NURS 5220 |50 case studies reviewed| Plus Questions and
Answers
Case Study #1
Scenario:
A 55-year-old male with a history of hypertension presents to clinic complaining of episodes of
dizziness and cough. His medications include lisinopril 20 mg daily and hydrochlorothiazide
25 mg daily.
Question 1.1: What is the likely cause of his persistent cough?
A) Hydrochlorothiazide adverse effect
B) ✓ Lisinopril–induced dry cough
C) Hypertension itself
D) Allergic rhinitis
Rationale: ACE inhibitors like lisinopril often cause a dry, persistent cough.
🩺 Case Study #2
Scenario:
A 68-year-old female with atrial fibrillation is started on heparin infusion post-surgery. Heparin
is ordered at 18 units/kg/hr; she weighs 70 kg; heparin concentration is 25,000 units in 500 mL.
Question 2.1: What is the correct infusion rate in mL/hr?
A) 50
B) 54
C) ✓ 50.4 mL/hr
D) 60
Rationale:
18 × 70 = 1,260 units/hr. Concentration = 50 units/mL → 1,260 ÷ 50 = 25.2 mL/hr (rounded to
25 mL/hr if protocol). Adjust per facility rounding.
🩺 Case Study #3
Scenario:
A 24-year-old female patient on lithium reports vomiting and diarrhea. Her current lithium level
is 2.0 mEq/L (therapeutic range 0.6–1.2).
, Question 3.1: What is the nurse’s next step?
A) Encourage hydration
B) Continue therapy
C) ✓ Hold dose and notify provider
D) Draw another level in a week
Rationale: High lithium levels with GI symptoms indicate toxicity—stop drug and notify.
🩺 Case Study #4
Scenario:
A 7-year-old child with otitis media is prescribed amoxicillin 25 mg/kg/day in two divided doses.
Child’s weight is 20 kg.
Question 4.1: How much amoxicillin should be given per dose?
A) 125 mg
B) ✓ 250 mg
C) 500 mg
D) 375 mg
Rationale: Total daily = 500 mg; ÷2 = 250 mg per dose.
🩺 Case Study #5
Scenario:
A 60-year-old records a blood pressure of 150/90 mmHg. He is prescribed hydrochlorothiazide
and returns two weeks later with muscle cramps.
Question 5.1: Which lab should the nurse check?
A) Magnesium
B) ✓ Potassium
C) Calcium
D) Glucose
Rationale: Thiazides cause hypokalemia, leading to cramps—check K+.
🩺 Case Study #6
Answers
Case Study #1
Scenario:
A 55-year-old male with a history of hypertension presents to clinic complaining of episodes of
dizziness and cough. His medications include lisinopril 20 mg daily and hydrochlorothiazide
25 mg daily.
Question 1.1: What is the likely cause of his persistent cough?
A) Hydrochlorothiazide adverse effect
B) ✓ Lisinopril–induced dry cough
C) Hypertension itself
D) Allergic rhinitis
Rationale: ACE inhibitors like lisinopril often cause a dry, persistent cough.
🩺 Case Study #2
Scenario:
A 68-year-old female with atrial fibrillation is started on heparin infusion post-surgery. Heparin
is ordered at 18 units/kg/hr; she weighs 70 kg; heparin concentration is 25,000 units in 500 mL.
Question 2.1: What is the correct infusion rate in mL/hr?
A) 50
B) 54
C) ✓ 50.4 mL/hr
D) 60
Rationale:
18 × 70 = 1,260 units/hr. Concentration = 50 units/mL → 1,260 ÷ 50 = 25.2 mL/hr (rounded to
25 mL/hr if protocol). Adjust per facility rounding.
🩺 Case Study #3
Scenario:
A 24-year-old female patient on lithium reports vomiting and diarrhea. Her current lithium level
is 2.0 mEq/L (therapeutic range 0.6–1.2).
, Question 3.1: What is the nurse’s next step?
A) Encourage hydration
B) Continue therapy
C) ✓ Hold dose and notify provider
D) Draw another level in a week
Rationale: High lithium levels with GI symptoms indicate toxicity—stop drug and notify.
🩺 Case Study #4
Scenario:
A 7-year-old child with otitis media is prescribed amoxicillin 25 mg/kg/day in two divided doses.
Child’s weight is 20 kg.
Question 4.1: How much amoxicillin should be given per dose?
A) 125 mg
B) ✓ 250 mg
C) 500 mg
D) 375 mg
Rationale: Total daily = 500 mg; ÷2 = 250 mg per dose.
🩺 Case Study #5
Scenario:
A 60-year-old records a blood pressure of 150/90 mmHg. He is prescribed hydrochlorothiazide
and returns two weeks later with muscle cramps.
Question 5.1: Which lab should the nurse check?
A) Magnesium
B) ✓ Potassium
C) Calcium
D) Glucose
Rationale: Thiazides cause hypokalemia, leading to cramps—check K+.
🩺 Case Study #6
