NU 136 | CLINICAL CASE STUDIES | 2026/2027
NU 136
CLINICAL CASE STUDIES
2026/2027 | Patient Assessment & Nursing Interventions
Purpose: Original case-based practice for recognizing patient cues, analyzing assessment
findings, prioritizing concerns, selecting nursing interventions, and evaluating outcomes. These
are educational practice materials, not official NU 136 examination questions.
Clinical safety note: Use the scenarios for study. In actual care, follow current facility
protocols, orders, scope-of-practice requirements, and instructor or licensed-clinician
guidance.
Clinical Case Studies and Questions
Case 1 — Respiratory Deterioration
Case scenario: A 68-year-old client admitted with pneumonia becomes restless and newly
confused. Respiratory rate is 30/min, oxygen saturation is 86% on room air, heart rate is
118/min, and the client is using accessory muscles.
Question 1. Which assessment cue is the highest priority?
New confusion with oxygen saturation of 86%
Temperature of 38.1°C (100.6°F)
Productive cough for two days
Reduced appetite since admission
Correct Answer: A
Detailed Rationale: Hypoxemia with a new mental-status change suggests impaired
oxygenation and acute deterioration. The nurse should immediately assess airway and
breathing and initiate emergency measures according to orders and protocol.
Why the Other Options Are Incorrect
Original educational resource • Follow current clinical policies and instructor guidance
, NU 136 | CLINICAL CASE STUDIES | 2026/2027
A. The combination indicates possible inadequate oxygen delivery to the brain and requires
urgent action.
B. Fever is relevant but does not outweigh the immediate breathing concern.
C. The cough is consistent with the known respiratory illness but is less urgent than
hypoxemia.
D. Reduced appetite is not the immediate threat.
Key Clinical Judgment Concept: Recognize cues: connect oxygenation changes with acute
mental-status changes.
Question 2. What should the nurse do first?
Collect a sputum sample before intervening
Assess airway and breathing, call for assistance, and provide oxygen per protocol/order
Encourage the client to drink water
Complete routine documentation before reassessment
Correct Answer: B
Detailed Rationale: The immediate priority is to address respiratory compromise. Rapid
assessment, help, and oxygen support under the applicable order or emergency protocol
should not be delayed for specimen collection, oral fluids, or documentation.
Why the Other Options Are Incorrect
A. Specimen collection must not delay support for severe hypoxemia.
B. This responds to the immediate threat and brings help to the bedside.
C. Oral fluids do not correct acute hypoxemia and may be unsafe with distress.
D. Documentation must not delay urgent assessment and treatment.
Key Clinical Judgment Concept: Take action: stabilize breathing and escalate promptly.
Question 3. After intervention, which finding best indicates improvement?
Oxygen saturation rises to 94% and work of breathing decreases
Original educational resource • Follow current clinical policies and instructor guidance
, NU 136 | CLINICAL CASE STUDIES | 2026/2027
The client asks to postpone lunch
The cough remains productive
The temperature remains 38.1°C
Correct Answer: A
Detailed Rationale: Improved oxygen saturation together with reduced work of breathing
directly reflects a better respiratory response. Other findings may still need management
but do not best demonstrate improved oxygenation.
Why the Other Options Are Incorrect
A. Both measures indicate improved oxygenation and respiratory effort.
B. Meal preference does not measure respiratory response.
C. A productive cough may persist despite improvement or deterioration.
D. Persistent fever does not directly show whether oxygenation improved.
Key Clinical Judgment Concept: Evaluate outcomes: compare respiratory status with baseline
and expected response.
Case 2 — Postoperative Pain and Safety
Case scenario: A 54-year-old client is six hours after abdominal surgery. The client reports
incisional pain of 7/10, is reluctant to cough, and has shallow respirations. The dressing is dry,
blood pressure is 126/78 mmHg, and oxygen saturation is 95% on room air.
Question 4. Which assessment should the nurse complete before administering the
prescribed opioid analgesic?
