Next Generation NCLEX (NGN) Case Study with Solutions (All Case Studies Included) (2023/2024)

Next Generation NCLEX (NGN) Case Study with Solutions (All Case Studies Included) (2023/2024) Next Generation NCLEX (NGN) Case Study Case Study: Patient Profile: Jane Smith, a 32-year-old female, presents to the emergency department with complaints of severe abdominal pain, nausea, and vomiting. She has a medical history of cholecystitis and a previous cholecystectomy. She reports that the pain started in the right upper quadrant and has since radiated to her right shoulder. She denies any recent trauma or illness. Assessment Findings: Vital signs: Blood pressure 130/80 mmHg, heart rate 90 bpm, respiratory rate 18 bpm, temperature 37.2°C (99°F) Abdominal examination reveals tenderness in the right upper quadrant with guarding Laboratory results: Complete blood count: WBC 14,000/mm³, hemoglobin 13.5 g/dL, hematocrit 40% Liver function tests: Elevated levels of AST, ALT, and total bilirubin Amylase and lipase levels within normal range Diagnosis: Based on the patient's symptoms, history of cholecystitis, and physical examination findings, the nurse suspects acute pancreatitis. Plan of Care: Pain management: Administer analgesics as prescribed, such as intravenous morphine, to alleviate pain and promote patient comfort. Assess pain levels regularly using a pain scale and adjust medication dosages accordingly. Monitor for any adverse effects of pain medications, such as respiratory depression or sedation. Nausea and vomiting management: Administer antiemetic medications, such as ondansetron, to control nausea and vomiting. Encourage the patient to avoid oral intake until nausea subsides to prevent further discomfort and potential exacerbation of symptoms. Provide frequent oral hygiene to relieve dry mouth and promote patient comfort. Monitoring and supportive measures: Monitor vital signs regularly, including temperature, heart rate, blood pressure, and respiratory rate, to assess for any signs of deterioration or complications. Maintain strict intake and output records to monitor fluid balance and detect any signs of dehydration. Insert a nasogastric tube if necessary to decompress the stomach and relieve gastrointestinal symptoms. NPO (nothing by mouth) and bowel rest: Maintain the patient on NPO status to allow the pancreas to rest and reduce pancreatic secretions. Provide intravenous fluids and electrolyte replacement as prescribed to maintain hydration and electrolyte balance. Collaborate with the healthcare team to determine the optimal timing for resuming oral intake based on the patient's clinical progress. Education and discharge planning: Provide the patient with information about acute pancreatitis, including its causes, symptoms, and risk factors. Discuss the importance of adherence to a low-fat diet and abstinence from alcohol to prevent future episodes of pancreatitis. Arrange for follow-up appointments with the healthcare provider to monitor the patient's progress and adjust the treatment plan if necessary. Solution: The patient's symptoms, history, and assessment findings indicate acute pancreatitis. The nurse's plan of care focuses on pain management, nausea and vomiting control, monitoring and supportive measures, NPO status and bowel rest, as well as patient education and discharge planning. By effectively managing the patient's pain, the nurse can enhance comfort and facilitate recovery. Regular assessment of pain levels and adjustment of analgesics accordingly are essential to meet the patient's individual needs. Concurrently, antiemetic medications help alleviate nausea and vomiting, promoting patient comfort and minimizing the risk of dehydration. Close monitoring of vital signs, fluid balance, and electrolyte levels is crucial for early detection of complications and to ensure appropriate interventions. Maintaining the patient on NPO status and providing intravenous Case Study: Patient Profile: John Davis, a 45-year-old male, is admitted to the hospital with a chief complaint of shortness of breath and chest pain. He has a medical history of hypertension, hyperlipidemia, and obesity. He is a smoker and admits to occasionally skipping his medications. He reports experiencing increased fatigue and decreased exercise tolerance over the past month. Assessment Findings: Vital signs: Blood pressure 160/90 mmHg, heart rate 100 bpm, respiratory rate 20 bpm, temperature 37.0°C (98.6°F), oxygen saturation 92% on room air Lung auscultation reveals crackles in the bases bilaterally ECG shows