Which statement best describes a strain?

A. Heparin: Heparin is an anticoagulant, but it is not typically used in the acute management of ischemic stroke because it does not dissolve clots already formed. It may be used later for prophylaxis against new clots.
B. Tissue-type plasminogen activator (tPA): This is correct. tPA is a thrombolytic agent that can dissolve the clot causing the stroke. It is most effective when given within a few hours of symptom onset, making it the appropriate medication in this scenario.
C. Warfarin: Warfarin is an oral anticoagulant used for long-term prevention of clot formation but is not suitable for immediate thrombolytic therapy in acute ischemic stroke.
D. Clopidogrel: Clopidogrel is an antiplatelet medication used for secondary prevention of strokes but is not used for acute thrombolysis.

Has the patient been taking his medications as prescribed? This is the most important information to collect. Understanding the patient's medication adherence is crucial because if the patient is not taking his medications as prescribed, it could explain why his blood pressure is elevated. Noncompliance with medication regimens is a common cause of hypertensive urgency and can lead to severe complications. Therefore, knowing whether he has been taking his medications regularly and correctly would directly influence the management plan and help identify the cause of the current crisis.

Does the patient hurt anywhere else? While it’s important to assess for pain and discomfort to address immediate symptoms, this information does not directly address the potential cause of the elevated blood pressure. The patient already reported pain in the head, chest, and left leg, so the primary concern is managing his hypertensive urgency and understanding its underlying causes rather than identifying additional pain locations at this moment.

When does the patient take his furosemide? Knowing the timing of furosemide intake could provide insights into his diuretic therapy management and its potential impact on his blood pressure. However, it is less immediately relevant than understanding whether he has been taking all his medications as prescribed. This question might be more pertinent once medication adherence is confirmed to understand diuretic effects throughout the day.

Has the patient fallen before? This is relevant for assessing the risk of recurrent falls and potential underlying issues such as orthostatic hypotension or balance problems, which are crucial for long-term management and safety. However, it is not as immediately critical in the context of the current hypertensive urgency and the elevated blood pressure despite medication.