NCLEX RN Next Generation NGN Case
Study Practice Exam 10 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
Case Study 1: Acute Ischemic Stroke
A 68-year-old client arrives in the emergency department with sudden
right-sided weakness, facial drooping, and difficulty speaking that
began 90 minutes ago. Blood pressure is 178/96 mm Hg, heart rate
88/min, respiratory rate 18/min, and oxygen saturation 96% on room
air. The client is awake but has expressive aphasia.
1. Which finding is most important for the nurse to report
immediately?
A. Blood pressure of 178/96 mm Hg
B. Heart rate of 88/min
C. Sudden right-sided weakness
D. Oxygen saturation of 96%
Sudden right-sided weakness
Sudden unilateral weakness is a classic manifestation of acute stroke
and requires immediate evaluation and treatment.
2. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast computed tomography of the head
, C. Chest x-ray
D. Abdominal ultrasound
Noncontrast computed tomography of the head
Noncontrast CT is performed rapidly to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy.
3. Which assessment finding supports a left hemispheric stroke?
A. Left-sided neglect
B. Right-sided weakness and aphasia
C. Severe truncal ataxia
D. Bilateral hearing loss
Right-sided weakness and aphasia
The left cerebral hemisphere generally controls language and motor
function on the right side of the body.
4. Which intervention has the highest priority?
A. Offer oral fluids
B. Maintain airway and assess neurologic status
C. Encourage ambulation
D. Place the client flat without assessment
Maintain airway and assess neurologic status
Airway, breathing, circulation, and rapid neurologic assessment are
priorities in acute stroke.
5. The CT scan shows no hemorrhage. Which therapy may be
prescribed if eligibility criteria are met?
A. Alteplase
B. Warfarin immediately
C. Aspirin before CT
D. Heparin bolus for every client
,Alteplase
Intravenous thrombolytic therapy may be used for eligible clients with
acute ischemic stroke within the appropriate treatment window.
6. Which finding would make thrombolytic therapy unsafe?
A. Recent intracranial hemorrhage
B. Mild headache
C. Expressive aphasia
D. Right-arm weakness
Recent intracranial hemorrhage
Previous intracranial bleeding is a major contraindication to
thrombolytic therapy because of the risk of catastrophic bleeding.
7. Which nursing action is appropriate before giving oral
medications?
A. Give medication with water
B. Perform a swallowing assessment
C. Place food at the bedside
D. Encourage rapid drinking
Perform a swallowing assessment
Stroke can impair swallowing and increase the risk for aspiration.
8. Which finding indicates possible aspiration?
A. Clear speech
B. Coughing during swallowing
C. Strong hand grasp
D. Equal pupils
Coughing during swallowing
Coughing during swallowing can indicate impaired airway protection
and dysphagia.
, 9. Which positioning is appropriate during feeding after swallowing
safety is established?
A. Supine
B. Upright
C. Trendelenburg
D. Prone
Upright
An upright position reduces aspiration risk during oral intake.
10. Which outcome indicates improvement?
A. Increasing aphasia
B. New unilateral weakness
C. Improved ability to follow commands
D. Decreasing level of consciousness
Improved ability to follow commands
Improved neurologic function and ability to follow commands indicate
recovery or stabilization.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria,
vomiting, abdominal pain, dehydration, and deep rapid respirations.
Glucose is 560 mg/dL, pH is 7.18, bicarbonate is 12 mEq/L, and serum
ketones are positive.
11. Which condition does the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperthyroidism
D. Diabetes insipidus
Study Practice Exam 10 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Ischemic Stroke
A 68-year-old client arrives in the emergency department with sudden
right-sided weakness, facial drooping, and difficulty speaking that
began 90 minutes ago. Blood pressure is 178/96 mm Hg, heart rate
88/min, respiratory rate 18/min, and oxygen saturation 96% on room
air. The client is awake but has expressive aphasia.
1. Which finding is most important for the nurse to report
immediately?
A. Blood pressure of 178/96 mm Hg
B. Heart rate of 88/min
C. Sudden right-sided weakness
D. Oxygen saturation of 96%
Sudden right-sided weakness
Sudden unilateral weakness is a classic manifestation of acute stroke
and requires immediate evaluation and treatment.
2. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast computed tomography of the head
, C. Chest x-ray
D. Abdominal ultrasound
Noncontrast computed tomography of the head
Noncontrast CT is performed rapidly to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy.
3. Which assessment finding supports a left hemispheric stroke?
A. Left-sided neglect
B. Right-sided weakness and aphasia
C. Severe truncal ataxia
D. Bilateral hearing loss
Right-sided weakness and aphasia
The left cerebral hemisphere generally controls language and motor
function on the right side of the body.
4. Which intervention has the highest priority?
A. Offer oral fluids
B. Maintain airway and assess neurologic status
C. Encourage ambulation
D. Place the client flat without assessment
Maintain airway and assess neurologic status
Airway, breathing, circulation, and rapid neurologic assessment are
priorities in acute stroke.
5. The CT scan shows no hemorrhage. Which therapy may be
prescribed if eligibility criteria are met?
A. Alteplase
B. Warfarin immediately
C. Aspirin before CT
D. Heparin bolus for every client
,Alteplase
Intravenous thrombolytic therapy may be used for eligible clients with
acute ischemic stroke within the appropriate treatment window.
6. Which finding would make thrombolytic therapy unsafe?
A. Recent intracranial hemorrhage
B. Mild headache
C. Expressive aphasia
D. Right-arm weakness
Recent intracranial hemorrhage
Previous intracranial bleeding is a major contraindication to
thrombolytic therapy because of the risk of catastrophic bleeding.
7. Which nursing action is appropriate before giving oral
medications?
A. Give medication with water
B. Perform a swallowing assessment
C. Place food at the bedside
D. Encourage rapid drinking
Perform a swallowing assessment
Stroke can impair swallowing and increase the risk for aspiration.
8. Which finding indicates possible aspiration?
A. Clear speech
B. Coughing during swallowing
C. Strong hand grasp
D. Equal pupils
Coughing during swallowing
Coughing during swallowing can indicate impaired airway protection
and dysphagia.
, 9. Which positioning is appropriate during feeding after swallowing
safety is established?
A. Supine
B. Upright
C. Trendelenburg
D. Prone
Upright
An upright position reduces aspiration risk during oral intake.
10. Which outcome indicates improvement?
A. Increasing aphasia
B. New unilateral weakness
C. Improved ability to follow commands
D. Decreasing level of consciousness
Improved ability to follow commands
Improved neurologic function and ability to follow commands indicate
recovery or stabilization.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria,
vomiting, abdominal pain, dehydration, and deep rapid respirations.
Glucose is 560 mg/dL, pH is 7.18, bicarbonate is 12 mEq/L, and serum
ketones are positive.
11. Which condition does the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperthyroidism
D. Diabetes insipidus