ST-segment elevation in leads II, III, and aVF, indicating inferior myocardial infarction Laboratory results: Troponin levels: Elevated Lipid panel: Elevated LDL cholesterol and triglycerides Diagnosis: Based on the patient's symptoms, medical history, physical examination findings, and ECG results, the nurse suspects an acute myocardial infarction (AMI). Plan of Care: Oxygen administration and respiratory support: Administer supplemental oxygen to maintain oxygen saturation above 94%. Monitor oxygen saturation continuously and assess respiratory status regularly. Assist with activities of daily living to conserve energy and reduce the workload on the heart. Pain management: Administer nitroglycerin as prescribed to relieve chest pain and improve coronary blood flow. Assess pain levels using a pain scale and administer additional analgesics, such as morphine, if needed. Monitor blood pressure closely, as nitroglycerin may cause hypotension. Medication administration: Administer aspirin and clopidogrel as prescribed to prevent further clot formation and platelet aggregation. Initiate intravenous heparin or other anticoagulants as ordered to prevent extension of the thrombus. Ensure the patient's regular medications for hypertension and hyperlipidemia are administered as scheduled. Cardiac monitoring and ECG interpretation: Continuously monitor cardiac rhythm and vital signs, including heart rate, blood pressure, and oxygen saturation. Notify the healthcare provider promptly of any changes in cardiac rhythm or clinical deterioration. Document and interpret ECG changes, including ST-segment elevation and any subsequent Q waves or T-wave inversions. Coronary intervention and reperfusion therapy: Collaborate with the healthcare team to determine the need for emergent percutaneous coronary intervention (PCI) or fibrinolytic therapy. Ensure timely transfer of the patient to the cardiac catheterization lab for angiography and possible PCI. Monitor the patient closely for complications related to the procedure, such as bleeding or vascular injury. Patient and family education: Educate the patient and family about AMI, its causes, and the importance of adherence to prescribed medications and lifestyle modifications. Provide information on smoking cessation programs and resources. Arrange for follow-up appointments and cardiac rehabilitation to support the patient's recovery and promote long-term cardiovascular health. Solution: The patient's symptoms, medical history, physical examination findings, and ECG results strongly suggest an acute myocardial infarction (AMI). The nurse's plan of care involves respiratory support, pain management, medication administration, cardiac monitoring, coronary intervention, and patient education. Respiratory support is crucial to ensure adequate oxygenation. Administering supplemental oxygen helps maintain oxygen saturation above 94% and reduces the workload on the heart. Continuous monitoring of oxygen saturation and regular respiratory assessments assist in detecting any respiratory deterioration. Effective pain management is vital in Case Study: Patient Profile: Sarah Johnson, a 68-year-old female, is brought to the emergency department by her daughter. She presents with confusion, restlessness, and difficulty speaking. Her daughter reports that Sarah has a history of hypertension, diabetes mellitus, and atrial fibrillation. She takes multiple medications but is unsure of the specific details. Assessment Findings: Vital signs: Blood pressure 170/100 mmHg, heart rate 110 bpm, respiratory rate 20 bpm, temperature 37.5°C (99.5°F) Neurological examination reveals slurred speech, right-sided facial droop, and rightsided weakness. Blood glucose level: 350 mg/dL ECG shows irregularly irregular rhythm consistent with atrial fibrillation. Diagnosis: Based on the patient's symptoms, medical history, physical examination findings, and ECG results, the nurse suspects an acute ischemic stroke. Plan of Care: Rapid assessment and stabilization: Ensure a patent airway and administer supplemental oxygen if needed to maintain oxygen saturation above 94%. Establish intravenous access and draw blood samples for laboratory tests, including a complete blood count, electrolytes, coagulation profile, and blood glucose level. Initiate cardiac monitoring and continuous pulse oximetry to monitor the patient's heart rhythm and oxygenation status. Neurological assessment and stroke scale: Perform a thorough neurological examination, including assessing the patient's level of consciousness, pupillary