NDEE Exam 6 Clinical Case Studies 100
Scenario-Based Questions & Expert Rationales
2026/2027 Edition
SECTION 1: Medical-Surgical Case Studies (Questions 1-35)
Cardiovascular Cases
Question 1
A 68-year-old male presents to the emergency department with
sudden onset of crushing substernal chest pain radiating to his
left arm, accompanied by diaphoresis and nausea. His vital signs
are: BP 150/90, HR 110, RR 22, SpO2 94% on room air. An EKG
shows ST-segment elevation in leads V1-V4. Which intervention
should the nurse implement first?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Administer oxygen via nasal cannula
D) Establish IV access
Correct Answer: C
Rationale: This patient is experiencing an acute ST-segment
elevation myocardial infarction (STEMI). The priority
intervention is to administer oxygen to maintain SpO2 ≥95% and
ensure adequate tissue perfusion. Option A (nitroglycerin) is
indicated for chest pain but should be given after oxygen and IV
access. Option B (obtain 12-lead EKG) has already been done
based on the scenario. Option D (IV access) is important for
,medication administration but should follow oxygen therapy. The
"ABCs" (Airway, Breathing, Circulation) framework guides
prioritization; oxygen addresses the breathing component. After
oxygen, the nurse should administer aspirin, nitroglycerin, and
morphine as prescribed, and prepare for percutaneous coronary
intervention (PCI) or thrombolytic therapy.
Question 2
A 72-year-old female with a history of heart failure is admitted
with shortness of breath, crackles in the lung bases, and
peripheral edema. She has gained 5 pounds in the past 3 days. Her
medications include furosemide, lisinopril, and carvedilol. Which
assessment finding indicates worsening heart failure and requires
immediate intervention?
A) Weight gain of 2 pounds in 24 hours
B) Serum potassium of 3.8 mEq/L
C) Blood pressure of 135/85 mm Hg
D) Heart rate of 72 beats/min
Correct Answer: A
Rationale: Weight gain of 2-3 pounds in 24 hours (or 5 pounds in
3 days) indicates fluid retention and worsening heart failure. This
requires immediate intervention, typically diuretic adjustment.
Option B (potassium 3.8) is within normal range (3.5-5.0 mEq/L)
but should be monitored, especially with furosemide use. Option
C (BP 135/85) is elevated but not the most urgent finding. Option
D (HR 72) is normal. The nurse should notify the healthcare
provider, assess for other signs of fluid overload (jugular venous
distention, crackles, dyspnea), and prepare for diuretic
,administration. Daily weights are the most reliable indicator of
fluid status in heart failure patients.
Question 3
A 60-year-old male with a history of hypertension and diabetes
presents with sudden onset of severe, tearing chest pain radiating
to his back. His blood pressure is 160/95 in the right arm and
140/85 in the left arm. Which condition should the nurse suspect?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: This patient's presentation is classic for aortic
dissection: sudden, severe, tearing chest pain radiating to the
back, with a blood pressure differential between arms (≥20
mmHg systolic difference). Risk factors include hypertension and
diabetes. Option A (MI) typically presents with crushing
substernal pain, not tearing pain. Option B (PE) presents with
pleuritic chest pain and dyspnea. Option D (pericarditis) pain
improves with leaning forward. Immediate interventions include
pain management (morphine), blood pressure control (beta-
blockers), and surgical consultation. The nurse should prepare
the patient for CT angiography for definitive diagnosis.
, Question 4
A 55-year-old female post-operative day 2 from a total knee
arthroplasty develops sudden onset of pleuritic chest pain,
shortness of breath, and tachycardia. Her oxygen saturation is
88% on room air. She has been on bed rest since surgery. Which
intervention should the nurse implement first?
A) Apply oxygen via non-rebreather mask
B) Administer heparin as prescribed
C) Notify the healthcare provider
D) Obtain a stat chest X-ray
Correct Answer: A
Rationale: This patient is presenting with signs of a pulmonary
embolism (PE): sudden pleuritic chest pain, dyspnea, tachycardia,
and hypoxia with risk factors of recent surgery and immobility.
The priority intervention is to apply oxygen to correct hypoxemia.
Option B (heparin) is indicated for PE but requires a provider
order. Option C (notify healthcare provider) is important but
should occur after stabilizing the patient's oxygenation. Option D
(chest X-ray) is diagnostic but not the first intervention. The
nurse should also assess for signs of deep vein thrombosis (DVT),
prepare for diagnostic testing (CT angiography or V/Q scan), and
monitor for hemodynamic instability.
Question 5
A 65-year-old male with a history of atrial fibrillation is
prescribed warfarin. His INR is 2.8. The patient reports dark, tarry
stools and easy bruising. Which action should the nurse take?
