# Stage 6 — Evaluate outcomes. Review the neurologic trend and answer both questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568851&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

Stage 6 — Evaluate outcomes. Review the neurologic trend and answer both questions.

| Time | Data |
| --- | --- |
| Arrival | NIHSS 14; aphasia; left gaze preference; right face, arm, and leg weakness |
| After tenecteplase | Sudden headache and vomiting; emergency CT shows no hemorrhage |
| After thrombectomy | TICI 3 reperfusion; follows one-step commands; right leg strength improves |
| 6 hours | NIHSS 6; speech clearer; mild right facial droop and cough with oral secretions remain |

Q1. Which interpretation is best supported at 6 hours?

The client has progressive global neurologic failure
Reperfusion is associated with substantial neurologic improvement
The original event was a glucose mimic
The client has no remaining safety risks

Q2. Which action remains necessary before oral medication or fluids?

Ask the spouse to offer water
Use a straw to bypass facial weakness
Complete the prescribed swallow screen and maintain aspiration precautions
Delay all rehabilitation assessment until discharge

## Explanation

Emergency CT excludes hemorrhage, thrombectomy restores flow, and improving NIHSS findings indicate neurologic benefit. Persistent facial weakness still requires a formal swallow screen and aspiration precautions before oral intake.

## In-depth explanation

Quick answer
The neurologic trend is improving, but residual facial and secretion findings keep aspiration prevention active.

Why this is correct
A lower NIHSS and improved language and strength support reperfusion benefit. Recovery in one domain does not establish safe swallowing.

Easy analogy or mental picture
The brain map is relighting in sections; speech and strength can improve before the swallow circuit is safe.

Memory hook
Better neuro score does not equal safe swallow.

NCLEX decision rule
Evaluate outcomes with serial objective findings and continue precautions for any unresolved deficit.

Why the other choices are wrong
Unscreened water or a straw can precipitate aspiration, and early rehabilitation planning should not be postponed without cause.

References
12026 Guideline for the Early Management of Patients With Acute Ischemic StrokeRapid stroke recognition, thrombolysis, thrombectomy pathways, and early management
2Care of the Patient With Acute Ischemic StrokeNursing monitoring, dysphagia safety, neurologic deterioration, and post-procedure care

## Clinical scenario

Case update
Emergency imaging shows no hemorrhage. The client undergoes successful thrombectomy and returns to the stroke unit for serial assessment.

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