Clinical Reasoning Cases 150 Practice
Questions
Case-Based Clinical Judgment Across Nursing Content Areas — Straight Answers
This document has question set using case-based vignettes to build clinical reasoning skills (recognizing cues, analyzing cues,
prioritizing hypotheses, generating solutions, and evaluating outcomes) across major nursing content areas — respiratory,
cardiovascular, endocrine, GI/hepatic, renal, neuro, musculoskeletal, perioperative, hematology/oncology, mental health,
maternal-newborn, pediatric, critical care, fluid/electrolyte, and older adult/chronic disease. Correct answers are bolded
and highlighted.
1. Respiratory Clinical Reasoning
1. A 68-year-old client with a history of COPD is admitted with increased dyspnea, productive cough, and SpO2
of 87% on room air. The nurse's priority action is to:
A) Apply oxygen at 100% via non-rebreather mask
B) Apply supplemental oxygen titrated to a target SpO2 of 88-92% and reassess
C) Withhold oxygen until ABG results return
D) Encourage the client to lie flat to rest
Answer: B) Apply supplemental oxygen titrated to a target SpO2 of 88-92% and reassess
2. A client with pneumonia develops new confusion, respiratory rate of 28, and blood pressure of 88/54.
Recognizing these cues together, the nurse should suspect:
A) Improving clinical status
B) Early sepsis and impending respiratory failure requiring urgent escalation
C) A normal response to infection requiring no action
D) Anxiety related to hospitalization
Answer: B) Early sepsis and impending respiratory failure requiring urgent escalation
3. A client post-thoracic surgery has a chest tube with continuous bubbling in the water seal chamber and new
subcutaneous crepitus around the insertion site. The nurse's priority hypothesis is:
A) Normal postoperative finding requiring no action
B) An air leak with possible ongoing pneumothorax requiring prompt assessment and provider
notification
C) Chest tube malfunction requiring immediate clamping
D) Resolved pneumothorax
Answer: B) An air leak with possible ongoing pneumothorax requiring prompt assessment and provider
notification
4. A client with acute asthma exacerbation initially has audible wheezing; over the next 20 minutes the
wheezing disappears while respiratory effort increases. The nurse recognizes this cue as indicating:
A) Improvement in airway obstruction
B) Worsening obstruction with minimal air movement — a silent chest is an ominous sign
C) No clinical significance
D) Resolution of the exacerbation
, Answer: B) Worsening obstruction with minimal air movement — a silent chest is an ominous sign
5. A client recovering from abdominal surgery reports shallow breathing due to incisional pain and declines to
use the incentive spirometer. The nurse's priority action to prevent atelectasis is to:
A) Document the refusal and take no further action
B) Provide adequate analgesia first, then re-encourage incentive spirometry and deep breathing
C) Restrict all activity until pain resolves independently
D) Discontinue oxygen therapy
Answer: B) Provide adequate analgesia first, then re-encourage incentive spirometry and deep breathing
6. A client with suspected pulmonary embolism reports sudden pleuritic chest pain and dyspnea after a long
flight. Analyzing these cues, the nurse's priority action is to:
A) Encourage ambulation to improve circulation
B) Notify the provider promptly, apply oxygen as needed, and prepare for diagnostic evaluation
C) Administer an antacid for suspected indigestion
D) Delay assessment until the next scheduled rounds
Answer: B) Notify the provider promptly, apply oxygen as needed, and prepare for diagnostic evaluation
7. A client with a tracheostomy becomes acutely distressed with absent air movement through the tube
despite the presence of respiratory effort. The nurse's priority action is to:
A) Reassure the client and wait for spontaneous improvement
B) Attempt to clear/suction the tube and be prepared to remove and replace it if obstruction persists
C) Increase the oxygen flow rate only
D) Document the finding for the next shift
Answer: B) Attempt to clear/suction the tube and be prepared to remove and replace it if obstruction
persists
8. A client with cystic fibrosis reports increased sputum production and mild fever. Generating solutions, the
nurse anticipates the plan of care will most likely include:
A) Fluid restriction
B) Airway clearance techniques, prescribed antibiotics, and continued monitoring for respiratory decline
C) Discontinuation of all pulmonary medications
D) No changes to the current care plan
Answer: B) Airway clearance techniques, prescribed antibiotics, and continued monitoring for respiratory
decline
9. A client on mechanical ventilation has a sudden drop in SpO2 and increased peak airway pressures. Using
the DOPE mnemonic approach (Displacement, Obstruction, Pneumothorax, Equipment failure), the nurse's
priority action is to:
A) Assume equipment failure only and replace the ventilator
B) Systematically assess for tube displacement, obstruction, pneumothorax, or equipment issues while
manually ventilating if needed
C) Increase sedation only
D) Wait for respiratory therapy without any nursing assessment
Answer: B) Systematically assess for tube displacement, obstruction, pneumothorax, or equipment issues
while manually ventilating if needed
10. A client recovering from a COPD exacerbation is being prepared for discharge. Evaluating the outcome of
teaching, which client statement best indicates understanding of self-management?
