Kaplan NGN Case Study Practice Exam With Actual
Questions & Verified Answers ,Plus Explained
Rationales/Expert Verified For Guaranteed Pass
2026/Latest Update/Instant Download Pdf
CASE STUDY 1: Postoperative Complications
Scenario: A 68-year-old male (Mr. Johnson) is admitted to the medical-surgical unit
6 hours after a right total knee replacement. He has a history of hypertension, type
2 diabetes, and obesity. Vital signs: BP 142/88 mmHg, HR 98 bpm, RR 22/min,
SpO₂ 94% on room air, temperature 99.8°F (37.7°C). He rates his pain as 7/10. He
has an IV infusing at 100 mL/hr, a PCA pump with morphine, and a sequential
compression device (SCD) on the left leg.
Question 1 (Recognizing Cues): The nurse assesses Mr. Johnson and notes the
following findings. Which finding is the most concerning and requires immediate
follow-up?
A) Pain rating of 7/10
B) Heart rate of 98 bpm
C) SpO₂ of 94% on room air
D) Temperature of 99.8°F (37.7°C)
,Correct Answer: C
Rationale: An SpO₂ of 94% on room air is below the normal range (95–100%) and
may indicate early postoperative pulmonary complications such as atelectasis or
pneumonia. Pain (A) is expected postoperatively and is being managed with PCA.
Tachycardia (B) and low-grade fever (D) can be normal physiological responses to
surgery but should be monitored.
Question 2 (Analyzing Cues): The nurse reviews Mr. Johnson's assessment data.
Which two findings are consistent with an increased risk for venous
thromboembolism (VTE)?
Select all that apply.
A) Obesity
B) Right total knee replacement
C) Heart rate of 98 bpm
D) Pain rating of 7/10
E) History of hypertension
Correct Answer: A, B
Rationale: Obesity (A) is a risk factor for VTE due to decreased mobility and
increased venous stasis. Major orthopedic surgery, particularly lower extremity
joint replacement (B), significantly increases VTE risk. Tachycardia (C), pain (D),
and hypertension (E) are not direct VTE risk factors.
Question 3 (Prioritizing Hypotheses): The nurse is prioritizing potential
complications for Mr. Johnson. Which complication should the nurse address first?
,A) Deep vein thrombosis (DVT)
B) Surgical site infection
C) Pulmonary embolism (PE)
D) Constipation from opioid use
Correct Answer: C
Rationale: While all options are potential complications, pulmonary embolism (C)
is the most immediately life-threatening and requires the highest priority. DVT (A) is
a precursor to PE; infection (B) and constipation (D) are important but lower
priority.
Question 4 (Generating Solutions): Which three interventions should the nurse
implement to reduce Mr. Johnson's risk of VTE?
Select all that apply.
A) Encourage early ambulation
B) Apply SCDs bilaterally
C) Administer prophylactic anticoagulants as ordered
D) Massage the surgical leg
E) Maintain bed rest for 48 hours
F) Perform passive range-of-motion exercises
Correct Answer: A, B, C
Rationale: Early ambulation (A), SCDs (B), and prophylactic anticoagulants (C) are
evidence-based VTE prevention strategies. Massaging the surgical leg (D) can
dislodge a clot; prolonged bed rest (E) increases VTE risk; passive ROM (F) is less
effective than active ambulation.
, Question 5 (Taking Action): The nurse is preparing to administer Mr. Johnson's
morning medications. Which action is most important before administering
enoxaparin (Lovenox)?
A) Check the client's blood pressure
B) Assess the client's pain level
C) Verify the client's weight and renal function
D) Review the client's allergy history
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin dosed by weight, and it is
renally excreted. Verifying weight and renal function (C) is essential for safe dosing.
Blood pressure (A), pain (B), and allergies (D) are important but not the priority for
this specific medication.
Question 6 (Evaluating Outcomes): The nurse evaluates Mr. Johnson's response
to pain management. Which finding indicates the PCA morphine is effective?
A) The client reports pain is now 3/10
B) The client's respiratory rate is 10/min
C) The client requests pain medication every hour
D) The client is somnolent but arousable
Correct Answer: A
Rationale: A decrease in the client's self-reported pain score from 7/10 to 3/10 (A)
indicates effective pain management. Respiratory rate of 10/min (B) is a sign of
opioid-induced respiratory depression. Frequent requests (C) suggest inadequate
pain control. Somnolence (D) may indicate sedation but is not the best indicator of
analgesic effectiveness.
