A patient enters the emergency department with right-sided weakness and vision changes. What assessment finding should be communicated to the registered nurse (RN) or HCP immediately?
a. Blood glucose 150 mg/dL
b. Blood pressure 148/92 mm Hg
c. Onset of symptoms occurred 90 minutes ago
d. History of transient ischemic attack (TIA) 3 months ago
ANS: C
All the data are significant. However, the onset of symptoms is within the time frame for the patient to receive a thrombolytic. If the nurse acts quickly, the patient's stroke may be able to be reversed.
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