responses, motor strength, and cranial nerve function. Utilize a stroke scale, such as the NIH Stroke Scale, to quantify the severity of the stroke and guide further management decisions. Time-sensitive interventions: Administer intravenous tissue plasminogen activator (tPA) within the appropriate time window if the patient meets eligibility criteria. Collaborate with the healthcare team to determine the need for endovascular therapy or mechanical thrombectomy. Provide supportive care measures, such as maintaining the head of the bed elevated, to optimize cerebral perfusion. Blood pressure management: Administer antihypertensive medications as prescribed to achieve blood pressure control, keeping in mind the target blood pressure range for acute ischemic stroke. Monitor blood pressure frequently and titrate medications to maintain the desired blood pressure parameters. Blood glucose control: Administer insulin as needed to achieve glycemic control and maintain blood glucose levels within the target range. Monitor blood glucose levels regularly, especially during the acute phase of the stroke, to prevent hyperglycemia-related complications. Rehabilitation and support: Collaborate with the rehabilitation team to initiate early mobilization and physical therapy as soon as the patient's condition permits. Involve the speech-language pathologist for assessment and management of swallowing difficulties and speech therapy needs. Provide emotional support to the patient and family, and offer education regarding stroke prevention, medication adherence, and lifestyle modifications. Solution: Based on the patient's symptoms, medical history, physical examination findings, and ECG results, the nurse suspects an acute ischemic stroke. The plan of care focuses on rapid assessment and stabilization, neurological assessment using a stroke scale, time-sensitive interventions such as tPA administration or mechanical thrombectomy, blood pressure management, blood glucose control, and rehabilitation and support. Prompt assessment and stabilization are crucial in stroke management. Establishing a patent airway, ensuring oxygenation, and initiating intravenous access are priorities. A comprehensive neurological assessment, including utilizing a stroke scale, helps determine the severity of the stroke and guides subsequent interventions. Time-sensitive interventions, such as administering tPA within the appropriate time window or considering endovascular therapy, aim to restore Case Study: Patient Profile: Mark Thompson, a 56-year-old male, presents to the primary care clinic with complaints of fatigue, unintentional weight loss, and persistent cough. He has a history of smoking for 30 years and reports experiencing a gradual decrease in exercise tolerance over the past few months. He denies any recent illnesses or significant medical history. Assessment Findings: Vital signs: Blood pressure 140/90 mmHg, heart rate 80 bpm, respiratory rate 18 bpm, temperature 36.8°C (98.2°F) Lung auscultation reveals decreased breath sounds and crackles in the right lower lung field. Laboratory results: Complete blood count: Mild anemia (hemoglobin 10.5 g/dL) Chest X-ray: Presence of a solitary pulmonary nodule in the right lower lobe Diagnosis: Based on the patient's symptoms, history of smoking, physical examination findings, and imaging results, the nurse suspects lung cancer. Plan of Care: Referral and diagnostic workup: Consult a pulmonologist for further evaluation and management. Schedule a computed tomography (CT) scan of the chest to assess the size, location, and characteristics of the pulmonary nodule. Consider a biopsy or further imaging studies, such as positron emission tomography (PET) scan, to determine the nature and staging of the lung lesion. Symptom management and supportive care: Provide education and support to the patient regarding smoking cessation and the importance of quitting. Offer assistance and resources for smoking cessation programs, nicotine replacement therapy, or other appropriate interventions. Address the patient's fatigue by promoting rest, conserving energy, and exploring strategies to manage activities of daily living. Collaborate with the healthcare team to manage pain, if present, using analgesics and other appropriate interventions. Coordination of treatment options: Facilitate consultations with an oncologist and radiation oncologist to discuss potential treatment options based on the final diagnosis and staging. Coordinate with the healthcare team to develop an individualized