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 planning care for this patient with DKA.
The nurse is triaging Liam upon arrival. Which findings from the assessment are consistent with the diagnosis of moderate diabetic ketoacidosis (DKA) in a pediatric patient?
The nurse completes the initial assessment of Mrs. Holloway during check-in. Select ALL findings that indicate hypoglycemia requiring immediate treatment.
Elijah is a 9-year-old male (28 kg) with no PMH. Mother reports 2 days of vomiting, polydipsia, polyuria, and now confusion. T 37.8°C, HR 138, RR 30 (deep, sighing), BP 88/54, SpO2 98%, glucose 684 mg/dL, capillary refill 3.5 sec, dry mucous membranes, fruity breath, confused. ABG: pH 7.09, PaCO2 18
CASE 12 — Maya Johnson, 11-year-old, newly diagnosed Type 1 DM. Parents noted 3 weeks of polyuria, polydipsia, weight loss. Today: lethargic, vomiting, Kussmaul respirations (deep, rapid). Glucose 648 mg/dL, pH 7.12, HCO3 8, pCO2 18, Na+ 128 (corrected ~137), K+ 5.8 mEq/L. Large urinary ketones. Wei
CASE 15 — Mr. Patrick Sullivan, 52-year-old male. PMH: Alcohol use disorder (daily drinking since age 28; approximately 750 mL vodka/day). Admitted for elective hernia repair 36 hours ago. Surgical team did NOT obtain alcohol history. Surgery uneventful. NPO post-op. PRESENTING at 36 hours post-op:
Mr. Roberto Vasquez is a 46-year-old male admitted for severe necrotizing pancreatitis from hypertriglyceridemia (TG 4,820 mg/dL) and chronic alcohol use. He is on day 5 of treatment. TG have decreased to 820 mg/dL with insulin infusion. Pain is controlled. He was started on nasojejunal tube feeds o
Darnell Washington is a 58-year-old male with CKD 3b (baseline creatinine 2.8, baseline K+ 4.8), T2DM, and HTN admitted for an infected diabetic foot ulcer. Home medications continued: lisinopril 20 mg daily, spironolactone 25 mg daily, insulin glargine. Current IV antibiotic: TMP-SMX for MRSA foot
Gabriel Santos is a 67-year-old male with 22-year history of type 2 diabetes (HbA1c 10.8%), PAD (ABI 0.58 bilaterally), and peripheral neuropathy (absent 10-gram monofilament bilateral feet). He presents to the wound care clinic because his wife noticed his left foot is 'red and swollen' and he feel
[NURSE'S NOTES] Patient: Gabriel Santos, 67-year-old male Setting: Wound Care Clinic → Medical-Surgical Unit Clinical Context: Gabriel Santos is a 67-year-old male with a 22-year history of type 2 diabetes (HbA1c 10.8%), peripheral artery disease (ABI 0.58 bilaterally), and peripheral neuropathy con
[NURSE'S NOTES] Patient: Florence Nakamura, 54-year-old female Setting: Medical-Surgical Unit Clinical Context: Florence Nakamura is a 54-year-old female with a 12-year history of alcohol use disorder (AUD) — drinks a fifth of vodka daily, last drink approximately 36 hours ago. She is malnourished (
The nurse reviews Mr. Okafor's admission data: blood glucose 740 mg/dL, Na 148 mEq/L, serum osmolality 328 mOsm/kg, BUN 32, creatinine 1.6, no urine ketones, BP 98/60 mmHg, HR 118 bpm, GCS 13, dry mucous membranes, poor skin turgor. He has T2DM, HTN, and CKD stage 2. Which findings are PRIORITY conc
Jordan Kim, 14-year-old male, is brought to the pediatric ED by his parents who report a 2-week history of polyuria, polydipsia, and 8-pound weight loss. Today he vomited twice and is breathing 'strangely.' Assessment: T 37.2C, HR 118, BP 98/62, RR 28 (deep, sighing respirations), SpO2 97%, fruity o
Mr. Torres, 38M heavy drinker with SAP, shock, Ranson criteria. Aggressive LR, thiamine before glucose, CIWA monitoring, infected necrosis management.
