NCLEX RN Stroke Management
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client arrives in the emergency department with sudden right-sided
weakness and aphasia. What is the nurse’s priority action?
A. Administer aspirin
B. Determine the exact time the client was last known well
C. Give the client oral fluids
D. Place the client in Trendelenburg position
Answer: B. Determine the exact time the client was last known well
Rationale: The time the client was last known well is critical for determining
eligibility for time-sensitive reperfusion therapies, including IV thrombolysis
and mechanical thrombectomy.
2. Which finding is most characteristic of an acute ischemic stroke?
A. Sudden unilateral facial drooping
B. Gradual onset of generalized weakness over several weeks
C. Bilateral ankle edema
D. Chronic low back pain
Answer: A. Sudden unilateral facial drooping
Rationale: Acute ischemic stroke commonly presents suddenly with focal
neurologic deficits such as facial drooping, unilateral weakness, speech
difficulty, visual changes, or loss of coordination.
,3. Which assessment finding requires immediate intervention in a client with
suspected stroke?
A. Blood pressure of 168/88 mm Hg
B. Oxygen saturation of 97%
C. Blood glucose of 42 mg/dL
D. Temperature of 37.1°C (98.8°F)
Answer: C. Blood glucose of 42 mg/dL
Rationale: Severe hypoglycemia can mimic stroke and can cause neurologic
impairment. It must be identified and treated promptly.
4. A client with suspected stroke has difficulty speaking. Which additional
assessment is most important?
A. Determine the client’s ability to swallow
B. Assess bowel sounds
C. Measure abdominal girth
D. Assess pedal pulses
Answer: A. Determine the client’s ability to swallow
Rationale: Dysphagia is common after stroke and significantly increases the
risk for aspiration pneumonia. Oral intake should be withheld until
swallowing is assessed.
5. Which diagnostic test is typically performed urgently to differentiate
ischemic from hemorrhagic stroke?
A. Noncontrast CT scan of the head
B. Abdominal ultrasound
C. Chest x-ray
D. Electroencephalogram
Answer: A. Noncontrast CT scan of the head
,Rationale: An urgent noncontrast CT of the head is used to identify
intracranial hemorrhage and help determine the appropriate acute stroke
treatment.
6. A client is receiving alteplase for acute ischemic stroke. Which finding
requires immediate attention?
A. Mild headache
B. Sudden severe headache and vomiting
C. Blood pressure of 130/78 mm Hg
D. Improved speech
Answer: B. Sudden severe headache and vomiting
Rationale: Sudden severe headache, vomiting, acute hypertension, or
neurologic deterioration during thrombolytic therapy may indicate
intracranial hemorrhage.
7. Before administering IV thrombolytic therapy, which finding is most
important for the nurse to verify?
A. The client ate breakfast
B. There is no evidence of intracranial hemorrhage on imaging
C. The client has a history of hypertension
D. The client has a mild headache
Answer: B. There is no evidence of intracranial hemorrhage on imaging
Rationale: Thrombolytic therapy can worsen bleeding. Brain imaging must
exclude intracranial hemorrhage before treatment for presumed ischemic
stroke.
8. Which client is at greatest risk for an ischemic stroke?
A. A 25-year-old with seasonal allergies
B. A 68-year-old with atrial fibrillation
, C. A 30-year-old with a sprained ankle
D. A 40-year-old with myopia
Answer: B. A 68-year-old with atrial fibrillation
Rationale: Atrial fibrillation promotes formation of atrial thrombi that can
embolize to cerebral arteries and cause ischemic stroke.
9. A client with a suspected stroke has a Glasgow Coma Scale score that
decreases from 14 to 9. What should the nurse do first?
A. Document the finding and reassess in 4 hours
B. Notify the healthcare provider immediately
C. Encourage oral fluids
D. Ambulate the client
Answer: B. Notify the healthcare provider immediately
Rationale: A declining level of consciousness can indicate worsening cerebral
edema, hemorrhage, increased intracranial pressure, or other neurologic
deterioration and requires immediate evaluation.
10. Which intervention is appropriate for a client with increased intracranial
pressure after a hemorrhagic stroke?
A. Keep the head flat
B. Maintain the head of the bed elevated as prescribed
C. Encourage frequent coughing
D. Place the client in Trendelenburg position
Answer: B. Maintain the head of the bed elevated as prescribed
Rationale: Elevating the head of the bed and maintaining neutral head and
neck alignment can promote cerebral venous drainage and help reduce
intracranial pressure.