treatment plan, which may include surgery, chemotherapy, radiation therapy, or targeted therapies. Psychosocial support and counseling: Provide emotional support to the patient and family members, as a lung cancer diagnosis can be distressing. Offer information about local support groups, counseling services, and resources to address the psychosocial impact of the diagnosis and treatment. Education and follow-up: Educate the patient about lung cancer, its risk factors, treatment options, and potential side effects. Encourage regular follow-up appointments to monitor treatment response, address concerns, and adjust the care plan as necessary. Discuss the importance of a healthy lifestyle, including proper nutrition and exercise, to optimize overall well-being and support the treatment process. Solution: Based on the patient's symptoms, history of smoking, physical examination findings, and imaging results, the nurse suspects lung cancer. The plan of care involves referral for further evaluation and diagnostic workup, symptom management and supportive care, coordination of treatment options, psychosocial support and counseling, as well as education and follow-up. Referral to a pulmonologist and additional imaging studies, such as a CT scan and potentially a biopsy or PET scan, are necessary to establish a definitive diagnosis and determine the staging of the lung lesion. Supportive care focuses on smoking cessation interventions, fatigue management, and addressing pain if present. Collaborating with an oncologist and radiation oncologist is crucial to develop an individualized treatment plan that may involve surgery, chemotherapy, radiation therapy, or targeted therapies. Psychosocial support and counseling play a significant role in helping the patient and family cope Case Study: Patient Profile: Emily Rodriguez, a 42-year-old female, presents to the emergency department with severe abdominal pain, distention, and constipation. She has a medical history of Crohn's disease and has been on maintenance medication for the past five years. She reports that her symptoms have worsened over the past week, and she has not had a bowel movement for three days. Assessment Findings: Vital signs: Blood pressure 120/80 mmHg, heart rate 90 bpm, respiratory rate 18 bpm, temperature 37.0°C (98.6°F) Abdominal examination reveals diffuse tenderness, abdominal distention, and highpitched bowel sounds. Laboratory results: Complete blood count: Mild leukocytosis (WBC 12,500/mm³) C-reactive protein (CRP) level: Elevated Diagnosis: Based on the patient's symptoms, medical history, physical examination findings, and laboratory results, the nurse suspects a bowel obstruction secondary to Crohn's disease. Plan of Care: Initial stabilization and assessment: Ensure a patent airway and administer supplemental oxygen if needed to maintain oxygen saturation above 94%. Establish intravenous access and initiate fluid resuscitation with isotonic solutions to correct dehydration and electrolyte imbalances. Monitor vital signs closely and assess for signs of hemodynamic instability or sepsis. Pain management and symptom relief: Administer analgesics as prescribed, such as intravenous opioids, to alleviate pain and provide comfort. Utilize non-pharmacological pain management strategies, such as heat packs or positioning, as adjuncts to medication. Monitor pain levels regularly using a pain scale and adjust the analgesic regimen accordingly. Bowel decompression and management: Insert a nasogastric tube to decompress the bowel and relieve abdominal distention. Collaborate with the healthcare team to determine the need for surgical intervention or further imaging studies, such as an abdominal X-ray or CT scan, to assess the extent and cause of the obstruction. Initiate bowel rest by maintaining the patient on NPO (nothing by mouth) status and providing intravenous fluids and nutrition as prescribed. Medication management: Ensure the patient's regular maintenance medication for Crohn's disease is continued as prescribed, unless contraindicated due to the acute bowel obstruction. Administer antibiotics if there are signs of infection or sepsis, guided by the healthcare provider's orders. Monitoring and complications: Monitor bowel sounds regularly to assess for improvement or worsening of the obstruction. Monitor for signs of complications, such as bowel perforation, peritonitis, or sepsis, and notify the healthcare provider promptly if any concerning symptoms arise. Case Study: Patient Profile: Michael Thompson, a 62-year-old