right side of the body, dilated right pupil, confusion), there is a significant concern for intracranial hemorrhage. These symptoms suggest possible bleeding within the skull, which can rapidly escalate and become life-threatening.

Heart rate: The client's decreasing heart rate from 70/min at 1230 to 40/min at 1430 indicates bradycardia, which can be a critical sign of increased intracranial pressure (ICP) due to intracranial hemorrhage. Bradycardia is a late sign of increased ICP and indicates severe neurological compromise. In this context, the irregular heart rate and the associated neurological symptoms raise concerns for impending or ongoing intracranial hemorrhage.