2026 Nursing Pathophysiology Case Studies Clinical
Scenarios Disease Processes Patient Findings
Diagnosis Treatment Nursing Implications Answer
Rationales
SECTION 1: CARDIOVASCULAR CASE STUDIES (Questions 1–20)
Question 1. Mr. Johnson, a 62-year-old man with a history of hypertension and
diabetes, presents to the emergency department with crushing chest pain radiating
to his left arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The right coronary artery supplies the inferior wall of the left
ventricle, the right ventricle, and the inferior portion of the interventricular septum.
Question 2. A nurse is caring for Mr. Johnson, who is 2 days post-myocardial
infarction. He develops a new holosystolic murmur at the apex, hypotension, and
pulmonary edema. Which complication should the nurse suspect?
A. Pericarditis
B. Papillary muscle rupture
C. Ventricular aneurysm
D. Dressler syndrome
Rationale: Papillary muscle rupture is a life-threatening complication of
myocardial infarction that typically occurs 2–7 days post-MI. It presents with a
new holosystolic murmur at the apex (mitral regurgitation), acute hypotension, and
pulmonary edema due to acute mitral valve insufficiency.
,Question 3. Mrs. Garcia, a 70-year-old woman with heart failure, is admitted with
worsening dyspnea, orthopnea, and bilateral crackles. Her BNP is elevated at 1,200
pg/mL. Which type of heart failure is most likely?
A. Right-sided heart failure
B. Left-sided heart failure
C. Diastolic heart failure
D. High-output heart failure
Rationale: Left-sided heart failure is characterized by pulmonary congestion,
leading to dyspnea, orthopnea, and crackles. An elevated BNP (above 100 pg/mL)
supports the diagnosis of heart failure. Right-sided heart failure would present with
systemic congestion (edema, JVD, hepatomegaly).
Question 4. A nurse is caring for Mrs. Garcia, who is receiving IV furosemide.
Which laboratory value requires immediate intervention?
A. Serum sodium of 138 mEq/L
B. Serum potassium of 2.8 mEq/L
C. Serum calcium of 9.2 mg/dL
D. Serum magnesium of 2.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 2.8 mEq/L indicates severe hypokalemia, which can cause life-
threatening cardiac arrhythmias. The nurse should notify the provider immediately
and anticipate potassium supplementation.
Question 5. Mr. Chen, a 55-year-old man, presents with sudden onset of severe
tearing chest pain radiating to his back. His blood pressure is 180/100 mm Hg, and
a chest X-ray shows a widened mediastinum. Which condition should the nurse
suspect?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Rationale: Aortic dissection is characterized by sudden onset of severe tearing
chest pain radiating to the back, often with a widened mediastinum on chest X-ray.
It is a life-threatening emergency requiring immediate surgical intervention.
,Question 6. A nurse is caring for Mr. Chen, who is scheduled for surgical repair of
an aortic dissection. Which medication should the nurse anticipate administering
first to reduce the risk of extension?
A. Nitroglycerin
B. IV beta-blocker (esmolol)
C. Morphine sulfate
D. Heparin
Rationale: IV beta-blockers (e.g., esmolol) are the first-line treatment for aortic
dissection to reduce heart rate and blood pressure, thereby decreasing shear stress
on the aorta and reducing the risk of extension. Nitroglycerin may be added for
blood pressure control.
Question 7. Mrs. Williams, a 45-year-old woman, presents with palpitations and a
heart rate of 160 bpm. Her ECG shows a narrow-complex tachycardia with a
regular rhythm. Which condition should the nurse suspect?
A. Atrial fibrillation
B. Supraventricular tachycardia (SVT)
C. Ventricular tachycardia
D. Sinus tachycardia
Rationale: Supraventricular tachycardia (SVT) is characterized by a narrow-
complex tachycardia with a regular rhythm and a rate of 150–250 bpm. Atrial
fibrillation would have an irregular rhythm.
Question 8. A nurse is caring for Mrs. Williams, who is hemodynamically stable
with SVT. Which intervention should the nurse attempt first?
