NCLEX RN Next Generation NGN Case
Study Exam 9 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 is brought to the emergency department by family
members after suddenly developing right-sided weakness and difficulty
speaking 45 minutes ago. The client has a history of hypertension and
atrial fibrillation. Assessment reveals facial drooping, right arm
weakness, and expressive aphasia. Blood pressure is 178/96 mm Hg,
pulse 104/min and irregular, respirations 20/min, and oxygen
saturation 96% on room air.
1. Which finding is the nurse's priority?
A. Blood pressure of 178/96 mm Hg
B. Irregular pulse
C. Sudden onset of expressive aphasia
D. History of hypertension
Answer: C. Sudden onset of expressive aphasia
Rationale: Sudden neurological deficits such as aphasia strongly
indicate an acute stroke. Rapid evaluation is essential because
thrombolytic therapy may be time dependent.
2. Which additional assessment is most important before
administering thrombolytic therapy?
,A. Bowel sounds
B. Blood glucose level
C. Skin turgor
D. Deep tendon reflexes
Answer: B. Blood glucose level
Rationale: Hypoglycemia can mimic stroke symptoms and must be
identified before thrombolytic treatment.
3. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Chest x-ray
D. Abdominal ultrasound
Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast head CT rapidly differentiates ischemic
stroke from intracranial hemorrhage before thrombolytic therapy is
considered.
4. Which findings support an ischemic stroke? Select all that apply.
A. Sudden unilateral weakness
B. Aphasia
C. Facial drooping
D. Gradual bilateral leg edema
E. Sudden visual disturbance
Answer: A. Sudden unilateral weakness; B. Aphasia; C. Facial
drooping; E. Sudden visual disturbance
Rationale: Acute focal neurological deficits are characteristic of
stroke. Edema is not a typical presenting feature of an acute ischemic
stroke.
,5. The client's blood glucose is 42 mg/dL. What should the nurse do
first?
A. Prepare alteplase
B. Administer prescribed glucose
C. Restrict oral fluids
D. Place the client flat
Answer: B. Administer prescribed glucose
Rationale: Severe hypoglycemia can produce neurological symptoms
resembling stroke and requires immediate correction.
6. Which intervention is appropriate while the client is being
evaluated for swallowing ability?
A. Give water to assess swallowing
B. Keep the client NPO
C. Offer soft foods
D. Give oral medications with applesauce
Answer: B. Keep the client NPO
Rationale: Stroke can impair the gag and swallowing reflexes,
creating a high risk for aspiration.
7. Which complication should the nurse monitor most closely during
the acute phase?
A. Aspiration
B. Constipation
C. Hair loss
D. Hyperpigmentation
Answer: A. Aspiration
, Rationale: Dysphagia is common after stroke and can result in
aspiration pneumonia.
8. Which nursing action best reduces aspiration risk?
A. Place the client supine during meals
B. Perform a swallow assessment before oral intake
C. Encourage rapid eating
D. Give thin liquids immediately
Answer: B. Perform a swallow assessment before oral intake
Rationale: A formal swallowing assessment helps determine whether
oral intake is safe.
9. Which medication may be prescribed for eligible clients with acute
ischemic stroke?
A. Alteplase
B. Warfarin immediately
C. Furosemide
D. Digoxin
Answer: A. Alteplase
Rationale: Intravenous alteplase may be used in appropriately
selected patients with acute ischemic stroke within the treatment
window.
10. Which finding would make the nurse question administration of
alteplase?
A. Recent intracranial hemorrhage
B. Atrial fibrillation
C. Hypertension history
D. Expressive aphasia
Study Exam 9 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 by family
members after suddenly developing right-sided weakness and difficulty
speaking 45 minutes ago. The client has a history of hypertension and
atrial fibrillation. Assessment reveals facial drooping, right arm
weakness, and expressive aphasia. Blood pressure is 178/96 mm Hg,
pulse 104/min and irregular, respirations 20/min, and oxygen
saturation 96% on room air.
1. Which finding is the nurse's priority?
A. Blood pressure of 178/96 mm Hg
B. Irregular pulse
C. Sudden onset of expressive aphasia
D. History of hypertension
Answer: C. Sudden onset of expressive aphasia
Rationale: Sudden neurological deficits such as aphasia strongly
indicate an acute stroke. Rapid evaluation is essential because
thrombolytic therapy may be time dependent.
2. Which additional assessment is most important before
administering thrombolytic therapy?
,A. Bowel sounds
B. Blood glucose level
C. Skin turgor
D. Deep tendon reflexes
Answer: B. Blood glucose level
Rationale: Hypoglycemia can mimic stroke symptoms and must be
identified before thrombolytic treatment.
3. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Chest x-ray
D. Abdominal ultrasound
Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast head CT rapidly differentiates ischemic
stroke from intracranial hemorrhage before thrombolytic therapy is
considered.
4. Which findings support an ischemic stroke? Select all that apply.
A. Sudden unilateral weakness
B. Aphasia
C. Facial drooping
D. Gradual bilateral leg edema
E. Sudden visual disturbance
Answer: A. Sudden unilateral weakness; B. Aphasia; C. Facial
drooping; E. Sudden visual disturbance
Rationale: Acute focal neurological deficits are characteristic of
stroke. Edema is not a typical presenting feature of an acute ischemic
stroke.
,5. The client's blood glucose is 42 mg/dL. What should the nurse do
first?
A. Prepare alteplase
B. Administer prescribed glucose
C. Restrict oral fluids
D. Place the client flat
Answer: B. Administer prescribed glucose
Rationale: Severe hypoglycemia can produce neurological symptoms
resembling stroke and requires immediate correction.
6. Which intervention is appropriate while the client is being
evaluated for swallowing ability?
A. Give water to assess swallowing
B. Keep the client NPO
C. Offer soft foods
D. Give oral medications with applesauce
Answer: B. Keep the client NPO
Rationale: Stroke can impair the gag and swallowing reflexes,
creating a high risk for aspiration.
7. Which complication should the nurse monitor most closely during
the acute phase?
A. Aspiration
B. Constipation
C. Hair loss
D. Hyperpigmentation
Answer: A. Aspiration
, Rationale: Dysphagia is common after stroke and can result in
aspiration pneumonia.
8. Which nursing action best reduces aspiration risk?
A. Place the client supine during meals
B. Perform a swallow assessment before oral intake
C. Encourage rapid eating
D. Give thin liquids immediately
Answer: B. Perform a swallow assessment before oral intake
Rationale: A formal swallowing assessment helps determine whether
oral intake is safe.
9. Which medication may be prescribed for eligible clients with acute
ischemic stroke?
A. Alteplase
B. Warfarin immediately
C. Furosemide
D. Digoxin
Answer: A. Alteplase
Rationale: Intravenous alteplase may be used in appropriately
selected patients with acute ischemic stroke within the treatment
window.
10. Which finding would make the nurse question administration of
alteplase?
A. Recent intracranial hemorrhage
B. Atrial fibrillation
C. Hypertension history
D. Expressive aphasia
