NCLEX RN Next Generation Case Study
Exam 3 100 Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant
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CASE STUDY 1: ACUTE HEART FAILURE
A 72-year-old client with a history of hypertension and coronary artery disease
presents to the emergency department with increasing shortness of breath,
orthopnea, and bilateral lower-extremity edema. The client reports gaining 4 kg
(8.8 lb) over the past week. Assessment reveals crackles throughout both lung
fields, jugular venous distention, BP 168/94 mm Hg, HR 108/min, RR 30/min,
and SpO₂ 86% on room air.
Question 1
Which finding is the nurse's priority?
A. Bilateral lower-extremity edema
B. Weight gain
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia and
impaired oxygenation. Airway and breathing take priority over fluid retention
and hypertension.
Question 2
Which nursing action should the nurse implement first?
,A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain a daily weight
D. Apply compression stockings
Answer: Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes lung expansion and decreases
venous return, helping reduce pulmonary congestion and improve
oxygenation.
Question 3
Which findings support acute decompensated heart failure? Select all that
apply.
A. Crackles
B. Jugular venous distention
C. Sudden weight gain
D. SpO₂ of 86%
E. Increased urine output
F. Bilateral peripheral edema
Answer: Crackles, jugular venous distention, sudden weight gain, SpO₂ of
86%, bilateral peripheral edema
Rationale: Pulmonary crackles, JVD, rapid weight gain, hypoxemia, and
peripheral edema are classic manifestations of fluid overload associated with
acute heart failure.
Question 4
The provider prescribes IV furosemide. Which laboratory value is most
important for the nurse to monitor?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: Potassium
,Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss. Hypokalemia increases the risk for dysrhythmias.
Question 5
Which client statement indicates an understanding of heart failure self-
management?
A. "I should drink as much water as possible every day."
B. "I will weigh myself at the same time each morning."
C. "I can stop my medications when my swelling improves."
D. "I should add extra salt when food tastes bland."
Answer: "I will weigh myself at the same time each morning."
Rationale: Daily weights obtained under consistent conditions help detect
early fluid retention before symptoms become severe.
Question 6
The client develops severe dyspnea, pink frothy sputum, and increasing
crackles. Which complication should the nurse suspect?
A. Pulmonary edema
B. Pneumothorax
C. Pulmonary embolism
D. Pleural effusion
Answer: Pulmonary edema
Rationale: Severe dyspnea, diffuse crackles, and pink frothy sputum are
hallmark findings of acute pulmonary edema caused by severe pulmonary
congestion.
Question 7
Which prescription should the nurse question for this client?
A. IV furosemide
B. Oxygen therapy
C. Sodium-restricted diet
D. Rapid infusion of 1 L normal saline
Answer: Rapid infusion of 1 L normal saline
, Rationale: Rapid administration of a large volume of isotonic fluid can worsen
pulmonary and systemic congestion in a client with acute heart failure.
CASE STUDY 2: DIABETIC KETOACIDOSIS
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and increasing thirst. The client reports missing
several insulin doses. Laboratory results include glucose 498 mg/dL, arterial pH
7.19, bicarbonate 12 mEq/L, and positive serum ketones. The client is lethargic
and has deep, rapid respirations.
Question 8
Which condition is most likely occurring?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Metabolic alkalosis
Answer: Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, ketones, dehydration, and
Kussmaul respirations are characteristic of diabetic ketoacidosis.
Question 9
Which finding requires immediate nursing intervention?
A. Blood glucose of 498 mg/dL
B. Abdominal discomfort
C. Deep, rapid respirations
D. Increased thirst
Answer: Deep, rapid respirations
Rationale: Kussmaul respirations indicate severe metabolic acidosis. They
represent the client's compensatory attempt to eliminate carbon dioxide and
require immediate attention.
Question 10
Which intervention is the priority during initial treatment?
Exam 3 100 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 coronary artery disease
presents to the emergency department with increasing shortness of breath,
orthopnea, and bilateral lower-extremity edema. The client reports gaining 4 kg
(8.8 lb) over the past week. Assessment reveals crackles throughout both lung
fields, jugular venous distention, BP 168/94 mm Hg, HR 108/min, RR 30/min,
and SpO₂ 86% on room air.
