NURSING PRACTICE 100+ CASE STUDIES 2026/2027
Case Study 1: Postpartum Hemorrhage
Scenario: A 30-year-old woman, G2P2, is two hours postpartum following a vaginal delivery of
a healthy baby boy. Her labor was prolonged, lasting 18 hours. She has a history of anemia
during pregnancy and received oxytocin during labor for augmentation. The nurse notes that the
patient’s fundus is boggy and located above the umbilicus. The perineal pad is saturated with
bright red blood within 15 minutes.
1. What is the nurse's priority action?
o A. Perform a fundal massage.
o B. Notify the healthcare provider immediately.
o C. Increase the rate of oxytocin infusion.
o D. Administer methylergonovine as ordered.
Answer: A. Perform a fundal massage. Rationale: A boggy uterus indicates uterine
atony, the most common cause of postpartum hemorrhage. The nurse should first perform
a fundal massage to stimulate uterine contractions and control the bleeding. While
notifying the healthcare provider, increasing oxytocin, and administering other
medications may be appropriate, the immediate action should focus on controlling the
bleeding.
2. What other assessment should the nurse perform immediately?
o A. Monitor vital signs, including blood pressure and heart rate.
o B. Check the newborn’s Apgar score.
o C. Assess the mother’s pain level.
o D. Measure the fundal height.
Answer: A. Monitor vital signs, including blood pressure and heart rate. Rationale:
Monitoring vital signs is crucial in detecting early signs of hypovolemic shock due to
excessive blood loss. An elevated heart rate and low blood pressure may indicate
significant blood loss. While assessing fundal height is also important, vital signs take
priority when suspecting hemorrhage.
Case Study 2: Diabetes Management
Scenario: A 45-year-old male with Type 1 diabetes mellitus is admitted to the hospital for
poorly controlled blood sugar levels. He has been experiencing frequent episodes of
hyperglycemia and occasional hypoglycemia. His current medications include insulin glargine
once daily and insulin lispro with meals. The patient reports that he sometimes skips meals due
to his busy work schedule.
1. What is the nurse’s priority intervention to prevent hypoglycemia?
o A. Educate the patient on the importance of regular meal times.
o B. Administer additional insulin lispro to manage hyperglycemia.
o C. Increase the dosage of insulin glargine.
,o D. Instruct the patient to reduce insulin doses if skipping meals.
, Answer: A. Educate the patient on the importance of regular meal times. Rationale:
Skipping meals can result in hypoglycemia, especially when taking mealtime insulin such
as insulin lispro. Educating the patient on consistent meal times and the relationship
between meals and insulin administration is crucial to preventing blood sugar
fluctuations. Adjusting insulin doses should only be done under a healthcare provider's
guidance.
2. The patient’s blood sugar is 60 mg/dL, and he feels shaky. What is the most
appropriate nursing action?
o A. Administer a glass of orange juice.
o B. Administer 10 units of insulin lispro.
o C. Have the patient perform moderate exercise.
o D. Encourage the patient to drink water.
Answer: A. Administer a glass of orange juice. Rationale: A blood sugar level of 60
mg/dL indicates hypoglycemia. The nurse should provide a rapid-acting carbohydrate,
such as orange juice, to quickly raise blood sugar levels. Administering insulin would
worsen hypoglycemia, and exercise could further lower blood sugar.
Case Study 3: Heart Failure
Scenario: An 80-year-old female with a history of congestive heart failure (CHF) is admitted
with worsening dyspnea and peripheral edema. Her current medications include furosemide,
metoprolol, and lisinopril. The nurse notes that the patient has gained 5 pounds over the last three
days and has jugular vein distention.
1. What is the nurse's priority assessment?
o A. Monitor the patient’s daily intake and output.
o B. Auscultate lung sounds.
o C. Measure the patient’s blood glucose level.
o D. Check for signs of deep vein thrombosis.
Answer: B. Auscultate lung sounds. Rationale: In a patient with worsening CHF,
auscultating lung sounds is crucial to assess for pulmonary congestion or fluid overload,
which can cause dyspnea. This assessment can help determine the severity of the
condition and guide further interventions, such as administering diuretics.
2. Which medication is most important for the nurse to review for possible
adjustment?
o A. Metoprolol
o B. Furosemide
o C. Lisinopril
o D. Acetaminophen
Answer: B. Furosemide Rationale: Furosemide is a diuretic used to reduce fluid
overload in heart failure. If the patient is experiencing worsening symptoms, the dose
, may need to be adjusted to remove excess fluid. Adjusting other medications may also be
necessary, but addressing fluid overload is the immediate priority.