,A) 'I'll only use my rescue inhaler if I completely stop breathing.'
B) 'I will use pursed-lip breathing during activity and contact my provider if my symptoms suddenly
worsen.'
C) 'I can stop all my medications once I feel better.'
D) 'I don't need to follow up unless I am hospitalized again.'
Answer: B) 'I will use pursed-lip breathing during activity and contact my provider if my symptoms
suddenly worsen.'
, 2. Cardiovascular Clinical Reasoning
11. A client with a history of heart failure reports a 4-pound weight gain over 2 days along with increased
shortness of breath. Recognizing these cues, the nurse's priority action is to:
A) Reassure the client that this is a normal fluctuation
B) Notify the provider, as this suggests worsening fluid retention/decompensation requiring evaluation
C) Encourage increased sodium intake
D) Delay any action until the next scheduled visit
Answer: B) Notify the provider, as this suggests worsening fluid retention/decompensation requiring
evaluation
12. A client post-MI develops new-onset crackles bilaterally, jugular venous distension, and an S3 heart sound.
Analyzing these cues together, the nurse recognizes this pattern as most consistent with:
A) Resolving cardiac status
B) Acute decompensated heart failure
C) Normal postoperative recovery
D) Anxiety-related symptoms only
Answer: B) Acute decompensated heart failure
13. A client on telemetry develops a wide-complex tachycardia with a heart rate of 180 and becomes
unresponsive with no pulse. The nurse's priority action is to:
A) Administer oral antiarrhythmic medication
B) Initiate CPR and prepare for defibrillation per ACLS protocol
C) Reposition the client and reassess in 5 minutes
D) Call for a routine ECG only
Answer: B) Initiate CPR and prepare for defibrillation per ACLS protocol
14. A client with atrial fibrillation and a rapid ventricular response reports dizziness and blood pressure of
82/50. Prioritizing hypotheses, the nurse recognizes the priority concern is:
A) Stable arrhythmia requiring no urgent action
B) Hemodynamically unstable arrhythmia requiring prompt intervention
C) Normal variant requiring only observation
D) Anxiety requiring reassurance only
Answer: B) Hemodynamically unstable arrhythmia requiring prompt intervention
15. A client recovering from cardiac catheterization via the femoral approach reports new numbness and
coolness in the affected leg. The nurse's priority action is to:
A) Document and reassess in 4 hours
B) Assess pulses and notify the provider promptly, as this may indicate vascular compromise
C) Encourage ambulation to improve circulation
D) Apply a warm compress and wait
Answer: B) Assess pulses and notify the provider promptly, as this may indicate vascular compromise
16. A client with suspected acute coronary syndrome reports chest pressure that has been unrelieved by three
sublingual nitroglycerin doses given 5 minutes apart. The nurse's priority action is to:
A) Administer a fourth dose and wait
B) Notify the provider immediately, as this suggests ongoing ischemia/possible infarction
Questions
Case-Based Clinical Judgment Across Nursing Content Areas — Straight Answers
This document has question set using case-based vignettes to build clinical reasoning skills (recognizing cues, analyzing cues,
prioritizing hypotheses, generating solutions, and evaluating outcomes) across major nursing content areas — respiratory,
cardiovascular, endocrine, GI/hepatic, renal, neuro, musculoskeletal, perioperative, hematology/oncology, mental health,
maternal-newborn, pediatric, critical care, fluid/electrolyte, and older adult/chronic disease. Correct answers are bolded
and highlighted.
