Winningham's Critical Thinking Cases in Nursing 6th Ed.
Case Study Test Bank Actual Exam 2026/2027 – Med-Surg,
Peds, Maternity & Psych with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION A: MEDICAL-SURGICAL NURSING CASE STUDIES (30
Questions)
Q1: A 62-year-old man arrives in the emergency department with crushing substernal
chest pain radiating to his left arm, diaphoresis, and nausea for 1 hour. His ECG shows
ST elevation in leads II, III, and aVF. Which action does the nurse take FIRST?
A. Administer prescribed sublingual nitroglycerin after confirming BP of 160/92 mm Hg
B. Obtain a 12-lead ECG (even though one was completed in the ambulance)
C. Give aspirin 325 mg to chew [CORRECT]
D. Draw serial troponin levels and wait for results before notifying the provider
Correct Answer: C
Rationale: Immediate aspirin (162–325 mg chewed) reduces platelet aggregation and
mortality in ACS and should precede other interventions unless contraindicated.
Nitroglycerin comes after confirming no right ventricular involvement and adequate BP;
troponin results never delay reperfusion decisions.
Q2: A patient is 2 hours post–cardiac catheterization with femoral access. Which
finding requires IMMEDIATE action?
A. Groin pressure dressing with minimal oozing
B. Vital signs stable at BP 122/78, HR 76
C. Patient reports sudden severe back/flank pain with BP drop to 82/50 [CORRECT]
D. Sandbag placed over the insertion site
Correct Answer: C
Rationale: Sudden back pain with hypotension signals retroperitoneal hemorrhage—a
vascular emergency requiring immediate pressure, fluid resuscitation, and provider
,notification (Tanner's responding). The other findings are expected post-catheterization
observations.
Q3: A nurse uses Tanner's clinical judgment model. Which behavior best demonstrates
the phase of "interpreting"?
A. Noticing a patient's respiratory rate increase from 16 to 28
B. Clustering data to decide the patient is developing fluid overload [CORRECT]
C. Notifying the provider via SBAR of the change
D. Documenting the assessment findings in the chart
Correct Answer: B
Rationale: Interpreting involves making sense of clustered cues to form a clinical
judgment—linking tachypnea with other data to conclude fluid overload. Noticing (A) is
data perception, and responding (C) is taking action; documentation (D) follows
reflection.
Q4: A patient with acute decompensated heart failure has bilateral crackles, SpO₂ 88%,
and is anxious. Per the provider's standing orders, which intervention is the priority?
A. Administer furosemide 40 mg IV push [CORRECT]
B. Place the patient in a supine position for comfort
C. Encourage oral fluids to thin respiratory secretions
D. Administer the scheduled beta-blocker
Correct Answer: A
Rationale: IV loop diuretics are the priority to reduce pulmonary congestion per
ABC/airway-breathing priority; the patient should sit upright, fluids are typically
restricted, and beta-blockers are held in acute decompensation due to their negative
inotropic effect.
Q5: A patient is prescribed digoxin 0.25 mg daily. Before administration, the nurse notes
apical HR 56, serum potassium 2.9 mEq/L, and digoxin level pending. What is the best
action?
A. Administer the dose as prescribed
B. Hold the digoxin and notify the provider about the apical pulse and potassium
[CORRECT]
C. Give half the dose to be safe
D. Administer with a potassium supplement without an order
,Correct Answer: B
Rationale: Digoxin is held for apical pulse <60, and hypokalemia dramatically increases
digoxin toxicity risk. Administering the dose or improvising a half dose is unsafe, and
giving potassium without a prescriber order is outside nursing scope.
Q6: A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. Arterial blood
gases show pH 7.32, PaCO₂ 58 mm Hg, PaO₂ 62 mm Hg. Which interpretation by the
nurse is correct?
A. The patient is over-oxygenated; reduce oxygen to room air
B. Chronic CO₂ retention is present; maintain low-flow oxygen and monitor mental
status [CORRECT]
C. The patient has pure metabolic acidosis unrelated to oxygenation
D. PaO₂ of 62 mm Hg is normal for this patient
Correct Answer: B
Rationale: A mildly acidotic pH with elevated PaCO₂ reflects chronic CO₂ retention;
hypoxic drive necessitates low-flow O₂ with vigilant neurologic monitoring to prevent
CO₂ narcosis. Room air would worsen hypoxemia, and PaO₂ 62 is abnormally low.
Q7: A postoperative patient suddenly develops tachycardia, tachypnea, pleuritic chest
pain, and SpO₂ 84%. Which finding in the history most supports a pulmonary embolism?
A. Long airplane flight 3 weeks ago with no immobility since surgery
B. Recent hip replacement surgery with current bedrest [CORRECT]
C. History of seasonal allergic rhinitis
D. Mild asthma controlled with albuterol
Correct Answer: B
Rationale: Recent orthopedic surgery and immobility are classic Virchow's triad risk
factors (stasis, hypercoagulability, endothelial injury) for PE. Distant travel without
current immobility and allergic/asthmatic histories don't match the acute presentation.
