NCLEX RN Next Generation Case Study
Exam 7 100 Questions And Correct
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Rationales 2026 Q&A Instant
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Case Study 1: Acute Ischemic Stroke
A 68-year-old client arrives in the emergency department with sudden right-
sided weakness, facial drooping, and difficulty speaking. Symptoms began 45
minutes ago. Blood pressure is 178/96 mm Hg, heart rate 88/min, respiratory
rate 18/min, and oxygen saturation 96% on room air. The client is awake but
has expressive aphasia.
1. Which assessment finding is the nurse's priority?
A. Blood pressure of 178/96 mm Hg
B. Difficulty speaking
C. Sudden unilateral weakness
D. Oxygen saturation of 96%
Answer: C. Sudden unilateral weakness
Rationale: Sudden unilateral weakness is a classic manifestation of an acute
stroke and requires immediate assessment and intervention to minimize
neurologic injury.
2. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Carotid Doppler ultrasound
D. Lumbar puncture
,Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast CT scan rapidly determines whether intracranial
hemorrhage is present and helps determine eligibility for thrombolytic
therapy.
3. Which finding would make the client ineligible for thrombolytic therapy?
A. Symptom onset 45 minutes ago
B. Blood glucose of 110 mg/dL
C. Evidence of intracranial hemorrhage
D. Mild expressive aphasia
Answer: C. Evidence of intracranial hemorrhage
Rationale: Thrombolytic therapy can worsen bleeding and is contraindicated
when intracranial hemorrhage is present.
4. Which nursing action is most appropriate before administering oral
medications?
A. Offer water to assess swallowing
B. Perform a swallowing assessment
C. Place the client supine
D. Encourage rapid drinking
Answer: B. Perform a swallowing assessment
Rationale: Dysphagia is common after stroke and can lead to aspiration.
Swallowing ability should be evaluated before oral intake.
5. The client's speech becomes increasingly difficult to understand. Which
action should the nurse take first?
A. Document the finding at the end of the shift
B. Notify the healthcare provider immediately
C. Encourage the client to sleep
D. Administer an oral analgesic
Answer: B. Notify the healthcare provider immediately
Rationale: Worsening neurologic deficits may indicate progression of the
stroke or cerebral edema and require immediate evaluation.
,Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes is admitted with nausea, vomiting,
abdominal pain, and deep rapid respirations. Blood glucose is 480 mg/dL, pH
7.18, bicarbonate 12 mEq/L, and serum ketones are positive.
6. Which condition is most likely occurring?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Metabolic alkalosis
Answer: B. Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, positive ketones, and Kussmaul
respirations are characteristic of diabetic ketoacidosis.
7. Which prescription should the nurse implement first?
A. IV regular insulin
B. IV isotonic fluid
C. Oral potassium
D. Subcutaneous long-acting insulin
Answer: B. IV isotonic fluid
Rationale: Severe dehydration and intravascular volume depletion are major
problems in DKA. Initial treatment typically begins with isotonic IV fluid
replacement.
8. Which respiratory pattern should the nurse expect?
A. Cheyne-Stokes respirations
B. Bradypnea
C. Kussmaul respirations
D. Apneustic respirations
Answer: C. Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid respirations that
compensate for metabolic acidosis by increasing carbon dioxide elimination.
9. The client's potassium level is 3.0 mEq/L before insulin therapy. Which
action is appropriate?
A. Start insulin immediately without replacement
B. Anticipate potassium replacement before insulin
C. Restrict potassium intake
D. Administer sodium bicarbonate routinely
Answer: B. Anticipate potassium replacement before insulin
Rationale: Insulin drives potassium into cells and can cause dangerous
hypokalemia. Severe hypokalemia must be corrected before insulin is
initiated.
10. Which finding indicates improvement in DKA?
A. Glucose remains 450 mg/dL
B. Serum bicarbonate increases
C. Respirations become deeper and faster
D. Serum ketones increase
Answer: B. Serum bicarbonate increases
Rationale: Increasing bicarbonate indicates correction of metabolic acidosis
and improvement in the underlying ketoacidosis.
Case Study 3: Heart Failure
A 76-year-old client with chronic heart failure reports increasing shortness of
breath, a 3-kg weight gain over 4 days, and difficulty sleeping flat. Crackles are
heard bilaterally.