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A client arrives in the emergency department with sudden right-sided
weakness and aphasia. What is the nurse’s priority action?
A. Administer aspirin
B. Determine the exact time the client was last known well
C. Give the client oral fluids
D. Place the client in Trendelenburg position
Answer: B. Determine the exact time the client was last known well
Rationale: The time the client was last known well is critical for determining
eligibility for time-sensitive reperfusion therapies, including IV thrombolysis
and mechanical thrombectomy.
2. Which finding is most characteristic of an acute ischemic stroke?
A. Sudden unilateral facial drooping
B. Gradual onset of generalized weakness over several weeks
C. Bilateral ankle edema
D. Chronic low back pain
Answer: A. Sudden unilateral facial drooping
Rationale: Acute ischemic stroke commonly presents suddenly with focal
neurologic deficits such as facial drooping, unilateral weakness, speech
difficulty, visual changes, or loss of coordination.
,3. Which assessment finding requires immediate intervention in a client with
suspected stroke?
A. Blood pressure of 168/88 mm Hg
B. Oxygen saturation of 97%
C. Blood glucose of 42 mg/dL
D. Temperature of 37.1°C (98.8°F)
Answer: C. Blood glucose of 42 mg/dL
Rationale: Severe hypoglycemia can mimic stroke and can cause neurologic
impairment. It must be identified and treated promptly.
4. A client with suspected stroke has difficulty speaking. Which additional
assessment is most important?
A. Determine the client’s ability to swallow
B. Assess bowel sounds
C. Measure abdominal girth
D. Assess pedal pulses
Answer: A. Determine the client’s ability to swallow
Rationale: Dysphagia is common after stroke and significantly increases the
risk for aspiration pneumonia. Oral intake should be withheld until
swallowing is assessed.
5. Which diagnostic test is typically performed urgently to differentiate
ischemic from hemorrhagic stroke?
A. Noncontrast CT scan of the head
B. Abdominal ultrasound
C. Chest x-ray
D. Electroencephalogram
Answer: A. Noncontrast CT scan of the head
,Rationale: An urgent noncontrast CT of the head is used to identify
intracranial hemorrhage and help determine the appropriate acute stroke
treatment.
6. A client is receiving alteplase for acute ischemic stroke. Which finding
requires immediate attention?
A. Mild headache
B. Sudden severe headache and vomiting
C. Blood pressure of 130/78 mm Hg
D. Improved speech
Answer: B. Sudden severe headache and vomiting
Rationale: Sudden severe headache, vomiting, acute hypertension, or
neurologic deterioration during thrombolytic therapy may indicate
intracranial hemorrhage.
7. Before administering IV thrombolytic therapy, which finding is most
important for the nurse to verify?
A. The client ate breakfast
B. There is no evidence of intracranial hemorrhage on imaging
C. The client has a history of hypertension
D. The client has a mild headache
Answer: B. There is no evidence of intracranial hemorrhage on imaging
Rationale: Thrombolytic therapy can worsen bleeding. Brain imaging must
exclude intracranial hemorrhage before treatment for presumed ischemic
stroke.
8. Which client is at greatest risk for an ischemic stroke?
A. A 25-year-old with seasonal allergies
B. A 68-year-old with atrial fibrillation
, C. A 30-year-old with a sprained ankle
D. A 40-year-old with myopia
Answer: B. A 68-year-old with atrial fibrillation
Rationale: Atrial fibrillation promotes formation of atrial thrombi that can
embolize to cerebral arteries and cause ischemic stroke.
9. A client with a suspected stroke has a Glasgow Coma Scale score that
decreases from 14 to 9. What should the nurse do first?
A. Document the finding and reassess in 4 hours
B. Notify the healthcare provider immediately
C. Encourage oral fluids
D. Ambulate the client
Answer: B. Notify the healthcare provider immediately
Rationale: A declining level of consciousness can indicate worsening cerebral
edema, hemorrhage, increased intracranial pressure, or other neurologic
deterioration and requires immediate evaluation.
10. Which intervention is appropriate for a client with increased intracranial
pressure after a hemorrhagic stroke?
A. Keep the head flat
B. Maintain the head of the bed elevated as prescribed
C. Encourage frequent coughing
D. Place the client in Trendelenburg position
Answer: B. Maintain the head of the bed elevated as prescribed
Rationale: Elevating the head of the bed and maintaining neutral head and
neck alignment can promote cerebral venous drainage and help reduce
intracranial pressure.
