NCLEX RN Next Generation Case Study
Exam 8 100 Questions And Correct
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Case Study 1: Acute Heart Failure
A 72-year-old client with a history of hypertension and coronary artery disease is admitted
with worsening shortness of breath. The client reports gaining 4 kg (8.8 lb) over the past
week. Assessment findings include bilateral crackles, jugular venous distention, 2+ bilateral
lower-extremity edema, BP 168/94 mm Hg, HR 108/min, RR 30/min, and oxygen saturation
86% on room air.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. Bilateral 2+ lower-extremity edema
B. Weight gain of 4 kg
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: Oxygen saturation of 86%
Rationale: Hypoxemia is the immediate priority because impaired oxygenation can rapidly
become life-threatening. The client's crackles and dyspnea indicate pulmonary congestion
associated with acute heart failure.
Question 2
Which intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Encourage ambulation
D. Place the client in a supine position
Answer: Place the client in high-Fowler's position
,Rationale: High-Fowler's positioning improves lung expansion and decreases venous
return, helping reduce pulmonary congestion and improve oxygenation.
Question 3
The provider prescribes IV furosemide. Which laboratory value is most important for the
nurse to monitor?
A. Potassium
B. Hemoglobin
C. Platelets
D. Amylase
Answer: Potassium
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss.
Hypokalemia increases the risk of dysrhythmias.
Question 4 — Select all that apply
Which findings indicate worsening fluid overload?
A. Increasing crackles
B. Decreased peripheral edema
C. Increasing daily weight
D. Jugular venous distention
E. Increased urine output
F. Increasing dyspnea
Answer: Increasing crackles, Increasing daily weight, Jugular venous distention,
Increasing dyspnea
Rationale: Pulmonary crackles, weight gain, jugular venous distention, and dyspnea are
classic indicators of worsening fluid retention and heart failure.
Question 5
After treatment, which finding best indicates improvement?
A. Oxygen saturation 94% on prescribed oxygen
B. Respiratory rate 32/min
C. Increasing crackles
D. New confusion
Answer: Oxygen saturation 94% on prescribed oxygen
Rationale: Improved oxygen saturation indicates better gas exchange and response to
treatment.
,Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea, vomiting, abdominal
pain, and excessive thirst. The client is lethargic. Blood glucose is 548 mg/dL, pH 7.18,
bicarbonate 12 mEq/L, and potassium 5.6 mEq/L. Respirations are deep and rapid.
Question 6
Which finding is most characteristic of diabetic ketoacidosis?
A. Slow shallow respirations
B. Kussmaul respirations
C. Bradycardia
D. Severe hypertension
Answer: Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid respirations that compensate for
metabolic acidosis by increasing carbon dioxide elimination.
Question 7
Which prescribed treatment should the nurse anticipate first?
A. IV regular insulin
B. IV isotonic fluid replacement
C. Oral hypoglycemic medication
D. Sodium restriction
Answer: IV isotonic fluid replacement
Rationale: Initial DKA management prioritizes restoration of circulating volume with
isotonic IV fluids. Insulin is then administered according to the treatment protocol.
Question 8
The client's serum potassium is 5.6 mEq/L. Why can potassium levels become dangerously
low during treatment?
A. Insulin shifts potassium into cells
B. Insulin causes potassium to leave cells
C. IV fluids directly destroy potassium
D. Glucose prevents renal potassium excretion
Answer: Insulin shifts potassium into cells
, Rationale: Although serum potassium may initially be elevated in DKA, total-body
potassium is depleted. Insulin moves potassium intracellularly, potentially causing
hypokalemia during treatment.
Question 9 — Select all that apply
Which findings are consistent with DKA?
A. Hyperglycemia
B. Metabolic acidosis
C. Ketone production
D. Dehydration
E. Severe respiratory alkalosis
F. Kussmaul respirations
Answer: Hyperglycemia, Metabolic acidosis, Ketone production, Dehydration,
Kussmaul respirations
Rationale: DKA results from insulin deficiency, causing hyperglycemia, fat breakdown,
ketone production, dehydration, and metabolic acidosis with compensatory Kussmaul
respirations.
Question 10
Which finding best indicates that DKA treatment is effective?
A. Blood glucose decreases while acidosis resolves
B. Urine output decreases
C. Respirations become more rapid
D. Serum ketones increase
Answer: Blood glucose decreases while acidosis resolves
Rationale: Effective DKA treatment reverses hyperglycemia, ketone production,
dehydration, and metabolic acidosis.
Case Study 3: Stroke
A 68-year-old client suddenly develops right-sided weakness, facial drooping, and difficulty
speaking while eating breakfast. The last known well time was 45 minutes ago.
Question 11
What is the nurse's priority action?