Q8: Using SBAR to call the provider about a patient with suspected PE, which statement
is the appropriate "B" (Background)?
A. "I need you to order a stat CT pulmonary angiogram."
B. "The patient had total hip arthroplasty yesterday and has been on bedrest since
surgery." [CORRECT]
C. "I think the patient has a pulmonary embolism."
D. "The patient's oxygen saturation dropped from 96% to 84%."
, Correct Answer: B
Rationale: Background covers relevant history and context—recent surgery and
immobility. Option A is a request, option C is assessment framing, and option D is the
situation (current status), not background.
Q9: A patient with pneumonia has a temperature of 102.6°F (39.2°C), HR 118, RR 26, BP
88/54, and new confusion. Which finding suggests the patient is progressing to septic
shock rather than uncomplicated pneumonia?
A. Fever of 102.6°F
B. Systolic BP 88 mm Hg with altered mental status [CORRECT]
C. Respiratory rate of 26 breaths/min
D. HR of 118 beats/min
Correct Answer: B
Rationale: Hypotension with altered mentation indicates hypoperfusion/septic shock.
Fever, tachycardia, and tachypnea are expected in pneumonia alone and don't signal
shock.
Q10: A patient is admitted with DKA: glucose 512 mg/dL, K⁺ 5.4 mEq/L, pH 7.22. IV
regular insulin infusion is started. Thirty minutes later, K⁺ is 3.4 mEq/L. What is the
nurse's priority action?
A. Stop the insulin infusion immediately
B. Administer potassium per protocol as the insulin shifts K⁺ intracellularly [CORRECT]
C. Increase the insulin rate to correct the glucose faster
D. Recheck glucose in 4 hours
Correct Answer: B
Rationale: Insulin drives potassium into cells, causing hypokalemia, which can
precipitate fatal dysrhythmias; potassium must be replaced when <5.2 mEq/L during
DKA treatment per protocol. Stopping insulin would halt glucose correction, and
increasing the rate worsens hypokalemia.
Q11: A patient with type 1 diabetes becomes diaphoretic, shaky, and confused before
breakfast. Glucose is 48 mg/dL. The patient is alert and able to swallow. What does the
nurse do FIRST?
A. Administer glucagon 1 mg subcutaneously
B. Give 15 g of fast-acting carbohydrate (e.g., 4 oz fruit juice) [CORRECT]
Case Study Test Bank Actual Exam 2026/2027 – Med-Surg,
Peds, Maternity & Psych with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION A: MEDICAL-SURGICAL NURSING CASE STUDIES (30
Questions)
Q1: A 62-year-old man arrives in the emergency department with crushing substernal
chest pain radiating to his left arm, diaphoresis, and nausea for 1 hour. His ECG shows
ST elevation in leads II, III, and aVF. Which action does the nurse take FIRST?
A. Administer prescribed sublingual nitroglycerin after confirming BP of 160/92 mm Hg
B. Obtain a 12-lead ECG (even though one was completed in the ambulance)
C. Give aspirin 325 mg to chew [CORRECT]
D. Draw serial troponin levels and wait for results before notifying the provider
Correct Answer: C
Rationale: Immediate aspirin (162–325 mg chewed) reduces platelet aggregation and
mortality in ACS and should precede other interventions unless contraindicated.
Nitroglycerin comes after confirming no right ventricular involvement and adequate BP;
troponin results never delay reperfusion decisions.
Q2: A patient is 2 hours post–cardiac catheterization with femoral access. Which
finding requires IMMEDIATE action?
A. Groin pressure dressing with minimal oozing
B. Vital signs stable at BP 122/78, HR 76
C. Patient reports sudden severe back/flank pain with BP drop to 82/50 [CORRECT]
D. Sandbag placed over the insertion site
Correct Answer: C
Rationale: Sudden back pain with hypotension signals retroperitoneal hemorrhage—a
vascular emergency requiring immediate pressure, fluid resuscitation, and provider
,notification (Tanner's responding). The other findings are expected post-catheterization
observations.
Q3: A nurse uses Tanner's clinical judgment model. Which behavior best demonstrates
the phase of "interpreting"?
A. Noticing a patient's respiratory rate increase from 16 to 28
B. Clustering data to decide the patient is developing fluid overload [CORRECT]
C. Notifying the provider via SBAR of the change
D. Documenting the assessment findings in the chart
Correct Answer: B
Rationale: Interpreting involves making sense of clustered cues to form a clinical
judgment—linking tachypnea with other data to conclude fluid overload. Noticing (A) is
data perception, and responding (C) is taking action; documentation (D) follows
reflection.
Q4: A patient with acute decompensated heart failure has bilateral crackles, SpO₂ 88%,
and is anxious. Per the provider's standing orders, which intervention is the priority?
