NCLEX RN Next Generation Case Study
Exam 2 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
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Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and heart failure is admitted
with worsening dyspnea, orthopnea, and bilateral lower-extremity edema.
Assessment reveals BP 168/94 mm Hg, HR 108/min, RR 30/min, SpO₂ 86% on
room air, crackles throughout both lung bases, and 3+ pitting edema. The client
reports a 4-kg weight gain over the past week.
Question 1 — Recognize Cues
Which findings require the nurse's immediate attention? Select all that apply.
A. 4-kg weight gain
B. SpO₂ 86%
C. RR 30/min
D. Bilateral 3+ edema
E. BP 168/94 mm Hg
F. Orthopnea
Answer: SpO₂ 86%, RR 30/min, and orthopnea
Rationale: Hypoxemia, tachypnea, and difficulty breathing when lying flat
indicate significant pulmonary congestion and impaired oxygenation. These
findings require immediate intervention. Weight gain, edema, and
hypertension are important but are less immediately life-threatening.
Question 2 — Prioritize Hypotheses
,Which condition is the priority hypothesis?
A. Stable chronic heart failure
B. Acute pulmonary edema
C. Viral pneumonia
D. Deep-vein thrombosis
Answer: Acute pulmonary edema
Rationale: Severe dyspnea, hypoxemia, crackles, orthopnea, rapid weight
gain, and peripheral edema strongly indicate acute worsening of heart failure
with pulmonary fluid accumulation.
Question 3 — Take Action
Which intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Assist the client to ambulate
D. Administer a high-sodium meal
Answer: Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases
venous return, helping reduce pulmonary congestion and improve
oxygenation.
Question 4 — Take Action
Which prescription should the nurse anticipate?
A. IV furosemide
B. IV potassium chloride without laboratory results
C. Rapid IV fluid bolus
D. Oral sodium supplementation
Answer: IV furosemide
Rationale: Loop diuretics such as furosemide reduce intravascular volume and
pulmonary congestion in acute decompensated heart failure.
Question 5 — Evaluate Outcomes
,Which finding best indicates that treatment is effective?
A. SpO₂ increases to 94%
B. Weight increases by 1 kg
C. Crackles become more pronounced
D. Respiratory rate increases to 34/min
Answer: SpO₂ increases to 94%
Rationale: Improved oxygen saturation indicates improved gas exchange and
response to treatment.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, polyuria, and polydipsia. The client has missed
several insulin doses. Laboratory results show glucose 520 mg/dL, pH 7.19,
bicarbonate 12 mEq/L, and positive serum ketones. The client is lethargic and
has deep, rapid respirations.
Question 6 — Recognize Cues
Which findings support diabetic ketoacidosis (DKA)? Select all that apply.
A. Glucose 520 mg/dL
B. Positive serum ketones
C. Bicarbonate 12 mEq/L
D. pH 7.19
E. Bradycardia
F. Deep, rapid respirations
Answer: Glucose 520 mg/dL, positive serum ketones, bicarbonate 12 mEq/L,
pH 7.19, and deep, rapid respirations
Rationale: DKA is characterized by hyperglycemia, ketone production,
metabolic acidosis, and compensatory Kussmaul respirations.
Question 7 — Prioritize Hypotheses
Which problem is the priority?
, A. Fluid volume deficit
B. Constipation
C. Chronic pain
D. Impaired mobility
Answer: Fluid volume deficit
Rationale: Severe hyperglycemia causes osmotic diuresis, producing profound
dehydration and electrolyte losses. Restoring circulating volume is an
immediate priority.
Question 8 — Take Action
Which intervention should the nurse anticipate first?
A. IV isotonic fluid replacement
B. Oral glucose administration
C. Restriction of fluids
D. Administration of long-acting insulin only
Answer: IV isotonic fluid replacement
Rationale: Initial DKA management focuses on restoring intravascular volume
with isotonic fluids. Insulin therapy follows according to the treatment
protocol and potassium status.
Question 9 — Recognize Cues
Before starting an IV insulin infusion, which laboratory value is especially
important?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelet count
Answer: Potassium
Rationale: Insulin shifts potassium into cells and can cause dangerous
hypokalemia. Potassium must be assessed and corrected when necessary
before or during insulin therapy.
