NGN Case Study
Study online at https://quizlet.com/_ej2ei5
1. Cardiac - Patient 1
Client was brought to the emergency department by his son with reports of
difficulty breathing and inability to walk short distances without becoming
extremely short of breath. Client is a 72-year-old African American man with
a history of obesity, hypertension, coronary artery disease, and diabetes mel-
litus.
Client reports fatigue related to difficulty sleeping at night as a result of a
nonproductive cough that is unresolved with cough drops.
Client reports a weight gain of 10 pounds in the past week, despite his de-
creased appetite.
The son reports that his father has been unable to care for himself as a result of
the fatigue and increasing shortness of breath. He states "he has not showered
in over a week.": Assessment findings:
Cardiovascular: Sinus tachycardia with occasional premature ventricular contractions (PVCs). No murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated throughout bilateral lung fields, dyspnea with mild exertion,
orthopnea, nonproductive chronic cough
Gastrointestinal: Positive bowel sounds
Genitourinary: Clear yellow urine, urinary frequency, and nocturia
Peripheral: +4 pitting edema in bilateral lower extremities
Vital signs:
Temperature: 98.6°F (37°C)Heart rate: 120 beats/minRespiratory rate: 26 breaths/minBlood pressure: 152/90 mm
HgPulse oximetry reading of 93%
Imaging Studies
Electrocardiogram (ECG) reveals ventricular hypertrophy
Chest x-ray reveals cardiomegaly
Echocardiogram results pending
2. The nurse is preparing a plan of care for the client. Based on the information
provided, choose the potential condition with anticipated medication and side
effect from the list of options provided.
, NGN Case Study
Study online at https://quizlet.com/_ej2ei5
Potential Conditions
gastroparesis
acute renal failure
HF
hypothyroidism
Anticipated Meds
finasteride
furosemide
docusate sodium
nitroglycerin
levothyroxine
SEs to monitor
hypokalemia
hypoglycemia
stomatitis
hypotension
nausea: Potential Conditions
HF
Anticipated Meds
furosemide
nitroglycerin
SEs to monitor
hypokalemia
hypotension
Rationale:
Heart failure is a chronic condition when the heart does not effectively work as a pump. This condition is evident
by tachycardia, orthopnea, fatigue, edema, fluid overload, and elevated BNP levels. Furosemide is a loop diuretic
prescribed to treat heart failure. It is potassium wasting so the nurse should monitor for hypokalemia. Nitroglycerin is
, NGN Case Study
Study online at https://quizlet.com/_ej2ei5
a vasodilator prescribed to decrease the volume of blood return to the heart. Because it causes a decrease in blood
pressure, the nurse should monitor for hypotension. Gastroparesis is a complication caused by decreased stimulation
and peristalsis in the stomach. Acute renal failure is a temporary decrease in renal function that causes elevated serum
waste products. Hypothyroidism is a decrease in the thyroid hormone production causing weight gain and muscle
weakness. Levothyroxine is a medication that can treat hypothyroidism. Finasteride is a medication given to decrease
an enlarged prostate, not treat heart failure. Docusate sodium is a stool softener prescribed for constipation, not for
heart failure. Stomatitis are sores in the mouth often caused by chemotherapy treatment, not heart failure. Nausea is
not a common side effect of either furosemide of nitroglycerin.
3. Cardiac - Patient 2
A 64-year-old male client has arrived for an appointment at the outpatient clinic
because of difficulty breathing and a rash.
History:
Hypertension
Hypothyroidism
Depression
Erectile dysfunction
Chronic back pain
Hyperlipidemia
Anterior wall myocardial infarction (MI) at age 44. Up until the MI, he smoked
two packs of cigarettes per day for 25 years. After the MI, he completed a
cardiac rehabilitation program. His only current physical activity is walking
around at work.: He reports sleeping on two pillows and waking at night one to two times per week, gasping
with difficulty breathing and having to get up during the night to urinate. He has noticed increased irritability and
anxiety. Client reports joint and back pain in the evenings. He has increasing shortness of breath when he walks more
than 30 feet and is concerned about a red scaly rash on his left lower leg.
His body mass index (BMI) is 32 kg/m2. He works as the manager in a retail clothing store. He is divorced and has two
adult children and a grandchild who lives in another state. He lives in an apartment on the second floor.
