NCLEX RN Next Generation Case Study
Exam 4 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
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Case Study 1: Acute Ischemic Stroke
A 68-year-old client is brought to the emergency department 45 minutes after
sudden onset of right-sided weakness and difficulty speaking. The client has a
history of hypertension and atrial fibrillation. Blood pressure is 178/96 mm Hg,
heart rate 104/min and irregular, respirations 18/min, and oxygen saturation
96% on room air. The client is awake but has expressive aphasia and right facial
drooping.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. Blood pressure of 178/96 mm Hg
B. Expressive aphasia
C. Sudden unilateral weakness
D. Irregular heart rate
Answer: Sudden unilateral weakness
Rationale: Sudden unilateral weakness is a classic manifestation of acute
stroke and requires immediate stroke evaluation because rapid treatment can
reduce permanent neurologic injury.
Question 2
Which diagnostic study should the nurse anticipate first?
,A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Carotid Doppler ultrasound
D. Magnetic resonance angiography
Answer: Noncontrast CT scan of the head
Rationale: A noncontrast CT scan is performed urgently to distinguish
ischemic stroke from intracranial hemorrhage before thrombolytic therapy is
considered.
Question 3
The CT scan shows no evidence of hemorrhage. Which prescription should the
nurse anticipate if the client meets eligibility criteria?
A. Alteplase IV
B. Warfarin orally
C. Aspirin immediately before thrombolysis
D. Heparin intramuscularly
Answer: Alteplase IV
Rationale: IV thrombolytic therapy may be administered to eligible clients
with acute ischemic stroke within the appropriate treatment window after
hemorrhage has been excluded.
Question 4
Which finding would make the nurse question administration of alteplase?
A. Blood pressure of 178/96 mm Hg
B. Symptom onset 45 minutes ago
C. History of atrial fibrillation
D. No evidence of intracranial hemorrhage
Answer: Blood pressure of 178/96 mm Hg
Rationale: Blood pressure must be controlled to the recommended threshold
before IV thrombolytic therapy because severe hypertension increases the
risk of intracranial bleeding.
Question 5
,Which nursing action is the priority while the client is being evaluated for
swallowing ability?
A. Offer water to assess swallowing
B. Keep the client NPO
C. Give oral aspirin
D. Place food at the bedside
Answer: Keep the client NPO
Rationale: Dysphagia is common after stroke and can cause aspiration. The
client should remain NPO until a swallowing assessment has been completed.
Question 6
Which finding best indicates worsening neurologic status?
A. Headache rated 3/10
B. Improved speech
C. New decrease in level of consciousness
D. Heart rate of 92/min
Answer: New decrease in level of consciousness
Rationale: A new decline in consciousness can indicate cerebral edema,
increased intracranial pressure, hemorrhagic transformation, or extension of
the stroke and requires immediate evaluation.
Question 7
Which intervention is appropriate for prevention of complications related to
immobility?
A. Restrict repositioning
B. Maintain the client in one position
C. Perform regular repositioning and range-of-motion exercises
D. Massage the affected extremity vigorously
Answer: Perform regular repositioning and range-of-motion exercises
Rationale: Regular repositioning and appropriate range-of-motion exercises
help prevent pressure injuries, contractures, venous stasis, and other
complications of immobility.
, Question 8
Which client statement indicates a need for additional teaching about stroke
prevention?
A. "I will take my prescribed medications consistently."
B. "I will monitor my blood pressure."
C. "I can stop my medications when I feel better."
D. "I will keep follow-up appointments."
Answer: "I can stop my medications when I feel better."
Rationale: Stroke-prevention medications should not be stopped without
consulting the healthcare provider because discontinuation may increase the
risk of recurrent stroke.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus is admitted with nausea,
vomiting, abdominal pain, and rapid deep respirations. The client reports
missing several insulin doses because of a gastrointestinal illness. Laboratory
results include glucose 486 mg/dL, arterial pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones.
Question 9
Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia
D. Severe hypertension
Answer: Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid respirations that develop as
the body attempts to compensate for metabolic acidosis caused by ketone
accumulation.
