The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the:

Patients with TIAs are at increased risk of developing an ischemic stroke due to transient but recurrent interruptions in cerebral blood flow. Administration of daily low-dose aspirin, an antiplatelet medication, reduces platelet aggregation and prevents clot formation in cerebral arteries. This prophylactic therapy significantly decreases the likelihood of progression from TIA to stroke in high-risk individuals. Because of its proven effectiveness, aspirin is the most widely recommended first-line medication for secondary stroke prevention.

Rationale for correct answer:
3. Daily low-dose aspirin. Aspirin works by irreversibly inhibiting platelet aggregation, thereby reducing the risk of thrombus formation in cerebral arteries. Multiple studies have shown that aspirin decreases the incidence of ischemic stroke in patients with TIAs and other vascular risk factors. It is a cornerstone therapy in secondary prevention of ischemic stroke.

Rationale for incorrect answers:
1. Furosemide (Lasix). This is a loop diuretic used to manage fluid overload in conditions like heart failure or renal disease. It has no role in preventing thrombus formation or reducing stroke incidence in TIA patients.

2. Lovastatin (Mevacor). Statins help reduce cholesterol and are useful in long-term prevention of atherosclerotic disease. However, their role is more in reducing cardiovascular risk over time rather than immediate prevention of stroke following TIAs.

4. Nimodipine (Nimotop). This calcium channel blocker is specifically used to prevent cerebral vasospasm after subarachnoid hemorrhage, not in the prevention of ischemic stroke after TIAs.

Take-home points:

• Low-dose aspirin is the most effective and widely recommended medication to reduce stroke risk in patients with TIAs.
• Antiplatelet therapy plays a central role in secondary prevention of ischemic stroke.
• Medications like diuretics, statins, and calcium channel blockers have roles in cardiovascular care but do not replace aspirin for TIA-related stroke prevention.

After a stroke, patients are at high risk for aspiration due to impaired swallowing function. The first nursing action is to check the gag reflex before offering any food, fluids, or medications orally. Ensuring airway protection is critical, since aspiration can lead to pneumonia and further complications. Early assessment of swallowing safety guides dietary decisions and prevents potentially life-threatening respiratory issues.

Rationale for correct answer:
1. Check the patient’s gag reflex. This assessment provides crucial information about the safety of oral intake and helps prevent aspiration. A weak or absent gag reflex indicates the need for swallowing studies or alternate feeding methods until the patient’s airway protection is assured. Performing this check first ensures patient safety before advancing to diet orders or swallowing trials.

Rationale for incorrect answers:
2. Order a soft diet for the patient. Ordering food before assessing the patient’s gag reflex or swallow ability is unsafe. If the patient aspirates, it may lead to pneumonia or airway obstruction, which worsens outcomes after a stroke.

3. Raise the head of the bed to a sitting position. While this position is helpful in reducing aspiration risk and aiding breathing, it should not be the very first action. Without confirming the gag reflex, even upright positioning cannot fully protect against aspiration during oral intake.

4. Evaluate the patient’s ability to swallow small amounts of crushed ice or ice water. Swallow trials should never be attempted before confirming a gag reflex. Testing swallowing too early may directly expose the patient to aspiration risks.

Take-home points:

• Always assess gag reflex first in stroke patients before offering food, fluids, or medications orally.
• Airway protection takes priority over comfort or nutrition in the immediate phase of care.
• Safe feeding decisions must be guided by swallowing assessments and may involve referral to speech-language pathology.