Case Study 4: Asthma Exacerbation
Scenario: A 16-year-old female with a history of asthma presents to the emergency department
with shortness of breath, wheezing, and a persistent cough. She reports using her rescue inhaler
(albuterol) multiple times today without relief. Her oxygen saturation is 90% on room air.
1. What is the nurse's priority intervention?
o A. Administer a dose of albuterol via a nebulizer.
o B. Start intravenous corticosteroids immediately.
o C. Place the patient in a supine position.
o D. Administer a dose of oral antibiotics.
Answer: A. Administer a dose of albuterol via a nebulizer. Rationale: Albuterol is a
bronchodilator that helps open the airways during an asthma exacerbation. Administering
albuterol via nebulizer can be more effective than an inhaler in delivering the medication
during an acute asthma attack. IV corticosteroids may be considered, but bronchodilator
therapy is the priority for immediate symptom relief.
2. What additional action should the nurse take to help improve the patient's
oxygenation?
o A. Apply a non-rebreather mask with 100% oxygen.
o B. Administer humidified air via nasal cannula.
o C. Encourage the patient to perform pursed-lip breathing.
o D. Provide chest physiotherapy.
Answer: C. Encourage the patient to perform pursed-lip breathing. Rationale: Pursed-lip
breathing helps to improve ventilation by keeping the airways open longer and promoting
the exhalation of trapped air. While oxygen supplementation may be necessary, pursed-
lip breathing is a helpful initial non-pharmacological intervention to improve oxygenation
and ease breathing.
Case Study 5: Acute Kidney Injury
Scenario: A 60-year-old male with a history of hypertension and type 2 diabetes mellitus is
admitted with a diagnosis of acute kidney injury (AKI). His current symptoms include decreased
urine output, generalized edema, and elevated serum creatinine and blood urea nitrogen (BUN)
levels. His blood pressure is 170/95 mmHg, and his potassium level is 6.2 mEq/L.
1. What is the nurse’s priority intervention?
o A. Administer furosemide as ordered.
o B. Prepare the patient for hemodialysis.
o C. Administer sodium polystyrene sulfonate.
o D. Restrict the patient’s fluid intake.
Case Study 1: Postpartum Hemorrhage
Scenario: A 30-year-old woman, G2P2, is two hours postpartum following a vaginal delivery of
a healthy baby boy. Her labor was prolonged, lasting 18 hours. She has a history of anemia
during pregnancy and received oxytocin during labor for augmentation. The nurse notes that the
patient’s fundus is boggy and located above the umbilicus. The perineal pad is saturated with
bright red blood within 15 minutes.
1. What is the nurse's priority action?
o A. Perform a fundal massage.
o B. Notify the healthcare provider immediately.
o C. Increase the rate of oxytocin infusion.
o D. Administer methylergonovine as ordered.
Answer: A. Perform a fundal massage. Rationale: A boggy uterus indicates uterine
atony, the most common cause of postpartum hemorrhage. The nurse should first perform
a fundal massage to stimulate uterine contractions and control the bleeding. While
notifying the healthcare provider, increasing oxytocin, and administering other
medications may be appropriate, the immediate action should focus on controlling the
bleeding.
2. What other assessment should the nurse perform immediately?
o A. Monitor vital signs, including blood pressure and heart rate.
o B. Check the newborn’s Apgar score.
o C. Assess the mother’s pain level.
o D. Measure the fundal height.
Answer: A. Monitor vital signs, including blood pressure and heart rate. Rationale:
Monitoring vital signs is crucial in detecting early signs of hypovolemic shock due to
excessive blood loss. An elevated heart rate and low blood pressure may indicate
significant blood loss. While assessing fundal height is also important, vital signs take
priority when suspecting hemorrhage.
Case Study 2: Diabetes Management
Scenario: A 45-year-old male with Type 1 diabetes mellitus is admitted to the hospital for
poorly controlled blood sugar levels. He has been experiencing frequent episodes of
hyperglycemia and occasional hypoglycemia. His current medications include insulin glargine
once daily and insulin lispro with meals. The patient reports that he sometimes skips meals due
to his busy work schedule.
1. What is the nurse’s priority intervention to prevent hypoglycemia?
o A. Educate the patient on the importance of regular meal times.
o B. Administer additional insulin lispro to manage hyperglycemia.
o C. Increase the dosage of insulin glargine.
