NGN Case Study – Cardiac Nursing Assessment and Clinical Decision-
Making – Complete Clinical Case Review and Answers
Cardiac - Patient 1
Client was brought to the emergency department by his son with reports of difficulty breathing and
inability to walk short distances without becoming extremely short of breath. Client is a 72-year-old
African American man with a history of obesity, hypertension, coronary artery disease, and diabetes
mellitus.
Client reports fatigue related to difficulty sleeping at night as a result of a nonproductive cough that is
unresolved with cough drops.
Client reports a weight gain of 10 pounds in the past week, despite his decreased appetite.
The son reports that his father has been unable to care for himself as a result of the fatigue and
increasing shortness of breath. He states "he has not showered in over a week." - correct answer
Assessment findings:
Cardiovascular: Sinus tachycardia with occasional premature ventricular contractions (PVCs). No
murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated throughout bilateral lung fields, dyspnea with
mild exertion, orthopnea, nonproductive chronic cough
Gastrointestinal: Positive bowel sounds
Genitourinary: Clear yellow urine, urinary frequency, and nocturia
Peripheral: +4 pitting edema in bilateral lower extremities
Vital signs:
Temperature: 98.6°F (37°C)Heart rate: 120 beats/minRespiratory rate: 26 breaths/minBlood pressure:
152/90 mm HgPulse oximetry reading of 93%
Imaging Studies
Electrocardiogram (ECG) reveals ventricular hypertrophy
Chest x-ray reveals cardiomegaly
Echocardiogram results pending
,The nurse is preparing a plan of care for the client. Based on the information provided, choose the
potential condition with anticipated medication and side effect from the list of options provided.
Potential Conditions
gastroparesis
acute renal failure
HF
hypothyroidism
Anticipated Meds
finasteride
furosemide
docusate sodium
nitroglycerin
levothyroxine
SEs to monitor
hypokalemia
hypoglycemia
stomatitis
hypotension
nausea - correct answer Potential Conditions
HF
Anticipated Meds
furosemide
nitroglycerin
SEs to monitor
, hypokalemia
hypotension
Rationale:
Heart failure is a chronic condition when the heart does not effectively work as a pump. This condition is
evident by tachycardia, orthopnea, fatigue, edema, fluid overload, and elevated BNP levels. Furosemide
is a loop diuretic prescribed to treat heart failure. It is potassium wasting so the nurse should monitor
for hypokalemia. Nitroglycerin is a vasodilator prescribed to decrease the volume of blood return to the
heart. Because it causes a decrease in blood pressure, the nurse should monitor for hypotension.
Gastroparesis is a complication caused by decreased stimulation and peristalsis in the stomach. Acute
renal failure is a temporary decrease in renal function that causes elevated serum waste products.
Hypothyroidism is a decrease in the thyroid hormone production causing weight gain and muscle
weakness. Levothyroxine is a medication that can treat hypothyroidism. Finasteride is a medication
given to decrease an enlarged prostate, not treat heart failure. Docusate sodium is a stool softener
prescribed for constipation, not for heart failure. Stomatitis are sores in the mouth often caused by
chemotherapy treatment, not heart failure. Nausea is not a common side effect of either furosemide of
nitroglycerin.
Cardiac - Patient 2
A 64-year-old male client has arrived for an appointment at the outpatient clinic because of difficulty
breathing and a rash.
History:
Hypertension
Hypothyroidism
Depression
Erectile dysfunction
Chronic back pain
Hyperlipidemia
Anterior wall myocardial infarction (MI) at age 44. Up until the MI, he smoked two packs of cigarettes
per day for 25 years. After the MI, he completed a cardiac rehabilitation program. His only current
physical activity is walking around at work. - correct answer He reports sleeping on two pillows and
waking at night one to two times per week, gasping with difficulty breathing and having to get up during
the night to urinate. He has noticed increased irritability and anxiety. Client reports joint and back pain
Making – Complete Clinical Case Review and Answers
Cardiac - Patient 1
Client was brought to the emergency department by his son with reports of difficulty breathing and
inability to walk short distances without becoming extremely short of breath. Client is a 72-year-old
African American man with a history of obesity, hypertension, coronary artery disease, and diabetes
mellitus.
Client reports fatigue related to difficulty sleeping at night as a result of a nonproductive cough that is
unresolved with cough drops.
Client reports a weight gain of 10 pounds in the past week, despite his decreased appetite.
The son reports that his father has been unable to care for himself as a result of the fatigue and
increasing shortness of breath. He states "he has not showered in over a week." - correct answer
Assessment findings:
Cardiovascular: Sinus tachycardia with occasional premature ventricular contractions (PVCs). No
murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated throughout bilateral lung fields, dyspnea with
mild exertion, orthopnea, nonproductive chronic cough
Gastrointestinal: Positive bowel sounds
Genitourinary: Clear yellow urine, urinary frequency, and nocturia
Peripheral: +4 pitting edema in bilateral lower extremities
Vital signs:
Temperature: 98.6°F (37°C)Heart rate: 120 beats/minRespiratory rate: 26 breaths/minBlood pressure:
152/90 mm HgPulse oximetry reading of 93%
Imaging Studies
Electrocardiogram (ECG) reveals ventricular hypertrophy
Chest x-ray reveals cardiomegaly
Echocardiogram results pending
,The nurse is preparing a plan of care for the client. Based on the information provided, choose the
potential condition with anticipated medication and side effect from the list of options provided.
Potential Conditions
gastroparesis
acute renal failure
HF
hypothyroidism
Anticipated Meds
finasteride
furosemide
docusate sodium
nitroglycerin
levothyroxine
SEs to monitor
hypokalemia
hypoglycemia
stomatitis
hypotension
nausea - correct answer Potential Conditions
HF
Anticipated Meds
furosemide
nitroglycerin
SEs to monitor
, hypokalemia
hypotension
Rationale:
Heart failure is a chronic condition when the heart does not effectively work as a pump. This condition is
evident by tachycardia, orthopnea, fatigue, edema, fluid overload, and elevated BNP levels. Furosemide
is a loop diuretic prescribed to treat heart failure. It is potassium wasting so the nurse should monitor
for hypokalemia. Nitroglycerin is a vasodilator prescribed to decrease the volume of blood return to the
heart. Because it causes a decrease in blood pressure, the nurse should monitor for hypotension.
Gastroparesis is a complication caused by decreased stimulation and peristalsis in the stomach. Acute
renal failure is a temporary decrease in renal function that causes elevated serum waste products.
Hypothyroidism is a decrease in the thyroid hormone production causing weight gain and muscle
weakness. Levothyroxine is a medication that can treat hypothyroidism. Finasteride is a medication
given to decrease an enlarged prostate, not treat heart failure. Docusate sodium is a stool softener
prescribed for constipation, not for heart failure. Stomatitis are sores in the mouth often caused by
chemotherapy treatment, not heart failure. Nausea is not a common side effect of either furosemide of
nitroglycerin.
Cardiac - Patient 2
A 64-year-old male client has arrived for an appointment at the outpatient clinic because of difficulty
breathing and a rash.
History:
Hypertension
Hypothyroidism
Depression
Erectile dysfunction
Chronic back pain
Hyperlipidemia
Anterior wall myocardial infarction (MI) at age 44. Up until the MI, he smoked two packs of cigarettes
per day for 25 years. After the MI, he completed a cardiac rehabilitation program. His only current
physical activity is walking around at work. - correct answer He reports sleeping on two pillows and
waking at night one to two times per week, gasping with difficulty breathing and having to get up during
the night to urinate. He has noticed increased irritability and anxiety. Client reports joint and back pain
