Back-to-School Nursing Exam Prep September
2025/2026 | 3Ps Test Bank with Clinical Case Studies
(Primary Care, Advanced Pathophysiology,
Pharmacology & Physical Assessment) | 200+
Verified Practice Questions with Detailed Answers &
Rationales | Comprehensive Study Guide for Nurse
Practitioner (NP), MSN, DNP & NCLEX Preparation
CASE: 1: Patient with Diabetes and Foot
Ulcer SCENARIO:
A 58-year-old male with a history of type 2 diabetes presents to the clinic with a non- healing
ulcer on the plantar surface of his left foot. He reports numbness in his feet and has difficulty
controlling his blood sugar levels. His HbA1c is 9.2%.
Questions and Answers:
1. Patient:
o What additional information would you gather about the
patient’s medical history and current medications?
▪ I would inquire about the duration of his diabetes, any previous
foot ulcers or infections, his current medication regimen (including oral
hypoglycemics or insulin), and adherence to these
medications. I'd also assess his lifestyle habits, such as diet,
exercise, and smoking status, as well as any recent changes in his
health or medical treatments.
o How does the patient's diabetes impact his healing process?
▪ Diabetes can impair wound healing due to factors such as poor
circulation, neuropathy, and a compromised immune response.
Elevated blood sugar levels can also lead to increased
inflammation, reducing the body's ability to heal wounds
effectively.
2. Problem:
o Identify the primary problems this patient is facing.
What complications could arise from his foot ulcer?
▪ The primary problems include the non-healing foot ulcer, neuropathy
(as indicated by numbness), and poor glycemic control (as indicated
by the elevated HbA1c). Complications may include infection
(potentially leading to cellulitis or osteomyelitis),
gangrene, and, in severe CASE: s, the need for amputation.
,o How might his neuropathy contribute to the severity of his condition?
, ▪ Neuropathy can lead to a loss of sensation in the feet, making the
patient unaware of injuries or pressure points. This can result in
undetected wounds or ulcers that worsen over time, as the patient may
not seek timely medical attention.
3. Plan:
o What immediate interventions should be implemented to manage
the foot ulcer?
▪ Immediate interventions include cleaning and debriding the ulcer,
applying appropriate dressings, and possibly initiating topical or
systemic antibiotics if infection is suspected. Additionally,
offloading pressure from the ulcer using special footwear or a
protective boot is crucial.
o What long-term strategies should be recommended to improve
his diabetes management and prevent future ulcers?
▪ Long-term strategies should include:
▪ Tight glycemic control through medication adjustments and
lifestyle modifications (diet and exercise).
▪ Regular foot examinations and education on foot care practices.
▪ Referral to a diabetes educator or dietitian for nutritional
counseling.
▪ Encouragement to quit smoking if applicable, as it impairs
circulation.
CASE: 2: Elderly Patient with Heart Failure
SCENARIO:
A 75-year-old female with a history of congestive heart failure (CHF) is admitted to the hospital
with acute shortness of breath and edema. She is on a low-sodium diet and takes
furosemide, lisinopril, and metoprolol. Her vital signs show a blood pressure of 110/70
mmHg, heart rate of 90 bpm, and respiratory rate of 24 breaths/min.
Questions and Answers:
1. Patient:
o What factors in her history might contribute to her current condition?
▪ Contributing factors may include non-compliance with her low-
sodium diet, inadequate diuretic therapy, recent illness (like a
respiratory infection), or medication interactions. Comorbid
, conditions (such as renal impairment or arrhythmias) could also
exacerbate her heart failure.
o How do her age and comorbidities affect her treatment options?
▪ Her age may increase her susceptibility to side effects from
medications and limit her ability to tolerate aggressive treatments.
Comorbidities such as renal disease may necessitate adjustments in
diuretics and careful monitoring of fluid and electrolyte balance.
2. Problem:
o What are the key indicators of worsening heart failure in this patient?
▪ Key indicators include acute shortness of breath, edema, elevated
respiratory rate, and potential changes in weight. The presence of
jugular venous distension and crackles upon lung auscultation may
also indicate fluid overload.
o What potential complications should be monitored during
her hospital stay?
▪ Potential complications include pulmonary edema, acute renal
failure, electrolyte imbalances (particularly hypokalemia or
hyperkalemia due to diuretics), and arrhythmias.
3. Plan:
o Outline a nursing care plan addressing her acute symptoms.
What assessments and interventions are necessary?
▪ The nursing care plan should include:
▪ Continuous monitoring of vital signs and oxygen saturation.
▪ Assessment of lung sounds and peripheral edema.
▪ Administering diuretics as ordered and monitoring urine output.
▪ Providing supplemental oxygen if needed.
▪ Educating the patient on her condition and the importance of
adherence to her medication and diet.
o What education should be provided to the patient and
family regarding lifestyle modifications and medication
adherence?
▪ Education should focus on the importance of adhering to a low-
sodium diet, recognizing signs of fluid overload, and
understanding the purpose and side effects of medications.
Encouragement to engage in light physical activity as tolerated and to
schedule regular follow-up appointments is also essential.
