Adult Health Nursing I – Exam Case Studies &
Clinical Application Questions
Question 1: A 68-year-old patient with heart failure reports gaining 3 pounds over
two days and experiencing increasing shortness of breath. The nurse hears bilateral
crackles. Which action is the priority?
A. Encourage increased oral fluids
B. Place the patient in high-Fowler’s position and administer oxygen as prescribed
C. Place the patient flat and reassess in 30 minutes
D. Encourage ambulation to improve circulation
Correct Answer: B. Place the patient in high-Fowler’s position and administer
oxygen as prescribed.
Rationale: Rapid weight gain, dyspnea, and crackles indicate fluid accumulation
and worsening pulmonary congestion. High-Fowler’s positioning improves lung
expansion and reduces venous return. Oxygen supports gas exchange. The nurse
should also assess vital signs, notify the provider, monitor urine output, and
prepare to administer prescribed diuretics.
Question 2
Question 2: A patient with heart failure is receiving intravenous furosemide.
Which finding requires immediate reporting?
A. Urine output of 1,000 mL over eight hours
B. Serum potassium of 2.8 mEq/L
,C. Mild thirst
D. Blood pressure of 128/76 mmHg
Correct Answer: B. Serum potassium of 2.8 mEq/L.
Rationale: Furosemide can cause significant potassium loss. A potassium level of
2.8 mEq/L indicates hypokalemia, which can cause muscle weakness and life-
threatening cardiac dysrhythmias. The nurse should place the patient on cardiac
monitoring, notify the provider, and prepare for prescribed potassium replacement.
Question 3
Question 3: A patient taking digoxin has an apical pulse of 54 beats per minute,
nausea, and blurred vision. Which action should the nurse take?
A. Administer digoxin and reassess later
B. Withhold digoxin and notify the provider
C. Give an additional dose to improve cardiac output
D. Encourage the patient to ambulate
Correct Answer: B. Withhold digoxin and notify the provider.
Rationale: Bradycardia, nausea, and visual disturbances suggest digoxin toxicity.
Digoxin should be withheld, and the provider should be notified. The nurse should
assess the apical pulse for one full minute, review renal function and electrolytes,
and monitor for dysrhythmias.
Question 4
Question 4: A patient arrives in the emergency department reporting crushing
chest pain radiating to the left arm. Which action should the nurse perform first?
,A. Obtain a 12-lead ECG
B. Offer a full meal
C. Encourage the patient to walk
D. Apply a warm compress to the chest
Correct Answer: A. Obtain a 12-lead ECG.
Rationale: Crushing chest pain radiating to the arm is concerning for acute
coronary syndrome. A 12-lead ECG should be obtained promptly to identify
ischemic changes and determine treatment. The nurse should also assess vital
signs, oxygenation, pain, allergies, medication history, and prepare prescribed
emergency therapies.
Question 5
Question 5: A patient with suspected myocardial infarction has a prescription for
aspirin. Which assessment is most important before administration?
A. Last bowel movement
B. Allergy history and active bleeding
C. Skin turgor
D. Visual acuity
Correct Answer: B. Allergy history and active bleeding.
Rationale: Aspirin decreases platelet aggregation and is commonly administered
during suspected myocardial infarction. However, it may cause serious bleeding or
allergic reactions. The nurse should assess for aspirin allergy, active bleeding,
bleeding disorders, and the patient’s ability to chew and swallow.
Question 6
, Question 6: A patient using sublingual nitroglycerin reports dizziness after taking
one tablet. What should the nurse instruct the patient to do?
A. Stand and walk to improve circulation
B. Sit or lie down and recheck blood pressure
C. Take another medication immediately
D. Drink an alcoholic beverage
Correct Answer: B. Sit or lie down and recheck blood pressure.
Rationale: Nitroglycerin causes vasodilation and may produce hypotension and
dizziness. Sitting or lying down helps prevent falls and injury. The nurse should
assess blood pressure, determine whether chest pain persists, and follow
emergency instructions if symptoms do not resolve.
Question 7
Question 7: A patient with peripheral arterial disease reports calf pain when
walking that improves with rest. Which teaching is appropriate?
A. Avoid all exercise
B. Begin a prescribed walking program with rest periods
C. Elevate the legs above the heart continuously
D. Apply ice directly to the feet
Correct Answer: B. Begin a prescribed walking program with rest periods.
Rationale: Intermittent claudication occurs when arterial blood flow cannot meet
muscle oxygen demands during activity. A structured walking program can
improve circulation and exercise tolerance. The patient should stop and rest when
pain occurs, avoid tobacco, protect the feet, and report nonhealing wounds.