male, presents to the primary care clinic with complaints of frequent urination, increased thirst, and unintentional weight loss. He has a medical history of type 2 diabetes mellitus and hypertension. He takes oral antidiabetic medication and an angiotensin-converting enzyme (ACE) inhibitor for his hypertension. Assessment Findings: Vital signs: Blood pressure 140/90 mmHg, heart rate 80 bpm, respiratory rate 16 bpm, temperature 36.9°C (98.4°F) Blood glucose level: 320 mg/dL (elevated) Urinalysis: Presence of glucose and ketones in the urine Body mass index (BMI): 23 kg/m² (within normal range) Diagnosis: Based on the patient's symptoms, medical history, physical examination findings, and laboratory results, the nurse suspects diabetic ketoacidosis (DKA) in the setting of uncontrolled diabetes. Plan of Care: Fluid and electrolyte management: Initiate intravenous fluid replacement with isotonic saline to correct dehydration and electrolyte imbalances. Monitor fluid status, vital signs, and urine output closely, and adjust fluid therapy accordingly. Check electrolyte levels, especially potassium, and replace deficits as needed. Insulin therapy: Administer intravenous regular insulin as prescribed to lower blood glucose levels and promote resolution of ketosis and acidosis. Monitor blood glucose levels frequently and titrate insulin infusion based on the patient's response. Acid-base balance correction: Monitor arterial blood gas (ABG) values to assess acid-base status and guide treatment. Administer sodium bicarbonate if the patient's pH is critically low or if severe acidosis persists despite insulin therapy. Diagnostic investigations and monitoring: Perform additional laboratory tests, including complete blood count, renal function panel, liver function tests, and serum ketones, to assess the patient's overall condition and identify potential complications. Monitor vital signs, cardiac rhythm, urine output, and mental status regularly to detect any deterioration or changes. Identification and treatment of precipitating factors: Investigate and address potential triggers for DKA, such as infection, non-adherence to medication, or recent illness. Initiate appropriate treatments, such as antibiotics for infections, to manage the underlying cause. Patient education and self-management: Educate the patient about the signs and symptoms of DKA and the importance of regular monitoring of blood glucose levels. Reinforce the importance of medication adherence, lifestyle modifications, and regular follow-up appointments. Provide guidance on sick day management, including the need for increased insulin doses during illness or stress. Solution: Based on the patient's symptoms, medical history, physical examination findings, and laboratory results, the nurse suspects diabetic ketoacidosis (DKA) in the setting of uncontrolled diabetes. The plan of care involves fluid and electrolyte management, insulin therapy, correction of acid-base imbalance, diagnostic investigations and monitoring, identification and treatment of precipitating factors, and patient education and self-management. Fluid and electrolyte management is the initial priority to correct dehydration and electrolyte imbalances. Intravenous fluids with isotonic saline are administered, and electrolyte levels are closely monitored and corrected as necessary. Insulin therapy is initiated to lower blood glucose levels and promote resolution of ketosis and acidosis. Regular insulin is administered intravenously, and blood glucose levels are closely monitored and insulin infusion adjusted accordingly. Correction of acid-base imbalance is achieved by monitoring ABG values and administering sodium bicarbonate if necessary to normalize the patient's pH and resolve severe acidosis. Diagnostic investigations and monitoring are performed to assess the patient's overall condition, identify potential complications, and guide treatment decisions. Vital signs, urine output, and mental status are closely monitored. The identification and treatment of precipitating factors, such as infection or nonadherence to medication, are important to address the underlying cause of DKA. Appropriate treatments, such as antibiotics, are initiated as needed. Patient education and self-management play a crucial role in preventing future episodes of DKA. The patient is educated about the signs and symptoms of DKA, medication adherence, lifestyle modifications, and sick day management. Regular follow-up appointments are emphasized to monitor the patient's progress and provide ongoing