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 patient's clinical data to assist the stroke team in determining tPA eligibility. Select ALL findings from the patient's presentation that support tPA candidacy.
The nurse assesses Maria G., a 28-year-old G3P3 who delivered vaginally 45 minutes ago. Which clinical FINDINGS from the nurse's assessment indicate active postpartum hemorrhage with hemodynamic instability?
Marcus arrives with BP 82/48 mmHg, HR 48 bpm, warm/dry skin below the injury, and SpO2 92%. The trauma nurse must differentiate neurogenic shock from hemorrhagic shock to guide treatment. Select ALL findings that distinguish neurogenic shock FROM hemorrhagic shock in this patient.
The nurse completes the 6-hour neurovascular assessment of Marcus's right lower extremity. Select ALL findings that indicate developing acute compartment syndrome requiring immediate intervention.
Bernard Collins is a 72-year-old male with Stage IIIA SCLC on cisplatin/etoposide. He was started on carbamazepine 400 mg BID 3 months ago for chemotherapy-induced peripheral neuropathy. He presents with 48 hours of confusion, nausea, headache, and one episode of vomiting. No diarrhea, no edema, wei
Margaret Wilson is a 52-year-old female brought to the psychiatric ED by her daughter after the daughter found her giving away her jewelry, cleaning out her closets, and 'saying goodbye' to family photos. Margaret has a 20-year history of major depressive disorder, managed outpatient with sertraline
Robert Torres is a 45-year-old male with anxiety disorder, managed with alprazolam (Xanax) 4 mg/day in divided doses for 10 years. He lost his prescription 2 days ago and has been unable to obtain a refill. He presents to the ED with tremors, diaphoresis, anxiety, hypertension BP 172/106, HR 118, te
Marcus Williams is a 66-year-old male admitted 14 days ago for a left middle cerebral artery (MCA) ischemic stroke. He received IV tPA in the ED and was transferred to the stroke unit. He has right-sided hemiplegia (face, arm, and leg), Broca's aphasia (understands language but cannot produce meanin
CASE 2 — Mr. David Park, 52-year-old male, no PMH. Admitted 3 days ago for aspiration pneumonia after witnessed seizure. Intubated in ED. ICU Day 3: Mode Volume Control AC, Vt 550 mL, FiO2 0.80, PEEP 8, RR set 16 (total 22 — patient triggering 6 extra breaths). ABG: pH 7.30, PaCO2 52, PaO2 58, HCO3
CASE 11 — Ms. Heather Brandt, 38-year-old female, bipolar disorder type I. Medications: lithium carbonate 900 mg BID (6 years), levothyroxine 88 mcg, lisinopril 10 mg daily (started 2 months ago for hypertension). Husband: 'She's been confused and trembling all day and vomited three times.' Lithium
Mr. Tyler Rhodes is a 22-year-old male brought in by EMS after a diving accident into a shallow pool. He is alert and oriented. He has no motor function below the shoulders, no sensation below the clavicle, and priapism is noted. Vitals: BP 78/44, HR 48 bpm, Temperature 35.4°C. He is warm, pink, and
Amelia Okonkwo is a 26-year-old G2P1 at 33+4 weeks gestation who presents after a witnessed tonic-clonic seizure at home lasting approximately 90 seconds. She had no prenatal care before 28 weeks. BP 5 days ago was 148/96 at prenatal visit. Husband reports severe headache for 24 hours, visual change
Renata Osei (42F, bipolar I on lithium 900mg BID for 6 years, lisinopril 10mg daily) is on hospital day 3. She developed nausea, vomiting x4, diarrhea and has eaten/drunk very little for 48 hours. VS: BP 102/64, HR 96, SpO₂ 97%, GCS 12 — confused, slurred speech. Tremor: COARSE RESTING tremor. DTRs:
Sylvia Park is a 27-year-old G1P1 who delivered her son (James, 3.4 kg, Apgar 9/9) by SVD 4 days ago — uncomplicated delivery. Husband calls on day 4 postpartum: 'She hasn't slept in 3 days. She says she's receiving messages from God that the baby is in danger. Last night she was talking to people w
Leo Marchetti is a 45-year-old male with 14-year history of epilepsy (focal onset with secondary generalization) on levetiracetam 1,500 mg BID. He presents via EMS after a generalized tonic-clonic seizure that started 22 minutes ago and has not stopped. His partner reports Leo has not taken his leve
[NURSE'S NOTES] Patient: Amelia Okonkwo, 26-year-old female, G2P1 Setting: Labor and Delivery Unit → Obstetric ICU Clinical Context: Amelia is a 26-year-old G2P1 at 33+4 weeks gestation who presents after a witnessed tonic-clonic seizure at home lasting approximately 90 seconds. EMS was called. She
[NURSE'S NOTES] Patient: Winston Okafor, 22-year-old male Setting: Emergency Department → Trauma ICU Clinical Context: Winston Okafor is a 22-year-old male collegiate football player who was struck helmet-to-helmet during a game. He was found face-down on the field, unable to move his arms or legs.
