Each case presents a real patient scenario with 6–7 linked clinical-judgment questions — exactly the NCSBN April 2026 NGN format. Bow-tie, matrix, cloze, trend, and extended-response items across all 6 CJMM layers.
The nurse is prioritizing care for Mr. Webb upon admission to the cardiac step-down unit. Select ALL nursing actions that are priority interventions for this patient at this time.
The nurse is planning post-procedure care for this patient following femoral artery PCI. Select ALL assessments and interventions that are essential in the immediate post-catheterization period.
The nurse is reviewing the assessment findings for the 58-year-old male presenting with suspected STEMI. Select ALL findings that the nurse should recognize as clinical cues consistent with an anterior STEMI requiring immediate intervention.
The nurse reviews the patient's report during the phone call and clinic assessment findings. Select ALL findings that indicate acute heart failure exacerbation requiring immediate clinical intervention.
Harold Foster is a 65-year-old male with Stage IV NSCLC with pericardial metastases. He presents with 3-day progressive dyspnea at rest. No chest pain. Vital signs: BP 82/60, HR 118, RR 24, SpO2 93% on 2L NC. JVD at 8 cm above sternal angle, heart sounds barely audible/muffled. Pulsus paradoxus: 18
William Brown is a 79-year-old male with ischemic cardiomyopathy, EF 15%, NYHA Class IV HF, and a dual-chamber ICD/CRT device implanted 4 years ago. He is admitted for the 4th time in 3 months for fluid overload (weight gain 7 kg, SpO2 88% on 3L NC, BNP 8,400 pg/mL). His medications include maximall
Walter Johnson is a 72-year-old male with Stage 3 CKD (creatinine 1.8 mg/dL, eGFR 38 mL/min), T2DM managed with metformin 1000 mg BID, and recently diagnosed stable multivessel coronary artery disease on cardiac catheterization referral. He takes: metformin 1000 mg BID, lisinopril 20 mg daily, atorv
Diana’s current situation: new AF with RVR, BP 102/66, EF 45%, post-NSTEMI + DES day 2.
CASE 1 — Mrs. Gloria Mendez, 64-year-old female with T2DM, hypertension, hyperlipidemia. 90 minutes of substernal chest pressure radiating to jaw and left arm, diaphoresis, nausea. BP 82/50, HR 118 (sinus tachycardia), RR 28, SpO2 88% (room air), T 36.9C. ECG: ST elevation 3-4 mm in V1-V4; reciproca
CASE 6 — Ms. Priya Sharma, 42-year-old female. PMH: Combined OCP (3 years), Factor V Leiden heterozygous, BMI 32. Three weeks ago: 11-hour flight. 4-day right calf pain/swelling, then today sudden severe dyspnea, pleuritic right chest pain, hemoptysis (blood-streaked sputum). BP 106/68, HR 126, RR 3
CASE 10 — Mr. Andres Cordero, 48-year-old male. PMH: Alcohol use disorder (daily drinking since age 28; approximately 750 mL vodka/day), hypertriglyceridemia (TG 2,140 last year), obesity BMI 38. No medications. Severe epigastric and periumbilical pain radiating to back (9/10), onset 12 hours ago af
Mrs. Carmela Russo is a 67-year-old female with T2DM and hypertension who presented with anterior STEMI. She underwent successful primary PCI (LAD stented, TIMI 3 flow restored) and is now in the cardiac ICU on dobutamine 5 mcg/kg/min and norepinephrine 0.08 mcg/kg/min. She is 12 hours post-PCI.
Mrs. Fatima Al-Rashid is a 31-year-old G2P1 at 34 weeks gestation who presented with sudden-onset severe abdominal pain, vaginal bleeding, and a rigid, board-like abdomen. She underwent emergency cesarean section for severe placental abruption with Category III fetal heart tracing. Her baby was deli
Ingrid Larsson is a 67-year-old female with COPD (GOLD Stage III), obesity (BMI 42), and OSA. She underwent a surgical tracheostomy on hospital day 5 following prolonged intubation for a COPD exacerbation. Her tracheostomy is now 10 days old (cuffed, size 8 Shiley). She is on a tracheostomy collar w
Alejandro Vega is a 72-year-old male with a history of atrial fibrillation (on warfarin, last INR 2 weeks ago was 1.6 — sub-therapeutic), hypertension, and prior MI (LAD stent 4 years ago). He presents via EMS for severe abdominal pain for the past 3 hours, rated 9/10, described as 'cramping everywh
[NURSE'S NOTES] Patient: Carmen Delgado, 28-year-old female Setting: Nephrology Clinic → Hospital Admission Clinical Context: Carmen Delgado is a 28-year-old female with systemic lupus erythematosus (SLE) diagnosed 4 years ago, currently on hydroxychloroquine 400 mg daily and low-dose prednisone 5 m
Naomi Watkins is a 58-year-old female with hypertension (poorly controlled — last BP 178/106), hyperlipidemia, and Marfan syndrome (confirmed FBN1 mutation). She presents via EMS: 'worst pain of my life' — sudden onset, tearing quality, radiating from chest to back between the shoulder blades. Onset
[NURSE'S NOTES] Patient: Ingrid Larsson, 67-year-old female Setting: Medical-Surgical / Step-Down Unit Clinical Context: Ingrid Larsson is a 67-year-old female with a history of COPD (GOLD Stage III), obesity (BMI 42), and obstructive sleep apnea. She underwent a surgical tracheostomy on hospital da
