Adult Health Nursing II – Complex Patient
Care Case Studies & Answers
Question 1:
A 72-year-old client with heart failure, type 2 diabetes, chronic kidney disease, and
osteoarthritis is admitted with weakness and poor appetite. The client takes 11
medications at home. Which nursing action should occur first?
A. Ask the client to list all current medications, including over-the-counter
products
B. Encourage the client to increase physical activity
C. Hold all home medications
D. Provide a high-protein meal
Correct Answer: A. Ask the client to list all current medications, including over-
the-counter products
Rationale: Polypharmacy increases the risk of interactions, duplication, adverse
effects, and medication-related hospitalization. A complete medication
reconciliation should include prescription drugs, OTC medications, supplements,
and herbal products. Identifying the complete regimen allows the healthcare team
to safely evaluate medications before treatment decisions are made.
Question 2:
A client with COPD, osteoporosis, and chronic back pain is prescribed a new
opioid for severe pain. Which assessment is most important before administration?
,A. Bowel movement pattern
B. Respiratory rate and oxygenation
C. Visual acuity
D. Appetite
Correct Answer: B. Respiratory rate and oxygenation
Rationale: Opioids can depress respiratory drive, creating particular concern in
clients with underlying respiratory disease. Before administration, the nurse should
assess respiratory rate, oxygen saturation, level of consciousness, and other
relevant findings. Ongoing monitoring is necessary after administration to identify
respiratory depression promptly.
Question 3:
A 68-year-old client with diabetes and peripheral neuropathy reports accidentally
stepping on a sharp object but denies pain. What should the nurse do first?
A. Reassure the client because there is no pain
B. Inspect the foot carefully for injury
C. Encourage barefoot walking to improve sensation
D. Apply a heating pad
Correct Answer: B. Inspect the foot carefully for injury
Rationale: Peripheral neuropathy can reduce protective sensation, allowing
significant injury to occur without pain. The nurse should inspect the foot for
puncture wounds, bleeding, swelling, infection, and foreign objects. Any wound
requires appropriate assessment and management because impaired sensation and
circulation can delay healing.
,Question 4:
A client with chronic kidney disease, diabetes, and hypertension becomes
increasingly confused. The blood pressure is 196/108 mmHg. Which assessment
should the nurse prioritize?
A. Neurological status
B. Dietary preferences
C. Hearing acuity
D. Skin moisture
Correct Answer: A. Neurological status
Rationale: Severe hypertension accompanied by acute confusion may indicate
hypertensive encephalopathy or another neurological emergency. The nurse should
promptly assess level of consciousness, pupils, motor function, speech, and other
neurological findings while monitoring vital signs and notifying the provider.
Question 5:
A client with cirrhosis, diabetes, and chronic kidney disease has poor oral intake.
Which finding is most concerning?
A. Mild fatigue
B. Blood glucose of 58 mg/dL
C. Dry lips
D. Reduced appetite
Correct Answer: B. Blood glucose of 58 mg/dL
Rationale: Hypoglycemia can cause neurological injury and may progress rapidly,
particularly when the client has impaired nutritional intake. The nurse should
, follow the prescribed hypoglycemia protocol, reassess glucose, and investigate
contributing factors such as medication effects, hepatic dysfunction, and
inadequate caloric intake.
Question 6:
A client with advanced Parkinson disease has dysphagia, weight loss, and recurrent
coughing during meals. Which intervention should the nurse prioritize?
A. Provide thin liquids with every meal
B. Request a swallowing evaluation
C. Encourage rapid eating
D. Place the client supine during meals
Correct Answer: B. Request a swallowing evaluation
Rationale: Dysphagia and coughing during meals indicate significant aspiration
risk. A speech-language pathologist can evaluate swallowing and recommend
appropriate food consistency, positioning, and techniques. Nutritional status should
also be assessed because progressive swallowing difficulty can lead to inadequate
intake and weight loss.
Question 7:
A client with rheumatoid arthritis, chronic kidney disease, and a history of peptic
ulcer disease reports severe joint pain. Which medication-related concern should
the nurse identify?
