1
2025/2026 NGN Case Study Bundle Actual
Exam – 10 Full Scenarios with Extended
Multiple Responses and Highlighted Correct
Answers | Clinical Judgment Explanations
Case Study 1: Pediatric Asthma Exacerbation
Scenario: A 7-year-old male presents to the emergency department (ED) with wheezing,
shortness of breath, and a cough for 2 days. He has a history of asthma and uses an albuterol
inhaler as needed. His mother reports he has been using the inhaler every 4 hours without relief.
Vital signs: HR 120 bpm, RR 40 breaths/min, SpO2 89%, temp 99.2°F. The child is using
accessory muscles and speaking in short sentences.
Question 1: Recognize Cues (Multiple Choice)
Which findings indicate a need for immediate intervention? (Select all that apply.)
A. Heart rate of 120 bpm
B. Respiratory rate of 40 breaths/min
C. Temperature of 99.2°F
D. SpO2 of 89%
E. Use of accessory muscles
F. Speaking in short sentences
Rationale: Tachypnea (RR 40 breaths/min), low oxygen saturation (SpO2 89%), use of
accessory muscles, and difficulty speaking in full sentences are critical indicators of severe
respiratory distress in an asthma exacerbation, requiring immediate intervention. Heart rate of
120 bpm is elevated but less urgent, and a temperature of 99.2°F is not immediately concerning.
Question 2: Analyze Cues (Matrix)
Match the assessment findings to their clinical significance:
Finding Hypoxemia Airway Obstruction Infection
SpO2 89% Yes No No
Use of accessory muscles No Yes No
Temperature 99.2°F No No Yes
Wheezing No Yes No
, 2
Rationale: Low SpO2 indicates hypoxemia, while accessory muscle use and wheezing reflect
airway obstruction due to bronchospasm. A slightly elevated temperature may suggest a mild
infection but is not the primary concern.
Question 3: Prioritize Hypotheses (Drag-and-Drop)
Rank the following nursing diagnoses in order of priority:
A. Ineffective Airway Clearance
B. Impaired Gas Exchange
C. Anxiety
D. Risk for Infection
Correct Order:
1. Impaired Gas Exchange
2. Ineffective Airway Clearance
3. Anxiety
4. Risk for Infection
Rationale: Impaired Gas Exchange is the highest priority due to low SpO2 and respiratory
distress, followed by Ineffective Airway Clearance due to wheezing and bronchospasm. Anxiety
and Risk for Infection are less urgent in this acute scenario.
Question 4: Take Action (Multiple Choice)
What is the nurse’s priority action?
A. Encourage oral fluids
B. Administer oxygen via nasal cannula
C. Teach proper inhaler technique
D. Monitor temperature
Rationale: Administering oxygen addresses hypoxemia (SpO2 89%), the most immediate threat
to the child’s life.
Question 5: Evaluate Outcomes (Multiple Choice)
After administering oxygen and albuterol, the child’s SpO2 is 95% and wheezing is decreased.
Which finding indicates effective treatment?
A. Heart rate of 110 bpm
B. SpO2 of 95%
C. Temperature of 99°F
D. Continued cough
Rationale: An SpO2 of 95% indicates improved oxygenation, a direct measure of effective
asthma treatment. Decreased wheezing further supports this.
, 3
Case Study 2: Acute Myocardial Infarction
Scenario: A 55-year-old female presents to the ED with chest pain for 1 hour, radiating to her
left arm. She reports nausea and diaphoresis. Vital signs: BP 160/90 mmHg, HR 100 bpm, RR 22
breaths/min, SpO2 96%, temp 98.6°F. An ECG shows ST elevation in leads II, III, and aVF.
Question 1: Recognize Cues (Multiple Choice)
Which findings require immediate reporting to the provider? (Select all that apply.)
A. Chest pain radiating to left arm
B. Nausea
C. Diaphoresis
D. Blood pressure of 160/90 mmHg
E. ST elevation on ECG
Rationale: Chest pain, nausea, diaphoresis, and ST elevation are classic signs of acute
myocardial infarction (MI), requiring immediate reporting for urgent intervention. Elevated BP
is concerning but not the primary focus.
Question 2: Analyze Cues (Matrix)
Match the findings to their clinical significance:
Finding Myocardial Ischemia Hypertension Anxiety
Chest pain radiating to arm Yes No No
BP 160/90 mmHg No Yes No
Nausea Yes No No
Diaphoresis Yes No Yes
Rationale: Chest pain, nausea, and diaphoresis are indicative of myocardial ischemia, while
elevated BP reflects hypertension. Diaphoresis can also occur with anxiety but is primarily
linked to MI in this context.