A. Administer adenosine
B. Vagal maneuvers
C. Synchronized cardioversion
D. Administer amiodarone
Rationale: Vagal maneuvers (e.g., Valsalva maneuver, carotid sinus massage) are
the first-line intervention for hemodynamically stable SVT. If vagal maneuvers are
unsuccessful, adenosine is administered.
Question 9. Mr. Rodriguez, a 68-year-old man, presents with fatigue, dyspnea, and
bilateral lower extremity edema. His echocardiogram shows an ejection fraction of
30%. Which type of heart failure is most likely?
, A. Diastolic heart failure
B. Systolic heart failure
C. Right-sided heart failure
D. High-output heart failure
Rationale: Systolic heart failure is characterized by impaired ventricular
contraction and a reduced ejection fraction (less than 40%). Diastolic heart failure
has a preserved ejection fraction.
Question 10. A nurse is caring for Mr. Rodriguez, who is prescribed carvedilol.
Which instruction is most important?
A. "Take this medication with food."
B. "Do not stop this medication abruptly."
C. "Take this medication at bedtime."
D. "Increase your salt intake."
Rationale: Carvedilol is a beta-blocker that should not be stopped abruptly due to
the risk of rebound tachycardia, hypertension, and myocardial ischemia. It should
be taken with food to improve absorption.
Question 11. Mrs. Thompson, a 72-year-old woman, presents with sudden onset of
palpitations and lightheadedness. Her ECG shows an irregularly irregular rhythm
with no discernible P waves. Which condition should the nurse suspect?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm
with no discernible P waves. It is the most common sustained cardiac arrhythmia
and increases the risk of stroke.
Question 12. A nurse is caring for Mrs. Thompson, who is prescribed warfarin for
atrial fibrillation. Which instruction is most important?
A. "Increase your intake of leafy green vegetables."
B. "Maintain a consistent intake of vitamin K-rich foods."
C. "Take aspirin for headaches without consulting your provider."
D. "Double your dose if you miss a dose."
Scenarios Disease Processes Patient Findings
Diagnosis Treatment Nursing Implications Answer
Rationales
SECTION 1: CARDIOVASCULAR CASE STUDIES (Questions 1–20)
Question 1. Mr. Johnson, a 62-year-old man with a history of hypertension and
diabetes, presents to the emergency department with crushing chest pain radiating
to his left arm, diaphoresis, and nausea. His ECG shows ST-segment elevation in
leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall
myocardial infarction, which is most commonly caused by occlusion of the right
coronary artery. The right coronary artery supplies the inferior wall of the left
ventricle, the right ventricle, and the inferior portion of the interventricular septum.
Question 2. A nurse is caring for Mr. Johnson, who is 2 days post-myocardial
infarction. He develops a new holosystolic murmur at the apex, hypotension, and
pulmonary edema. Which complication should the nurse suspect?
A. Pericarditis
B. Papillary muscle rupture
C. Ventricular aneurysm
D. Dressler syndrome
Rationale: Papillary muscle rupture is a life-threatening complication of
myocardial infarction that typically occurs 2–7 days post-MI. It presents with a
new holosystolic murmur at the apex (mitral regurgitation), acute hypotension, and
pulmonary edema due to acute mitral valve insufficiency.
,Question 3. Mrs. Garcia, a 70-year-old woman with heart failure, is admitted with
worsening dyspnea, orthopnea, and bilateral crackles. Her BNP is elevated at 1,200
pg/mL. Which type of heart failure is most likely?
A. Right-sided heart failure
B. Left-sided heart failure
C. Diastolic heart failure
D. High-output heart failure
Rationale: Left-sided heart failure is characterized by pulmonary congestion,
leading to dyspnea, orthopnea, and crackles. An elevated BNP (above 100 pg/mL)
supports the diagnosis of heart failure. Right-sided heart failure would present with
systemic congestion (edema, JVD, hepatomegaly).
Question 4. A nurse is caring for Mrs. Garcia, who is receiving IV furosemide.
Which laboratory value requires immediate intervention?
