This patient has had an acute ischemic stroke and should be admitted to the inpatient stroke unit. Several studies have shown that admission of patients with stroke to an organized inpatient stroke unit compared with a general medical ward is associated with a reduction in mortality at 1 year, with benefits persisting up to several years after stroke. Stroke units are beneficial because of the multidisciplinary nature of care, with an emphasis on specialized nursing, early mobilization, removal of urinary bladder catheters, and adherence to stroke-specific protocols. An important component of the success of stroke units is early referral for rehabilitation services to promote stroke recovery.

Adding clopidogrel to this patient's medication regimen is inappropriate management because the combination of aspirin and clopidogrel has not been shown to be effective and may increase the risk of hemorrhage over the next 3 months. The combination of aspirin and clopidogrel recently was found to reduce the risk of recurrent stroke compared with aspirin alone when administered within 24 hours of transient ischemic attack or minor stroke (National Institutes of Health [NIH] Stroke Scale score less than 5). Because this patient is beyond the 24-hour mark and scored 8 on the NIH Stroke Scale, no evidence supports giving her combination therapy.

This patient's blood pressure is within the acceptable range for someone who has had an acute ischemic stroke. Immediate blood pressure lowering with labetalol or other antihypertensive agents in patients who do not receive intravenous thrombolysis is only recommended if the blood pressure is greater than 220/120 mm Hg or if a high risk or evidence of other end-organ damage exists; neither situation applies.

This patient is well beyond the acceptable timeframe for thrombolysis (3 hours).