Clinical Decision-Making: Nursing Case Studies for Professional Exams

Master Complex Patient Scenarios with Detailed Rationales

1. Scenario: A 58-year-old male is 12 hours postoperative following a total hip arthroplasty. The nurse notes the patient is suddenly tachycardic, tachypneic, and complaining of sharp chest pain upon inspiration.

What is the priority nursing action?

A. Administer the prescribed PRN morphine for pain.

B. Encourage the use of the incentive spirometer.

C. Apply supplemental oxygen and notify the Rapid Response Team.

D. Check the surgical site for signs of hemorrhage.

Rationale: The symptoms (tachycardia, tachypnea, pleuritic chest pain) are classic indicators of a Pulmonary Embolism (PE), a high-risk complication after orthopedic surgery. (C) is the priority to maintain oxygenation and seek immediate medical intervention.

2. Scenario: A patient with a history of Chronic Obstructive Pulmonary Disease (COPD) is receiving oxygen via nasal cannula at 2L/min. The nurse notes the patient’s SpO_2 is 89%.

What is the most appropriate nursing interpretation of this finding?

A. The patient is in acute respiratory failure.

B. This is a normal and expected finding for a patient with COPD.

C. The oxygen flow rate must be immediately increased to 6L/min.

D. The pulse oximeter is likely malfunctioning.

Rationale: For patients with COPD, an oxygen saturation of 88-92% (B) is often the clinical goal to prevent the suppression of their hypoxic drive to breathe. Excessive oxygen can lead to CO2 retention in these patients.

3. Scenario: A nurse is preparing to administer Digoxin to a patient with heart failure. The patient’s potassium level is reported as 3.1 mEq/L.

Which action should the nurse take?

A. Administer the medication as scheduled.

B. Give the medication and document the potassium level.

C. Withhold the medication and notify the healthcare provider.

D. Administer the medication with a glass of orange juice.

Rationale: Hypokalemia (C) (potassium below 3.5 mEq/L) significantly increases the risk of Digoxin toxicity. The nurse must withhold the dose and address the low potassium first to ensure patient safety.

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