support. Case Study: Patient Profile: John Davis, a 55-year-old male, presents to the emergency department with sudden onset severe chest pain radiating to his left arm, shortness of breath, and diaphoresis. He has a medical history of hypertension and hyperlipidemia. He smokes a pack of cigarettes daily and leads a sedentary lifestyle. Assessment Findings: Vital signs: Blood pressure 180/110 mmHg, heart rate 110 bpm, respiratory rate 24 bpm, temperature 37.2°C (99°F) Cardiac examination reveals an irregular rhythm and audible S4 heart sound. Electrocardiogram (ECG): ST-segment elevation in leads II, III, and aVF. Diagnosis: Based on the patient's symptoms, medical history, physical examination findings, and ECG results, the nurse suspects an acute myocardial infarction (AMI) involving the inferior wall of the heart. Plan of Care: Rapid assessment and stabilization: Ensure a patent airway and administer supplemental oxygen to maintain oxygen saturation above 94%. Establish intravenous access and obtain blood samples for cardiac biomarkers, complete blood count, electrolytes, and coagulation profile. Initiate continuous cardiac monitoring and pulse oximetry. Time-sensitive interventions: Administer aspirin 325 mg orally or chewed, nitroglycerin sublingually, and morphine sulfate intravenously as prescribed for pain relief and coronary artery dilation. Initiate immediate reperfusion therapy, such as percutaneous coronary intervention (PCI), if available within the recommended time window. If PCI is not feasible, administer thrombolytic therapy (e.g., alteplase) as indicated, considering contraindications and the patient's eligibility criteria. Blood pressure management: Administer antihypertensive medications, such as beta-blockers and/or ACE inhibitors, to achieve blood pressure control and reduce myocardial oxygen demand. Monitor blood pressure closely and titrate medications to maintain the desired blood pressure parameters. Cardiac monitoring and rhythm management: Continuously monitor the patient's cardiac rhythm and institute appropriate interventions for arrhythmias or conduction abnormalities. Consider the need for antiarrhythmic medications, such as beta-blockers or antiplatelet agents, based on the patient's clinical presentation and ECG findings. Secondary prevention and risk factor modification: Initiate statin therapy, such as atorvastatin or simvastatin, to lower cholesterol levels and reduce the risk of recurrent cardiovascular events. Offer smoking cessation counseling and support, emphasizing the importance of quitting smoking to improve long-term outcomes. Provide education on lifestyle modifications, including regular exercise, healthy diet, weight management, and stress reduction techniques. Cardiac rehabilitation and follow-up: Refer the patient to a cardiac rehabilitation program to initiate supervised exercise and lifestyle counseling. Schedule follow-up appointments to monitor the patient's cardiac function, medication adherence, and progress in risk factor modification. Solution: Based on the patient's symptoms, medical history, physical examination findings, and ECG results, the nurse suspects an acute myocardial infarction (AMI) involving the inferior wall of the heart. The plan of care focuses on rapid assessment and stabilization, time-sensitive interventions such as reperfusion therapy, blood pressure management, cardiac monitoring and rhythm management, secondary prevention and risk factor modification, as well as cardiac rehabilitation and followup. Rapid assessment and stabilization are essential, with a focus on maintaining a patent airway, administering oxygen, establishing intravenous access, and obtaining necessary blood samples for diagnostic tests. Time-sensitive interventions include pain relief, coronary artery dilation, and reperfusion therapy. Aspirin, nitroglycerin, and morphine sulfate are administered for pain relief and coronary artery dilation. Immediate reperfusion therapy is initiated, either through percutaneous coronary intervention (PCI) or thrombolytic therapy, depending on the availability and eligibility criteria. Blood pressure management involves the administration of antihypertensive medications to control blood pressure and reduce myocardial oxygen demand. Close monitoring and titration of medications are performed to maintain the desired blood pressure parameters. Cardiac monitoring and rhythm management are crucial, with continuous monitoring of the patient's cardiac rhythm and interventions for arrhythmias or conduction abnormalities