Questions & Verified Answers ,Plus Explained
Rationales/Expert Verified For Guaranteed Pass
2026/Latest Update/Instant Download Pdf
CASE STUDY 1: Postoperative Complications
Scenario: A 68-year-old male (Mr. Johnson) is admitted to the medical-surgical unit
6 hours after a right total knee replacement. He has a history of hypertension, type
2 diabetes, and obesity. Vital signs: BP 142/88 mmHg, HR 98 bpm, RR 22/min,
SpO₂ 94% on room air, temperature 99.8°F (37.7°C). He rates his pain as 7/10. He
has an IV infusing at 100 mL/hr, a PCA pump with morphine, and a sequential
compression device (SCD) on the left leg.
Question 1 (Recognizing Cues): The nurse assesses Mr. Johnson and notes the
following findings. Which finding is the most concerning and requires immediate
follow-up?
A) Pain rating of 7/10
B) Heart rate of 98 bpm
C) SpO₂ of 94% on room air
D) Temperature of 99.8°F (37.7°C)
,Correct Answer: C
Rationale: An SpO₂ of 94% on room air is below the normal range (95–100%) and
may indicate early postoperative pulmonary complications such as atelectasis or
pneumonia. Pain (A) is expected postoperatively and is being managed with PCA.
Tachycardia (B) and low-grade fever (D) can be normal physiological responses to
surgery but should be monitored.
Question 2 (Analyzing Cues): The nurse reviews Mr. Johnson's assessment data.
Which two findings are consistent with an increased risk for venous
thromboembolism (VTE)?
Select all that apply.
A) Obesity
B) Right total knee replacement
C) Heart rate of 98 bpm
D) Pain rating of 7/10
E) History of hypertension
Correct Answer: A, B
Rationale: Obesity (A) is a risk factor for VTE due to decreased mobility and
increased venous stasis. Major orthopedic surgery, particularly lower extremity
joint replacement (B), significantly increases VTE risk. Tachycardia (C), pain (D),
and hypertension (E) are not direct VTE risk factors.
Question 3 (Prioritizing Hypotheses): The nurse is prioritizing potential
complications for Mr. Johnson. Which complication should the nurse address first?
,A) Deep vein thrombosis (DVT)
B) Surgical site infection
C) Pulmonary embolism (PE)
D) Constipation from opioid use
Correct Answer: C
Rationale: While all options are potential complications, pulmonary embolism (C)
is the most immediately life-threatening and requires the highest priority. DVT (A) is
a precursor to PE; infection (B) and constipation (D) are important but lower
priority.
Question 4 (Generating Solutions): Which three interventions should the nurse
implement to reduce Mr. Johnson's risk of VTE?
Select all that apply.
A) Encourage early ambulation
B) Apply SCDs bilaterally
C) Administer prophylactic anticoagulants as ordered
D) Massage the surgical leg
E) Maintain bed rest for 48 hours
F) Perform passive range-of-motion exercises
Correct Answer: A, B, C
Rationale: Early ambulation (A), SCDs (B), and prophylactic anticoagulants (C) are
evidence-based VTE prevention strategies. Massaging the surgical leg (D) can
dislodge a clot; prolonged bed rest (E) increases VTE risk; passive ROM (F) is less
effective than active ambulation.
, Question 5 (Taking Action): The nurse is preparing to administer Mr. Johnson's
morning medications. Which action is most important before administering
enoxaparin (Lovenox)?
A) Check the client's blood pressure
B) Assess the client's pain level
C) Verify the client's weight and renal function
D) Review the client's allergy history
Correct Answer: C
Rationale: Enoxaparin is a low-molecular-weight heparin dosed by weight, and it is
renally excreted. Verifying weight and renal function (C) is essential for safe dosing.
Blood pressure (A), pain (B), and allergies (D) are important but not the priority for
this specific medication.
Question 6 (Evaluating Outcomes): The nurse evaluates Mr. Johnson's response
to pain management. Which finding indicates the PCA morphine is effective?
A) The client reports pain is now 3/10
B) The client's respiratory rate is 10/min
C) The client requests pain medication every hour
D) The client is somnolent but arousable
Correct Answer: A
Rationale: A decrease in the client's self-reported pain score from 7/10 to 3/10 (A)
indicates effective pain management. Respiratory rate of 10/min (B) is a sign of
opioid-induced respiratory depression. Frequent requests (C) suggest inadequate
pain control. Somnolence (D) may indicate sedation but is not the best indicator of
analgesic effectiveness.