1. Respiratory Clinical Reasoning
1. A 68-year-old client with a history of COPD is admitted with increased dyspnea, productive cough, and SpO2
of 87% on room air. The nurse's priority action is to:
A) Apply oxygen at 100% via non-rebreather mask
B) Apply supplemental oxygen titrated to a target SpO2 of 88-92% and reassess
C) Withhold oxygen until ABG results return
D) Encourage the client to lie flat to rest
Answer: B) Apply supplemental oxygen titrated to a target SpO2 of 88-92% and reassess
2. A client with pneumonia develops new confusion, respiratory rate of 28, and blood pressure of 88/54.
Recognizing these cues together, the nurse should suspect:
A) Improving clinical status
B) Early sepsis and impending respiratory failure requiring urgent escalation
C) A normal response to infection requiring no action
D) Anxiety related to hospitalization
Answer: B) Early sepsis and impending respiratory failure requiring urgent escalation
3. A client post-thoracic surgery has a chest tube with continuous bubbling in the water seal chamber and new
subcutaneous crepitus around the insertion site. The nurse's priority hypothesis is:
A) Normal postoperative finding requiring no action
B) An air leak with possible ongoing pneumothorax requiring prompt assessment and provider
notification
C) Chest tube malfunction requiring immediate clamping
D) Resolved pneumothorax
Answer: B) An air leak with possible ongoing pneumothorax requiring prompt assessment and provider
notification
4. A client with acute asthma exacerbation initially has audible wheezing; over the next 20 minutes the
wheezing disappears while respiratory effort increases. The nurse recognizes this cue as indicating:
A) Improvement in airway obstruction
B) Worsening obstruction with minimal air movement — a silent chest is an ominous sign
C) No clinical significance
D) Resolution of the exacerbation
, Answer: B) Worsening obstruction with minimal air movement — a silent chest is an ominous sign
5. A client recovering from abdominal surgery reports shallow breathing due to incisional pain and declines to
use the incentive spirometer. The nurse's priority action to prevent atelectasis is to:
A) Document the refusal and take no further action
B) Provide adequate analgesia first, then re-encourage incentive spirometry and deep breathing
C) Restrict all activity until pain resolves independently
D) Discontinue oxygen therapy
Answer: B) Provide adequate analgesia first, then re-encourage incentive spirometry and deep breathing
6. A client with suspected pulmonary embolism reports sudden pleuritic chest pain and dyspnea after a long
flight. Analyzing these cues, the nurse's priority action is to:
A) Encourage ambulation to improve circulation
B) Notify the provider promptly, apply oxygen as needed, and prepare for diagnostic evaluation
C) Administer an antacid for suspected indigestion
D) Delay assessment until the next scheduled rounds
Answer: B) Notify the provider promptly, apply oxygen as needed, and prepare for diagnostic evaluation
7. A client with a tracheostomy becomes acutely distressed with absent air movement through the tube
despite the presence of respiratory effort. The nurse's priority action is to:
A) Reassure the client and wait for spontaneous improvement
B) Attempt to clear/suction the tube and be prepared to remove and replace it if obstruction persists
C) Increase the oxygen flow rate only
D) Document the finding for the next shift
Answer: B) Attempt to clear/suction the tube and be prepared to remove and replace it if obstruction
persists
8. A client with cystic fibrosis reports increased sputum production and mild fever. Generating solutions, the
nurse anticipates the plan of care will most likely include:
A) Fluid restriction
B) Airway clearance techniques, prescribed antibiotics, and continued monitoring for respiratory decline
C) Discontinuation of all pulmonary medications
D) No changes to the current care plan
Answer: B) Airway clearance techniques, prescribed antibiotics, and continued monitoring for respiratory
decline
9. A client on mechanical ventilation has a sudden drop in SpO2 and increased peak airway pressures. Using
the DOPE mnemonic approach (Displacement, Obstruction, Pneumothorax, Equipment failure), the nurse's
priority action is to:
A) Assume equipment failure only and replace the ventilator
B) Systematically assess for tube displacement, obstruction, pneumothorax, or equipment issues while
manually ventilating if needed
C) Increase sedation only
D) Wait for respiratory therapy without any nursing assessment
Answer: B) Systematically assess for tube displacement, obstruction, pneumothorax, or equipment issues
while manually ventilating if needed
10. A client recovering from a COPD exacerbation is being prepared for discharge. Evaluating the outcome of
teaching, which client statement best indicates understanding of self-management?
