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Transient ischemic attack: Heed the warning

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doi: 10.1097/01.NURSE.0000446626.47843.14
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INSTRUCTIONS Transient ischemic attack: Heed the warning

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Transient ischemic attack: Heed the warning

GENERAL PURPOSE: To provide information about evidence-based interventions for TIA and stroke. LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to: 1. Describe the signs and symptoms of TIA. 2. Discuss the diagnostic criteria for TIA. 3. Identify evidence-based strategies for TIA and stroke prevention.

  1. Which of the following best describes TIA?
    1. It results in tissue death visible on cerebral imaging.
    2. It's a transient episode of neurologic dysfunction.
    3. It results in cerebral infarction.
    4. It's characterized by a gradual onset of neurologic signs and symptoms.
  2. Which statement about TIA is correct?
    1. It affects more females than males.
    2. The incidence of TIA doesn't change with advancing age.
    3. It doesn't resolve spontaneously.
    4. It can be a precursor to stroke.
  3. A typical clinical feature of TIA is
    1. absence of nonspecific symptoms.
    2. symptom onset within days of the event.
    3. a history of similar episodes.
    4. gradual development of chest pain.
  4. A TIA involving the anterior cerebral artery circulation can manifest as
    1. dysphagia.
    2. bilateral blindness.
    3. quadriparesis.
    4. hemianesthesia.
  5. The risk of a TIA progressing to stroke is highest with
    1. carotid artery stenosis.
    2. lacunar pathology.
    3. occlusion of small distal arteries.
    4. cardioembolic sources.
  6. Which statement about the NIHSS is accurate?
    1. It's a seven-item assessment tool.
    2. It's been shown to predict mortality in acute hemorrhagic stroke.
    3. It uses qualitative measures of neurologic deficits.
    4. It should be used with every patient with stroke-like signs and symptoms.
  7. One factor used to calculate the ABCD2 score is
    1. awareness.
    2. coronary artery disease.
    3. diabetes.
    4. intracranial pressure.
  8. An ABCD2 score of 7 signifies
    1. a need for emergent carotid endarterectomy.
    2. no need for hospitalization.
    3. a low stroke risk.
    4. a high 2-day stroke risk.
  9. If your patient has a ABCD2 score of 4,
    1. the 2-day stroke risk is 40%.
    2. head and neck imaging is indicated in the ED.
    3. hospital admission is required.
    4. emergent carotid arteriography is indicated.
  10. Nonmodifiable risk factors for TIA and stroke include
    1. heredity.
    2. smoking.
    3. sedentary lifestyle.
    4. alcohol abuse.
  11. AHA Class I recommendations for TIA workup within 24 hours of symptom onset include all of the followingexcept
    1. brain CT.
    2. carotid angiography.
    3. craniocervical vessel MRA.
    4. brain MRI.
  12. After arrival in the ED, patients with stroke signs and symptoms should undergo a stat noncontrast CT scan within
    1. 25 minutes.
    2. 40 minutes.
    3. 60 minutes.
    4. 90 minutes.
  13. Which statement is correct about DWI?
    1. It's inferior to noncontrast CT for showing areas of infarcted brain tissue.
    2. It can't show infarcted brain tissue in small cerebral arterial territories.
    3. It's the best test for showing infarcted brain tissue in perforator cerebral arterial territories.
    4. It should be performed within 48 hours of symptom onset.
  14. Which is not an antiplatelet drug used to prevent secondary ischemic events?
    1. dipyridamole
    2. clopidogrel
    3. aspirin
    4. warfarin
  15. A target goal for aggressive stroke risk factor modification is
    1. BP less than 160/90.
    2. BP less than 140/90 in patients with diabetes.
    3. LDL less than 70 mg/dL.
    4. LDL greater than 90 mg/dL.
  16. Which risk factor should have the highest priority to prevent TIA and stroke?
    1. dyslipidemia
    2. hypertension
    3. hyperglycemia
    4. obesity
  17. Atorvastatin therapy in patients with a recent TIA or stroke has been shown to
    1. have no effect on the incidence of fatal stroke.
    2. have a positive effect on the incidence of future TIAs.
    3. reduce the incidence of fatal or nonfatal stroke by 16%.
    4. reduce mortality by 61%.
  18. Which intervention has been shown to reduce stroke risk in symptomatic patients with a history of TIA or stroke and 70% to 99% carotid artery stenosis?
    1. carotid endarterectomy
    2. carotid artery stenting
    3. aortic valvuloplasty
    4. vena cava filter placement
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