2025/2026 | 3Ps Test Bank with Clinical Case Studies
(Primary Care, Advanced Pathophysiology,
Pharmacology & Physical Assessment) | 200+
Verified Practice Questions with Detailed Answers &
Rationales | Comprehensive Study Guide for Nurse
Practitioner (NP), MSN, DNP & NCLEX Preparation
CASE: 1: Patient with Diabetes and Foot
Ulcer SCENARIO:
A 58-year-old male with a history of type 2 diabetes presents to the clinic with a non- healing
ulcer on the plantar surface of his left foot. He reports numbness in his feet and has difficulty
controlling his blood sugar levels. His HbA1c is 9.2%.
Questions and Answers:
1. Patient:
o What additional information would you gather about the
patient’s medical history and current medications?
▪ I would inquire about the duration of his diabetes, any previous
foot ulcers or infections, his current medication regimen (including oral
hypoglycemics or insulin), and adherence to these
medications. I'd also assess his lifestyle habits, such as diet,
exercise, and smoking status, as well as any recent changes in his
health or medical treatments.
o How does the patient's diabetes impact his healing process?
▪ Diabetes can impair wound healing due to factors such as poor
circulation, neuropathy, and a compromised immune response.
Elevated blood sugar levels can also lead to increased
inflammation, reducing the body's ability to heal wounds
effectively.
2. Problem:
o Identify the primary problems this patient is facing.
What complications could arise from his foot ulcer?
▪ The primary problems include the non-healing foot ulcer, neuropathy
(as indicated by numbness), and poor glycemic control (as indicated
by the elevated HbA1c). Complications may include infection
(potentially leading to cellulitis or osteomyelitis),
gangrene, and, in severe CASE: s, the need for amputation.
,o How might his neuropathy contribute to the severity of his condition?
, ▪ Neuropathy can lead to a loss of sensation in the feet, making the
patient unaware of injuries or pressure points. This can result in
undetected wounds or ulcers that worsen over time, as the patient may
not seek timely medical attention.
3. Plan:
o What immediate interventions should be implemented to manage
the foot ulcer?
▪ Immediate interventions include cleaning and debriding the ulcer,
applying appropriate dressings, and possibly initiating topical or
systemic antibiotics if infection is suspected. Additionally,
offloading pressure from the ulcer using special footwear or a
protective boot is crucial.
o What long-term strategies should be recommended to improve
his diabetes management and prevent future ulcers?
▪ Long-term strategies should include:
▪ Tight glycemic control through medication adjustments and
lifestyle modifications (diet and exercise).
▪ Regular foot examinations and education on foot care practices.
▪ Referral to a diabetes educator or dietitian for nutritional
counseling.
▪ Encouragement to quit smoking if applicable, as it impairs
circulation.
CASE: 2: Elderly Patient with Heart Failure
SCENARIO:
A 75-year-old female with a history of congestive heart failure (CHF) is admitted to the hospital
with acute shortness of breath and edema. She is on a low-sodium diet and takes
furosemide, lisinopril, and metoprolol. Her vital signs show a blood pressure of 110/70
mmHg, heart rate of 90 bpm, and respiratory rate of 24 breaths/min.
Questions and Answers:
1. Patient:
o What factors in her history might contribute to her current condition?
▪ Contributing factors may include non-compliance with her low-
sodium diet, inadequate diuretic therapy, recent illness (like a
respiratory infection), or medication interactions. Comorbid
, conditions (such as renal impairment or arrhythmias) could also
exacerbate her heart failure.
o How do her age and comorbidities affect her treatment options?
▪ Her age may increase her susceptibility to side effects from
medications and limit her ability to tolerate aggressive treatments.
Comorbidities such as renal disease may necessitate adjustments in
diuretics and careful monitoring of fluid and electrolyte balance.
2. Problem:
o What are the key indicators of worsening heart failure in this patient?
▪ Key indicators include acute shortness of breath, edema, elevated
respiratory rate, and potential changes in weight. The presence of
jugular venous distension and crackles upon lung auscultation may
also indicate fluid overload.
o What potential complications should be monitored during
her hospital stay?
▪ Potential complications include pulmonary edema, acute renal
failure, electrolyte imbalances (particularly hypokalemia or
hyperkalemia due to diuretics), and arrhythmias.
3. Plan:
o Outline a nursing care plan addressing her acute symptoms.
What assessments and interventions are necessary?
▪ The nursing care plan should include:
▪ Continuous monitoring of vital signs and oxygen saturation.
▪ Assessment of lung sounds and peripheral edema.
▪ Administering diuretics as ordered and monitoring urine output.
▪ Providing supplemental oxygen if needed.
▪ Educating the patient on her condition and the importance of
adherence to her medication and diet.
o What education should be provided to the patient and
family regarding lifestyle modifications and medication
adherence?
▪ Education should focus on the importance of adhering to a low-
sodium diet, recognizing signs of fluid overload, and
understanding the purpose and side effects of medications.
Encouragement to engage in light physical activity as tolerated and to
schedule regular follow-up appointments is also essential.
