NGN NCLEX RN ACTUAL
CASE STUDIES WELL
ANSWERED 2024
Case Study 1: Patient with Chronic Obstructive Pulmonary Disease (COPD)
Scenario:
You are working on a medical-surgical unit, and your patient is a 68-year-old male admitted with
an exacerbation of chronic obstructive pulmonary disease (COPD). He has a history of smoking
for 40 years and recently stopped smoking. He is using 3 liters of oxygen at home and reports
increasing dyspnea over the last few days.
Vital Signs:
● Temperature: 98.7°F (37°C)
● Pulse: 88 bpm
● Respiratory Rate: 24 breaths/min
● Blood Pressure: 140/90 mmHg
● O2 Saturation: 89% on 3L oxygen via nasal cannula
Lab Results:
● Arterial Blood Gas (ABG): pH 7.34, PaCO2 55 mmHg, PaO2 60 mmHg, HCO3 28
mEq/L
● Hemoglobin: 16.5 g/dL
● Hematocrit: 52%
Question 1:
What is the most likely reason for this patient’s dyspnea?
A. Increased mucus production
B. Hypercapnia due to COPD
C. Hypoxia due to ineffective gas exchange
D. Anxiety related to hospitalization
, Correct Answer: C. Hypoxia due to ineffective gas exchange
Rationale: The patient has COPD, a disease characterized by reduced gas exchange, leading
to hypoxia. The O2 saturation of 89% and PaO2 of 60 mmHg confirm the hypoxia, and the lab
results suggest chronic respiratory acidosis with compensatory metabolic alkalosis (high PaCO2
and near-normal pH).
Question 2:
Which of the following interventions should be prioritized for this patient? (Select all that
apply)
A. Increase oxygen flow rate to 6 L/min
B. Position the patient in high Fowler's position
C. Administer bronchodilators as prescribed
D. Instruct the patient in pursed-lip breathing
E. Encourage oral fluid intake to thin secretions
Correct Answers: B, C, D, E
Rationale:
● B. Positioning in high Fowler's position helps improve lung expansion.
● C. Administer bronchodilators to open the airways and improve gas exchange.
● D. Pursed-lip breathing helps improve oxygenation and reduces CO2 retention.
● E. Oral fluids will help thin secretions, making it easier for the patient to expectorate
mucus.
● A. Increasing oxygen flow should be done cautiously in COPD patients due to the risk
of reducing their respiratory drive.
Question 3:
Based on the ABG results, what is the patient’s acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Compensated respiratory acidosis
Correct Answer: D. Compensated respiratory acidosis
Rationale: The ABG shows a high PaCO2 and a near-normal pH, indicating that the kidneys
have compensated for the chronic respiratory acidosis by retaining bicarbonate (HCO3).
Question 4:
What is the next best action to take if the patient’s oxygen saturation drops to 85%
despite the current interventions?
A. Administer a dose of antibiotics
B. Start non-invasive positive pressure ventilation (NIPPV)
C. Initiate mechanical ventilation
D. Call for a rapid response team
CASE STUDIES WELL
ANSWERED 2024
Case Study 1: Patient with Chronic Obstructive Pulmonary Disease (COPD)
Scenario:
You are working on a medical-surgical unit, and your patient is a 68-year-old male admitted with
an exacerbation of chronic obstructive pulmonary disease (COPD). He has a history of smoking
for 40 years and recently stopped smoking. He is using 3 liters of oxygen at home and reports
increasing dyspnea over the last few days.
Vital Signs:
● Temperature: 98.7°F (37°C)
● Pulse: 88 bpm
● Respiratory Rate: 24 breaths/min
● Blood Pressure: 140/90 mmHg
● O2 Saturation: 89% on 3L oxygen via nasal cannula
Lab Results:
● Arterial Blood Gas (ABG): pH 7.34, PaCO2 55 mmHg, PaO2 60 mmHg, HCO3 28
mEq/L
● Hemoglobin: 16.5 g/dL
● Hematocrit: 52%
Question 1:
What is the most likely reason for this patient’s dyspnea?
A. Increased mucus production
B. Hypercapnia due to COPD
C. Hypoxia due to ineffective gas exchange
D. Anxiety related to hospitalization
, Correct Answer: C. Hypoxia due to ineffective gas exchange
Rationale: The patient has COPD, a disease characterized by reduced gas exchange, leading
to hypoxia. The O2 saturation of 89% and PaO2 of 60 mmHg confirm the hypoxia, and the lab
results suggest chronic respiratory acidosis with compensatory metabolic alkalosis (high PaCO2
and near-normal pH).
Question 2:
Which of the following interventions should be prioritized for this patient? (Select all that
apply)
A. Increase oxygen flow rate to 6 L/min
B. Position the patient in high Fowler's position
C. Administer bronchodilators as prescribed
D. Instruct the patient in pursed-lip breathing
E. Encourage oral fluid intake to thin secretions
Correct Answers: B, C, D, E
Rationale:
● B. Positioning in high Fowler's position helps improve lung expansion.
● C. Administer bronchodilators to open the airways and improve gas exchange.
● D. Pursed-lip breathing helps improve oxygenation and reduces CO2 retention.
● E. Oral fluids will help thin secretions, making it easier for the patient to expectorate
mucus.
● A. Increasing oxygen flow should be done cautiously in COPD patients due to the risk
of reducing their respiratory drive.
Question 3:
Based on the ABG results, what is the patient’s acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Compensated respiratory acidosis
Correct Answer: D. Compensated respiratory acidosis
Rationale: The ABG shows a high PaCO2 and a near-normal pH, indicating that the kidneys
have compensated for the chronic respiratory acidosis by retaining bicarbonate (HCO3).
Question 4:
What is the next best action to take if the patient’s oxygen saturation drops to 85%
despite the current interventions?
A. Administer a dose of antibiotics
B. Start non-invasive positive pressure ventilation (NIPPV)
C. Initiate mechanical ventilation
D. Call for a rapid response team
