NCLEX RN Next Case Study Exam 9 100
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A Instant Download Pdf
Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and heart failure with
reduced ejection fraction is admitted with increasing dyspnea, orthopnea, and
bilateral lower-extremity edema. The client reports a 3-kg weight gain over the
past week.
Vital signs: BP 168/94 mm Hg, HR 108/min, RR 28/min, SpO₂ 88% on room air,
temperature 36.8°C (98.2°F).
Assessment reveals bilateral crackles, jugular venous distention, and 3+ pitting
edema.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. 3+ bilateral ankle edema
B. Jugular venous distention
C. Oxygen saturation of 88%
D. Weight gain of 3 kg
Answer: Oxygen saturation of 88%
Rationale: An SpO₂ of 88% indicates significant hypoxemia and impaired
oxygenation. Airway and breathing take priority over manifestations such as
edema, weight gain, or jugular venous distention.
Question 2
Which prescriptions should the nurse anticipate? Select all that apply.
,A. IV furosemide
B. Supplemental oxygen
C. IV isotonic fluid bolus
D. Sodium-restricted diet
E. Continuous cardiac monitoring
Answer: IV furosemide; Supplemental oxygen; Sodium-restricted diet;
Continuous cardiac monitoring
Rationale: Acute decompensated heart failure commonly requires diuresis,
oxygen support, sodium restriction, and cardiac monitoring. A routine
isotonic fluid bolus can worsen pulmonary and systemic congestion.
Question 3
The nurse administers IV furosemide. Which finding best indicates therapeutic
effectiveness?
A. Increased urine output
B. Increased heart rate
C. Increased jugular venous pressure
D. Increased peripheral edema
Answer: Increased urine output
Rationale: Furosemide promotes sodium and water excretion. Increased urine
output, decreased pulmonary congestion, and improved oxygenation indicate
effective diuresis.
Question 4
Which laboratory value is most important for the nurse to monitor after
administering repeated doses of furosemide?
A. Hemoglobin
B. Potassium
C. Platelet count
D. White blood cell count
Answer: Potassium
,Rationale: Loop diuretics can cause significant potassium loss, increasing the
risk of dysrhythmias and muscle weakness.
Question 5
The client's potassium level decreases to 3.0 mEq/L (3.0 mmol/L). Which action
is the priority?
A. Administer potassium replacement as prescribed
B. Restrict dietary potassium
C. Administer another dose of furosemide immediately
D. Encourage ambulation
Answer: Administer potassium replacement as prescribed
Rationale: A potassium level of 3.0 mEq/L represents hypokalemia. Prompt
replacement helps prevent potentially dangerous cardiac dysrhythmias,
especially in a client with heart failure.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and extreme thirst. The client reports missing insulin
doses because of a recent viral illness.
Vital signs: BP 94/58 mm Hg, HR 124/min, RR 30/min, temperature 38.1°C
(100.6°F).
Laboratory results: glucose 540 mg/dL, pH 7.18, bicarbonate 12 mEq/L,
potassium 5.6 mEq/L, positive serum ketones.
Question 6
Which finding is most characteristic of diabetic ketoacidosis?
A. Bradycardia
B. Kussmaul respirations
C. Respiratory depression
D. Severe hypertension
Answer: Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid respirations that occur as
the body attempts to compensate for metabolic acidosis by eliminating
carbon dioxide.
Question 7
Which intervention should the nurse implement first?
A. Administer IV regular insulin
B. Begin prescribed IV isotonic fluid replacement
C. Administer potassium immediately
D. Give oral glucose
Answer: Begin prescribed IV isotonic fluid replacement
Rationale: Severe dehydration and hypovolemia are major features of DKA.
Initial treatment generally prioritizes restoration of circulating volume with
isotonic IV fluids, followed by insulin and electrolyte management.
Question 8
Why is the client's serum potassium elevated despite total-body potassium
depletion?
A. Insulin causes potassium to leave the cells
B. Acidosis shifts potassium from cells into the bloodstream
C. The kidneys are retaining excessive potassium because of hyperglycemia
D. The client has increased dietary potassium intake
Answer: Acidosis shifts potassium from cells into the bloodstream
Rationale: In DKA, insulin deficiency and acidosis cause potassium to shift
from the intracellular to extracellular space. Despite the elevated serum level,
total-body potassium is usually depleted because of urinary losses.
Question 9
The client's glucose decreases to 240 mg/dL, but metabolic acidosis persists.
Which intervention should the nurse anticipate?
