NCLEX RN Next Generation NGN Case
Study Exam 8 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 with
sudden right-sided weakness, facial drooping, and difficulty speaking.
Symptoms began 45 minutes ago. Blood pressure is 186/102 mm Hg,
heart rate 88/min, respiratory rate 18/min, and oxygen saturation 97%
on room air. Blood glucose is 108 mg/dL. The client takes aspirin daily
and has a history of hypertension.
100. Which finding is most important for the nurse to report
immediately?
A. Blood pressure of 186/102 mm Hg
B. Heart rate of 88/min
C. Oxygen saturation of 97%
D. Blood glucose of 108 mg/dL
Answer: Blood pressure of 186/102 mm Hg
The markedly elevated blood pressure is important because
thrombolytic therapy may require blood pressure control before
administration.
101. Which assessment finding most strongly supports an acute
stroke?
,A. Gradual onset of bilateral weakness
B. Sudden unilateral weakness and aphasia
C. Chronic headache
D. Generalized muscle fatigue
Answer: Sudden unilateral weakness and aphasia
Sudden focal neurologic deficits such as unilateral weakness and
aphasia are classic manifestations of an acute stroke.
102. 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: Noncontrast CT scan of the head
An immediate noncontrast CT is used to distinguish ischemic stroke
from intracranial hemorrhage before thrombolytic treatment.
103. Which finding would make the nurse question administration of
alteplase?
A. Symptoms began 45 minutes ago
B. Blood glucose is 108 mg/dL
C. CT scan demonstrates intracranial hemorrhage
D. Client has unilateral weakness
Answer: CT scan demonstrates intracranial hemorrhage
Alteplase is contraindicated when the stroke is hemorrhagic because it
can worsen bleeding.
,104. The nurse is preparing the client for thrombolytic therapy. Which
action is appropriate?
A. Administer aspirin immediately
B. Maintain frequent neurologic and bleeding assessments
C. Encourage ambulation
D. Insert an intramuscular injection
Answer: Maintain frequent neurologic and bleeding assessments
Thrombolytic therapy increases the risk of bleeding and requires close
neurologic and hemodynamic monitoring.
105. Which findings indicate possible neurologic deterioration? Select
all that apply.
A. Decreased level of consciousness
B. New unequal pupils
C. Increased ability to speak
D. New-onset vomiting
E. Improved right-sided strength
Answers: Decreased level of consciousness; New unequal pupils; New-
onset vomiting
Decreased consciousness, pupillary changes, and vomiting may indicate
increasing intracranial pressure or neurologic deterioration.
106. Which intervention should the nurse prioritize to reduce
aspiration risk?
, A. Offer thin liquids
B. Perform a swallowing assessment before oral intake
C. Place food at the bedside
D. Encourage rapid eating
Answer: Perform a swallowing assessment before oral intake
Stroke can impair swallowing and increase the risk for aspiration
pneumonia.
107. Which finding best indicates improvement in neurologic status?
A. Increasing facial droop
B. New confusion
C. Improved speech and right-arm strength
D. Increasing headache
Answer: Improved speech and right-arm strength
Improvement in previously impaired neurologic functions indicates
recovery of neurologic status.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with
polyuria, vomiting, abdominal pain, and deep rapid respirations. Blood
glucose is 580 mg/dL, arterial pH is 7.18, bicarbonate is 10 mEq/L, and
serum potassium is 5.6 mEq/L.
108. Which condition does the nurse suspect?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
Study Exam 8 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 with
sudden right-sided weakness, facial drooping, and difficulty speaking.
Symptoms began 45 minutes ago. Blood pressure is 186/102 mm Hg,
heart rate 88/min, respiratory rate 18/min, and oxygen saturation 97%
on room air. Blood glucose is 108 mg/dL. The client takes aspirin daily
and has a history of hypertension.
100. Which finding is most important for the nurse to report
immediately?
A. Blood pressure of 186/102 mm Hg
B. Heart rate of 88/min
C. Oxygen saturation of 97%
D. Blood glucose of 108 mg/dL
Answer: Blood pressure of 186/102 mm Hg
The markedly elevated blood pressure is important because
thrombolytic therapy may require blood pressure control before
administration.
101. Which assessment finding most strongly supports an acute
stroke?
,A. Gradual onset of bilateral weakness
B. Sudden unilateral weakness and aphasia
C. Chronic headache
D. Generalized muscle fatigue
Answer: Sudden unilateral weakness and aphasia
Sudden focal neurologic deficits such as unilateral weakness and
aphasia are classic manifestations of an acute stroke.
102. 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: Noncontrast CT scan of the head
An immediate noncontrast CT is used to distinguish ischemic stroke
from intracranial hemorrhage before thrombolytic treatment.
103. Which finding would make the nurse question administration of
alteplase?
A. Symptoms began 45 minutes ago
B. Blood glucose is 108 mg/dL
C. CT scan demonstrates intracranial hemorrhage
D. Client has unilateral weakness
Answer: CT scan demonstrates intracranial hemorrhage
Alteplase is contraindicated when the stroke is hemorrhagic because it
can worsen bleeding.
,104. The nurse is preparing the client for thrombolytic therapy. Which
action is appropriate?
A. Administer aspirin immediately
B. Maintain frequent neurologic and bleeding assessments
C. Encourage ambulation
D. Insert an intramuscular injection
Answer: Maintain frequent neurologic and bleeding assessments
Thrombolytic therapy increases the risk of bleeding and requires close
neurologic and hemodynamic monitoring.
105. Which findings indicate possible neurologic deterioration? Select
all that apply.
A. Decreased level of consciousness
B. New unequal pupils
C. Increased ability to speak
D. New-onset vomiting
E. Improved right-sided strength
Answers: Decreased level of consciousness; New unequal pupils; New-
onset vomiting
Decreased consciousness, pupillary changes, and vomiting may indicate
increasing intracranial pressure or neurologic deterioration.
106. Which intervention should the nurse prioritize to reduce
aspiration risk?
, A. Offer thin liquids
B. Perform a swallowing assessment before oral intake
C. Place food at the bedside
D. Encourage rapid eating
Answer: Perform a swallowing assessment before oral intake
Stroke can impair swallowing and increase the risk for aspiration
pneumonia.
107. Which finding best indicates improvement in neurologic status?
A. Increasing facial droop
B. New confusion
C. Improved speech and right-arm strength
D. Increasing headache
Answer: Improved speech and right-arm strength
Improvement in previously impaired neurologic functions indicates
recovery of neurologic status.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with
polyuria, vomiting, abdominal pain, and deep rapid respirations. Blood
glucose is 580 mg/dL, arterial pH is 7.18, bicarbonate is 10 mEq/L, and
serum potassium is 5.6 mEq/L.
108. Which condition does the nurse suspect?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