Question 10 — Evaluate Outcomes
Exam 2 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
Download Pdf
Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and heart failure is admitted
with worsening dyspnea, orthopnea, and bilateral lower-extremity edema.
Assessment reveals BP 168/94 mm Hg, HR 108/min, RR 30/min, SpO₂ 86% on
room air, crackles throughout both lung bases, and 3+ pitting edema. The client
reports a 4-kg weight gain over the past week.
Question 1 — Recognize Cues
Which findings require the nurse's immediate attention? Select all that apply.
A. 4-kg weight gain
B. SpO₂ 86%
C. RR 30/min
D. Bilateral 3+ edema
E. BP 168/94 mm Hg
F. Orthopnea
Answer: SpO₂ 86%, RR 30/min, and orthopnea
Rationale: Hypoxemia, tachypnea, and difficulty breathing when lying flat
indicate significant pulmonary congestion and impaired oxygenation. These
findings require immediate intervention. Weight gain, edema, and
hypertension are important but are less immediately life-threatening.
Question 2 — Prioritize Hypotheses
,Which condition is the priority hypothesis?
A. Stable chronic heart failure
B. Acute pulmonary edema
C. Viral pneumonia
D. Deep-vein thrombosis
Answer: Acute pulmonary edema
Rationale: Severe dyspnea, hypoxemia, crackles, orthopnea, rapid weight
gain, and peripheral edema strongly indicate acute worsening of heart failure
with pulmonary fluid accumulation.
Question 3 — Take Action
Which intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Assist the client to ambulate
D. Administer a high-sodium meal
Answer: Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases
venous return, helping reduce pulmonary congestion and improve
oxygenation.
Question 4 — Take Action
Which prescription should the nurse anticipate?
A. IV furosemide
B. IV potassium chloride without laboratory results
C. Rapid IV fluid bolus
D. Oral sodium supplementation
Answer: IV furosemide
Rationale: Loop diuretics such as furosemide reduce intravascular volume and
pulmonary congestion in acute decompensated heart failure.
Question 5 — Evaluate Outcomes
,Which finding best indicates that treatment is effective?
A. SpO₂ increases to 94%
B. Weight increases by 1 kg
C. Crackles become more pronounced
D. Respiratory rate increases to 34/min
Answer: SpO₂ increases to 94%
Rationale: Improved oxygen saturation indicates improved gas exchange and
response to treatment.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, polyuria, and polydipsia. The client has missed
several insulin doses. Laboratory results show glucose 520 mg/dL, pH 7.19,
bicarbonate 12 mEq/L, and positive serum ketones. The client is lethargic and
has deep, rapid respirations.
Question 6 — Recognize Cues
Which findings support diabetic ketoacidosis (DKA)? Select all that apply.
A. Glucose 520 mg/dL
B. Positive serum ketones
C. Bicarbonate 12 mEq/L
D. pH 7.19
E. Bradycardia
F. Deep, rapid respirations
Answer: Glucose 520 mg/dL, positive serum ketones, bicarbonate 12 mEq/L,
pH 7.19, and deep, rapid respirations
Rationale: DKA is characterized by hyperglycemia, ketone production,
metabolic acidosis, and compensatory Kussmaul respirations.
Question 7 — Prioritize Hypotheses
Which problem is the priority?
, A. Fluid volume deficit
B. Constipation
C. Chronic pain
D. Impaired mobility
Answer: Fluid volume deficit
Rationale: Severe hyperglycemia causes osmotic diuresis, producing profound
dehydration and electrolyte losses. Restoring circulating volume is an
immediate priority.
Question 8 — Take Action
Which intervention should the nurse anticipate first?
A. IV isotonic fluid replacement
B. Oral glucose administration
C. Restriction of fluids
D. Administration of long-acting insulin only
Answer: IV isotonic fluid replacement
Rationale: Initial DKA management focuses on restoring intravascular volume
with isotonic fluids. Insulin therapy follows according to the treatment
protocol and potassium status.
Question 9 — Recognize Cues
Before starting an IV insulin infusion, which laboratory value is especially
important?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelet count
Answer: Potassium
Rationale: Insulin shifts potassium into cells and can cause dangerous
hypokalemia. Potassium must be assessed and corrected when necessary
before or during insulin therapy.
Question 10 — Evaluate Outcomes
