Clinical Judgment: Essential Nursing Scenarios for Professional Excellence

Master Complex Patient Care with Evidence-Based Rationales

1. Scenario: A 68-year-old male is 24 hours post-abdominal surgery. The nurse notes the patient is suddenly restless, tachycardic (115 bpm), and his blood pressure has dropped to 94/60 mmHg. The abdominal dressing is dry, but the patient complains of severe back pain.

What is the nurse's most appropriate initial action?

A. Administer the prescribed PRN analgesic for back pain.

B. Increase the IV fluid rate as per standing orders.

C. Assess the patient for signs of internal hemorrhage and notify the surgeon.

D. Re-position the patient to a High-Fowler’s position.

Rationale: Restlessness, tachycardia, and hypotension are classic "shock" indicators. Since the dressing is dry, the nurse must suspect internal hemorrhage (C), especially with the complaint of back pain which could indicate retroperitoneal bleeding. Assessment must precede intervention.

2. Scenario: A patient is receiving a continuous infusion of Magnesium Sulfate for preeclampsia. During the hourly assessment, the nurse finds the patellar reflex is absent and the respiratory rate is 10 breaths/minute.

What is the priority nursing intervention?

A. Continue the infusion and document the findings.

B. Stop the Magnesium Sulfate infusion immediately.

C. Increase the patient's fluid intake to flush the medication.

D. Administer a dose of Nifedipine as a substitute.

Rationale: Absent deep tendon reflexes and respiratory depression are signs of Magnesium Toxicity (B). The first action is to stop the infusion to prevent cardiac or respiratory arrest. The antidote (Calcium Gluconate) should be kept at the bedside.

3. Scenario: A nurse is preparing to administer a tube feeding via a nasogastric (NG) tube.

Which method is the most reliable for confirming the placement of the NG tube before starting the feeding?

A. Aspirating gastric contents and checking the pH.

B. Monitoring the patient for coughing or choking.

C. Injecting air into the tube and auscultating for a "whoosh" sound.

D. Obtaining a chest X-ray.

Rationale: While pH testing is common, a Chest X-ray (D) is the "gold standard" and most reliable method to ensure the tube is in the stomach and not the lungs. Auscultation is no longer considered a safe or reliable primary method.

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