| Course | DNP 627 Management of Complex Health Problems in Adult-Gerontology Theory |
|---|---|
| Module | Module 2 |
| Paper type | Clinical vignette discussion post with peer replies |
| Length | About 560 words |
| Format | Discussion post with APA 7 citations |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 627 Module 2
Clinical Vignette Discussion Board 2: Twenty Minutes of a Clumsy Hand
It Went Away, So Why the Hurry? Same-Day Evaluation and Secondary Prevention After a Transient Ischemic Attack at 74
The Vignette and My Assigned Question
G.M. is a 74-year-old retired bus driver with hypertension, type 2 diabetes and hyperlipidemia who calls the clinic the morning after an episode in which his right hand felt weak and clumsy and his speech was slurred for about 20 minutes. Symptoms resolved completely. He takes lisinopril, metformin and simvastatin 20 mg. In the office his blood pressure is 162/90, his pulse is regular and his neurological examination is normal. My assigned question: How high is his stroke risk, how quickly and how should he be evaluated, and which secondary prevention steps should begin now?
Initial Post
Risk
G.M.'s story fits a transient ischemic attack (TIA), defined today as a brief episode of neurological dysfunction caused by focal ischemia without acute infarction on imaging (Easton et al., 2009). His ABCD2 score is 6: age 60 or older (1), blood pressure 140/90 or higher (1), unilateral weakness (2), duration 10 to 59 minutes (1) and diabetes (1). That places him in the high-risk group. The score should not be used to decide who can wait, though, because patients with low scores can still have carotid stenosis or atrial fibrillation. In a large registry of patients seen promptly in specialized TIA services, the one-year risk of stroke was about 5%, with much of it concentrated in the first days (Amarenco et al., 2016), which is why speed matters.
Evaluation
He should be evaluated today, either in the emergency department or a rapid-access TIA clinic if one is available within 24 hours. The workup includes brain MRI with diffusion-weighted imaging, imaging of the head and neck arteries (CT or MR angiography, or carotid ultrasound), a 12-lead ECG and cardiac rhythm monitoring, and laboratory tests including glucose, A1c, lipid panel, complete blood count and coagulation studies (Kleindorfer et al., 2021).
Secondary Prevention
For a high-risk TIA without a cardioembolic source, aspirin plus clopidogrel started within 24 hours and continued for 21 days, followed by a single antiplatelet agent, lowers early recurrence (Kleindorfer et al., 2021). In the POINT trial, the combination reduced major ischemic events at 90 days but increased major bleeding, and most of the benefit came in the first weeks, which supports the shorter course (Johnston et al., 2018). I would also change simvastatin to a high-intensity statin, plan to lower his blood pressure toward a goal below 130/80 after the acute phase, keep his diabetes care on track and refer him for carotid endarterectomy or stenting if imaging shows symptomatic stenosis of 70% or more, ideally within two weeks.
Reply to a Classmate (On Atrial Fibrillation)
Danielle, your question on what happens if monitoring finds atrial fibrillation is an important branch. In that case the plan changes from antiplatelet therapy to anticoagulation, and the guideline supports prolonged monitoring when the first ECG and telemetry are normal but the stroke pattern looks embolic. For G.M., would you favor a 30-day ambulatory monitor if his imaging shows no carotid disease?
Reply to a Classmate (On Driving)
Owen, I am glad you raised driving. G.M. no longer drives professionally, but he still drives daily. I would ask him not to drive until his evaluation is complete and to call 911 for any new symptoms rather than driving himself in.