Question 10
Exam 4 100 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 45 minutes after
sudden onset of right-sided weakness and difficulty speaking. The client has a
history of hypertension and atrial fibrillation. Blood pressure is 178/96 mm Hg,
heart rate 104/min and irregular, respirations 18/min, and oxygen saturation
96% on room air. The client is awake but has expressive aphasia and right facial
drooping.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. Blood pressure of 178/96 mm Hg
B. Expressive aphasia
C. Sudden unilateral weakness
D. Irregular heart rate
Answer: Sudden unilateral weakness
Rationale: Sudden unilateral weakness is a classic manifestation of acute
stroke and requires immediate stroke evaluation because rapid treatment can
reduce permanent neurologic injury.
Question 2
Which diagnostic study should the nurse anticipate first?
,A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Carotid Doppler ultrasound
D. Magnetic resonance angiography
Answer: Noncontrast CT scan of the head
Rationale: A noncontrast CT scan is performed urgently to distinguish
ischemic stroke from intracranial hemorrhage before thrombolytic therapy is
considered.
Question 3
The CT scan shows no evidence of hemorrhage. Which prescription should the
nurse anticipate if the client meets eligibility criteria?
A. Alteplase IV
B. Warfarin orally
C. Aspirin immediately before thrombolysis
D. Heparin intramuscularly
Answer: Alteplase IV
Rationale: IV thrombolytic therapy may be administered to eligible clients
with acute ischemic stroke within the appropriate treatment window after
hemorrhage has been excluded.
Question 4
Which finding would make the nurse question administration of alteplase?
A. Blood pressure of 178/96 mm Hg
B. Symptom onset 45 minutes ago
C. History of atrial fibrillation
D. No evidence of intracranial hemorrhage
Answer: Blood pressure of 178/96 mm Hg
Rationale: Blood pressure must be controlled to the recommended threshold
before IV thrombolytic therapy because severe hypertension increases the
risk of intracranial bleeding.
Question 5
,Which nursing action is the priority while the client is being evaluated for
swallowing ability?
A. Offer water to assess swallowing
B. Keep the client NPO
C. Give oral aspirin
D. Place food at the bedside
Answer: Keep the client NPO
Rationale: Dysphagia is common after stroke and can cause aspiration. The
client should remain NPO until a swallowing assessment has been completed.
Question 6
Which finding best indicates worsening neurologic status?
A. Headache rated 3/10
B. Improved speech
C. New decrease in level of consciousness
D. Heart rate of 92/min
Answer: New decrease in level of consciousness
Rationale: A new decline in consciousness can indicate cerebral edema,
increased intracranial pressure, hemorrhagic transformation, or extension of
the stroke and requires immediate evaluation.
Question 7
Which intervention is appropriate for prevention of complications related to
immobility?
A. Restrict repositioning
B. Maintain the client in one position
C. Perform regular repositioning and range-of-motion exercises
D. Massage the affected extremity vigorously
Answer: Perform regular repositioning and range-of-motion exercises
Rationale: Regular repositioning and appropriate range-of-motion exercises
help prevent pressure injuries, contractures, venous stasis, and other
complications of immobility.
, Question 8
Which client statement indicates a need for additional teaching about stroke
prevention?
A. "I will take my prescribed medications consistently."
B. "I will monitor my blood pressure."
C. "I can stop my medications when I feel better."
D. "I will keep follow-up appointments."
Answer: "I can stop my medications when I feel better."
Rationale: Stroke-prevention medications should not be stopped without
consulting the healthcare provider because discontinuation may increase the
risk of recurrent stroke.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus is admitted with nausea,
vomiting, abdominal pain, and rapid deep respirations. The client reports
missing several insulin doses because of a gastrointestinal illness. Laboratory
results include glucose 486 mg/dL, arterial pH 7.18, bicarbonate 11 mEq/L, and
positive serum ketones.
Question 9
Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Bradycardia
B. Kussmaul respirations
C. Hypothermia
D. Severe hypertension
Answer: Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid respirations that develop as
the body attempts to compensate for metabolic acidosis caused by ketone
accumulation.
Question 10