A. Serum sodium of 138 mEq/L
B. Serum potassium of 2.8 mEq/L
C. Serum calcium of 9.2 mg/dL
D. Serum magnesium of 2.0 mEq/L
Rationale: Furosemide is a loop diuretic that causes potassium loss. A serum
potassium of 2.8 mEq/L indicates severe hypokalemia, which can cause life-
threatening cardiac arrhythmias. The nurse should notify the provider immediately
and anticipate potassium supplementation.
Question 5. Mr. Chen, a 55-year-old man, presents with sudden onset of severe
tearing chest pain radiating to his back. His blood pressure is 180/100 mm Hg, and
a chest X-ray shows a widened mediastinum. Which condition should the nurse
suspect?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Rationale: Aortic dissection is characterized by sudden onset of severe tearing
chest pain radiating to the back, often with a widened mediastinum on chest X-ray.
It is a life-threatening emergency requiring immediate surgical intervention.
,Question 6. A nurse is caring for Mr. Chen, who is scheduled for surgical repair of
an aortic dissection. Which medication should the nurse anticipate administering
first to reduce the risk of extension?
A. Nitroglycerin
B. IV beta-blocker (esmolol)
C. Morphine sulfate
D. Heparin
Rationale: IV beta-blockers (e.g., esmolol) are the first-line treatment for aortic
dissection to reduce heart rate and blood pressure, thereby decreasing shear stress
on the aorta and reducing the risk of extension. Nitroglycerin may be added for
blood pressure control.
Question 7. Mrs. Williams, a 45-year-old woman, presents with palpitations and a
heart rate of 160 bpm. Her ECG shows a narrow-complex tachycardia with a
regular rhythm. Which condition should the nurse suspect?
A. Atrial fibrillation
B. Supraventricular tachycardia (SVT)
C. Ventricular tachycardia
D. Sinus tachycardia
Rationale: Supraventricular tachycardia (SVT) is characterized by a narrow-
complex tachycardia with a regular rhythm and a rate of 150–250 bpm. Atrial
fibrillation would have an irregular rhythm.
Question 8. A nurse is caring for Mrs. Williams, who is hemodynamically stable
with SVT. Which intervention should the nurse attempt first?
A. Administer adenosine
B. Vagal maneuvers
C. Synchronized cardioversion
D. Administer amiodarone
Rationale: Vagal maneuvers (e.g., Valsalva maneuver, carotid sinus massage) are
the first-line intervention for hemodynamically stable SVT. If vagal maneuvers are
unsuccessful, adenosine is administered.
Question 9. Mr. Rodriguez, a 68-year-old man, presents with fatigue, dyspnea, and
bilateral lower extremity edema. His echocardiogram shows an ejection fraction of
30%. Which type of heart failure is most likely?
, A. Diastolic heart failure
B. Systolic heart failure
C. Right-sided heart failure
D. High-output heart failure
Rationale: Systolic heart failure is characterized by impaired ventricular
contraction and a reduced ejection fraction (less than 40%). Diastolic heart failure
has a preserved ejection fraction.
Question 10. A nurse is caring for Mr. Rodriguez, who is prescribed carvedilol.
Which instruction is most important?
A. "Take this medication with food."
B. "Do not stop this medication abruptly."
C. "Take this medication at bedtime."
D. "Increase your salt intake."
Rationale: Carvedilol is a beta-blocker that should not be stopped abruptly due to
the risk of rebound tachycardia, hypertension, and myocardial ischemia. It should
be taken with food to improve absorption.
Question 11. Mrs. Thompson, a 72-year-old woman, presents with sudden onset of
palpitations and lightheadedness. Her ECG shows an irregularly irregular rhythm
with no discernible P waves. Which condition should the nurse suspect?
A. Atrial flutter
B. Atrial fibrillation
C. Ventricular tachycardia
D. Sinus arrhythmia
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm
with no discernible P waves. It is the most common sustained cardiac arrhythmia
and increases the risk of stroke.
Question 12. A nurse is caring for Mrs. Thompson, who is prescribed warfarin for
atrial fibrillation. Which instruction is most important?
A. "Increase your intake of leafy green vegetables."
B. "Maintain a consistent intake of vitamin K-rich foods."
C. "Take aspirin for headaches without consulting your provider."
D. "Double your dose if you miss a dose."