,o D. Instruct the patient to reduce insulin doses if skipping meals.
, Answer: A. Educate the patient on the importance of regular meal times. Rationale:
Skipping meals can result in hypoglycemia, especially when taking mealtime insulin such
as insulin lispro. Educating the patient on consistent meal times and the relationship
between meals and insulin administration is crucial to preventing blood sugar
fluctuations. Adjusting insulin doses should only be done under a healthcare provider's
guidance.
2. The patient’s blood sugar is 60 mg/dL, and he feels shaky. What is the most
appropriate nursing action?
o A. Administer a glass of orange juice.
o B. Administer 10 units of insulin lispro.
o C. Have the patient perform moderate exercise.
o D. Encourage the patient to drink water.
Answer: A. Administer a glass of orange juice. Rationale: A blood sugar level of 60
mg/dL indicates hypoglycemia. The nurse should provide a rapid-acting carbohydrate,
such as orange juice, to quickly raise blood sugar levels. Administering insulin would
worsen hypoglycemia, and exercise could further lower blood sugar.
Case Study 3: Heart Failure
Scenario: An 80-year-old female with a history of congestive heart failure (CHF) is admitted
with worsening dyspnea and peripheral edema. Her current medications include furosemide,
metoprolol, and lisinopril. The nurse notes that the patient has gained 5 pounds over the last three
days and has jugular vein distention.
1. What is the nurse's priority assessment?
o A. Monitor the patient’s daily intake and output.
o B. Auscultate lung sounds.
o C. Measure the patient’s blood glucose level.
o D. Check for signs of deep vein thrombosis.
Answer: B. Auscultate lung sounds. Rationale: In a patient with worsening CHF,
auscultating lung sounds is crucial to assess for pulmonary congestion or fluid overload,
which can cause dyspnea. This assessment can help determine the severity of the
condition and guide further interventions, such as administering diuretics.
2. Which medication is most important for the nurse to review for possible
adjustment?
o A. Metoprolol
o B. Furosemide
o C. Lisinopril
o D. Acetaminophen
Answer: B. Furosemide Rationale: Furosemide is a diuretic used to reduce fluid
overload in heart failure. If the patient is experiencing worsening symptoms, the dose
, may need to be adjusted to remove excess fluid. Adjusting other medications may also be
necessary, but addressing fluid overload is the immediate priority.
Case Study 4: Asthma Exacerbation
Scenario: A 16-year-old female with a history of asthma presents to the emergency department
with shortness of breath, wheezing, and a persistent cough. She reports using her rescue inhaler
(albuterol) multiple times today without relief. Her oxygen saturation is 90% on room air.
1. What is the nurse's priority intervention?
o A. Administer a dose of albuterol via a nebulizer.
o B. Start intravenous corticosteroids immediately.
o C. Place the patient in a supine position.
o D. Administer a dose of oral antibiotics.
Answer: A. Administer a dose of albuterol via a nebulizer. Rationale: Albuterol is a
bronchodilator that helps open the airways during an asthma exacerbation. Administering
albuterol via nebulizer can be more effective than an inhaler in delivering the medication
during an acute asthma attack. IV corticosteroids may be considered, but bronchodilator
therapy is the priority for immediate symptom relief.
2. What additional action should the nurse take to help improve the patient's
oxygenation?
o A. Apply a non-rebreather mask with 100% oxygen.
o B. Administer humidified air via nasal cannula.
o C. Encourage the patient to perform pursed-lip breathing.
o D. Provide chest physiotherapy.
Answer: C. Encourage the patient to perform pursed-lip breathing. Rationale: Pursed-lip
breathing helps to improve ventilation by keeping the airways open longer and promoting
the exhalation of trapped air. While oxygen supplementation may be necessary, pursed-
lip breathing is a helpful initial non-pharmacological intervention to improve oxygenation
and ease breathing.
Case Study 5: Acute Kidney Injury
Scenario: A 60-year-old male with a history of hypertension and type 2 diabetes mellitus is
admitted with a diagnosis of acute kidney injury (AKI). His current symptoms include decreased
urine output, generalized edema, and elevated serum creatinine and blood urea nitrogen (BUN)
levels. His blood pressure is 170/95 mmHg, and his potassium level is 6.2 mEq/L.
1. What is the nurse’s priority intervention?
o A. Administer furosemide as ordered.
o B. Prepare the patient for hemodialysis.
o C. Administer sodium polystyrene sulfonate.
o D. Restrict the patient’s fluid intake.
