NCLEX RN Next Generation NGN Case
Study Exam 3 Questions And Correct
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Rationales 2026 Q&A Instant Download
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CASE STUDY 1 — ACUTE HEART FAILURE
A 72-year-old client with a history of hypertension and heart failure
presents with worsening dyspnea for 2 days. The client reports sleeping
in a recliner because breathing becomes difficult when lying flat.
Assessment findings include BP 168/94 mm Hg, HR 108/min, RR
30/min, SpO₂ 86% on room air, bilateral crackles, jugular venous
distention, and 3+ bilateral lower-extremity edema.
1. Which finding requires the nurse's immediate attention?
A. Bilateral lower-extremity edema
B. Jugular venous distention
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: C. Oxygen saturation of 86%
An oxygen saturation of 86% indicates significant hypoxemia and
requires immediate intervention to improve oxygenation.
2. Which assessment findings support acute decompensated heart
failure? Select all that apply.
,A. Bilateral crackles
B. Jugular venous distention
C. 3+ peripheral edema
D. Orthopnea
E. Bradycardia
Answer: A. Bilateral crackles; B. Jugular venous distention; C. 3+
peripheral edema; D. Orthopnea
Pulmonary crackles, venous distention, peripheral edema, and
orthopnea are classic manifestations of fluid overload associated with
heart failure.
3. Which prescription should the nurse anticipate?
A. Rapid infusion of isotonic fluid
B. Intravenous loop diuretic
C. Oral potassium restriction only
D. Intramuscular antibiotic
Answer: B. Intravenous loop diuretic
Loop diuretics such as furosemide promote sodium and water excretion
and are commonly used for acute fluid overload.
4. Which position is most appropriate?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: C. High-Fowler's
High-Fowler's positioning promotes lung expansion and decreases
venous return to the heart, helping reduce pulmonary congestion.
,5. The nurse administers furosemide. Which laboratory value is most
important to monitor?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Calcium only
Answer: A. Potassium
Loop diuretics can cause significant potassium loss, increasing the risk
for dysrhythmias.
6. Which finding indicates that treatment is effective?
A. Increasing crackles
B. SpO₂ increasing to 94%
C. Increasing edema
D. Respiratory rate increasing to 34/min
Answer: B. SpO₂ increasing to 94%
Improved oxygen saturation indicates improved oxygenation and
response to therapy.
7. Which new finding is most concerning?
A. Urine output of 40 mL/hr
B. Weight loss of 1 kg
C. New confusion and restlessness
D. Decreased ankle edema
Answer: C. New confusion and restlessness
New neurologic changes can indicate worsening hypoxemia or
decreased cerebral perfusion and require prompt assessment.
8. Which discharge instruction is most important?
, A. Increase sodium intake
B. Weigh yourself daily
C. Avoid all physical activity
D. Drink unlimited fluids
Answer: B. Weigh yourself daily
Daily weights help identify early fluid retention before severe symptoms
develop.
9. Which finding should the client report immediately?
A. Weight gain of 2 kg in 2 days
B. Mild fatigue after walking
C. Occasional dry mouth
D. Appetite improvement
Answer: A. Weight gain of 2 kg in 2 days
Rapid weight gain usually indicates fluid retention and possible
worsening heart failure.
10. Which statement demonstrates understanding?
A. "I will stop my medications when I feel better."
B. "I should follow my prescribed sodium and fluid restrictions."
C. "I should drink extra fluids when my legs swell."
D. "I only need to check my weight once a month."
Answer: B. "I should follow my prescribed sodium and fluid
restrictions."
Following prescribed sodium and fluid restrictions reduces fluid
retention and helps prevent exacerbations.
CASE STUDY 2 — DIABETIC KETOACIDOSIS
Study Exam 3 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
CASE STUDY 1 — ACUTE HEART FAILURE
A 72-year-old client with a history of hypertension and heart failure
presents with worsening dyspnea for 2 days. The client reports sleeping
in a recliner because breathing becomes difficult when lying flat.
Assessment findings include BP 168/94 mm Hg, HR 108/min, RR
30/min, SpO₂ 86% on room air, bilateral crackles, jugular venous
distention, and 3+ bilateral lower-extremity edema.
1. Which finding requires the nurse's immediate attention?
A. Bilateral lower-extremity edema
B. Jugular venous distention
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: C. Oxygen saturation of 86%
An oxygen saturation of 86% indicates significant hypoxemia and
requires immediate intervention to improve oxygenation.
2. Which assessment findings support acute decompensated heart
failure? Select all that apply.
,A. Bilateral crackles
B. Jugular venous distention
C. 3+ peripheral edema
D. Orthopnea
E. Bradycardia
Answer: A. Bilateral crackles; B. Jugular venous distention; C. 3+
peripheral edema; D. Orthopnea
Pulmonary crackles, venous distention, peripheral edema, and
orthopnea are classic manifestations of fluid overload associated with
heart failure.
3. Which prescription should the nurse anticipate?
A. Rapid infusion of isotonic fluid
B. Intravenous loop diuretic
C. Oral potassium restriction only
D. Intramuscular antibiotic
Answer: B. Intravenous loop diuretic
Loop diuretics such as furosemide promote sodium and water excretion
and are commonly used for acute fluid overload.
4. Which position is most appropriate?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: C. High-Fowler's
High-Fowler's positioning promotes lung expansion and decreases
venous return to the heart, helping reduce pulmonary congestion.
,5. The nurse administers furosemide. Which laboratory value is most
important to monitor?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Calcium only
Answer: A. Potassium
Loop diuretics can cause significant potassium loss, increasing the risk
for dysrhythmias.
6. Which finding indicates that treatment is effective?
A. Increasing crackles
B. SpO₂ increasing to 94%
C. Increasing edema
D. Respiratory rate increasing to 34/min
Answer: B. SpO₂ increasing to 94%
Improved oxygen saturation indicates improved oxygenation and
response to therapy.
7. Which new finding is most concerning?
A. Urine output of 40 mL/hr
B. Weight loss of 1 kg
C. New confusion and restlessness
D. Decreased ankle edema
Answer: C. New confusion and restlessness
New neurologic changes can indicate worsening hypoxemia or
decreased cerebral perfusion and require prompt assessment.
8. Which discharge instruction is most important?
, A. Increase sodium intake
B. Weigh yourself daily
C. Avoid all physical activity
D. Drink unlimited fluids
Answer: B. Weigh yourself daily
Daily weights help identify early fluid retention before severe symptoms
develop.
9. Which finding should the client report immediately?
A. Weight gain of 2 kg in 2 days
B. Mild fatigue after walking
C. Occasional dry mouth
D. Appetite improvement
Answer: A. Weight gain of 2 kg in 2 days
Rapid weight gain usually indicates fluid retention and possible
worsening heart failure.
10. Which statement demonstrates understanding?
A. "I will stop my medications when I feel better."
B. "I should follow my prescribed sodium and fluid restrictions."
C. "I should drink extra fluids when my legs swell."
D. "I only need to check my weight once a month."
Answer: B. "I should follow my prescribed sodium and fluid
restrictions."
Following prescribed sodium and fluid restrictions reduces fluid
retention and helps prevent exacerbations.
CASE STUDY 2 — DIABETIC KETOACIDOSIS