Current vital signs:
Study online at https://quizlet.com/_ej2ei5
1. Cardiac - Patient 1
Client was brought to the emergency department by his son with reports of
difficulty breathing and inability to walk short distances without becoming
extremely short of breath. Client is a 72-year-old African American man with
a history of obesity, hypertension, coronary artery disease, and diabetes mel-
litus.
Client reports fatigue related to difficulty sleeping at night as a result of a
nonproductive cough that is unresolved with cough drops.
Client reports a weight gain of 10 pounds in the past week, despite his de-
creased appetite.
The son reports that his father has been unable to care for himself as a result of
the fatigue and increasing shortness of breath. He states "he has not showered
in over a week.": Assessment findings:
Cardiovascular: Sinus tachycardia with occasional premature ventricular contractions (PVCs). No murmur noted
Respiratory: Tachypnea, inspiratory crackles auscultated throughout bilateral lung fields, dyspnea with mild exertion,
orthopnea, nonproductive chronic cough
Gastrointestinal: Positive bowel sounds
Genitourinary: Clear yellow urine, urinary frequency, and nocturia
Peripheral: +4 pitting edema in bilateral lower extremities
Vital signs:
Temperature: 98.6°F (37°C)Heart rate: 120 beats/minRespiratory rate: 26 breaths/minBlood pressure: 152/90 mm
HgPulse oximetry reading of 93%
Imaging Studies
Electrocardiogram (ECG) reveals ventricular hypertrophy
Chest x-ray reveals cardiomegaly
Echocardiogram results pending
2. The nurse is preparing a plan of care for the client. Based on the information
provided, choose the potential condition with anticipated medication and side
effect from the list of options provided.
, NGN Case Study
Study online at https://quizlet.com/_ej2ei5
Potential Conditions
gastroparesis
acute renal failure
HF
hypothyroidism
Anticipated Meds
finasteride
furosemide
docusate sodium
nitroglycerin
levothyroxine
SEs to monitor
hypokalemia
hypoglycemia
stomatitis
hypotension
nausea: Potential Conditions
HF
Anticipated Meds
furosemide
nitroglycerin
SEs to monitor
hypokalemia
hypotension
Rationale:
Heart failure is a chronic condition when the heart does not effectively work as a pump. This condition is evident
by tachycardia, orthopnea, fatigue, edema, fluid overload, and elevated BNP levels. Furosemide is a loop diuretic
prescribed to treat heart failure. It is potassium wasting so the nurse should monitor for hypokalemia. Nitroglycerin is
, NGN Case Study
Study online at https://quizlet.com/_ej2ei5
a vasodilator prescribed to decrease the volume of blood return to the heart. Because it causes a decrease in blood
pressure, the nurse should monitor for hypotension. Gastroparesis is a complication caused by decreased stimulation
and peristalsis in the stomach. Acute renal failure is a temporary decrease in renal function that causes elevated serum
waste products. Hypothyroidism is a decrease in the thyroid hormone production causing weight gain and muscle
weakness. Levothyroxine is a medication that can treat hypothyroidism. Finasteride is a medication given to decrease
an enlarged prostate, not treat heart failure. Docusate sodium is a stool softener prescribed for constipation, not for
heart failure. Stomatitis are sores in the mouth often caused by chemotherapy treatment, not heart failure. Nausea is
not a common side effect of either furosemide of nitroglycerin.
3. Cardiac - Patient 2
A 64-year-old male client has arrived for an appointment at the outpatient clinic
because of difficulty breathing and a rash.
History:
Hypertension
Hypothyroidism
Depression
Erectile dysfunction
Chronic back pain
Hyperlipidemia
Anterior wall myocardial infarction (MI) at age 44. Up until the MI, he smoked
two packs of cigarettes per day for 25 years. After the MI, he completed a
cardiac rehabilitation program. His only current physical activity is walking
around at work.: He reports sleeping on two pillows and waking at night one to two times per week, gasping
with difficulty breathing and having to get up during the night to urinate. He has noticed increased irritability and
anxiety. Client reports joint and back pain in the evenings. He has increasing shortness of breath when he walks more
than 30 feet and is concerned about a red scaly rash on his left lower leg.
His body mass index (BMI) is 32 kg/m2. He works as the manager in a retail clothing store. He is divorced and has two
adult children and a grandchild who lives in another state. He lives in an apartment on the second floor.
Current vital signs:
