NCLEX RN Next Generation NGN Case
Study Exam 5 Questions And Correct
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Rationales 2026 Q&A Instant Download
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Case Study 1: Acute Ischemic Stroke
A 68-year-old client is brought to the emergency department with
sudden right-sided weakness and difficulty speaking that began 45
minutes ago. The client has hypertension and atrial fibrillation. Blood
pressure is 178/96 mm Hg, pulse 92/min and irregular, respirations
18/min, and oxygen saturation 96% on room air.
1. Recognize Cues — Multiple Choice
Which finding is the highest priority?
A. Blood pressure of 178/96 mm Hg
B. Irregular pulse
C. Sudden right-sided weakness and aphasia
D. History of hypertension
Answer: C. Sudden right-sided weakness and aphasia
Rationale: Sudden focal neurologic deficits strongly suggest an acute
stroke. Rapid assessment and treatment are essential because eligible
clients may benefit from reperfusion therapy.
2. Recognize Cues — Multiple Response
,Which findings support a possible acute ischemic stroke? Select all that
apply.
A. Sudden unilateral weakness
B. Aphasia
C. Gradual bilateral leg edema
D. Facial asymmetry
E. Sudden visual disturbance
Answers: A. Sudden unilateral weakness; B. Aphasia; D. Facial
asymmetry; E. Sudden visual disturbance
Rationale: Acute unilateral weakness, aphasia, facial asymmetry, and
visual changes are classic manifestations of acute stroke.
3. Analyze Cues — Multiple Choice
Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Chest radiograph
D. Abdominal ultrasound
Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast CT is performed rapidly to determine whether
intracranial hemorrhage is present before thrombolytic therapy is
considered.
4. Generate Solutions — Multiple Response
Which interventions should the nurse implement immediately? Select
all that apply.
A. Establish IV access
B. Determine the exact time symptoms began
,C. Give oral fluids
D. Monitor neurologic status
E. Prepare the client for brain imaging
Answers: A. Establish IV access; B. Determine the exact time
symptoms began; D. Monitor neurologic status; E. Prepare the client
for brain imaging
Rationale: Stroke care requires rapid determination of symptom onset,
IV access, neurologic monitoring, and immediate diagnostic imaging.
Oral intake should be withheld until swallowing ability is assessed.
5. Take Action — Multiple Choice
The CT scan shows no intracranial hemorrhage. Which finding would
most strongly support administration of alteplase?
A. Symptoms began 45 minutes ago
B. Blood pressure is 210/118 mm Hg
C. Platelet count is 70,000/mm³
D. Recent intracranial surgery
Answer: A. Symptoms began 45 minutes ago
Rationale: A recent onset within the treatment window supports
consideration of IV thrombolysis when no contraindications are present.
Severe uncontrolled hypertension, thrombocytopenia, and recent
intracranial surgery can contraindicate thrombolytic therapy.
6. Evaluate Outcomes — Multiple Choice
Which finding best indicates improvement after treatment?
A. Increasing difficulty speaking
B. New left-sided weakness
C. Improved ability to move the right arm
D. Increasing level of confusion
, Answer: C. Improved ability to move the right arm
Rationale: Improved motor function indicates recovery of neurologic
function.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and excessive thirst. The client reports
missing insulin doses for 2 days. Respirations are deep and rapid.
Laboratory results include glucose 520 mg/dL, pH 7.18, bicarbonate 12
mEq/L, and potassium 5.6 mEq/L.
7. Recognize Cues
Which finding is most characteristic of diabetic ketoacidosis?
A. Slow shallow respirations
B. Kussmaul respirations
C. Bradycardia
D. Peripheral edema
Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid and occur as the
body attempts to compensate for metabolic acidosis.
8. Analyze Cues — Multiple Response
Which findings are consistent with diabetic ketoacidosis? Select all that
apply.
A. Hyperglycemia
B. Metabolic acidosis
C. Ketone production
Study Exam 5 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Ischemic Stroke
A 68-year-old client is brought to the emergency department with
sudden right-sided weakness and difficulty speaking that began 45
minutes ago. The client has hypertension and atrial fibrillation. Blood
pressure is 178/96 mm Hg, pulse 92/min and irregular, respirations
18/min, and oxygen saturation 96% on room air.
1. Recognize Cues — Multiple Choice
Which finding is the highest priority?
A. Blood pressure of 178/96 mm Hg
B. Irregular pulse
C. Sudden right-sided weakness and aphasia
D. History of hypertension
Answer: C. Sudden right-sided weakness and aphasia
Rationale: Sudden focal neurologic deficits strongly suggest an acute
stroke. Rapid assessment and treatment are essential because eligible
clients may benefit from reperfusion therapy.
2. Recognize Cues — Multiple Response
,Which findings support a possible acute ischemic stroke? Select all that
apply.
A. Sudden unilateral weakness
B. Aphasia
C. Gradual bilateral leg edema
D. Facial asymmetry
E. Sudden visual disturbance
Answers: A. Sudden unilateral weakness; B. Aphasia; D. Facial
asymmetry; E. Sudden visual disturbance
Rationale: Acute unilateral weakness, aphasia, facial asymmetry, and
visual changes are classic manifestations of acute stroke.
3. Analyze Cues — Multiple Choice
Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Chest radiograph
D. Abdominal ultrasound
Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast CT is performed rapidly to determine whether
intracranial hemorrhage is present before thrombolytic therapy is
considered.
4. Generate Solutions — Multiple Response
Which interventions should the nurse implement immediately? Select
all that apply.
A. Establish IV access
B. Determine the exact time symptoms began
,C. Give oral fluids
D. Monitor neurologic status
E. Prepare the client for brain imaging
Answers: A. Establish IV access; B. Determine the exact time
symptoms began; D. Monitor neurologic status; E. Prepare the client
for brain imaging
Rationale: Stroke care requires rapid determination of symptom onset,
IV access, neurologic monitoring, and immediate diagnostic imaging.
Oral intake should be withheld until swallowing ability is assessed.
5. Take Action — Multiple Choice
The CT scan shows no intracranial hemorrhage. Which finding would
most strongly support administration of alteplase?
A. Symptoms began 45 minutes ago
B. Blood pressure is 210/118 mm Hg
C. Platelet count is 70,000/mm³
D. Recent intracranial surgery
Answer: A. Symptoms began 45 minutes ago
Rationale: A recent onset within the treatment window supports
consideration of IV thrombolysis when no contraindications are present.
Severe uncontrolled hypertension, thrombocytopenia, and recent
intracranial surgery can contraindicate thrombolytic therapy.
6. Evaluate Outcomes — Multiple Choice
Which finding best indicates improvement after treatment?
A. Increasing difficulty speaking
B. New left-sided weakness
C. Improved ability to move the right arm
D. Increasing level of confusion
, Answer: C. Improved ability to move the right arm
Rationale: Improved motor function indicates recovery of neurologic
function.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and excessive thirst. The client reports
missing insulin doses for 2 days. Respirations are deep and rapid.
Laboratory results include glucose 520 mg/dL, pH 7.18, bicarbonate 12
mEq/L, and potassium 5.6 mEq/L.
7. Recognize Cues
Which finding is most characteristic of diabetic ketoacidosis?
A. Slow shallow respirations
B. Kussmaul respirations
C. Bradycardia
D. Peripheral edema
Answer: B. Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid and occur as the
body attempts to compensate for metabolic acidosis.
8. Analyze Cues — Multiple Response
Which findings are consistent with diabetic ketoacidosis? Select all that
apply.
A. Hyperglycemia
B. Metabolic acidosis
C. Ketone production