Clinical Application Questions
Question 1: A 68-year-old patient with heart failure reports gaining 3 pounds over
two days and experiencing increasing shortness of breath. The nurse hears bilateral
crackles. Which action is the priority?
A. Encourage increased oral fluids
B. Place the patient in high-Fowler’s position and administer oxygen as prescribed
C. Place the patient flat and reassess in 30 minutes
D. Encourage ambulation to improve circulation
Correct Answer: B. Place the patient in high-Fowler’s position and administer
oxygen as prescribed.
Rationale: Rapid weight gain, dyspnea, and crackles indicate fluid accumulation
and worsening pulmonary congestion. High-Fowler’s positioning improves lung
expansion and reduces venous return. Oxygen supports gas exchange. The nurse
should also assess vital signs, notify the provider, monitor urine output, and
prepare to administer prescribed diuretics.
Question 2
Question 2: A patient with heart failure is receiving intravenous furosemide.
Which finding requires immediate reporting?
A. Urine output of 1,000 mL over eight hours
B. Serum potassium of 2.8 mEq/L
,C. Mild thirst
D. Blood pressure of 128/76 mmHg
Correct Answer: B. Serum potassium of 2.8 mEq/L.
Rationale: Furosemide can cause significant potassium loss. A potassium level of
2.8 mEq/L indicates hypokalemia, which can cause muscle weakness and life-
threatening cardiac dysrhythmias. The nurse should place the patient on cardiac
monitoring, notify the provider, and prepare for prescribed potassium replacement.
Question 3
Question 3: A patient taking digoxin has an apical pulse of 54 beats per minute,
nausea, and blurred vision. Which action should the nurse take?
A. Administer digoxin and reassess later
B. Withhold digoxin and notify the provider
C. Give an additional dose to improve cardiac output
D. Encourage the patient to ambulate
Correct Answer: B. Withhold digoxin and notify the provider.
Rationale: Bradycardia, nausea, and visual disturbances suggest digoxin toxicity.
Digoxin should be withheld, and the provider should be notified. The nurse should
assess the apical pulse for one full minute, review renal function and electrolytes,
and monitor for dysrhythmias.
Question 4
Question 4: A patient arrives in the emergency department reporting crushing
chest pain radiating to the left arm. Which action should the nurse perform first?
,A. Obtain a 12-lead ECG
B. Offer a full meal
C. Encourage the patient to walk
D. Apply a warm compress to the chest
Correct Answer: A. Obtain a 12-lead ECG.
Rationale: Crushing chest pain radiating to the arm is concerning for acute
coronary syndrome. A 12-lead ECG should be obtained promptly to identify
ischemic changes and determine treatment. The nurse should also assess vital
signs, oxygenation, pain, allergies, medication history, and prepare prescribed
emergency therapies.
Question 5
Question 5: A patient with suspected myocardial infarction has a prescription for
aspirin. Which assessment is most important before administration?
A. Last bowel movement
B. Allergy history and active bleeding
C. Skin turgor
D. Visual acuity
Correct Answer: B. Allergy history and active bleeding.
Rationale: Aspirin decreases platelet aggregation and is commonly administered
during suspected myocardial infarction. However, it may cause serious bleeding or
allergic reactions. The nurse should assess for aspirin allergy, active bleeding,
bleeding disorders, and the patient’s ability to chew and swallow.
Question 6
, Question 6: A patient using sublingual nitroglycerin reports dizziness after taking
one tablet. What should the nurse instruct the patient to do?
A. Stand and walk to improve circulation
B. Sit or lie down and recheck blood pressure
C. Take another medication immediately
D. Drink an alcoholic beverage
Correct Answer: B. Sit or lie down and recheck blood pressure.
Rationale: Nitroglycerin causes vasodilation and may produce hypotension and
dizziness. Sitting or lying down helps prevent falls and injury. The nurse should
assess blood pressure, determine whether chest pain persists, and follow
emergency instructions if symptoms do not resolve.
Question 7
Question 7: A patient with peripheral arterial disease reports calf pain when
walking that improves with rest. Which teaching is appropriate?
A. Avoid all exercise
B. Begin a prescribed walking program with rest periods
C. Elevate the legs above the heart continuously
D. Apply ice directly to the feet
Correct Answer: B. Begin a prescribed walking program with rest periods.
Rationale: Intermittent claudication occurs when arterial blood flow cannot meet
muscle oxygen demands during activity. A structured walking program can
improve circulation and exercise tolerance. The patient should stop and rest when
pain occurs, avoid tobacco, protect the feet, and report nonhealing wounds.