,A) 'I'll only use my rescue inhaler if I completely stop breathing.'
B) 'I will use pursed-lip breathing during activity and contact my provider if my symptoms suddenly
worsen.'
C) 'I can stop all my medications once I feel better.'
D) 'I don't need to follow up unless I am hospitalized again.'
Answer: B) 'I will use pursed-lip breathing during activity and contact my provider if my symptoms
suddenly worsen.'
, 2. Cardiovascular Clinical Reasoning
11. A client with a history of heart failure reports a 4-pound weight gain over 2 days along with increased
shortness of breath. Recognizing these cues, the nurse's priority action is to:
A) Reassure the client that this is a normal fluctuation
B) Notify the provider, as this suggests worsening fluid retention/decompensation requiring evaluation
C) Encourage increased sodium intake
D) Delay any action until the next scheduled visit
Answer: B) Notify the provider, as this suggests worsening fluid retention/decompensation requiring
evaluation
12. A client post-MI develops new-onset crackles bilaterally, jugular venous distension, and an S3 heart sound.
Analyzing these cues together, the nurse recognizes this pattern as most consistent with:
A) Resolving cardiac status
B) Acute decompensated heart failure
C) Normal postoperative recovery
D) Anxiety-related symptoms only
Answer: B) Acute decompensated heart failure
13. A client on telemetry develops a wide-complex tachycardia with a heart rate of 180 and becomes
unresponsive with no pulse. The nurse's priority action is to:
A) Administer oral antiarrhythmic medication
B) Initiate CPR and prepare for defibrillation per ACLS protocol
C) Reposition the client and reassess in 5 minutes
D) Call for a routine ECG only
Answer: B) Initiate CPR and prepare for defibrillation per ACLS protocol
14. A client with atrial fibrillation and a rapid ventricular response reports dizziness and blood pressure of
82/50. Prioritizing hypotheses, the nurse recognizes the priority concern is:
A) Stable arrhythmia requiring no urgent action
B) Hemodynamically unstable arrhythmia requiring prompt intervention
C) Normal variant requiring only observation
D) Anxiety requiring reassurance only
Answer: B) Hemodynamically unstable arrhythmia requiring prompt intervention
15. A client recovering from cardiac catheterization via the femoral approach reports new numbness and
coolness in the affected leg. The nurse's priority action is to:
A) Document and reassess in 4 hours
B) Assess pulses and notify the provider promptly, as this may indicate vascular compromise
C) Encourage ambulation to improve circulation
D) Apply a warm compress and wait
Answer: B) Assess pulses and notify the provider promptly, as this may indicate vascular compromise
16. A client with suspected acute coronary syndrome reports chest pressure that has been unrelieved by three
sublingual nitroglycerin doses given 5 minutes apart. The nurse's priority action is to:
A) Administer a fourth dose and wait
B) Notify the provider immediately, as this suggests ongoing ischemia/possible infarction
