Adult Health II — NGN Case & Hard Practice

Minimal, self‑scoring practice built around a CAD/Cardiomyopathy/HF + BPH/UTI scenario.
Progress Score: 0 / 0

Client Case Chart (toggle)

Situation (0900): 65‑year‑old client to ED for shortness of breath and severe pain from bladder distention.

Background

  • PMH: CAD (2005), HTN (2012), CKD stage I (2015), MI (2019), Dilated cardiomyopathy (2020), BPH (2023)
  • HPI: BP 140/90 mm Hg, HR 125 bpm; pain 8/10 (bladder distention)

Assessment

  • Vitals: T 101 °F oral, HR 125, BP 140/90, RR 25, SpO₂ 85% on room air
  • HEENT: AAO ×1
  • Heart: systolic murmur
  • Lungs: labored, coarse crackles at BLL
  • GI: +nausea; LBM yesterday
  • GU: no urine output x 2 days (per daughter)
  • MSK: difficulty walking; pedal pulses +2
  • Allergy: banana (consider latex cross‑reactivity)

Case & keyed expectations adapted from your uploaded NGN-driven case study (CAD/Cardiomyopathy/HF with answer key). :contentReference[oaicite:1]{index=1}

1) Recognize Cues

1.1 Rhythm recognition: What is abnormal on this 5‑lead tracing?

Select all that apply (SATA)
Rationale
  • P waves abnormal → Atrial fibrillation typically lacks organized P waves; instead, fibrillatory activity is present.
  • QRS width is usually normal in AF unless there is a concurrent bundle branch block or ventricular conduction defect.

1.2 This is primarily an ______ dysrhythmia.

Rationale

The problem arises from the atria (disorganized atrial activity) rather than the ventricles.

1.3 Name the rhythm.

Rationale

Irregularly irregular rhythm without distinct P waves is classic for AF. Rate is elevated (RVR).

1.4 From the chart, select all findings that require immediate follow‑up.

SATA — choose all that apply
Rationale
  • Hypoxemia (SpO₂ 85%), tachypnea/labored breathing, and crackles are consistent with left‑sided HF and require oxygen + diuresis.
  • HR 125 with AF → rate control & evaluation for perfusion; acute confusion suggests poor oxygenation/perfusion.
  • Anuria ×2 days with BPH → urinary retention/infection risk; urology/foley planning.
  • Banana allergy raises concern for latex sensitivity before invasive procedures/catheters.
  • Fever (101 °F) → possible UTI/sepsis source from retention.
  • Isolated BP 140/90 and a systolic murmur are noteworthy but not the most time‑critical compared with hypoxia/retention.

Item intent matches the NGN “Recognize Cues” step in your source case. :contentReference[oaicite:2]{index=2}

2) Analyze Cues

2.1 Associate assessment findings with the cardiomyopathy type(s).

Select all that apply in the grid (according to the case key).
Assessment Finding Dilated CMT Restrictive CMT (“stiff heart”) Hypertrophic CMT (“rock hard”)
High BP
High HR
Hepatomegaly
Splenomegaly
Pulmonary congestion
High RR
Rationale

Per the provided key, each listed finding can be seen in all three cardiomyopathy types (dilated, restrictive, hypertrophic) in various combinations and severities; thus, all boxes are correct for this item as written in the source. :contentReference[oaicite:3]{index=3}

3) Prioritize Hypotheses

3.1 Which nursing diagnoses are appropriate now? (SATA)

Rationale
  • Electrolyte imbalance anticipated with HF diuresis and arrhythmia management.
  • Impaired breathing pattern + Decreased cardiac output supported by hypoxemia, crackles, tachycardia, cardiomyopathy.
  • Acute pain (bladder distention); Infection suspected (fever, urinary retention).
  • Ineffective coping pattern is not primary with the current physiologic instability per the key. :contentReference[oaicite:4]{index=4}

4) Generate Solutions

4.1 Before labs return: Indicate whether each intervention is Indicated (I), Contraindicated (C), or Non‑essential (NE) per case key

InterventionChoose
Call urology to insert 18F indwelling Foley STAT
Start 0.9% NaCl at 100 mL/hr continuous
Check iodine/shellfish allergy status
Check BUN/Creatinine
Administer Digoxin 125 mcg PO daily
Administer Lisinopril 25 mg PO daily
Rationale
  • Foley with urology is indicated for retention with BPH.
  • NS 100 mL/hr is contraindicated in acute decompensated HF with hypoxemia and congestion.
  • Allergy check + renal labs are indicated before contrast (angiogram/cath).
  • Digoxin is non‑essential until K⁺ is known (risk of toxicity with hypokalemia per key’s later “Take Action”). :contentReference[oaicite:5]{index=5}
  • Lisinopril is indicated for HF/afterload reduction if BP tolerates.