Question 1
Which finding is the nurse's priority?
A. Bilateral lower-extremity edema
B. Weight gain
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: Oxygen saturation of 86%
Rationale: An oxygen saturation of 86% indicates significant hypoxemia and
impaired oxygenation. Airway and breathing take priority over fluid retention
and hypertension.
Question 2
Which nursing action should the nurse implement first?
,A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Obtain a daily weight
D. Apply compression stockings
Answer: Place the client in high-Fowler's position
Rationale: High-Fowler's positioning promotes lung expansion and decreases
venous return, helping reduce pulmonary congestion and improve
oxygenation.
Question 3
Which findings support acute decompensated heart failure? Select all that
apply.
A. Crackles
B. Jugular venous distention
C. Sudden weight gain
D. SpO₂ of 86%
E. Increased urine output
F. Bilateral peripheral edema
Answer: Crackles, jugular venous distention, sudden weight gain, SpO₂ of
86%, bilateral peripheral edema
Rationale: Pulmonary crackles, JVD, rapid weight gain, hypoxemia, and
peripheral edema are classic manifestations of fluid overload associated with
acute heart failure.
Question 4
The provider prescribes IV furosemide. Which laboratory value is most
important for the nurse to monitor?
A. Calcium
B. Potassium
C. Hemoglobin
D. Platelets
Answer: Potassium
,Rationale: Furosemide is a loop diuretic that can cause significant potassium
loss. Hypokalemia increases the risk for dysrhythmias.
Question 5
Which client statement indicates an understanding of heart failure self-
management?
A. "I should drink as much water as possible every day."
B. "I will weigh myself at the same time each morning."
C. "I can stop my medications when my swelling improves."
D. "I should add extra salt when food tastes bland."
Answer: "I will weigh myself at the same time each morning."
Rationale: Daily weights obtained under consistent conditions help detect
early fluid retention before symptoms become severe.
Question 6
The client develops severe dyspnea, pink frothy sputum, and increasing
crackles. Which complication should the nurse suspect?
A. Pulmonary edema
B. Pneumothorax
C. Pulmonary embolism
D. Pleural effusion
Answer: Pulmonary edema
Rationale: Severe dyspnea, diffuse crackles, and pink frothy sputum are
hallmark findings of acute pulmonary edema caused by severe pulmonary
congestion.
Question 7
Which prescription should the nurse question for this client?
A. IV furosemide
B. Oxygen therapy
C. Sodium-restricted diet
D. Rapid infusion of 1 L normal saline
Answer: Rapid infusion of 1 L normal saline
, Rationale: Rapid administration of a large volume of isotonic fluid can worsen
pulmonary and systemic congestion in a client with acute heart failure.
CASE STUDY 2: DIABETIC KETOACIDOSIS
A 24-year-old client with type 1 diabetes mellitus presents with nausea,
vomiting, abdominal pain, and increasing thirst. The client reports missing
several insulin doses. Laboratory results include glucose 498 mg/dL, arterial pH
7.19, bicarbonate 12 mEq/L, and positive serum ketones. The client is lethargic
and has deep, rapid respirations.
Question 8
Which condition is most likely occurring?
A. Hyperosmolar hyperglycemic state
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Metabolic alkalosis
Answer: Diabetic ketoacidosis
Rationale: Hyperglycemia, metabolic acidosis, ketones, dehydration, and
Kussmaul respirations are characteristic of diabetic ketoacidosis.
Question 9
Which finding requires immediate nursing intervention?
A. Blood glucose of 498 mg/dL
B. Abdominal discomfort
C. Deep, rapid respirations
D. Increased thirst
Answer: Deep, rapid respirations
Rationale: Kussmaul respirations indicate severe metabolic acidosis. They
represent the client's compensatory attempt to eliminate carbon dioxide and
require immediate attention.
Question 10
Which intervention is the priority during initial treatment?