[NURSE'S NOTES] Patient: Patricia Wells, 51-year-old female Setting: Cardiology Clinic → Emergency Department → Cardiac ICU Clinical Context: Patricia Wells is a 51-year-old female with a 6-year history of idiopathic pulmonary arterial hypertension (iPAH), managed on ambrisentan (endothelin receptor
[NURSE'S NOTES] Patient: Alejandro Vega, 72-year-old male Setting: Emergency Department Clinical Context: Alejandro Vega is a 72-year-old male with a history of atrial fibrillation (on warfarin, last INR 2 weeks ago was 1.6 — sub-therapeutic), hypertension, and prior MI (LAD stent 4 years ago). He p
[NURSE'S NOTES] Patient: Hazel Nguyen, 19-year-old female Setting: Medical-Psychiatric Unit Clinical Context: Hazel Nguyen is a 19-year-old female with a 4-year history of anorexia nervosa (restricting type), admitted via the ED after her parents found her collapsed at home. She is a college freshma
The nurse completes the admission assessment for Mrs. Chen, 74-year-old female with COPD (GOLD II) and heart failure (EF 40%). Findings: SpO2 88% on room air, RR 26, HR 102, BP 136/84, T 38.9C, productive cough with yellow-green sputum, right lower lobe crackles and dullness to percussion, WBC 14,80
Ms. Delgado, 67-year-old female with HTN, T2DM, and CKD stage 2 (baseline Cr 1.4), underwent cardiac catheterization with contrast yesterday. Today's labs: Cr 2.8 mg/dL (up from 1.4), BUN 48, K+ 5.6 mEq/L, urine output 18 mL/hr over the past 4 hours. Current: BP 158/96, HR 88, no edema, no respirato
Mrs. Okonkwo, 48-year-old female with BMI 34, presents to the ED with sudden onset severe epigastric pain radiating to the back, nausea, and vomiting for 8 hours. She denies alcohol use. Assessment: T 38.2C, HR 106, BP 104/68, RR 20, guarding in the epigastric region. Labs: lipase 1,840 U/L (normal
Ms. Brooks, 19F with anorexia (BMI 13.2) develops hypophosphatemia, hypokalemia, QTc prolongation 48hrs after refeeding. Requires feed reduction, IV electrolytes, cardiac monitoring.
Mr. James, 61M with LAD occlusion, V1-V4 ST elevation. Door-to-balloon, aspirin/ticagrelor, post-PCI troponin, pulseless VT arrest.
Mr. Brooks, 58M with NSTEMI from 90% LAD stenosis. DAPT, anticoagulation, post-PCI troponin washout.
Ms. Priya Nair is a 28-year-old South Asian female with a 5-year history of SLE managed on hydroxychloroquine 400 mg daily and prednisone 5 mg daily (...
Mr. Samuel Greene, a 76-year-old male with a history of type 2 diabetes, peripheral vascular disease, and chronic heart failure (EF 35%), is admitted ...
Ms. Keisha Monroe, a 26-year-old G2P1, presents to Labor and Delivery at 39 weeks and 2 days gestation with regular contractions every 4–5 minutes las...
Ms. Aisha Goldberg, a 32-year-old female, presents to the emergency department via walk-in, visibly distressed. She reports her heart is 'pounding out of her chest,' she feels short of breath, is trembling, and believes she is 'about to die.' She is hyperventilating (RR 32/min). She reports this started suddenly 15 minutes ago while at the grocery store and has happened 3–4 times over the past month. She has been afraid to go out of the house since the last episode. PMH: mild persistent asthma (on fluticasone and albuterol PRN, last albuterol use 2 weeks ago), no cardiac history. Her mother has generalized anxiety disorder. Current medications: fluticasone inhaler daily, albuterol PRN. Allergies: penicillin (hives). Vital signs: BP 142/90 mmHg, HR 118 bpm, RR 32/min, Temp 37.1°C, SpO₂ 99% on room air. ECG: sinus tachycardia, no ischemic changes. Troponin and D-dimer: normal. CXR: normal. Fingerstick glucose: 96 mg/dL. The emergency physician diagnoses a panic attack in the context of likely panic disorder.
Complete the Bow-Tie clinical reasoning diagram for a 68-year-old female with acute decompensated heart failure and pulmonary edema. Select the condition most consistent with the presentation, TWO priority nursing actions, and TWO parameters to monitor.
Complete the Bow-Tie clinical reasoning diagram for a 48-year-old post-operative day 3 with acute cardiopulmonary distress. Select the condition most consistent with the presentation, TWO priority nursing actions, and TWO parameters to monitor.
A 62-year-old male is admitted from the emergency department to the medical-surgical unit at 1430 with a diagnosis of community-acquired pneumonia. Past medical history: type 2 diabetes (A1C 7.2% at last check), hypertension, BMI 32. Medications at home: metformin, lisinopril, atorvastatin. No known drug allergies. ED workup: chest X-ray showed right lower lobe consolidation. WBC 14,500 with 12% bands. Lactate 2.1 mmol/L. He received one dose of IV ceftriaxone and azithromycin in the ED and 1 L
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