Clinical Judgment Case Study • 2026 Test Plan
72-year-old male • Emergency Department
A 72-year-old male is brought to the emergency department by family after sudden onset of right-sided weakness and slurred speech that began 45 minutes ago. Past medical history includes atrial fibrillation (on warfarin), hypertension, and type 2 diabetes mellitus. Family reports he was alert and talking normally until this morning. Vital signs on arrival: BP 178/96 mmHg, HR 86 bpm irregular, RR 18 breaths/min, SpO₂ 96% on room air, T 36.8°C (98.2°F). Neurologic exam: right facial droop, right arm drift, expressive aphasia, NIH Stroke Scale score estimated at 8. Current medications: warfarin 5 mg PO nightly, lisinopril 20 mg PO daily, metformin 500 mg PO twice daily. The client is anxious but follows simple commands.
A noncontrast CT head is performed and shows no intracranial hemorrhage. Laboratory results return: INR 3.2 (elevated), blood glucose 6.1 mmol/L (110 mg/dL). Thirty minutes after CT, the client’s speech becomes more garbled and right-leg weakness is noted in addition to arm weakness. The stroke team documents onset-to-door time of 60 minutes and is considering thrombolytic therapy; however, elevated INR is a contraindication to IV alteplase. The provider asks the nurse to prepare for urgent reversal of anticoagulation and to facilitate transfer to interventional radiology for possible mechanical thrombectomy.
You will complete 6 clinical judgment questions based on the client scenario. Questions appear one at a time. You cannot go back.
This simulation reflects real NGN item types and partial credit scoring
Acute Ischemic Stroke • Clinical Judgment Score