A. NSAIDs may worsen renal function and gastrointestinal injury
B. Acetaminophen always causes renal failure
Care Case Studies & Answers
Question 1:
A 72-year-old client with heart failure, type 2 diabetes, chronic kidney disease, and
osteoarthritis is admitted with weakness and poor appetite. The client takes 11
medications at home. Which nursing action should occur first?
A. Ask the client to list all current medications, including over-the-counter
products
B. Encourage the client to increase physical activity
C. Hold all home medications
D. Provide a high-protein meal
Correct Answer: A. Ask the client to list all current medications, including over-
the-counter products
Rationale: Polypharmacy increases the risk of interactions, duplication, adverse
effects, and medication-related hospitalization. A complete medication
reconciliation should include prescription drugs, OTC medications, supplements,
and herbal products. Identifying the complete regimen allows the healthcare team
to safely evaluate medications before treatment decisions are made.
Question 2:
A client with COPD, osteoporosis, and chronic back pain is prescribed a new
opioid for severe pain. Which assessment is most important before administration?
,A. Bowel movement pattern
B. Respiratory rate and oxygenation
C. Visual acuity
D. Appetite
Correct Answer: B. Respiratory rate and oxygenation
Rationale: Opioids can depress respiratory drive, creating particular concern in
clients with underlying respiratory disease. Before administration, the nurse should
assess respiratory rate, oxygen saturation, level of consciousness, and other
relevant findings. Ongoing monitoring is necessary after administration to identify
respiratory depression promptly.
Question 3:
A 68-year-old client with diabetes and peripheral neuropathy reports accidentally
stepping on a sharp object but denies pain. What should the nurse do first?
A. Reassure the client because there is no pain
B. Inspect the foot carefully for injury
C. Encourage barefoot walking to improve sensation
D. Apply a heating pad
Correct Answer: B. Inspect the foot carefully for injury
Rationale: Peripheral neuropathy can reduce protective sensation, allowing
significant injury to occur without pain. The nurse should inspect the foot for
puncture wounds, bleeding, swelling, infection, and foreign objects. Any wound
requires appropriate assessment and management because impaired sensation and
circulation can delay healing.
,Question 4:
A client with chronic kidney disease, diabetes, and hypertension becomes
increasingly confused. The blood pressure is 196/108 mmHg. Which assessment
should the nurse prioritize?
A. Neurological status
B. Dietary preferences
C. Hearing acuity
D. Skin moisture
Correct Answer: A. Neurological status
Rationale: Severe hypertension accompanied by acute confusion may indicate
hypertensive encephalopathy or another neurological emergency. The nurse should
promptly assess level of consciousness, pupils, motor function, speech, and other
neurological findings while monitoring vital signs and notifying the provider.
Question 5:
A client with cirrhosis, diabetes, and chronic kidney disease has poor oral intake.
Which finding is most concerning?
A. Mild fatigue
B. Blood glucose of 58 mg/dL
C. Dry lips
D. Reduced appetite
Correct Answer: B. Blood glucose of 58 mg/dL
Rationale: Hypoglycemia can cause neurological injury and may progress rapidly,
particularly when the client has impaired nutritional intake. The nurse should
, follow the prescribed hypoglycemia protocol, reassess glucose, and investigate
contributing factors such as medication effects, hepatic dysfunction, and
inadequate caloric intake.
Question 6:
A client with advanced Parkinson disease has dysphagia, weight loss, and recurrent
coughing during meals. Which intervention should the nurse prioritize?
A. Provide thin liquids with every meal
B. Request a swallowing evaluation
C. Encourage rapid eating
D. Place the client supine during meals
Correct Answer: B. Request a swallowing evaluation
Rationale: Dysphagia and coughing during meals indicate significant aspiration
risk. A speech-language pathologist can evaluate swallowing and recommend
appropriate food consistency, positioning, and techniques. Nutritional status should
also be assessed because progressive swallowing difficulty can lead to inadequate
intake and weight loss.
Question 7:
A client with rheumatoid arthritis, chronic kidney disease, and a history of peptic
ulcer disease reports severe joint pain. Which medication-related concern should
the nurse identify?
A. NSAIDs may worsen renal function and gastrointestinal injury
B. Acetaminophen always causes renal failure
