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 reviewing the initial assessment data for the 34-year-old male. Which FINDINGS from the patient's presentation represent the HIGHEST-risk factors that increase his likelihood of a future suicide attempt?
The nurse completes the admission assessment for Marcus. Select ALL findings that are consistent with an acute manic episode and require immediate nursing intervention.
The nurse is reviewing the assessment data for this patient. Select ALL findings that are consistent with delirium rather than dementia, and that require immediate nursing assessment and intervention.
The nurse is completing the initial assessment. Select ALL findings that indicate acute psychotic decompensation requiring immediate psychiatric intervention.
Marcus Thompson is a 45-year-old male admitted to the ICU after aspiration of gastric contents during emergent intubation for altered mental status. PMH: alcohol use disorder, hypertension. He is on mechanical ventilation: AC/VC mode, TV 550 mL, RR 16, PEEP 14 cmH2O, FiO2 0.72. Weight 90 kg, IBW 75
Harriet Johnson is an 81-year-old female with a history of osteoporosis, atrial fibrillation (on warfarin), and mild cognitive impairment (baseline MMSE 22/30). She fell at home and sustained a right femoral neck fracture. She underwent right hip hemiarthroplasty under spinal anesthesia. Pre-operati
Emily Chen is a 19-year-old female brought to the ED by her roommate after she found Emily crying and confessing to ingesting 'all her Tylenol' approximately 6 hours ago. She has no prior psychiatric history. She is tearful but cooperative. She ingested 50 tablets of 500 mg acetaminophen (Tylenol) w
Ms. Claire Novak is a 38-year-old female with bipolar I disorder on lithium carbonate 900 mg BID for 6 years. She was started on lisinopril 10 mg daily 2 months ago for new hypertension. She presented with confusion, coarse tremor, vomiting, and ataxia. Lithium level on admission was 3.4 mEq/L (ther
[NURSE'S NOTES] Patient: Renata Osei, 42-year-old female Setting: Psychiatric Unit → Medical ICU Clinical Context: Renata Osei is a 42-year-old female with bipolar I disorder, well-controlled for 6 years on lithium carbonate 900 mg BID (therapeutic level 0.8 mEq/L, checked 3 months ago). PMH: hypert
Mr. Harris, 34-year-old male with bipolar I disorder, is brought to the psychiatric ED by his wife who reports he has not slept in 4 days, spent $12,000 on cryptocurrency without telling her, and has been 'talking a mile a minute.' Assessment: alert, oriented x3, speech is pressured and rapid, thoug
Mrs. Huang, 81F on apixaban with displaced femoral neck fracture. Post-op delirium, VTE prevention, hip precaution education, anticoagulation restart.
Ms. Ahmad, 29F with aborted attempt and severe depression. Inpatient safety, 1:1 observation, discharge planning.
Mr. Young, 26M first-episode psychosis. Risperidone, acute dystonia, delusional communication, family prodrome education.
Marcus Hayes is a 21-year-old college junior brought to the psychiatric emergency department by his roommate. Over the past 6 weeks, Marcus has become...
Mr. James Holloway, a 34-year-old male, is voluntarily admitted to the inpatient psychiatric unit following a visit to his primary care provider, wher...
Complete the Bow-Tie clinical reasoning diagram for a 38-year-old female admitted after intentional acetaminophen overdose. 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 this gerontology patient. Select the condition, TWO priority nursing actions, and TWO parameters to monitor.
A 34-year-old client arrives at the emergency department at 2200 accompanied by his sister. The triage note reads: "Brought in by family member — concerned about client's mental state after recent job loss and divorce. Client reluctantly agreed to come." The client is alert, oriented, and medically stable. Vital signs: BP 128/82, HR 88, RR 16, T 36.8°C, SpO2 98% on room air. The client's sister pulls the nurse aside and reports: "He lost his job three weeks ago and his divorce was finalized las
The evening nurse finds the hospitalized client with advanced dementia calling for her long-deceased mother and attempting to leave the unit.
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