NCLEX RN Next Generation NGN Case
Study Exam 4 Questions And Correct
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Case Study 1: Acute Ischemic Stroke
A 72-year-old client arrives in the emergency department with sudden
right-sided weakness, facial drooping, and difficulty speaking. The
symptoms began 90 minutes ago. Blood pressure is 184/96 mm Hg,
heart rate 88/min, respiratory rate 18/min, oxygen saturation 96% on
room air, and blood glucose 108 mg/dL. The client is awake but has
expressive aphasia.
100. Which assessment finding is most important for the nurse to
report immediately?
A. Blood pressure of 184/96 mm Hg
B. Heart rate of 88/min
C. Sudden onset of expressive aphasia
D. Oxygen saturation of 96%
Sudden onset of expressive aphasia
Expressive aphasia is a focal neurologic deficit that strongly suggests an
acute stroke and requires immediate stroke-team intervention.
101. Which diagnostic study should the nurse anticipate first?
,A. Electroencephalogram
B. Noncontrast computed tomography of the head
C. Carotid ultrasound
D. Magnetic resonance angiography
Noncontrast computed tomography of the head
An urgent noncontrast CT is used to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy is considered.
102. The nurse is reviewing the client's history. Which finding would
contraindicate thrombolytic therapy?
A. Symptom onset 90 minutes ago
B. Blood glucose of 108 mg/dL
C. Recent intracranial hemorrhage
D. Mild expressive aphasia
Recent intracranial hemorrhage
Recent intracranial bleeding substantially increases the risk of life-
threatening hemorrhage with thrombolytic therapy.
103. Which intervention has the highest priority while the client is
awaiting diagnostic imaging?
A. Give oral aspirin
B. Keep the client NPO
C. Encourage ambulation
D. Administer oral fluids
Keep the client NPO
Clients with acute stroke are at high risk for dysphagia and aspiration;
oral intake should be withheld until swallowing ability is assessed.
,104. Which findings indicate possible worsening neurologic status?
Select all that apply.
A. New unequal pupils
B. Decreased level of consciousness
C. New severe headache
D. Improved speech
E. New vomiting
New unequal pupils; Decreased level of consciousness; New severe
headache; New vomiting
These findings can indicate increased intracranial pressure or neurologic
deterioration and require immediate intervention.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and extreme thirst. The client has been ill
with influenza for 3 days and has not taken insulin regularly. Laboratory
results include glucose 498 mg/dL, pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones.
105. Which finding is most consistent with diabetic ketoacidosis?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia with slow respirations
D. Decreased thirst
Kussmaul respirations
Kussmaul respirations are deep, rapid respirations that occur as the
body attempts to compensate for metabolic acidosis.
, 106. Which prescription should the nurse implement first?
A. IV regular insulin
B. IV isotonic fluid
C. Oral potassium
D. Sodium bicarbonate
IV isotonic fluid
Fluid replacement is the initial priority in DKA because severe
dehydration and reduced circulating volume are common.
107. The client's serum potassium is 3.0 mEq/L. Which action is
appropriate?
A. Begin insulin immediately
B. Hold insulin and anticipate potassium replacement
C. Restrict potassium intake
D. Administer sodium bicarbonate first
Hold insulin and anticipate potassium replacement
Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. Significant hypokalemia must be corrected before insulin
is administered.
108. Which finding indicates that treatment is improving the client's
condition?
A. Glucose decreases while anion gap remains elevated
B. Serum ketones increase
C. Bicarbonate decreases further
D. Respirations become increasingly deep and rapid
Glucose decreases while anion gap remains elevated
Study Exam 4 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Ischemic Stroke
A 72-year-old client arrives in the emergency department with sudden
right-sided weakness, facial drooping, and difficulty speaking. The
symptoms began 90 minutes ago. Blood pressure is 184/96 mm Hg,
heart rate 88/min, respiratory rate 18/min, oxygen saturation 96% on
room air, and blood glucose 108 mg/dL. The client is awake but has
expressive aphasia.
100. Which assessment finding is most important for the nurse to
report immediately?
A. Blood pressure of 184/96 mm Hg
B. Heart rate of 88/min
C. Sudden onset of expressive aphasia
D. Oxygen saturation of 96%
Sudden onset of expressive aphasia
Expressive aphasia is a focal neurologic deficit that strongly suggests an
acute stroke and requires immediate stroke-team intervention.
101. Which diagnostic study should the nurse anticipate first?
,A. Electroencephalogram
B. Noncontrast computed tomography of the head
C. Carotid ultrasound
D. Magnetic resonance angiography
Noncontrast computed tomography of the head
An urgent noncontrast CT is used to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy is considered.
102. The nurse is reviewing the client's history. Which finding would
contraindicate thrombolytic therapy?
A. Symptom onset 90 minutes ago
B. Blood glucose of 108 mg/dL
C. Recent intracranial hemorrhage
D. Mild expressive aphasia
Recent intracranial hemorrhage
Recent intracranial bleeding substantially increases the risk of life-
threatening hemorrhage with thrombolytic therapy.
103. Which intervention has the highest priority while the client is
awaiting diagnostic imaging?
A. Give oral aspirin
B. Keep the client NPO
C. Encourage ambulation
D. Administer oral fluids
Keep the client NPO
Clients with acute stroke are at high risk for dysphagia and aspiration;
oral intake should be withheld until swallowing ability is assessed.
,104. Which findings indicate possible worsening neurologic status?
Select all that apply.
A. New unequal pupils
B. Decreased level of consciousness
C. New severe headache
D. Improved speech
E. New vomiting
New unequal pupils; Decreased level of consciousness; New severe
headache; New vomiting
These findings can indicate increased intracranial pressure or neurologic
deterioration and require immediate intervention.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and extreme thirst. The client has been ill
with influenza for 3 days and has not taken insulin regularly. Laboratory
results include glucose 498 mg/dL, pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones.
105. Which finding is most consistent with diabetic ketoacidosis?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia with slow respirations
D. Decreased thirst
Kussmaul respirations
Kussmaul respirations are deep, rapid respirations that occur as the
body attempts to compensate for metabolic acidosis.
, 106. Which prescription should the nurse implement first?
A. IV regular insulin
B. IV isotonic fluid
C. Oral potassium
D. Sodium bicarbonate
IV isotonic fluid
Fluid replacement is the initial priority in DKA because severe
dehydration and reduced circulating volume are common.
107. The client's serum potassium is 3.0 mEq/L. Which action is
appropriate?
A. Begin insulin immediately
B. Hold insulin and anticipate potassium replacement
C. Restrict potassium intake
D. Administer sodium bicarbonate first
Hold insulin and anticipate potassium replacement
Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. Significant hypokalemia must be corrected before insulin
is administered.
108. Which finding indicates that treatment is improving the client's
condition?
A. Glucose decreases while anion gap remains elevated
B. Serum ketones increase
C. Bicarbonate decreases further
D. Respirations become increasingly deep and rapid
Glucose decreases while anion gap remains elevated
