Next-Gen NCLEX Case Studies
Scenario:
A 19-year-old client with type 1 diabetes arrives at the emergency department. The client
reports nausea, abdominal pain, and increased thirst.
Vital Signs: T 98.9°F, HR 118, RR 28, BP 92/60
Breath has a fruity odor. Client appears lethargic.
Labs:
Glucose 520 mg/dL
pH 7.18
Potassium 5.6 mEq/L
Bicarbonate 14 mEq/L
Urine ketones positive
Question 1 (SATA): Which findings support DKA?
A. Fruity breath
B. pH 7.18
C. Glucose 520 mg/dL
D. Potassium 3.2 mEq/L
E. Positive urine ketones
Question 2: Priority nursing problem?
A. Risk for infection
B. Deficient fluid volume
C. Impaired vision
D. Chronic pain
Question 3 (Ordered Response): Place in correct order:
1. Start IV normal saline
2. Check serum potassium
3. Initiate IV insulin infusion
4. Monitor blood glucose hourly
Question 4: Which finding indicates improvement?
, A. pH increases to 7.32
B. Glucose remains 500 mg/dL
C. Potassium rises to 6.2
D. Client becomes more confused
------------------------------------------------------------
CASE STUDY 2: SIADH
Scenario:
A 68-year-old client with small-cell lung cancer is admitted for confusion and headache.
Labs:
Sodium 118 mEq/L
Serum osmolality low
Urine specific gravity high
Question 1 (SATA): Which findings indicate SIADH?
A. Hyponatremia
B. High urine specific gravity
C. Polyuria
D. Low serum osmolality
E. Weight gain
Question 2: The confusion is most likely caused by:
A. Cerebral edema from hyponatremia
B. Hyperglycemia
C. Hypoxia
D. Fever
Question 3: Which order should the nurse implement first?
A. Fluid restriction
B. Administer desmopressin
C. Encourage water intake
D. Administer diuretics
Scenario:
A 19-year-old client with type 1 diabetes arrives at the emergency department. The client
reports nausea, abdominal pain, and increased thirst.
Vital Signs: T 98.9°F, HR 118, RR 28, BP 92/60
Breath has a fruity odor. Client appears lethargic.
Labs:
Glucose 520 mg/dL
pH 7.18
Potassium 5.6 mEq/L
Bicarbonate 14 mEq/L
Urine ketones positive
Question 1 (SATA): Which findings support DKA?
A. Fruity breath
B. pH 7.18
C. Glucose 520 mg/dL
D. Potassium 3.2 mEq/L
E. Positive urine ketones
Question 2: Priority nursing problem?
A. Risk for infection
B. Deficient fluid volume
C. Impaired vision
D. Chronic pain
Question 3 (Ordered Response): Place in correct order:
1. Start IV normal saline
2. Check serum potassium
3. Initiate IV insulin infusion
4. Monitor blood glucose hourly
Question 4: Which finding indicates improvement?
, A. pH increases to 7.32
B. Glucose remains 500 mg/dL
C. Potassium rises to 6.2
D. Client becomes more confused
------------------------------------------------------------
CASE STUDY 2: SIADH
Scenario:
A 68-year-old client with small-cell lung cancer is admitted for confusion and headache.
Labs:
Sodium 118 mEq/L
Serum osmolality low
Urine specific gravity high
Question 1 (SATA): Which findings indicate SIADH?
A. Hyponatremia
B. High urine specific gravity
C. Polyuria
D. Low serum osmolality
E. Weight gain
Question 2: The confusion is most likely caused by:
A. Cerebral edema from hyponatremia
B. Hyperglycemia
C. Hypoxia
D. Fever
Question 3: Which order should the nurse implement first?
A. Fluid restriction
B. Administer desmopressin
C. Encourage water intake
D. Administer diuretics
