4/3/25, 6:18 NGN Case studies |
PM
NGN CASE STUDIES EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
Patient #1 History and Physical Assessment findings reveal the following:
22-year-old male client arrived at the Cardiovascular: Sinus tachycardia, no murmur noted
emergency department (ED) with Respiratory: Tachypnea, auscultated clear lung fields, dyspnea with mild exertion
complaints of excruciating pain in his Gastrointestinal: Active bowel sounds
back and lower extremities. Client is alert, Genitourinary: Dark orange-colored urine, episodes of urinary frequency and
and oriented to person, place, and time. nocturia, denies burning or pain when urinating
Family at the bedside. Client appears to Peripheral: +1 pitting edema in lower extremities bilaterally
have a grayish cast to his skin tone and
jaundiced mucous membranes. Client
rates pain at 10 out of 10 scale without any
relief. Client in tears and grimaces with
any movement. Client experiencing
shortness of breath, nausea, and fatigue.
He states the pain has overwhelmed him
and he can't eat or sleep. No prior
medical history other than a broken femur
from a football incident. Client states he
recently spent 2 weeks on a study abroad
trip in China.
1/
7
, 4/3/25, 6:18 NGN Case studies |
PM
Nurse notes cont.
2000
Client awake and complaining of chest pain 10/10, cough, and shortness of breath.
Assessment findings reveal the following:
Cardiovascular: Sinus tachycardia, no murmur noted, +2 radial and pedal pulses
Respiratory: Tachypnea, coarse crackles auscultated in bilateral lower lung
fields, dyspnea with mild exertion
Gastrointestinal: Active bowel sounds
Genitourinary: Clear yellow urine, denies burning or pain when urinating
Peripheral: +1 pitting edema in lower extremities bilaterally
Imaging: 1530
Doppler studies: negative for a deep vein thrombosis (DVT)
Nurse notes
1515 1630
Client admitted to the intensive care unit Chest X-ray: Infiltrates in bilateral lower lung fields
(ICU) with sickle cell crisis. RN inserted an Lab Results
18G intravenous (IV) line in left arm and 1500
started at 150 mL/hr infusion of normal
saline. Medicated with morphine 4 mg IV Laboratory Test
as ordered. Oxygen started at 4 L/minute Result
via nasal cannula. Family at the bedside. Reference Range
Red blood cells (RBC)
1600 4.1 x 106/µL (4.1 x 1012 cells/L)
Client states pain in the lower extremities Females: 4.2 to 5.4 x 106/µL (4.2 to 5.4 x 1012 cells/L)
has decreased to a 5 but the pain is still Males: 4.7 to 6.1 x 106/µL (4.7 to 6.1 x 1012 cells/L)
a 10 in his back. Repositioned client Hemoglobin (Hgb)
and 11 g/dL (6.8 mmol/L)
notified the health care provider. Females: 12 to 16 g/dL (7.4 to 9.9 mmol/L)
Males: 14 to 18 g/dL (8.7 to 11.2 mmol/L)
1615 Hematocrit (Hct)
Medicated with morphine 4 mg as 28% (0.28 volume fraction)
ordered. Instructed client to call for Females: 37% to 47% (0.37 to 0.47 volume fraction)
assistance to use the bathroom. Client Males: 42% to 52% (0.42 to 0.52 volume fraction)
verbalized understanding. Call light within White blood cell (WBC) count
reach. 14,000/mm3 (14.0 x 109 cells/L)
5,000 to 10,000/mm3 (5.0 to 10.0 x 109 cells/L)
1645 Potassium
Client resting quietly. 3.6 mEq/L (mmol/L)
3.5 to 5.0 mEq/L (mmol/L)
Total bilirubin
2.0 mg/dL (34 µmol/L)
0.3 to 1.0 mg/dL (5.1 to 17 µmol/L)
Urinalysis
Laboratory Test
Result
Reference
Range Bilirubin
Positive
Negative
2/
7
PM
NGN CASE STUDIES EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED GRADED A++
Patient #1 History and Physical Assessment findings reveal the following:
22-year-old male client arrived at the Cardiovascular: Sinus tachycardia, no murmur noted
emergency department (ED) with Respiratory: Tachypnea, auscultated clear lung fields, dyspnea with mild exertion
complaints of excruciating pain in his Gastrointestinal: Active bowel sounds
back and lower extremities. Client is alert, Genitourinary: Dark orange-colored urine, episodes of urinary frequency and
and oriented to person, place, and time. nocturia, denies burning or pain when urinating
Family at the bedside. Client appears to Peripheral: +1 pitting edema in lower extremities bilaterally
have a grayish cast to his skin tone and
jaundiced mucous membranes. Client
rates pain at 10 out of 10 scale without any
relief. Client in tears and grimaces with
any movement. Client experiencing
shortness of breath, nausea, and fatigue.