Question 3: Prioritize Hypotheses (Drag-and-Drop)
Rank the following interventions in order of priority:
A. Administer oxygen
B. Administer nitroglycerin
C. Obtain a 12-lead ECG
D. Monitor blood pressure
2025/2026 NGN Case Study Bundle Actual
Exam – 10 Full Scenarios with Extended
Multiple Responses and Highlighted Correct
Answers | Clinical Judgment Explanations
Case Study 1: Pediatric Asthma Exacerbation
Scenario: A 7-year-old male presents to the emergency department (ED) with wheezing,
shortness of breath, and a cough for 2 days. He has a history of asthma and uses an albuterol
inhaler as needed. His mother reports he has been using the inhaler every 4 hours without relief.
Vital signs: HR 120 bpm, RR 40 breaths/min, SpO2 89%, temp 99.2°F. The child is using
accessory muscles and speaking in short sentences.
Question 1: Recognize Cues (Multiple Choice)
Which findings indicate a need for immediate intervention? (Select all that apply.)
A. Heart rate of 120 bpm
B. Respiratory rate of 40 breaths/min
C. Temperature of 99.2°F
D. SpO2 of 89%
E. Use of accessory muscles
F. Speaking in short sentences
Rationale: Tachypnea (RR 40 breaths/min), low oxygen saturation (SpO2 89%), use of
accessory muscles, and difficulty speaking in full sentences are critical indicators of severe
respiratory distress in an asthma exacerbation, requiring immediate intervention. Heart rate of
120 bpm is elevated but less urgent, and a temperature of 99.2°F is not immediately concerning.
Question 2: Analyze Cues (Matrix)
Match the assessment findings to their clinical significance:
Finding Hypoxemia Airway Obstruction Infection
SpO2 89% Yes No No
Use of accessory muscles No Yes No
Temperature 99.2°F No No Yes
Wheezing No Yes No
, 2
Rationale: Low SpO2 indicates hypoxemia, while accessory muscle use and wheezing reflect
airway obstruction due to bronchospasm. A slightly elevated temperature may suggest a mild
infection but is not the primary concern.
Question 3: Prioritize Hypotheses (Drag-and-Drop)
Rank the following nursing diagnoses in order of priority:
A. Ineffective Airway Clearance
B. Impaired Gas Exchange
C. Anxiety
D. Risk for Infection
Correct Order:
1. Impaired Gas Exchange
2. Ineffective Airway Clearance
3. Anxiety
4. Risk for Infection
Rationale: Impaired Gas Exchange is the highest priority due to low SpO2 and respiratory
distress, followed by Ineffective Airway Clearance due to wheezing and bronchospasm. Anxiety
and Risk for Infection are less urgent in this acute scenario.
Question 4: Take Action (Multiple Choice)
What is the nurse’s priority action?
A. Encourage oral fluids
B. Administer oxygen via nasal cannula
C. Teach proper inhaler technique
D. Monitor temperature
Rationale: Administering oxygen addresses hypoxemia (SpO2 89%), the most immediate threat
to the child’s life.
Question 5: Evaluate Outcomes (Multiple Choice)
After administering oxygen and albuterol, the child’s SpO2 is 95% and wheezing is decreased.
Which finding indicates effective treatment?
A. Heart rate of 110 bpm
B. SpO2 of 95%
C. Temperature of 99°F
D. Continued cough
Rationale: An SpO2 of 95% indicates improved oxygenation, a direct measure of effective
asthma treatment. Decreased wheezing further supports this.
, 3
Case Study 2: Acute Myocardial Infarction
Scenario: A 55-year-old female presents to the ED with chest pain for 1 hour, radiating to her
left arm. She reports nausea and diaphoresis. Vital signs: BP 160/90 mmHg, HR 100 bpm, RR 22
breaths/min, SpO2 96%, temp 98.6°F. An ECG shows ST elevation in leads II, III, and aVF.
Question 1: Recognize Cues (Multiple Choice)
Which findings require immediate reporting to the provider? (Select all that apply.)
A. Chest pain radiating to left arm
B. Nausea
C. Diaphoresis
D. Blood pressure of 160/90 mmHg
E. ST elevation on ECG
Rationale: Chest pain, nausea, diaphoresis, and ST elevation are classic signs of acute
myocardial infarction (MI), requiring immediate reporting for urgent intervention. Elevated BP
is concerning but not the primary focus.
Question 2: Analyze Cues (Matrix)
Match the findings to their clinical significance:
Finding Myocardial Ischemia Hypertension Anxiety
Chest pain radiating to arm Yes No No
BP 160/90 mmHg No Yes No
Nausea Yes No No
Diaphoresis Yes No Yes
Rationale: Chest pain, nausea, and diaphoresis are indicative of myocardial ischemia, while
elevated BP reflects hypertension. Diaphoresis can also occur with anxiety but is primarily
linked to MI in this context.
Question 3: Prioritize Hypotheses (Drag-and-Drop)
Rank the following interventions in order of priority:
A. Administer oxygen
B. Administer nitroglycerin
C. Obtain a 12-lead ECG
D. Monitor blood pressure