A. Give aspirin immediately
B. Determine the exact time symptoms began
Exam 8 100 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 is admitted
with worsening shortness of breath. The client reports gaining 4 kg (8.8 lb) over the past
week. Assessment findings include bilateral crackles, jugular venous distention, 2+ bilateral
lower-extremity edema, BP 168/94 mm Hg, HR 108/min, RR 30/min, and oxygen saturation
86% on room air.
Question 1
Which assessment finding requires the nurse's immediate attention?
A. Bilateral 2+ lower-extremity edema
B. Weight gain of 4 kg
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: Oxygen saturation of 86%
Rationale: Hypoxemia is the immediate priority because impaired oxygenation can rapidly
become life-threatening. The client's crackles and dyspnea indicate pulmonary congestion
associated with acute heart failure.
Question 2
Which intervention should the nurse implement first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
C. Encourage ambulation
D. Place the client in a supine position
Answer: Place the client in high-Fowler's position
,Rationale: High-Fowler's positioning improves lung expansion and decreases venous
return, helping reduce pulmonary congestion and improve oxygenation.
Question 3
The provider prescribes IV furosemide. Which laboratory value is most important for the
nurse to monitor?
A. Potassium
B. Hemoglobin
C. Platelets
D. Amylase
Answer: Potassium
Rationale: Furosemide is a loop diuretic that can cause significant potassium loss.
Hypokalemia increases the risk of dysrhythmias.
Question 4 — Select all that apply
Which findings indicate worsening fluid overload?
A. Increasing crackles
B. Decreased peripheral edema
C. Increasing daily weight
D. Jugular venous distention
E. Increased urine output
F. Increasing dyspnea
Answer: Increasing crackles, Increasing daily weight, Jugular venous distention,
Increasing dyspnea
Rationale: Pulmonary crackles, weight gain, jugular venous distention, and dyspnea are
classic indicators of worsening fluid retention and heart failure.
Question 5
After treatment, which finding best indicates improvement?
A. Oxygen saturation 94% on prescribed oxygen
B. Respiratory rate 32/min
C. Increasing crackles
D. New confusion
Answer: Oxygen saturation 94% on prescribed oxygen
Rationale: Improved oxygen saturation indicates better gas exchange and response to
treatment.
,Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus presents with nausea, vomiting, abdominal
pain, and excessive thirst. The client is lethargic. Blood glucose is 548 mg/dL, pH 7.18,
bicarbonate 12 mEq/L, and potassium 5.6 mEq/L. Respirations are deep and rapid.
Question 6
Which finding is most characteristic of diabetic ketoacidosis?
A. Slow shallow respirations
B. Kussmaul respirations
C. Bradycardia
D. Severe hypertension
Answer: Kussmaul respirations
Rationale: Kussmaul respirations are deep and rapid respirations that compensate for
metabolic acidosis by increasing carbon dioxide elimination.
Question 7
Which prescribed treatment should the nurse anticipate first?
A. IV regular insulin
B. IV isotonic fluid replacement
C. Oral hypoglycemic medication
D. Sodium restriction
Answer: IV isotonic fluid replacement
Rationale: Initial DKA management prioritizes restoration of circulating volume with
isotonic IV fluids. Insulin is then administered according to the treatment protocol.
Question 8
The client's serum potassium is 5.6 mEq/L. Why can potassium levels become dangerously
low during treatment?
A. Insulin shifts potassium into cells
B. Insulin causes potassium to leave cells
C. IV fluids directly destroy potassium
D. Glucose prevents renal potassium excretion
Answer: Insulin shifts potassium into cells
, Rationale: Although serum potassium may initially be elevated in DKA, total-body
potassium is depleted. Insulin moves potassium intracellularly, potentially causing
hypokalemia during treatment.
Question 9 — Select all that apply
Which findings are consistent with DKA?
A. Hyperglycemia
B. Metabolic acidosis
C. Ketone production
D. Dehydration
E. Severe respiratory alkalosis
F. Kussmaul respirations
Answer: Hyperglycemia, Metabolic acidosis, Ketone production, Dehydration,
Kussmaul respirations
Rationale: DKA results from insulin deficiency, causing hyperglycemia, fat breakdown,
ketone production, dehydration, and metabolic acidosis with compensatory Kussmaul
respirations.
Question 10
Which finding best indicates that DKA treatment is effective?
A. Blood glucose decreases while acidosis resolves
B. Urine output decreases
C. Respirations become more rapid
D. Serum ketones increase
Answer: Blood glucose decreases while acidosis resolves
Rationale: Effective DKA treatment reverses hyperglycemia, ketone production,
dehydration, and metabolic acidosis.
Case Study 3: Stroke
A 68-year-old client suddenly develops right-sided weakness, facial drooping, and difficulty
speaking while eating breakfast. The last known well time was 45 minutes ago.
Question 11
What is the nurse's priority action?
A. Give aspirin immediately
B. Determine the exact time symptoms began
