NGN CLINICAL SCENARIOS | MENTAL HEALTH,
PHARMACOLOGY & MED-SURG | 2024 CASE-BASED
QUESTIONS WITH EXPLANATIONS.
1) NGN FOCUS: MENTAL HEALTH / SUICIDE ASSESSMENT
SCENARIO:
An adolescent patient with conduct disorder arrives at the emergency
department after threatening suicide to a teacher at school. The caregiver is
gathering additional assessment data.
VITAL SIGNS (for context):
• Temperature 36.9°C (98.4°F), HR 88/min, RR 18/min, BP 108/70 mm Hg
QUESTION:
Which of the following statements should the caregiver include during the
assessment?
A.“Tell me about your siblings?”
B.“Tell me what kind of music you like?”
C.“Tell me how often you drink alcohol?”
D.“Tell me about your school schedule?”
ANS: C. “Tell me how often you drink alcohol?” EXPLANATION:
• Assessing for substance use, including alcohol, is critical in adolescents with
conduct disorder and suicidal ideation, as substance misuse can exacerbate
mental health issues.
Options A, B, and D can offer general psychosocial
,• information but do not directly address a risk factor (substance use) that
could contribute significantly to suicidal behavior.
1)NGN FOCUS: MEDICAL-SURGICAL
PRIORITIZATION / HYPOPARATHYROIDISM
SCENARIO:
A caregiver on an acute medical-surgical unit is performing shift
assessments on multiple patients with varying diagnoses.
VITAL SIGNS (for context):
• Patient with possible hypoparathyroidism: BP 120/78 mm Hg, HR 76/min,
RR 18/min
QUESTION:
Which of the following patients is the highest priority to assess or intervene?
A. A patient who has surgical
hypoparathyroidism and a positive Trousseau’s sign
B. A patient with Clostridium difficile infection and acute diarrhea C.A patient with
acute kidney injury and urine with a low specific gravity
D.A patient who has oral cancer and reports a sore on his gums ANS: A. A patient who has
surgical hypoparathyroidism and a positive Trousseau’s sign
EXPLANATION:
• A positive Trousseau’s sign indicates neuromuscular irritability related to
hypocalcemia, which may progress to life- threatening tetany or seizures.
• While the other findings warrant follow-up, acute hypocalcemia poses the
greatest immediate risk.
2)NGN FOCUS: PHARMACOLOGY / HEART FAILURE
SCENARIO:
, A caregiver is reviewing new prescriptions for a patient admitted with congestive heart
failure (CHF).
QUESTION:
Which of the following provider prescriptions should the caregiver anticipate?
A. Call the provider if the patient’s respiratory rate is less than 18/min
B. Give the patient 500 mL IV bolus of 0.9% sodium chloride over 1 hour
C. Give the patient enalapril 2.5 mg PO twice daily
D. Call the provider if the patient’s pulse rate is less than 80/min ANS: C. Give the patient
enalapril 2.5 mg PO twice daily
EXPLANATION:
• An ACE inhibitor (e.g., enalapril) improves cardiac output and reduces
afterload in heart failure.
• Options A and D do not reflect common parameters for holding or calling
the provider in CHF management; option B (IV bolus) may worsen fluid
overload.
3)NGN FOCUS: PHARMACOLOGY / ANTIDEPRESSANTS
SCENARIO:
A caregiver is teaching a patient who has a new prescription for sertraline to
treat depression.
QUESTION:
Which statement by the patient indicates an understanding of the medication
treatment plan?
A.“I will be able to start this medication and immediately feel better.”
B.“I can expect to urinate frequently while on this medication.” C.“I understand I may
experience difficulty sleeping on this medication.”
PHARMACOLOGY & MED-SURG | 2024 CASE-BASED
QUESTIONS WITH EXPLANATIONS.
1) NGN FOCUS: MENTAL HEALTH / SUICIDE ASSESSMENT
SCENARIO:
An adolescent patient with conduct disorder arrives at the emergency
department after threatening suicide to a teacher at school. The caregiver is
gathering additional assessment data.
VITAL SIGNS (for context):
• Temperature 36.9°C (98.4°F), HR 88/min, RR 18/min, BP 108/70 mm Hg
QUESTION:
Which of the following statements should the caregiver include during the
assessment?
A.“Tell me about your siblings?”
B.“Tell me what kind of music you like?”
C.“Tell me how often you drink alcohol?”
D.“Tell me about your school schedule?”
ANS: C. “Tell me how often you drink alcohol?” EXPLANATION:
• Assessing for substance use, including alcohol, is critical in adolescents with
conduct disorder and suicidal ideation, as substance misuse can exacerbate
mental health issues.
Options A, B, and D can offer general psychosocial
,• information but do not directly address a risk factor (substance use) that
could contribute significantly to suicidal behavior.
1)NGN FOCUS: MEDICAL-SURGICAL
PRIORITIZATION / HYPOPARATHYROIDISM
SCENARIO:
A caregiver on an acute medical-surgical unit is performing shift
assessments on multiple patients with varying diagnoses.
VITAL SIGNS (for context):
• Patient with possible hypoparathyroidism: BP 120/78 mm Hg, HR 76/min,
RR 18/min
QUESTION:
Which of the following patients is the highest priority to assess or intervene?
A. A patient who has surgical
hypoparathyroidism and a positive Trousseau’s sign
B. A patient with Clostridium difficile infection and acute diarrhea C.A patient with
acute kidney injury and urine with a low specific gravity
D.A patient who has oral cancer and reports a sore on his gums ANS: A. A patient who has
surgical hypoparathyroidism and a positive Trousseau’s sign
EXPLANATION:
• A positive Trousseau’s sign indicates neuromuscular irritability related to
hypocalcemia, which may progress to life- threatening tetany or seizures.
• While the other findings warrant follow-up, acute hypocalcemia poses the
greatest immediate risk.
2)NGN FOCUS: PHARMACOLOGY / HEART FAILURE
SCENARIO:
, A caregiver is reviewing new prescriptions for a patient admitted with congestive heart
failure (CHF).
QUESTION:
Which of the following provider prescriptions should the caregiver anticipate?
A. Call the provider if the patient’s respiratory rate is less than 18/min
B. Give the patient 500 mL IV bolus of 0.9% sodium chloride over 1 hour
C. Give the patient enalapril 2.5 mg PO twice daily
D. Call the provider if the patient’s pulse rate is less than 80/min ANS: C. Give the patient
enalapril 2.5 mg PO twice daily
EXPLANATION:
• An ACE inhibitor (e.g., enalapril) improves cardiac output and reduces
afterload in heart failure.
• Options A and D do not reflect common parameters for holding or calling
the provider in CHF management; option B (IV bolus) may worsen fluid
overload.
3)NGN FOCUS: PHARMACOLOGY / ANTIDEPRESSANTS
SCENARIO:
A caregiver is teaching a patient who has a new prescription for sertraline to
treat depression.
QUESTION:
Which statement by the patient indicates an understanding of the medication
treatment plan?
A.“I will be able to start this medication and immediately feel better.”
B.“I can expect to urinate frequently while on this medication.” C.“I understand I may
experience difficulty sleeping on this medication.”
