A client is admitted to the health care facility with new onset of right-sided paralysis, slurred speech, and lethargy. A nurse obtains in the history that the client has uncontrolled hypertension and smokes 2 packs of cigarettes a day. Which nursing diagnosis is priority for the client upon admission?

Acute cerebrovascular accident (CVA) results in abrupt neurologic deficit, impaired airway protection, and dysphagia, particularly when brainstem or cortical swallowing centers are affected, leading to compromised gag reflex, reduced consciousness, and high risk of pulmonary aspiration and aspiration pneumonia development. Rationale: A. Unilateral neglect is a cortical perceptual deficit typically associated with right hemispheric stroke. It affects awareness of one side of the body. Although relevant, it is not immediately life threatening compared to airway compromise. It is a secondary priority diagnosis in acute stroke care. B. Risk for altered skin integrity relates to immobility and pressure injury formation. While paralysis increases risk for pressure ulcers, this develops over time. It is not the priority upon admission because it does not pose an immediate threat to airway, breathing, or circulation. C. Impaired verbal communication results from aphasia or dysarthria due to cerebral language center damage. It affects expressive or receptive language. Although important for rehabilitation, it does not pose an immediate physiological threat compared to swallowing dysfunction and airway protection failure. D. Risk for aspiration is the priority because neurologic impairment from stroke often causes dysphagia and reduced gag reflex. This increases likelihood of food or secretions entering the lungs. Aspiration can rapidly lead to airway obstruction, hypoxia, and aspiration pneumonia, making it the most urgent nursing diagnosis.