NCLEX RN Next Generation Case Study
Exam 10 100 Questions And Correct
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Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and coronary artery disease
presents with worsening dyspnea, orthopnea, bilateral crackles, and 3+ pitting
edema. The client is anxious and has an oxygen saturation of 86% on room air.
Question 1
Which finding requires the nurse's immediate attention?
A. 3+ bilateral lower-extremity edema
B. Blood pressure of 168/94 mm Hg
C. Oxygen saturation of 86%
D. Weight gain of 2 kg in 1 week
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia and
impaired gas exchange. Airway and breathing are prioritized before less
immediately threatening manifestations of fluid overload.
Question 2
Which assessment finding is most consistent with acute pulmonary edema?
A. Dry cough
B. Crackles throughout both lung fields
,C. Bradycardia
D. Increased bowel sounds
Answer: Crackles throughout both lung fields
Rationale: Pulmonary edema causes fluid accumulation in the alveoli,
producing diffuse crackles and impaired oxygenation.
Question 3
Which position should the nurse place the client in?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Sims' position
Answer: High-Fowler's
Rationale: High-Fowler's positioning promotes lung expansion and decreases
venous return to the heart, which can reduce pulmonary congestion.
Question 4
The provider prescribes IV furosemide. Which laboratory value is most
important for the nurse to monitor?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: Potassium
Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss, increasing the risk of dysrhythmias.
Question 5
Which finding best indicates that the diuretic therapy is effective?
A. Increased jugular venous distention
B. Decreased urine output
,C. Reduced crackles and improved oxygen saturation
D. Increased peripheral edema
Answer: Reduced crackles and improved oxygen saturation
Rationale: Effective diuresis decreases intravascular volume and pulmonary
congestion, improving oxygenation and reducing crackles.
Question 6
Which statement by the client indicates a need for further teaching about
heart failure?
A. "I will weigh myself every morning."
B. "I should report rapid weight gain."
C. "I can stop my medications when my breathing improves."
D. "I will follow the prescribed sodium restriction."
Answer: "I can stop my medications when my breathing improves."
Rationale: Heart failure medications control the disease and prevent
exacerbations. They should not be discontinued without provider guidance.
Question 7
Which daily weight change should the client report?
A. Loss of 0.2 kg
B. Gain of 0.5 kg over 1 month
C. Gain of 2.3 kg over several days
D. Loss of 1 kg after exercise
Answer: Gain of 2.3 kg over several days
Rationale: Rapid weight gain can indicate fluid retention and worsening heart
failure.
Question 8
Which dietary intervention is appropriate?
A. Increase processed foods
B. Follow a low-sodium diet
, C. Increase canned soups
D. Add salt to meals to improve appetite
Answer: Follow a low-sodium diet
Rationale: Sodium promotes water retention and can worsen edema and
heart failure symptoms.
Question 9
Which assessment finding suggests worsening left-sided heart failure?
A. Pulmonary crackles
B. Enlarged liver
C. Ascites
D. Peripheral edema only
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion because
blood backs up into the pulmonary circulation.
Question 10
Which finding is most concerning after administration of IV furosemide?
A. Urine output of 1,000 mL
B. Potassium of 2.8 mEq/L
C. Decreased ankle edema
D. Improved respiratory rate
Answer: Potassium of 2.8 mEq/L
Rationale: Severe hypokalemia can cause life-threatening cardiac
dysrhythmias and requires prompt intervention.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria, polydipsia,
abdominal pain, vomiting, and deep, rapid respirations. Laboratory results
include glucose 480 mg/dL, pH 7.18, bicarbonate 12 mEq/L, and positive serum
ketones.
Exam 10 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
Download Pdf
Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and coronary artery disease
presents with worsening dyspnea, orthopnea, bilateral crackles, and 3+ pitting
edema. The client is anxious and has an oxygen saturation of 86% on room air.
Question 1
Which finding requires the nurse's immediate attention?
A. 3+ bilateral lower-extremity edema
B. Blood pressure of 168/94 mm Hg
C. Oxygen saturation of 86%
D. Weight gain of 2 kg in 1 week
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia and
impaired gas exchange. Airway and breathing are prioritized before less
immediately threatening manifestations of fluid overload.
Question 2
Which assessment finding is most consistent with acute pulmonary edema?
A. Dry cough
B. Crackles throughout both lung fields
,C. Bradycardia
D. Increased bowel sounds
Answer: Crackles throughout both lung fields
Rationale: Pulmonary edema causes fluid accumulation in the alveoli,
producing diffuse crackles and impaired oxygenation.
Question 3
Which position should the nurse place the client in?
A. Supine
B. Trendelenburg
C. High-Fowler's
D. Sims' position
Answer: High-Fowler's
Rationale: High-Fowler's positioning promotes lung expansion and decreases
venous return to the heart, which can reduce pulmonary congestion.
Question 4
The provider prescribes IV furosemide. Which laboratory value is most
important for the nurse to monitor?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: Potassium
Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss, increasing the risk of dysrhythmias.
Question 5
Which finding best indicates that the diuretic therapy is effective?
A. Increased jugular venous distention
B. Decreased urine output
,C. Reduced crackles and improved oxygen saturation
D. Increased peripheral edema
Answer: Reduced crackles and improved oxygen saturation
Rationale: Effective diuresis decreases intravascular volume and pulmonary
congestion, improving oxygenation and reducing crackles.
Question 6
Which statement by the client indicates a need for further teaching about
heart failure?
A. "I will weigh myself every morning."
B. "I should report rapid weight gain."
C. "I can stop my medications when my breathing improves."
D. "I will follow the prescribed sodium restriction."
Answer: "I can stop my medications when my breathing improves."
Rationale: Heart failure medications control the disease and prevent
exacerbations. They should not be discontinued without provider guidance.
Question 7
Which daily weight change should the client report?
A. Loss of 0.2 kg
B. Gain of 0.5 kg over 1 month
C. Gain of 2.3 kg over several days
D. Loss of 1 kg after exercise
Answer: Gain of 2.3 kg over several days
Rationale: Rapid weight gain can indicate fluid retention and worsening heart
failure.
Question 8
Which dietary intervention is appropriate?
A. Increase processed foods
B. Follow a low-sodium diet
, C. Increase canned soups
D. Add salt to meals to improve appetite
Answer: Follow a low-sodium diet
Rationale: Sodium promotes water retention and can worsen edema and
heart failure symptoms.
Question 9
Which assessment finding suggests worsening left-sided heart failure?
A. Pulmonary crackles
B. Enlarged liver
C. Ascites
D. Peripheral edema only
Answer: Pulmonary crackles
Rationale: Left-sided heart failure causes pulmonary congestion because
blood backs up into the pulmonary circulation.
Question 10
Which finding is most concerning after administration of IV furosemide?
A. Urine output of 1,000 mL
B. Potassium of 2.8 mEq/L
C. Decreased ankle edema
D. Improved respiratory rate
Answer: Potassium of 2.8 mEq/L
Rationale: Severe hypokalemia can cause life-threatening cardiac
dysrhythmias and requires prompt intervention.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes presents with polyuria, polydipsia,
abdominal pain, vomiting, and deep, rapid respirations. Laboratory results
include glucose 480 mg/dL, pH 7.18, bicarbonate 12 mEq/L, and positive serum
ketones.
