A nurse is caring for a client with a suspected stroke. Which of the following assessments should the nurse perform first?

Choice A reason: Checking blood glucose is important in stroke management to rule out hypoglycemia mimicking stroke symptoms, but it is not the first action. A neurological exam identifies stroke signs like weakness or speech deficits, guiding urgent interventions like thrombolytics. Glucose testing follows to ensure metabolic causes are addressed after confirming neurological deficits. Choice B reason: Performing a neurological exam is the first priority in suspected stroke to identify focal deficits, such as hemiparesis, aphasia, or altered consciousness. This confirms the diagnosis and determines eligibility for time-sensitive treatments like thrombolytics or thrombectomy. Rapid assessment using tools like the NIH Stroke Scale ensures timely intervention to minimize brain damage. Choice C reason: Obtaining a CT scan is critical to differentiate ischemic from hemorrhagic stroke but follows a neurological exam. The exam confirms stroke symptoms, ensuring the scan is warranted. CT scans guide treatment decisions but are not the first step, as clinical assessment drives the urgency and direction of diagnostic imaging. Choice D reason: Monitoring blood pressure is important in stroke, as hypertension can worsen outcomes, but it is not the first action. A neurological exam identifies stroke symptoms, prioritizing rapid diagnosis and treatment. Blood pressure management follows to optimize cerebral perfusion, especially if thrombolytics are considered, but initial assessment takes precedence.