Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Next-Generation NCLEX (NGN) Case Study Item (6-
Part Evolving Scenario)
Clinical Scenario
A 67-year-old male with a history of chronic heart failure (HFrEF,
EF 32%), type 2 diabetes mellitus, and stage 3 chronic kidney
disease (CKD, baseline eGFR 41 mL/min/1.73 m²) is admitted to
the acute care telemetry unit following a 4-day history of
worsening dyspnea on exertion, orthopnea, 3+ bilateral pitting
pedal edema, and an acute weight gain of 4.5 kg (10 lbs).
Home Medications
• Lisinopril 20 mg PO daily
• Metformin 500 mg PO twice daily
• Carvedilol 12.5 mg PO twice daily
• Atorvastatin 20 mg PO nightly
Part 1: Recognizing Cues
Upon admission, the nurse reviews the electronic health record
and performs an initial physical assessment.
Current Vital Signs & Physical Findings:
• BP: 142/88 mmHg | HR: 92 bpm (sinus rhythm) | RR: 24
breaths/min | SpO2: 89% on room air | Temp: 36.8°C
(98.2°F)
, • Cardiovascular: S3 gallop noted on auscultation; jugular
venous distention (JVD) at 6 cm above the sternal angle.
• Respiratory: Bilateral crackles heard midway up the lung
fields; accessory muscle use noted.
Initial Laboratory Results:
• Serum Potassium: 4.8 mEq/L
• Serum Sodium: 134 mEq/L
• Blood Urea Nitrogen (BUN): 38 mg/dL
• Serum Creatinine: 1.8 mg/dL (Baseline: 1.4 mg/dL)
• Brain Natriuretic Peptide (BNP): 1,250 pg/mL
Question Stem
Click to highlight the four clinical findings that indicate the
patient is experiencing a severe exacerbation of fluid volume
overload that requires immediate pharmacotherapeutic
intervention.
- History of type 2 diabetes mellitus
- SpO2 of 89% on room air
- Bilateral crackles midway up the lung fields
- Heart rate of 92 bpm
- Atorvastatin 20 mg PO nightly
, - Brain Natriuretic Peptide (BNP) of 1,250 pg/mL
- 3+ bilateral pitting pedal edema
Correct Answers
• SpO2 of 89% on room air
• Bilateral crackles midway up the lung fields
• Brain Natriuretic Peptide (BNP) of 1,250 pg/mL
• 3+ bilateral pitting pedal edema
Comprehensive Rationale
The patient exhibits classic manifestations of an acute
decompensated heart failure (ADHF) exacerbation
characterized by profound volume overload and pulmonary
congestion. An SpO2 of 89% and bilateral crackles midway up
the lung fields confirm severe alveolar fluid accumulation
impairing gas exchange, which demands rapid diuresis. A BNP
of 1,250 pg/mL is highly elevated (normal is less than 100
pg/mL) and directly correlates with excessive ventricular wall
stretch caused by high filling pressures. The 3+ bilateral pitting
pedal edema quantifies systemic venous congestion. While the
patient's heart rate is elevated and he has a history of diabetes,
these are not acute indicators of severe volume overload
requiring instant pharmacologic diuresis like the pulmonary and
systemic fluid markers.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1: Next-Generation NCLEX (NGN) Case Study Item (6-
Part Evolving Scenario)
Clinical Scenario
A 67-year-old male with a history of chronic heart failure (HFrEF,
EF 32%), type 2 diabetes mellitus, and stage 3 chronic kidney
disease (CKD, baseline eGFR 41 mL/min/1.73 m²) is admitted to
the acute care telemetry unit following a 4-day history of
worsening dyspnea on exertion, orthopnea, 3+ bilateral pitting
pedal edema, and an acute weight gain of 4.5 kg (10 lbs).
Home Medications
• Lisinopril 20 mg PO daily
• Metformin 500 mg PO twice daily
• Carvedilol 12.5 mg PO twice daily
• Atorvastatin 20 mg PO nightly
Part 1: Recognizing Cues
Upon admission, the nurse reviews the electronic health record
and performs an initial physical assessment.
Current Vital Signs & Physical Findings:
• BP: 142/88 mmHg | HR: 92 bpm (sinus rhythm) | RR: 24
breaths/min | SpO2: 89% on room air | Temp: 36.8°C
(98.2°F)
, • Cardiovascular: S3 gallop noted on auscultation; jugular
venous distention (JVD) at 6 cm above the sternal angle.
• Respiratory: Bilateral crackles heard midway up the lung
fields; accessory muscle use noted.
Initial Laboratory Results:
• Serum Potassium: 4.8 mEq/L
• Serum Sodium: 134 mEq/L
• Blood Urea Nitrogen (BUN): 38 mg/dL
• Serum Creatinine: 1.8 mg/dL (Baseline: 1.4 mg/dL)
• Brain Natriuretic Peptide (BNP): 1,250 pg/mL
Question Stem
Click to highlight the four clinical findings that indicate the
patient is experiencing a severe exacerbation of fluid volume
overload that requires immediate pharmacotherapeutic
intervention.
- History of type 2 diabetes mellitus
- SpO2 of 89% on room air
- Bilateral crackles midway up the lung fields
- Heart rate of 92 bpm
- Atorvastatin 20 mg PO nightly
, - Brain Natriuretic Peptide (BNP) of 1,250 pg/mL
- 3+ bilateral pitting pedal edema
Correct Answers
• SpO2 of 89% on room air
• Bilateral crackles midway up the lung fields
• Brain Natriuretic Peptide (BNP) of 1,250 pg/mL
• 3+ bilateral pitting pedal edema
Comprehensive Rationale
The patient exhibits classic manifestations of an acute
decompensated heart failure (ADHF) exacerbation
characterized by profound volume overload and pulmonary
congestion. An SpO2 of 89% and bilateral crackles midway up
the lung fields confirm severe alveolar fluid accumulation
impairing gas exchange, which demands rapid diuresis. A BNP
of 1,250 pg/mL is highly elevated (normal is less than 100
pg/mL) and directly correlates with excessive ventricular wall
stretch caused by high filling pressures. The 3+ bilateral pitting
pedal edema quantifies systemic venous congestion. While the
patient's heart rate is elevated and he has a history of diabetes,
these are not acute indicators of severe volume overload
requiring instant pharmacologic diuresis like the pulmonary and
systemic fluid markers.
