NCLEX RN Next Generation (NGN) Case
Study Exam 1 Questions And Correct
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Case Study 1: Acute Heart Failure
1. A 72-year-old client with a history of heart failure presents with
increasing dyspnea, bilateral crackles, and 3+ lower-extremity edema.
Which assessment finding requires the nurse's immediate attention?
A. 3+ ankle edema
B. Weight gain of 2 kg in 3 days
C. Oxygen saturation of 86% on room air
D. Fatigue when walking
Answer: C. Oxygen saturation of 86% on room air
The oxygen saturation indicates significant hypoxemia and impaired
oxygenation, which is the immediate priority.
2. Which assessment finding most strongly supports worsening fluid
overload?
A. Dry mucous membranes
B. Flat neck veins
C. Rapid weight gain
D. Decreased blood pressure after standing
Answer: C. Rapid weight gain
,Rapid weight gain is a sensitive indicator of fluid retention in clients
with heart failure.
3. The nurse auscultates bilateral crackles. What is the most likely
cause?
A. Bronchospasm
B. Pulmonary fluid accumulation
C. Pleural infection
D. Upper-airway obstruction
Answer: B. Pulmonary fluid accumulation
Left-sided heart failure can cause pulmonary congestion and fluid
accumulation in the alveoli, producing crackles.
4. Which position should the nurse place the client in to improve
breathing?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: C. High-Fowler's
High-Fowler's promotes lung expansion and decreases venous return to
the heart, helping reduce pulmonary congestion.
5. The provider prescribes IV furosemide. Which laboratory value is
most important for the nurse to monitor?
A. Potassium
B. Hemoglobin
C. Platelets
D. Amylase
,Answer: A. Potassium
Furosemide promotes potassium loss, which can lead to hypokalemia
and dysrhythmias.
6. Which finding after administration of furosemide indicates the
medication is having the desired effect?
A. Increased peripheral edema
B. Increased urine output
C. Increased crackles
D. Increased body weight
Answer: B. Increased urine output
Furosemide promotes diuresis, reducing excess circulating and
interstitial fluid.
7. Which finding should the nurse report before administering digoxin?
A. Apical pulse of 54/min
B. Respiratory rate of 20/min
C. Blood pressure of 128/74 mm Hg
D. Temperature of 37.1°C
Answer: A. Apical pulse of 54/min
Digoxin can decrease the heart rate. Significant bradycardia should be
reported before administration.
8. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia only
Answer: B. Hypokalemia
, Low potassium increases myocardial sensitivity to digoxin and increases
the risk of toxicity.
9. Which symptom may indicate digoxin toxicity?
A. Increased appetite
B. Yellow-green visual disturbances
C. Increased urination
D. Flushed skin
Answer: B. Yellow-green visual disturbances
Visual disturbances, nausea, vomiting, and dysrhythmias are classic
manifestations of digoxin toxicity.
10. Which client statement indicates understanding of a low-sodium
diet?
A. "I will use salt substitutes freely."
B. "I will read food labels for sodium content."
C. "Canned soups are always healthy choices."
D. "I should add salt when food tastes bland."
Answer: B. "I will read food labels for sodium content."
Reading labels helps clients identify and limit foods high in sodium.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria,
polydipsia, abdominal pain, nausea, vomiting, and deep rapid
respirations. Blood glucose is 548 mg/dL, arterial pH is 7.18, and serum
bicarbonate is 12 mEq/L.
11. Which condition does the nurse suspect?
Study Exam 1 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Case Study 1: Acute Heart Failure
1. A 72-year-old client with a history of heart failure presents with
increasing dyspnea, bilateral crackles, and 3+ lower-extremity edema.
Which assessment finding requires the nurse's immediate attention?
A. 3+ ankle edema
B. Weight gain of 2 kg in 3 days
C. Oxygen saturation of 86% on room air
D. Fatigue when walking
Answer: C. Oxygen saturation of 86% on room air
The oxygen saturation indicates significant hypoxemia and impaired
oxygenation, which is the immediate priority.
2. Which assessment finding most strongly supports worsening fluid
overload?
A. Dry mucous membranes
B. Flat neck veins
C. Rapid weight gain
D. Decreased blood pressure after standing
Answer: C. Rapid weight gain
,Rapid weight gain is a sensitive indicator of fluid retention in clients
with heart failure.
3. The nurse auscultates bilateral crackles. What is the most likely
cause?
A. Bronchospasm
B. Pulmonary fluid accumulation
C. Pleural infection
D. Upper-airway obstruction
Answer: B. Pulmonary fluid accumulation
Left-sided heart failure can cause pulmonary congestion and fluid
accumulation in the alveoli, producing crackles.
4. Which position should the nurse place the client in to improve
breathing?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Prone
Answer: C. High-Fowler's
High-Fowler's promotes lung expansion and decreases venous return to
the heart, helping reduce pulmonary congestion.
5. The provider prescribes IV furosemide. Which laboratory value is
most important for the nurse to monitor?
A. Potassium
B. Hemoglobin
C. Platelets
D. Amylase
,Answer: A. Potassium
Furosemide promotes potassium loss, which can lead to hypokalemia
and dysrhythmias.
6. Which finding after administration of furosemide indicates the
medication is having the desired effect?
A. Increased peripheral edema
B. Increased urine output
C. Increased crackles
D. Increased body weight
Answer: B. Increased urine output
Furosemide promotes diuresis, reducing excess circulating and
interstitial fluid.
7. Which finding should the nurse report before administering digoxin?
A. Apical pulse of 54/min
B. Respiratory rate of 20/min
C. Blood pressure of 128/74 mm Hg
D. Temperature of 37.1°C
Answer: A. Apical pulse of 54/min
Digoxin can decrease the heart rate. Significant bradycardia should be
reported before administration.
8. Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hypercalcemia only
Answer: B. Hypokalemia
, Low potassium increases myocardial sensitivity to digoxin and increases
the risk of toxicity.
9. Which symptom may indicate digoxin toxicity?
A. Increased appetite
B. Yellow-green visual disturbances
C. Increased urination
D. Flushed skin
Answer: B. Yellow-green visual disturbances
Visual disturbances, nausea, vomiting, and dysrhythmias are classic
manifestations of digoxin toxicity.
10. Which client statement indicates understanding of a low-sodium
diet?
A. "I will use salt substitutes freely."
B. "I will read food labels for sodium content."
C. "Canned soups are always healthy choices."
D. "I should add salt when food tastes bland."
Answer: B. "I will read food labels for sodium content."
Reading labels helps clients identify and limit foods high in sodium.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria,
polydipsia, abdominal pain, nausea, vomiting, and deep rapid
respirations. Blood glucose is 548 mg/dL, arterial pH is 7.18, and serum
bicarbonate is 12 mEq/L.
11. Which condition does the nurse suspect?
