Stage 3 — Prioritize hypotheses. The 72-year-old client was speaking normally at 0715 and suddenly could not get words out. History includes hypertension, hyperlipidemia, migraine with aura since age 30, and one seizure after a fall in 2014; the client takes no anticonvulsant or anticoagulant. The spouse saw no shaking, and the client reports no headache or visual change. Findings: effortful short phrases, eyes deviated to the left, right lower facial droop, right arm drift. BP 178/96 mm Hg (similar to home readings), HR 88/min, glucose 118 mg/dL, platelets 224,000/mm3, INR 1.0. Noncontrast CT shows no hemorrhage; CT angiography shows a left M1 occlusion. It is now 0830 and the deficits persist. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Quick answer
Acute ischemic stroke with large-vessel occlusion. Take action: thrombolytic after the final eligibility check, and prepare for thrombectomy transfer. Monitor: NIH Stroke Scale score and blood pressure.

Why this is correct
The deficits localize to the left hemisphere, began at a witnessed time, and match the M1 occlusion; CT excludes hemorrhage, glucose excludes a metabolic mimic, and INR and platelets remove laboratory exclusions. BP 178/96 is already below the 185/110 limit for thrombolysis. Guidelines support giving an eligible client a thrombolytic and sending for thrombectomy without waiting to see whether the lytic works. After reperfusion the nurse trends NIHSS for improvement or deterioration and keeps blood pressure at or below 180/105 to limit hemorrhagic conversion.

Easy analogy or mental picture
A pipe is blocked: dissolve the clot with the drug and send the plumber with the retrieval tool at the same time; watch the pressure gauge and whether the water flows (the neuro score).

Memory hook
LVO = LYSE and LIFT (lytic plus thrombectomy); watch NIHSS and BP.

NCLEX decision rule
When imaging confirms an ischemic stroke in the treatment window, choose the reperfusion actions that run in parallel, and monitor the neurologic score and the bleeding-risk vital sign.

Why the other choices are wrong
CT rules out hemorrhage. A remote post-fall seizure without witnessed shaking does not explain an occluded artery, so lorazepam and EEG track the Todd paralysis differential. Migraine aura is positive and spreading and the client has no headache today. Delaying transfer for a lytic response loses brain tissue. Aspirin is withheld for 24 hours after thrombolysis, so giving it after the swallow screen is the right drug at the wrong time. INR tracks warfarin and a lipid panel is long-term prevention, not response to reperfusion.