Adult Health Nursing III – Complex Medical-
Surgical Nursing Case Studies
Question 1
A 68-year-old client with a history of heart failure and atrial fibrillation is admitted
with worsening dyspnea. The client's home medications include carvedilol,
furosemide, digoxin, and warfarin. Laboratory results show serum potassium 3.1
mEq/L, digoxin level 2.8 ng/mL, and INR 4.5. Which finding requires the most
immediate intervention?
A) Serum potassium of 3.1 mEq/L
B) Digoxin level of 2.8 ng/mL
C) INR of 4.5
D) Worsening dyspnea
Correct Answer: B) Digoxin level of 2.8 ng/mL
Rationale: A digoxin level of 2.8 ng/mL is above therapeutic range (0.5-2.0
ng/mL), indicating digoxin toxicity. Hypokalemia potentiates digoxin toxicity, and
the combination increases risk of lethal dysrhythmias. This requires immediate
intervention and possible administration of digoxin immune Fab.
Question 2
A 55-year-old client is admitted with acute pancreatitis secondary to alcohol use.
The client has a heart rate of 128 beats per minute, blood pressure of 88/52 mm
,Hg, respiratory rate of 28 breaths per minute, and temperature of 38.3°C. Which
intervention should the nurse implement first?
A) Administer broad-spectrum antibiotics
B) Begin fluid resuscitation with lactated Ringer's
C) Insert a nasogastric tube for decompression
D) Administer morphine for pain
Correct Answer: B) Begin fluid resuscitation with lactated Ringer's
Rationale: The client is demonstrating signs of hypovolemic shock due to third-
spacing from acute pancreatitis. Aggressive fluid resuscitation with lactated
Ringer's is the priority to restore intravascular volume and prevent organ failure.
Pain management and NG tube follow after stabilization.
Question 3
A 72-year-old client with chronic obstructive pulmonary disease (COPD) is
admitted with an exacerbation. The client is drowsy, confused, and has an oxygen
saturation of 82% on 4 L/min via nasal cannula. Arterial blood gas shows pH 7.28,
PaCO₂ 72 mm Hg, and PaO₂ 52 mm Hg. Which intervention should the nurse
anticipate?
A) Increase oxygen flow rate to 6 L/min
B) Prepare for noninvasive positive pressure ventilation (NIPPV)
C) Administer a PRN bronchodilator
D) Place the client in a supine position
,Correct Answer: B) Prepare for noninvasive positive pressure ventilation
(NIPPV)
Rationale: The client has acute hypercapnic respiratory failure with respiratory
acidosis. NIPPV provides ventilatory support without intubation, improving gas
exchange and reducing work of breathing. Increasing oxygen may worsen
hypercapnia by suppressing respiratory drive.
Question 4
A 60-year-old client is admitted with a traumatic brain injury after a fall. The
client's Glasgow Coma Scale score has decreased from 12 to 8 over 2 hours. Which
intervention should the nurse implement first?
A) Administer mannitol as prescribed
B) Prepare for endotracheal intubation
C) Elevate the head of the bed to 30 degrees
D) Notify the healthcare provider
Correct Answer: B) Prepare for endotracheal intubation
Rationale: A GCS score of 8 or less indicates severe neurologic impairment and
loss of airway protective reflexes. Endotracheal intubation is required to secure the
airway and prevent aspiration. Hyperventilation may also be used temporarily to
reduce ICP.
Question 5
A 45-year-old client with a spinal cord injury at T4 is admitted to the intensive care
, unit. The client suddenly develops a severe headache, blood pressure of 210/120
mm Hg, and heart rate of 48 beats per minute. Which action should the nurse take
first?
A) Administer antihypertensive medication
B) Check for bladder distention
C) Place the client in high Fowler's position
D) Notify the healthcare provider
Correct Answer: B) Check for bladder distention
Rationale: These findings indicate autonomic dysreflexia, most commonly
triggered by bladder distention. The first intervention is to identify and remove the
triggering stimulus. Placing the client upright and administering medication follow
if symptoms persist.
Question 6
A 58-year-old client with sepsis is receiving norepinephrine and has a mean arterial
pressure (MAP) of 58 mm Hg. The client's lactate level is 6.2 mmol/L and urine
output is 15 mL/hr. Which intervention should the nurse anticipate?