4.2 Also evaluate these orders per case key

InterventionChoose
Administer Furosemide 20 mg IV push ×1
Start oxygen 2–6 L/min via NC to maintain SpO₂ ≥95%
Administer regular insulin sliding scale TID
Start Vancomycin 1.5 g IV/500 mL over 4 h ×1 (with peak/trough monitoring)
Rationale
  • Diuresis + supplemental O₂ are indicated for pulmonary congestion/hypoxemia.
  • Sliding‑scale insulin is non‑essential without diabetes indication in the chart.
  • Antibiotic therapy is indicated for suspected UTI per the key (monitor levels for nephrotoxicity). Item intent per source file. :contentReference[oaicite:6]{index=6}

5) Take Action

12:00 — Key Results

CBC
  • WBC 13,000 ↑
  • Hgb 9 g/dL ↓
  • Hct 20% ↓
  • Plt 400k
BMP + Others
  • Na 125 mEq/L ↓
  • K 3.0 mEq/L ↓
  • Mg 2 mEq/L
  • P 3 mg/dL
  • Ca 9 mg/dL
  • BNP 1000 pg/mL ↑
  • BUN 20 / Cr 1.4 mg/dL
Diagnostics
  • Urine C&S: +E. coli; resistance to pip/tazo & amoxicillin
  • CXR: pulmonary infiltrates & consolidation (RLL/LLL)
  • 12‑lead: U waves (II, III, aVF) + inverted T (V1–V4)
  • Echo: Mitral stenosis; EF 30%

Abnormalities and their interpretations follow the source key (e.g., U wave = hypokalemia; elevated BNP = HF stress; infiltrates = L‑sided HF pattern). :contentReference[oaicite:7]{index=7}

5.1 Choose appropriate nurse actions now (SATA)

Rationale
  • Hold digoxin with K⁺ 3.0 to reduce toxicity risk; check serum digoxin. Target level 0.5–2.
  • Replete potassium and diurese; support oxygenation with titrated O₂ and positioning.
  • Avoid fluid bolus in the setting of congestion and hyponatremia (FVO).
  • Antibiotics warranted for UTI per C&S; plus allergy/renal checks ahead of contrast procedures.
  • Foley relieves retention in BPH (prefer urology/appropriate catheter selection).
  • These action priorities mirror the “Take Action” logic in your case key. :contentReference[oaicite:8]{index=8}

6) Evaluate Outcomes

6.1 On Day 4, classify each assessment finding as Improved (I), No change (N), or Declined (D) per case key

FindingStatus
BP 120/90 mm Hg
HR 100 bpm
K⁺ 5.0 mEq/L
Na 145 mEq/L
RR 16/min
Hemoglobin 9 g/dL
SpO₂ 95% on 6 L NC (was 2 L)
EKG: persistent U waves
Rationale
  • BP, HR, electrolytes, RR improved; Hgb unchanged.
  • Higher O₂ requirement to achieve 95% is a decline; U wave persistence also implies incomplete resolution of K⁺ effect.
  • Exact I/N/D mapping follows the case key. :contentReference[oaicite:9]{index=9}

Cardiac Catheterization Readiness (Day 3)

Classify each as Indicated (I), Contraindicated (C), or Non‑essential (NE)

InterventionChoose
Check femoral site for bleeding/hematoma
Activity restriction: lie flat 6–8 hours; assist to use bedpan
Confirm iodine/shellfish allergies
Hold Metformin (if applicable) for 48 hours
Check BUN/Creatinine
Hold Metoprolol PO prior to procedure
Rationale

All actions are indicated for a femoral approach with contrast except holding beta‑blocker without a provider directive—rate control/anti‑ischemic therapy is typically continued. Mapping per the case key. :contentReference[oaicite:10]{index=10}

Bonus: Hard NGN‑Style Adult Health II Items

H1. Furosemide is ordered. Which labs must you reassess first before/after dosing? (SATA)

Rationale

Loop diuretics can cause hypo‑K⁺/hypo‑Mg²⁺ and impact renal function. BNP trend follows fluid status; hepatic enzymes are less central here.

H2. AF with RVR (SBP 128). Which medication is the most appropriate initial rate control?

Rationale

Diltiazem (or β‑blocker) is standard for AF RVR with adequate BP. Adenosine is for SVT; epinephrine would worsen tachyarrhythmia; PO amiodarone has slow onset.

H3. Which findings most strongly support fluid overload in HF? (SATA)

Rationale

Edema, rapid weight gain, and orthopnea are classic fluid overload indicators; low‑grade fever is nonspecific.

H4. ACE inhibitor teaching (lisinopril). Include which points? (SATA)

Rationale

ACE inhibitors can increase K⁺, cause angioedema and cough; hypotension precautions apply. Never double doses.

H5. Prioritization: Who do you see first?

  1. HF pt, gained 1 kg in 3 days, mild ankle edema, SpO₂ 94% RA
  2. Post‑cath pt, stable, wants help with ambulation
  3. UTI pt on antibiotics, afebrile, asking about discharge
  4. AF RVR pt, HR 150, SBP 96, new dizziness
Rationale

#4 shows unstable tachyarrhythmia with borderline hypotension and cerebral hypoperfusion (dizziness): highest priority.

Your Performance

Click Check on each item (or Check All) to score. Partial credit is awarded on SATA/matrix/dropdown sets. You can reset anytime.

Score: 0 / 0