Ms. Williams, 29-year-old G2P2, delivered vaginally 1 hour ago after an 18-hour labor. The nurse assesses: fundus boggy and displaced to the right, lochia rubra heavy (2 pads soaked in 15 minutes), BP 92/58 mmHg, HR 124 bpm, skin pale and diaphoretic, estimated blood loss 650mL at delivery, urine ou
Mr. O'Brien, 52-year-old male with a 20-year history of heavy alcohol use, is brought to the ED by his roommate. He has not had a drink in approximately 36 hours after being unable to obtain alcohol. Assessment: T 37.9C, HR 118, BP 158/96, RR 20, diaphoretic, tremulous, CIWA-Ar score 18. He is confu
Mr. Bell, 28-year-old male, arrives via EMS following a motorcycle accident. He is immobilized on a long backboard with cervical collar in place. Assessment: GCS 15, alert, complaining of severe neck pain and inability to move his arms or legs. VS: BP 82/44 mmHg, HR 48 bpm, RR 18, SpO2 96% on 10L no
Mr. Foster, 68-year-old male with HTN and atrial fibrillation (not on anticoagulation), is brought to the ED by his wife who found him on the floor at 0800. She last saw him normal at 0730. Current time: 0845. Assessment: GCS 11 (E3V3M5), right-sided facial droop, right arm and leg weakness (drift p
Mr. Brown, 55-year-old male with poorly controlled hypertension (on amlodipine 5mg, no other medications), presents to the ED after his home BP monitor read 218/136 mmHg. He ran out of amlodipine 5 days ago. Assessment: BP 224/140 mmHg (bilateral arms), HR 96, RR 18, SpO2 98%. Neurological: severe o
Mr. Webb, 31M with epilepsy, 22-min seizure after stopping levetiracetam. Second-line ASM, airway management, NCSE monitoring, medication adherence.
Mrs. Owens, 67F with COPD and RLL CAP. Levofloxacin, oxygen target 88-92%, treatment failure recognition, prevention education.
Mr. Park, 44M with bilateral PE, RV dilation, elevated troponin. IV heparin, hemodynamic monitoring, progression to massive PE.
Ms. Pierce, 67F with AF-related MCA stroke. tPA eligibility, BP management, dysphagia screening, secondary prevention.
Ms. Johnson, 31F PPH from atony. Sequential uterotonics, carboprost contraindication in asthma, tranexamic acid.
Ms. Monroe, 24F at 28 weeks with cervical change. Corticosteroids, nifedipine, magnesium neuroprotection, PPROM.
Emma, 18-month-old with SFS. No LP/EEG needed, parent first aid, prolonged seizure emergency.
Mrs. Rosa Carvalho, a 69-year-old female with a history of ischemic stroke 10 days ago, is on a medical-surgical unit. Her stroke caused dysphagia (di...
Mrs. Fatima Al-Rashid, a 30-year-old G3P3, is on the mother-baby unit 12 hours after an uncomplicated vaginal delivery of a 3,650 g (8 lb 1 oz) male infant at 39 weeks gestation. Labor lasted 8 hours; she received an epidural. She had a second-degree perineal laceration repaired with absorbable sutures. Estimated blood loss at delivery: 350 mL. She is exclusively breastfeeding. Her husband is present and involved. Vital signs: BP 118/72 mmHg, HR 76 bpm, Temp 37.3°C, RR 16/min. Current assessment findings: Uterus firm, midline, at the umbilicus; lochia rubra, moderate (saturating 1 pad per 3 hours); perineum — mild edema, slight ecchymosis, sutures intact; breasts — slightly engorged bilaterally, no cracking or redness of nipples; baby feeding at breast every 2–3 hours with audible swallowing; Homan's sign — negative bilaterally; lower extremities — 1+ pitting edema bilaterally. She reports pain 3/10 at the perineum and is asking when she can go home.
Complete the Bow-Tie clinical reasoning diagram for a 26-year-old male presenting with acute neurological crisis after recent antipsychotic initiation. 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 38-year-old male with acute neurological deterioration. 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 32-year-old postpartum patient. 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 29-year-old pregnant woman at 36 weeks with known preeclampsia who develops a generalized tonic-clonic seizure in the labor room. 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 66-year-old male with acute focal neurologic deficits and time-critical presentation. Select the condition most consistent with the presentation, TWO priority nursing actions, and TWO parameters to monitor.
The 2-week postpartum client describes symptoms that may be more than the typical baby blues.
A 28-year-old G3P3 woman delivered a full-term female infant (birth weight 4,100 g) vaginally 45 minutes ago. Labor lasted 14 hours; the second stage was 2.5 hours. The delivery required a second-degree perineal laceration which was repaired. The placenta was delivered spontaneously 10 minutes after the infant and appeared intact. Pregnancy history: no significant complications. Labs on admission: hemoglobin 12.1, hematocrit 36%, platelets 210,000. Blood type O positive. Immediate postpartum v
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