NCLEX-RN Next Generation (NGN) Case
Study Exam 1 100 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
Question 1
Which finding is the nurse's priority concern?
A. Bilateral lower-extremity edema
B. Anxiety
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: C. Oxygen saturation of 86%
Rationale: Severe hypoxemia indicates impaired oxygenation and is the
immediate priority. Airway and breathing take precedence over circulation and
psychosocial concerns.
Question 2
Which assessment findings support acute pulmonary edema? Select all that apply.
A. Bilateral crackles
B. Orthopnea
C. SpO₂ 86%
D. 3+ peripheral edema
E. Bradycardia
Answers: Bilateral crackles; Orthopnea; SpO₂ 86%; 3+ peripheral edema
Rationale: Pulmonary and systemic fluid overload commonly cause crackles,
orthopnea, hypoxemia, and peripheral edema. Bradycardia is not an expected
finding in this presentation.
Question 3
Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
,C. Assist the client to ambulate
D. Place the client in Trendelenburg position
Answer: Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases venous
return, helping reduce pulmonary congestion while oxygen therapy and further
treatment are initiated.
Question 4
The provider prescribes IV furosemide. Which finding requires the most
immediate follow-up after administration?
A. Urine output of 800 mL
B. Potassium level of 2.9 mEq/L
C. Decreased ankle edema
D. Reduced respiratory rate
Answer: Potassium level of 2.9 mEq/L
Rationale: Furosemide can cause significant potassium loss. Severe hypokalemia
increases the risk of dysrhythmias and requires prompt intervention.
Question 5
Which client statement indicates correct understanding of heart-failure self-
management?
A. "I should weigh myself once a month."
B. "I can stop my medications when I feel better."
C. "I should report a rapid increase in my weight."
D. "I should increase sodium intake when I have edema."
Answer: I should report a rapid increase in my weight.
Rationale: Rapid weight gain can indicate fluid retention and worsening heart
failure. Daily weights are an important method of detecting fluid accumulation
early.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus arrives with nausea, vomiting,
abdominal pain, and deep, rapid respirations. The client reports missing several
insulin doses because of a recent viral illness. Laboratory results: glucose 486
mg/dL, pH 7.19, bicarbonate 12 mEq/L, potassium 5.6 mEq/L, and positive serum
ketones.
Question 6
Which finding is most consistent with diabetic ketoacidosis (DKA)?
, A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Answer: Metabolic acidosis
Rationale: DKA causes accumulation of ketones, producing metabolic acidosis
characterized by low pH and low bicarbonate.
Question 7
Which assessment finding requires immediate nursing attention?
A. Fruity breath odor
B. Abdominal discomfort
C. Deep, rapid respirations
D. Blood glucose of 486 mg/dL
Answer: Deep, rapid respirations
Rationale: Kussmaul respirations are a compensatory response to severe
metabolic acidosis and indicate significant physiologic disturbance.
Question 8
Which intervention should the nurse anticipate first?
A. Restrict fluids
B. Administer isotonic IV fluid
C. Administer oral glucose
D. Give sodium bicarbonate routinely
Answer: Administer isotonic IV fluid
Rationale: Severe dehydration is a major feature of DKA. Initial management
generally focuses on restoring circulating volume with isotonic fluids, followed
by insulin and electrolyte management.
Question 9
The client's potassium is initially 5.6 mEq/L. Why must potassium be monitored
closely during insulin therapy?
A. Insulin causes potassium to move into cells.
B. Insulin causes potassium to leave cells.
C. Insulin permanently increases serum potassium.
D. Insulin prevents renal potassium excretion.
Answer: Insulin causes potassium to move into cells.
Rationale: Although serum potassium may initially be elevated, total-body
potassium is usually depleted in DKA. Insulin shifts potassium intracellularly and
can cause dangerous hypokalemia.
Study Exam 1 100 Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Question 1
Which finding is the nurse's priority concern?