Scenario-Based Questions & Expert Rationales
2026/2027 Edition
SECTION 1: Medical-Surgical Case Studies (Questions 1-35)
Cardiovascular Cases
Question 1
A 68-year-old male presents to the emergency department with
sudden onset of crushing substernal chest pain radiating to his
left arm, accompanied by diaphoresis and nausea. His vital signs
are: BP 150/90, HR 110, RR 22, SpO2 94% on room air. An EKG
shows ST-segment elevation in leads V1-V4. Which intervention
should the nurse implement first?
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead EKG
C) Administer oxygen via nasal cannula
D) Establish IV access
Correct Answer: C
Rationale: This patient is experiencing an acute ST-segment
elevation myocardial infarction (STEMI). The priority
intervention is to administer oxygen to maintain SpO2 ≥95% and
ensure adequate tissue perfusion. Option A (nitroglycerin) is
indicated for chest pain but should be given after oxygen and IV
access. Option B (obtain 12-lead EKG) has already been done
based on the scenario. Option D (IV access) is important for
,medication administration but should follow oxygen therapy. The
"ABCs" (Airway, Breathing, Circulation) framework guides
prioritization; oxygen addresses the breathing component. After
oxygen, the nurse should administer aspirin, nitroglycerin, and
morphine as prescribed, and prepare for percutaneous coronary
intervention (PCI) or thrombolytic therapy.
Question 2
A 72-year-old female with a history of heart failure is admitted
with shortness of breath, crackles in the lung bases, and
peripheral edema. She has gained 5 pounds in the past 3 days. Her
medications include furosemide, lisinopril, and carvedilol. Which
assessment finding indicates worsening heart failure and requires
immediate intervention?
A) Weight gain of 2 pounds in 24 hours
B) Serum potassium of 3.8 mEq/L
C) Blood pressure of 135/85 mm Hg
D) Heart rate of 72 beats/min
Correct Answer: A
Rationale: Weight gain of 2-3 pounds in 24 hours (or 5 pounds in
3 days) indicates fluid retention and worsening heart failure. This
requires immediate intervention, typically diuretic adjustment.
Option B (potassium 3.8) is within normal range (3.5-5.0 mEq/L)
but should be monitored, especially with furosemide use. Option
C (BP 135/85) is elevated but not the most urgent finding. Option
D (HR 72) is normal. The nurse should notify the healthcare
provider, assess for other signs of fluid overload (jugular venous
distention, crackles, dyspnea), and prepare for diuretic
,administration. Daily weights are the most reliable indicator of
fluid status in heart failure patients.
Question 3
A 60-year-old male with a history of hypertension and diabetes
presents with sudden onset of severe, tearing chest pain radiating
to his back. His blood pressure is 160/95 in the right arm and
140/85 in the left arm. Which condition should the nurse suspect?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: This patient's presentation is classic for aortic
dissection: sudden, severe, tearing chest pain radiating to the
back, with a blood pressure differential between arms (≥20
mmHg systolic difference). Risk factors include hypertension and
diabetes. Option A (MI) typically presents with crushing
substernal pain, not tearing pain. Option B (PE) presents with
pleuritic chest pain and dyspnea. Option D (pericarditis) pain
improves with leaning forward. Immediate interventions include
pain management (morphine), blood pressure control (beta-
blockers), and surgical consultation. The nurse should prepare
the patient for CT angiography for definitive diagnosis.
, Question 4
A 55-year-old female post-operative day 2 from a total knee
arthroplasty develops sudden onset of pleuritic chest pain,
shortness of breath, and tachycardia. Her oxygen saturation is
88% on room air. She has been on bed rest since surgery. Which
intervention should the nurse implement first?
A) Apply oxygen via non-rebreather mask
B) Administer heparin as prescribed
C) Notify the healthcare provider
D) Obtain a stat chest X-ray
Correct Answer: A
Rationale: This patient is presenting with signs of a pulmonary
embolism (PE): sudden pleuritic chest pain, dyspnea, tachycardia,
and hypoxia with risk factors of recent surgery and immobility.
The priority intervention is to apply oxygen to correct hypoxemia.
Option B (heparin) is indicated for PE but requires a provider
order. Option C (notify healthcare provider) is important but
should occur after stabilizing the patient's oxygenation. Option D
(chest X-ray) is diagnostic but not the first intervention. The
nurse should also assess for signs of deep vein thrombosis (DVT),
prepare for diagnostic testing (CT angiography or V/Q scan), and
monitor for hemodynamic instability.
Question 5
A 65-year-old male with a history of atrial fibrillation is
prescribed warfarin. His INR is 2.8. The patient reports dark, tarry
stools and easy bruising. Which action should the nurse take?