He states the pain has overwhelmed him
and he can't eat or sleep. No prior
medical history other than a broken femur
from a football incident. Client states he
recently spent 2 weeks on a study abroad
trip in China.
1/
7
, 4/3/25, 6:18 NGN Case studies |
PM
Nurse notes cont.
2000
Client awake and complaining of chest pain 10/10, cough, and shortness of breath.
Assessment findings reveal the following:
Cardiovascular: Sinus tachycardia, no murmur noted, +2 radial and pedal pulses
Respiratory: Tachypnea, coarse crackles auscultated in bilateral lower lung
fields, dyspnea with mild exertion
Gastrointestinal: Active bowel sounds
Genitourinary: Clear yellow urine, denies burning or pain when urinating
Peripheral: +1 pitting edema in lower extremities bilaterally
Imaging: 1530
Doppler studies: negative for a deep vein thrombosis (DVT)
Nurse notes
1515 1630
Client admitted to the intensive care unit Chest X-ray: Infiltrates in bilateral lower lung fields
(ICU) with sickle cell crisis. RN inserted an Lab Results
18G intravenous (IV) line in left arm and 1500
started at 150 mL/hr infusion of normal
saline. Medicated with morphine 4 mg IV Laboratory Test
as ordered. Oxygen started at 4 L/minute Result
via nasal cannula. Family at the bedside. Reference Range
Red blood cells (RBC)
1600 4.1 x 106/µL (4.1 x 1012 cells/L)
Client states pain in the lower extremities Females: 4.2 to 5.4 x 106/µL (4.2 to 5.4 x 1012 cells/L)
has decreased to a 5 but the pain is still Males: 4.7 to 6.1 x 106/µL (4.7 to 6.1 x 1012 cells/L)
a 10 in his back. Repositioned client Hemoglobin (Hgb)
and 11 g/dL (6.8 mmol/L)
notified the health care provider. Females: 12 to 16 g/dL (7.4 to 9.9 mmol/L)
Males: 14 to 18 g/dL (8.7 to 11.2 mmol/L)
1615 Hematocrit (Hct)
Medicated with morphine 4 mg as 28% (0.28 volume fraction)
ordered. Instructed client to call for Females: 37% to 47% (0.37 to 0.47 volume fraction)
assistance to use the bathroom. Client Males: 42% to 52% (0.42 to 0.52 volume fraction)
verbalized understanding. Call light within White blood cell (WBC) count
reach. 14,000/mm3 (14.0 x 109 cells/L)
5,000 to 10,000/mm3 (5.0 to 10.0 x 109 cells/L)
1645 Potassium
Client resting quietly. 3.6 mEq/L (mmol/L)
3.5 to 5.0 mEq/L (mmol/L)
Total bilirubin
2.0 mg/dL (34 µmol/L)
0.3 to 1.0 mg/dL (5.1 to 17 µmol/L)
Urinalysis
Laboratory Test
Result
Reference
Range Bilirubin
Positive
Negative
2/
7