References
Amarenco, P., Lavallee, P. C., Labreuche, J., Albers, G. W., Bornstein, N. M., Canhao, P., Caplan, L. R., Donnan, G. A., Ferro, J. M., Hennerici, M. G., Molina, C., Rothwell, P. M., Sissani, L., Skoloudik, D., Steg, P. G., Touboul, P.-J., Uchiyama, S., Vicaut, E., & Wong, L. K. S. (2016). One-year risk of stroke after transient ischemic attack or minor stroke. New England Journal of Medicine, 374(16), 1533-1542. https://doi.org/10.1056/NEJMoa1412981
Easton, J. D., Saver, J. L., Albers, G. W., Alberts, M. J., Chaturvedi, S., Feldmann, E., Hatsukami, T. S., Higashida, R. T., Johnston, S. C., Kidwell, C. S., Lutsep, H. L., Miller, E., & Sacco, R. L. (2009). Definition and evaluation of transient ischemic attack. Stroke, 40(6), 2276-2293. https://doi.org/10.1161/STROKEAHA.108.192218
Johnston, S. C., Easton, J. D., Farrant, M., Barsan, W., Conwit, R. A., Elm, J. J., Kim, A. S., Lindblad, A. S., & Palesch, Y. Y. (2018). Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. New England Journal of Medicine, 379(3), 215-225. https://doi.org/10.1056/NEJMoa1800410
Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S. (2021). 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, 52(7), e364-e467. https://doi.org/10.1161/STR.0000000000000375
Reading the DNP 627 Module 2 assignment instructions
The second Clinical Vignette Discussion Board in DNP 627 falls in Week 7, the neurological system module. Its format repeats Week 3: a shared case, one question per student, your answer posted first and then discussion across the Monday to Friday week. Deadlines and the scoring rubric are posted in Canvas; together the Week 3 and Week 7 boards make up a tenth of the grade. Neurological vignettes in an adult-gerontology course often test whether you recognize time-sensitive conditions in older adults, so expect your answer to be judged on urgency and the timing of each step as much as on the diagnosis itself. Read the case through once for the time course before answering, because timing is usually what the assigned question turns on.
How the DNP 627 Module 2 example is put together
Built as a board post, the sample restates the vignette and quotes the assigned question first. Under "Risk," it applies the current tissue-based definition of TIA, works out the ABCD2 score item by item and explains why the score cannot justify a delay, citing a registry on one-year stroke risk. Under "Evaluation," it sets the timing and lists the imaging, cardiac and laboratory tests the guideline calls for. Under "Secondary Prevention," it gives dual antiplatelet therapy with its start time and duration, explains the trial behind it, and adds statin intensity, a blood pressure goal and the carotid surgery threshold. Two replies follow classmates into atrial fibrillation monitoring and driving advice, each adding something specific to the patient.
Reading the DNP 627 Module 2 grading rubric
The Canvas rubric governs scoring for both vignette boards, which share 10% of the grade. Neurological case answers in nurse practitioner courses are generally credited for accuracy, urgency, guideline-based workup and management, use of the case details and a clear plan with timing. An answer that names TIA but sends the patient for an outpatient workup next month, or that starts antiplatelet therapy without a duration, would lose points for safety. Citing current guidelines carries weight, since stroke prevention recommendations have changed in recent years. Replies are part of the grade, so add content or a well-aimed question. A late post loses 5% daily, and after a week it earns nothing.
DNP 627 Module 2 help from the desk
The most common error on TIA cases is treating a resolved episode as low priority. Make the timing explicit: evaluation today. Another is relying on the ABCD2 score to decide who can wait. Give doses and durations, not just drug names, and say when dual antiplatelet therapy stops. Check for the details that change the plan, such as atrial fibrillation or a high-grade carotid stenosis. Use the current guideline rather than older sources, and avoid UpToDate-style summaries as citations if the course discourages them. Every word must be your own because the course prohibits generative AI. The desk can help you plan the post if you pass along the vignette wording and your question.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 627 Module 2 questions, answered
Where can I find a free DNP 627 Module 2 sample paper?
A full DNP 627 Module 2 sample is posted here: a Clinical Vignette Discussion Board 2 answer on a transient ischemic attack in a 74-year-old, covering risk, evaluation and secondary prevention.
What is the ABCD2 score?
A five-item score for stroke risk after TIA based on age, blood pressure, clinical features, duration and diabetes; it ranges from 0 to 7 but should not be used alone to delay evaluation.
How long should dual antiplatelet therapy last after a high-risk TIA?
Current guidance supports aspirin plus clopidogrel started within 24 hours and continued for 21 days, then a single antiplatelet agent.
How soon should a patient with a TIA be evaluated?
The same day, in an emergency department or rapid-access TIA clinic, because stroke risk is highest in the first days.
What topics does DNP 627 cover in Week 7?
Week 7 covers the neurological system and includes the second Clinical Vignette Discussion Board.