Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is aspiration pneumonia. The patient's history of stroke puts them at risk for dysphagia (difficulty swallowing), which can lead to aspiration. The scenario describes a typical presentation of aspiration: difficulty swallowing during a meal, followed by coughing and respiratory distress. The physical examination finding of decreased breath sounds in the right lower lobe is consistent with aspiration, as the right lower lobe is the most common site for aspiration due to its anatomical position.

Pneumothorax is incorrect because it typically presents with sudden-onset chest pain and dyspnea, and would more likely cause absent breath sounds rather than decreased. COPD exacerbation is plausible but less likely given the acute onset during a meal and the localized decreased breath sounds. Pulmonary embolism typically presents with sudden-onset dyspnea and chest pain, often with risk factors such as recent surgery or prolonged immobility, which are not mentioned in this scenario.