11. Which finding requires the most immediate intervention?
A. 3-kg weight gain
B. Orthopnea
C. Bilateral crackles
D. Severe dyspnea at rest
Exam 7 100 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 arrives in the emergency department with sudden right-
sided weakness, facial drooping, and difficulty speaking. Symptoms began 45
minutes ago. Blood pressure is 178/96 mm Hg, heart rate 88/min, respiratory
rate 18/min, and oxygen saturation 96% on room air. The client is awake but
has expressive aphasia.
1. Which assessment finding is the nurse's priority?
A. Blood pressure of 178/96 mm Hg
B. Difficulty speaking
C. Sudden unilateral weakness
D. Oxygen saturation of 96%
Answer: C. Sudden unilateral weakness
Rationale: Sudden unilateral weakness is a classic manifestation of an acute
stroke and requires immediate assessment and intervention to minimize
neurologic injury.
2. Which diagnostic test should the nurse anticipate first?
A. Electroencephalogram
B. Noncontrast CT scan of the head
C. Carotid Doppler ultrasound
D. Lumbar puncture
,Answer: B. Noncontrast CT scan of the head
Rationale: A noncontrast CT scan rapidly determines whether intracranial
hemorrhage is present and helps determine eligibility for thrombolytic
therapy.
3. Which finding would make the client ineligible for thrombolytic therapy?
A. Symptom onset 45 minutes ago
B. Blood glucose of 110 mg/dL
C. Evidence of intracranial hemorrhage
D. Mild expressive aphasia
Answer: C. Evidence of intracranial hemorrhage
Rationale: Thrombolytic therapy can worsen bleeding and is contraindicated
when intracranial hemorrhage is present.
4. Which nursing action is most appropriate before administering oral
medications?
A. Offer water to assess swallowing
B. Perform a swallowing assessment
C. Place the client supine
D. Encourage rapid drinking
Answer: B. Perform a swallowing assessment
Rationale: Dysphagia is common after stroke and can lead to aspiration.
Swallowing ability should be evaluated before oral intake.
5. The client's speech becomes increasingly difficult to understand. Which
action should the nurse take first?
A. Document the finding at the end of the shift
B. Notify the healthcare provider immediately
C. Encourage the client to sleep
D. Administer an oral analgesic
Answer: B. Notify the healthcare provider immediately
Rationale: Worsening neurologic deficits may indicate progression of the
stroke or cerebral edema and require immediate evaluation.
,Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes is admitted with nausea, vomiting,
abdominal pain, and deep rapid respirations. Blood glucose is 480 mg/dL, pH
7.18, bicarbonate 12 mEq/L, and serum ketones are positive.
6. Which condition is most likely occurring?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Metabolic alkalosis
Answer: B. Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, positive ketones, and Kussmaul
respirations are characteristic of diabetic ketoacidosis.
7. Which prescription should the nurse implement first?
A. IV regular insulin
B. IV isotonic fluid
C. Oral potassium
D. Subcutaneous long-acting insulin
Answer: B. IV isotonic fluid
Rationale: Severe dehydration and intravascular volume depletion are major
problems in DKA. Initial treatment typically begins with isotonic IV fluid
replacement.
8. Which respiratory pattern should the nurse expect?
A. Cheyne-Stokes respirations
B. Bradypnea
C. Kussmaul respirations
D. Apneustic respirations
Answer: C. Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid respirations that
compensate for metabolic acidosis by increasing carbon dioxide elimination.
9. The client's potassium level is 3.0 mEq/L before insulin therapy. Which
action is appropriate?
A. Start insulin immediately without replacement
B. Anticipate potassium replacement before insulin
C. Restrict potassium intake
D. Administer sodium bicarbonate routinely
Answer: B. Anticipate potassium replacement before insulin
Rationale: Insulin drives potassium into cells and can cause dangerous
hypokalemia. Severe hypokalemia must be corrected before insulin is
initiated.
10. Which finding indicates improvement in DKA?
A. Glucose remains 450 mg/dL
B. Serum bicarbonate increases
C. Respirations become deeper and faster
D. Serum ketones increase
Answer: B. Serum bicarbonate increases
Rationale: Increasing bicarbonate indicates correction of metabolic acidosis
and improvement in the underlying ketoacidosis.
Case Study 3: Heart Failure
A 76-year-old client with chronic heart failure reports increasing shortness of
breath, a 3-kg weight gain over 4 days, and difficulty sleeping flat. Crackles are
heard bilaterally.
11. Which finding requires the most immediate intervention?
A. 3-kg weight gain
B. Orthopnea
C. Bilateral crackles
D. Severe dyspnea at rest