Assess pain, sedation level, respiratory status, allergies, and relevant medication history
Ask the client to walk in the hallway
Offer a large meal
Remove the dressing to inspect the incision without a clinical reason
Correct Answer: A
Original educational resource • Follow current clinical policies and instructor guidance
NU 136
CLINICAL CASE STUDIES
2026/2027 | Patient Assessment & Nursing Interventions
Purpose: Original case-based practice for recognizing patient cues, analyzing assessment
findings, prioritizing concerns, selecting nursing interventions, and evaluating outcomes. These
are educational practice materials, not official NU 136 examination questions.
Clinical safety note: Use the scenarios for study. In actual care, follow current facility
protocols, orders, scope-of-practice requirements, and instructor or licensed-clinician
guidance.
Clinical Case Studies and Questions
Case 1 — Respiratory Deterioration
Case scenario: A 68-year-old client admitted with pneumonia becomes restless and newly
confused. Respiratory rate is 30/min, oxygen saturation is 86% on room air, heart rate is
118/min, and the client is using accessory muscles.
Question 1. Which assessment cue is the highest priority?
New confusion with oxygen saturation of 86%
Temperature of 38.1°C (100.6°F)
Productive cough for two days
Reduced appetite since admission
Correct Answer: A
Detailed Rationale: Hypoxemia with a new mental-status change suggests impaired
oxygenation and acute deterioration. The nurse should immediately assess airway and
breathing and initiate emergency measures according to orders and protocol.
Why the Other Options Are Incorrect
Original educational resource • Follow current clinical policies and instructor guidance
, NU 136 | CLINICAL CASE STUDIES | 2026/2027
A. The combination indicates possible inadequate oxygen delivery to the brain and requires
urgent action.
B. Fever is relevant but does not outweigh the immediate breathing concern.
C. The cough is consistent with the known respiratory illness but is less urgent than
hypoxemia.
D. Reduced appetite is not the immediate threat.
Key Clinical Judgment Concept: Recognize cues: connect oxygenation changes with acute
mental-status changes.
Question 2. What should the nurse do first?
Collect a sputum sample before intervening
Assess airway and breathing, call for assistance, and provide oxygen per protocol/order
Encourage the client to drink water
Complete routine documentation before reassessment
Correct Answer: B
Detailed Rationale: The immediate priority is to address respiratory compromise. Rapid
assessment, help, and oxygen support under the applicable order or emergency protocol
should not be delayed for specimen collection, oral fluids, or documentation.
Why the Other Options Are Incorrect
A. Specimen collection must not delay support for severe hypoxemia.
B. This responds to the immediate threat and brings help to the bedside.
C. Oral fluids do not correct acute hypoxemia and may be unsafe with distress.
D. Documentation must not delay urgent assessment and treatment.
Key Clinical Judgment Concept: Take action: stabilize breathing and escalate promptly.
Question 3. After intervention, which finding best indicates improvement?
Oxygen saturation rises to 94% and work of breathing decreases
Original educational resource • Follow current clinical policies and instructor guidance
, NU 136 | CLINICAL CASE STUDIES | 2026/2027
The client asks to postpone lunch
The cough remains productive
The temperature remains 38.1°C
Correct Answer: A
Detailed Rationale: Improved oxygen saturation together with reduced work of breathing
directly reflects a better respiratory response. Other findings may still need management
but do not best demonstrate improved oxygenation.
Why the Other Options Are Incorrect
A. Both measures indicate improved oxygenation and respiratory effort.
B. Meal preference does not measure respiratory response.
C. A productive cough may persist despite improvement or deterioration.
D. Persistent fever does not directly show whether oxygenation improved.
Key Clinical Judgment Concept: Evaluate outcomes: compare respiratory status with baseline
and expected response.
Case 2 — Postoperative Pain and Safety
Case scenario: A 54-year-old client is six hours after abdominal surgery. The client reports
incisional pain of 7/10, is reluctant to cough, and has shallow respirations. The dressing is dry,
blood pressure is 126/78 mmHg, and oxygen saturation is 95% on room air.
Question 4. Which assessment should the nurse complete before administering the
prescribed opioid analgesic?
Assess pain, sedation level, respiratory status, allergies, and relevant medication history
Ask the client to walk in the hallway
Offer a large meal
Remove the dressing to inspect the incision without a clinical reason
Correct Answer: A
Original educational resource • Follow current clinical policies and instructor guidance
