A 67-year-old client arrives at the emergency department 40 minutes after the family saw sudden right-sided weakness, right facial droop, and slurred speech begin; the family clearly documents the last-known-well time. The client cannot raise the right arm against gravity and can wrinkle the forehead on both sides. There was no shaking or tongue biting, and the client has no seizure history. Blood glucose 112 mg/dL. The client takes no anticoagulants. BP 176/94 mm Hg, HR 88/min and irregular, RR 18/min, SpO2 96% on room air. A noncontrast head CT completed 15 minutes after arrival shows no hemorrhage. 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. Take action: prepare the prescribed thrombolytic for eligibility review and keep the client NPO until a swallow screen. Monitor: NIH Stroke Scale score and blood pressure.

Why this is correct
A central facial droop (forehead spared) plus arm weakness and dysarthria localizes to the brain. The documented last-known-well time places the client well within the thrombolytic window, glucose 112 excludes hypoglycemia, and CT excludes hemorrhage. BP 176/94 is below the 185/110 limit, so it does not need lowering before a lytic. Dysarthria and facial weakness raise aspiration risk, so nothing is given by mouth until the swallow screen. NIHSS and BP are trended frequently during and after thrombolysis.

Easy analogy or mental picture
Time is brain: the family's clock gives a ticket to the clot-busting line, and the CT confirms there is no bleeding blocking the door. Keep the mouth closed until the swallow test clears the way.

Memory hook
Clock known + CT clean + BP < 185/110 = LYTIC ready; NPO; watch NIHSS and BP.

NCLEX decision rule
In a suspected stroke within the window, remove barriers to reperfusion rather than adding steps that delay it, and protect the airway; monitor neurologic score and blood pressure.

Why the other choices are wrong
Bell palsy is a peripheral lesion that paralyzes the forehead and does not cause arm weakness. Todd paralysis requires a preceding seizure, which did not occur. Hypoglycemia is excluded by glucose 112, so dextrose treats a problem that is not present. Aggressive lowering to below 140/90 is not required before thrombolysis and can reduce brain perfusion; the target is below 185/110. Aspirin is not given before a thrombolytic decision or by mouth before a swallow screen. Forehead symmetry tracks Bell palsy, and potassium and urine output are not specific to stroke response.