A. Bilateral lower-extremity edema
B. Anxiety
C. Oxygen saturation of 86%
D. Blood pressure of 168/94 mm Hg
Answer: C. Oxygen saturation of 86%
Rationale: Severe hypoxemia indicates impaired oxygenation and is the
immediate priority. Airway and breathing take precedence over circulation and
psychosocial concerns.
Question 2
Which assessment findings support acute pulmonary edema? Select all that apply.
A. Bilateral crackles
B. Orthopnea
C. SpO₂ 86%
D. 3+ peripheral edema
E. Bradycardia
Answers: Bilateral crackles; Orthopnea; SpO₂ 86%; 3+ peripheral edema
Rationale: Pulmonary and systemic fluid overload commonly cause crackles,
orthopnea, hypoxemia, and peripheral edema. Bradycardia is not an expected
finding in this presentation.
Question 3
Which action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler's position
,C. Assist the client to ambulate
D. Place the client in Trendelenburg position
Answer: Place the client in high-Fowler's position
Rationale: Upright positioning improves lung expansion and decreases venous
return, helping reduce pulmonary congestion while oxygen therapy and further
treatment are initiated.
Question 4
The provider prescribes IV furosemide. Which finding requires the most
immediate follow-up after administration?
A. Urine output of 800 mL
B. Potassium level of 2.9 mEq/L
C. Decreased ankle edema
D. Reduced respiratory rate
Answer: Potassium level of 2.9 mEq/L
Rationale: Furosemide can cause significant potassium loss. Severe hypokalemia
increases the risk of dysrhythmias and requires prompt intervention.
Question 5
Which client statement indicates correct understanding of heart-failure self-
management?
A. "I should weigh myself once a month."
B. "I can stop my medications when I feel better."
C. "I should report a rapid increase in my weight."
D. "I should increase sodium intake when I have edema."
Answer: I should report a rapid increase in my weight.
Rationale: Rapid weight gain can indicate fluid retention and worsening heart
failure. Daily weights are an important method of detecting fluid accumulation
early.
Case Study 2: Diabetic Ketoacidosis
A 24-year-old client with type 1 diabetes mellitus arrives with nausea, vomiting,
abdominal pain, and deep, rapid respirations. The client reports missing several
insulin doses because of a recent viral illness. Laboratory results: glucose 486
mg/dL, pH 7.19, bicarbonate 12 mEq/L, potassium 5.6 mEq/L, and positive serum
ketones.
Question 6
Which finding is most consistent with diabetic ketoacidosis (DKA)?
, A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Answer: Metabolic acidosis
Rationale: DKA causes accumulation of ketones, producing metabolic acidosis
characterized by low pH and low bicarbonate.
Question 7
Which assessment finding requires immediate nursing attention?
A. Fruity breath odor
B. Abdominal discomfort
C. Deep, rapid respirations
D. Blood glucose of 486 mg/dL
Answer: Deep, rapid respirations
Rationale: Kussmaul respirations are a compensatory response to severe
metabolic acidosis and indicate significant physiologic disturbance.
Question 8
Which intervention should the nurse anticipate first?
A. Restrict fluids
B. Administer isotonic IV fluid
C. Administer oral glucose
D. Give sodium bicarbonate routinely
Answer: Administer isotonic IV fluid
Rationale: Severe dehydration is a major feature of DKA. Initial management
generally focuses on restoring circulating volume with isotonic fluids, followed
by insulin and electrolyte management.
Question 9
The client's potassium is initially 5.6 mEq/L. Why must potassium be monitored
closely during insulin therapy?
A. Insulin causes potassium to move into cells.
B. Insulin causes potassium to leave cells.
C. Insulin permanently increases serum potassium.
D. Insulin prevents renal potassium excretion.
Answer: Insulin causes potassium to move into cells.
Rationale: Although serum potassium may initially be elevated, total-body
potassium is usually depleted in DKA. Insulin shifts potassium intracellularly and
can cause dangerous hypokalemia.