A. Stop insulin permanently
B. Add dextrose to IV fluids while continuing insulin
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A Instant Download Pdf
Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and heart failure with
reduced ejection fraction is admitted with increasing dyspnea, orthopnea, and
bilateral lower-extremity edema. The client reports a 3-kg weight gain over the
past week.
Vital signs: BP 168/94 mm Hg, HR 108/min, RR 28/min, SpO₂ 88% on room air,
temperature 36.8°C (98.2°F).
Assessment reveals bilateral crackles, jugular venous distention, and 3+ pitting
edema.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. 3+ bilateral ankle edema
B. Jugular venous distention
C. Oxygen saturation of 88%
D. Weight gain of 3 kg
Answer: Oxygen saturation of 88%
Rationale: An SpO₂ of 88% indicates significant hypoxemia and impaired
oxygenation. Airway and breathing take priority over manifestations such as
edema, weight gain, or jugular venous distention.
Question 2
Which prescriptions should the nurse anticipate? Select all that apply.
,A. IV furosemide
B. Supplemental oxygen
C. IV isotonic fluid bolus
D. Sodium-restricted diet
E. Continuous cardiac monitoring
Answer: IV furosemide; Supplemental oxygen; Sodium-restricted diet;
Continuous cardiac monitoring
Rationale: Acute decompensated heart failure commonly requires diuresis,
oxygen support, sodium restriction, and cardiac monitoring. A routine
isotonic fluid bolus can worsen pulmonary and systemic congestion.
Question 3
The nurse administers IV furosemide. Which finding best indicates therapeutic
effectiveness?
A. Increased urine output
B. Increased heart rate
C. Increased jugular venous pressure
D. Increased peripheral edema
Answer: Increased urine output
Rationale: Furosemide promotes sodium and water excretion. Increased urine
output, decreased pulmonary congestion, and improved oxygenation indicate
effective diuresis.
Question 4
Which laboratory value is most important for the nurse to monitor after
administering repeated doses of furosemide?
A. Hemoglobin
B. Potassium
C. Platelet count
D. White blood cell count
Answer: Potassium
,Rationale: Loop diuretics can cause significant potassium loss, increasing the
risk of dysrhythmias and muscle weakness.
Question 5
The client's potassium level decreases to 3.0 mEq/L (3.0 mmol/L). Which action
is the priority?
A. Administer potassium replacement as prescribed
B. Restrict dietary potassium
C. Administer another dose of furosemide immediately
D. Encourage ambulation
Answer: Administer potassium replacement as prescribed
Rationale: A potassium level of 3.0 mEq/L represents hypokalemia. Prompt
replacement helps prevent potentially dangerous cardiac dysrhythmias,
especially in a client with heart failure.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and extreme thirst. The client reports missing insulin
doses because of a recent viral illness.
Vital signs: BP 94/58 mm Hg, HR 124/min, RR 30/min, temperature 38.1°C
(100.6°F).
Laboratory results: glucose 540 mg/dL, pH 7.18, bicarbonate 12 mEq/L,
potassium 5.6 mEq/L, positive serum ketones.
Question 6
Which finding is most characteristic of diabetic ketoacidosis?
A. Bradycardia
B. Kussmaul respirations
C. Respiratory depression
D. Severe hypertension
Answer: Kussmaul respirations
, Rationale: Kussmaul respirations are deep, rapid respirations that occur as
the body attempts to compensate for metabolic acidosis by eliminating
carbon dioxide.
Question 7
Which intervention should the nurse implement first?
A. Administer IV regular insulin
B. Begin prescribed IV isotonic fluid replacement
C. Administer potassium immediately
D. Give oral glucose
Answer: Begin prescribed IV isotonic fluid replacement
Rationale: Severe dehydration and hypovolemia are major features of DKA.
Initial treatment generally prioritizes restoration of circulating volume with
isotonic IV fluids, followed by insulin and electrolyte management.
Question 8
Why is the client's serum potassium elevated despite total-body potassium
depletion?
A. Insulin causes potassium to leave the cells
B. Acidosis shifts potassium from cells into the bloodstream
C. The kidneys are retaining excessive potassium because of hyperglycemia
D. The client has increased dietary potassium intake
Answer: Acidosis shifts potassium from cells into the bloodstream
Rationale: In DKA, insulin deficiency and acidosis cause potassium to shift
from the intracellular to extracellular space. Despite the elevated serum level,
total-body potassium is usually depleted because of urinary losses.
Question 9
The client's glucose decreases to 240 mg/dL, but metabolic acidosis persists.
Which intervention should the nurse anticipate?
A. Stop insulin permanently
B. Add dextrose to IV fluids while continuing insulin