Mrs. Mills, 58F with HbA1c 8.9%, polyuria/polydipsia. Metformin initiation, complication screening, hypoglycemia management, foot care.
Mr. Obi, 52M CKD with K+ 7.8, ECG changes. Sequential treatment, hypoglycemia monitoring.
Sophie, 11F newly diagnosed T1DM. Insulin technique, hypoglycemia management, school safety, sick-day rules.
Mr. David Torres, a 52-year-old male, presents to his primary care clinic for a routine physical. He reports increased thirst, frequent urination (app...
Mrs. Patricia Okafor, a 71-year-old female with a history of atrial fibrillation (on apixaban — last dose yesterday morning), hypertension, and hyperlipidemia, is brought to the ED by her husband at 9:15 AM. He reports she was 'perfectly fine' at breakfast at 8:45 AM and suddenly developed slurred speech and could not lift her right arm while clearing the table. Time last known well (LKW): 8:45 AM. Current time: 9:20 AM — symptom onset 35 minutes ago. Neurological exam: right facial droop, right upper extremity (RUE) weakness (4-/5 strength), slurred speech (dysarthria), mild right leg weakness. NIHSS (National Institutes of Health Stroke Scale) score: 9. Vital signs: BP 188/104 mmHg, HR 76 bpm (irregular), RR 16/min, Temp 36.9°C, SpO₂ 97% on room air. Fingerstick glucose: 142 mg/dL. CT head (non-contrast): no hemorrhage, no early ischemic changes. Platelet count: 218,000. INR: 1.1. The stroke team is activated.
Mr. Roberto Sanchez, a 64-year-old male with a 15-year history of type 2 diabetes and hypertension, is seen in the nephrology clinic for management of stage 3b chronic kidney disease (CKD). His most recent labs: eGFR 32 mL/min/1.73m², serum creatinine 2.4 mg/dL, BUN 38 mg/dL, potassium 5.4 mEq/L, sodium 138 mEq/L, bicarbonate 19 mEq/L, phosphorus 5.8 mg/dL, calcium 8.4 mg/dL, hemoglobin 10.1 g/dL, hematocrit 30%, albumin 3.4 g/dL, urine albumin-to-creatinine ratio (UACR) 380 mg/g (severely elevated). Current medications: lisinopril 10 mg daily, amlodipine 5 mg daily, metformin 1000 mg BID, atorvastatin 40 mg daily. BP today: 146/88 mmHg. He reports fatigue, mild ankle edema bilaterally, and decreased appetite. He asks, 'How serious is my kidney disease and what can I slow it down?'
A busy medical-surgical unit has a nurse preceptor (RN, 8 years experience) orienting a new graduate nurse (NGN) on day 3 of orientation. The unit cares for patients with a variety of medical diagnoses. The following scenarios occur during the shift. Patient 1: Mr. Henry Bloom, 78-year-old male, prescribed: insulin glargine (Lantus) 20 units SQ at bedtime AND insulin lispro (Humalog) sliding scale AC meals. Patient 2: Mrs. Clara Nguyen, 65-year-old female, prescribed: heparin 5,000 units SQ q8h for DVT prophylaxis. Patient 3: Mr. Tyler Ross, 52-year-old male, prescribed: metoprolol succinate (Toprol-XL) 50 mg PO daily AND metoprolol tartrate (Lopressor) 25 mg PO q6h PRN for HR >100 bpm. The preceptor uses each patient encounter to teach high-alert medication safety principles.
Complete the Bow-Tie clinical reasoning diagram for a 19-year-old male with Type 1 diabetes who ran out of insulin 2 days ago and presents with severe hyperglycemia, acidosis, and altered breathing pattern. Select the condition most consistent with the presentation, TWO priority nursing actions, and TWO parameters to monitor.
Case studies + traditional questions + full rationales — $29 one-time, 30-day access.
Get Full Access — $29