A) Increase norepinephrine infusion rate
B) Administer a 500 mL bolus of 0.9% normal saline
C) Add vasopressin infusion
D) Administer sodium bicarbonate
Correct Answer: A) Increase norepinephrine infusion rate
Surgical Nursing Case Studies
Question 1
A 68-year-old client with a history of heart failure and atrial fibrillation is admitted
with worsening dyspnea. The client's home medications include carvedilol,
furosemide, digoxin, and warfarin. Laboratory results show serum potassium 3.1
mEq/L, digoxin level 2.8 ng/mL, and INR 4.5. Which finding requires the most
immediate intervention?
A) Serum potassium of 3.1 mEq/L
B) Digoxin level of 2.8 ng/mL
C) INR of 4.5
D) Worsening dyspnea
Correct Answer: B) Digoxin level of 2.8 ng/mL
Rationale: A digoxin level of 2.8 ng/mL is above therapeutic range (0.5-2.0
ng/mL), indicating digoxin toxicity. Hypokalemia potentiates digoxin toxicity, and
the combination increases risk of lethal dysrhythmias. This requires immediate
intervention and possible administration of digoxin immune Fab.
Question 2
A 55-year-old client is admitted with acute pancreatitis secondary to alcohol use.
The client has a heart rate of 128 beats per minute, blood pressure of 88/52 mm
,Hg, respiratory rate of 28 breaths per minute, and temperature of 38.3°C. Which
intervention should the nurse implement first?
A) Administer broad-spectrum antibiotics
B) Begin fluid resuscitation with lactated Ringer's
C) Insert a nasogastric tube for decompression
D) Administer morphine for pain
Correct Answer: B) Begin fluid resuscitation with lactated Ringer's
Rationale: The client is demonstrating signs of hypovolemic shock due to third-
spacing from acute pancreatitis. Aggressive fluid resuscitation with lactated
Ringer's is the priority to restore intravascular volume and prevent organ failure.
Pain management and NG tube follow after stabilization.
Question 3
A 72-year-old client with chronic obstructive pulmonary disease (COPD) is
admitted with an exacerbation. The client is drowsy, confused, and has an oxygen
saturation of 82% on 4 L/min via nasal cannula. Arterial blood gas shows pH 7.28,
PaCO₂ 72 mm Hg, and PaO₂ 52 mm Hg. Which intervention should the nurse
anticipate?
A) Increase oxygen flow rate to 6 L/min
B) Prepare for noninvasive positive pressure ventilation (NIPPV)
C) Administer a PRN bronchodilator
D) Place the client in a supine position
,Correct Answer: B) Prepare for noninvasive positive pressure ventilation
(NIPPV)
Rationale: The client has acute hypercapnic respiratory failure with respiratory
acidosis. NIPPV provides ventilatory support without intubation, improving gas
exchange and reducing work of breathing. Increasing oxygen may worsen
hypercapnia by suppressing respiratory drive.
Question 4
A 60-year-old client is admitted with a traumatic brain injury after a fall. The
client's Glasgow Coma Scale score has decreased from 12 to 8 over 2 hours. Which
intervention should the nurse implement first?
A) Administer mannitol as prescribed
B) Prepare for endotracheal intubation
C) Elevate the head of the bed to 30 degrees
D) Notify the healthcare provider
Correct Answer: B) Prepare for endotracheal intubation
Rationale: A GCS score of 8 or less indicates severe neurologic impairment and
loss of airway protective reflexes. Endotracheal intubation is required to secure the
airway and prevent aspiration. Hyperventilation may also be used temporarily to
reduce ICP.
Question 5
A 45-year-old client with a spinal cord injury at T4 is admitted to the intensive care
, unit. The client suddenly develops a severe headache, blood pressure of 210/120
mm Hg, and heart rate of 48 beats per minute. Which action should the nurse take
first?
A) Administer antihypertensive medication
B) Check for bladder distention
C) Place the client in high Fowler's position
D) Notify the healthcare provider
Correct Answer: B) Check for bladder distention
Rationale: These findings indicate autonomic dysreflexia, most commonly
triggered by bladder distention. The first intervention is to identify and remove the
triggering stimulus. Placing the client upright and administering medication follow
if symptoms persist.
Question 6
A 58-year-old client with sepsis is receiving norepinephrine and has a mean arterial
pressure (MAP) of 58 mm Hg. The client's lactate level is 6.2 mmol/L and urine
output is 15 mL/hr. Which intervention should the nurse anticipate?
A) Increase norepinephrine infusion rate
B) Administer a 500 mL bolus of 0.9% normal saline
C) Add vasopressin infusion
D) Administer sodium bicarbonate
Correct Answer: A) Increase norepinephrine infusion rate