A. Administer furosemide 40 mg IV push [CORRECT]
B. Place the patient in a supine position for comfort
C. Encourage oral fluids to thin respiratory secretions
D. Administer the scheduled beta-blocker
Correct Answer: A
Rationale: IV loop diuretics are the priority to reduce pulmonary congestion per
ABC/airway-breathing priority; the patient should sit upright, fluids are typically
restricted, and beta-blockers are held in acute decompensation due to their negative
inotropic effect.
Q5: A patient is prescribed digoxin 0.25 mg daily. Before administration, the nurse notes
apical HR 56, serum potassium 2.9 mEq/L, and digoxin level pending. What is the best
action?
A. Administer the dose as prescribed
B. Hold the digoxin and notify the provider about the apical pulse and potassium
[CORRECT]
C. Give half the dose to be safe
D. Administer with a potassium supplement without an order
,Correct Answer: B
Rationale: Digoxin is held for apical pulse <60, and hypokalemia dramatically increases
digoxin toxicity risk. Administering the dose or improvising a half dose is unsafe, and
giving potassium without a prescriber order is outside nursing scope.
Q6: A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. Arterial blood
gases show pH 7.32, PaCO₂ 58 mm Hg, PaO₂ 62 mm Hg. Which interpretation by the
nurse is correct?
A. The patient is over-oxygenated; reduce oxygen to room air
B. Chronic CO₂ retention is present; maintain low-flow oxygen and monitor mental
status [CORRECT]
C. The patient has pure metabolic acidosis unrelated to oxygenation
D. PaO₂ of 62 mm Hg is normal for this patient
Correct Answer: B
Rationale: A mildly acidotic pH with elevated PaCO₂ reflects chronic CO₂ retention;
hypoxic drive necessitates low-flow O₂ with vigilant neurologic monitoring to prevent
CO₂ narcosis. Room air would worsen hypoxemia, and PaO₂ 62 is abnormally low.
Q7: A postoperative patient suddenly develops tachycardia, tachypnea, pleuritic chest
pain, and SpO₂ 84%. Which finding in the history most supports a pulmonary embolism?
A. Long airplane flight 3 weeks ago with no immobility since surgery
B. Recent hip replacement surgery with current bedrest [CORRECT]
C. History of seasonal allergic rhinitis
D. Mild asthma controlled with albuterol
Correct Answer: B
Rationale: Recent orthopedic surgery and immobility are classic Virchow's triad risk
factors (stasis, hypercoagulability, endothelial injury) for PE. Distant travel without
current immobility and allergic/asthmatic histories don't match the acute presentation.
Q8: Using SBAR to call the provider about a patient with suspected PE, which statement
is the appropriate "B" (Background)?
A. "I need you to order a stat CT pulmonary angiogram."
B. "The patient had total hip arthroplasty yesterday and has been on bedrest since
surgery." [CORRECT]
C. "I think the patient has a pulmonary embolism."
D. "The patient's oxygen saturation dropped from 96% to 84%."
, Correct Answer: B
Rationale: Background covers relevant history and context—recent surgery and
immobility. Option A is a request, option C is assessment framing, and option D is the
situation (current status), not background.
Q9: A patient with pneumonia has a temperature of 102.6°F (39.2°C), HR 118, RR 26, BP
88/54, and new confusion. Which finding suggests the patient is progressing to septic
shock rather than uncomplicated pneumonia?
A. Fever of 102.6°F
B. Systolic BP 88 mm Hg with altered mental status [CORRECT]
C. Respiratory rate of 26 breaths/min
D. HR of 118 beats/min
Correct Answer: B
Rationale: Hypotension with altered mentation indicates hypoperfusion/septic shock.
Fever, tachycardia, and tachypnea are expected in pneumonia alone and don't signal
shock.
Q10: A patient is admitted with DKA: glucose 512 mg/dL, K⁺ 5.4 mEq/L, pH 7.22. IV
regular insulin infusion is started. Thirty minutes later, K⁺ is 3.4 mEq/L. What is the
nurse's priority action?
A. Stop the insulin infusion immediately
B. Administer potassium per protocol as the insulin shifts K⁺ intracellularly [CORRECT]
C. Increase the insulin rate to correct the glucose faster
D. Recheck glucose in 4 hours
Correct Answer: B
Rationale: Insulin drives potassium into cells, causing hypokalemia, which can
precipitate fatal dysrhythmias; potassium must be replaced when <5.2 mEq/L during
DKA treatment per protocol. Stopping insulin would halt glucose correction, and
increasing the rate worsens hypokalemia.
Q11: A patient with type 1 diabetes becomes diaphoretic, shaky, and confused before
breakfast. Glucose is 48 mg/dL. The patient is alert and able to swallow. What does the
nurse do FIRST?
A. Administer glucagon 1 mg subcutaneously
B. Give 15 g of fast-acting carbohydrate (e.g., 4 oz fruit juice) [CORRECT]
