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.
CJMM Skill: Recognize Cues The nurse reviews Maya's initial assessment data collected at 0700—0800. Select ALL findings that are abnormal and require immediate nursing action or provider notification.
The nurse reviews the initial assessment findings for this 27-year-old patient. Select ALL findings that suggest ectopic pregnancy and require immediate clinical evaluation.
The nurse reviews the infant's assessment data and laboratory results. Select ALL findings that indicate this infant requires phototherapy rather than observation alone.
Sofia Martinez is a 32-year-old G2P1 at 36 weeks with pregnancy-induced hypertension and smoking history (1 ppd). Sudden-onset severe abdominal pain and vaginal bleeding at home 30 minutes ago. BP 142/94, HR 126, RR 22, SpO2 97%. Uterus: board-like rigidity, no relaxation between contractions (tetan
Rachel Kim is a 27-year-old G1P0 at 39 weeks gestation admitted for induction of labor for post-dates pregnancy. Her cervix was 3 cm dilated, 80% effaced, -2 station. The obstetrician performed AROM (artificial rupture of membranes) using an amnihook. Approximately 1,000 mL of clear amniotic fluid g
Amara Johnson is a 29-year-old G1P0 at 34+2 weeks gestation with no prior prenatal complications. She presents to triage with severe headache (7/10), 'spots in my vision' (scotoma), and epigastric/right upper quadrant pain for 3 hours. BP on arrival: 172/110 mmHg. Repeat BP 10 minutes later: 168/106
CASE 3 — Ms. Tamika Brooks, 28-year-old, G1P0. PMH: Chlamydia treated 3 years ago. Urine hCG positive, LMP 7 weeks ago. Sudden onset severe left lower quadrant pain 9/10, referred left shoulder pain, one episode of syncope. BP 74/42, HR 148, RR 26, SpO2 94% (15L NRB). Abdomen: rigid, exquisitely ten
CASE 9 — Mrs. Layla Haddad, 32-year-old, G3P2. PMH: Chronic hypertension (labetalol 200 mg BID). Lost to follow-up after 22 weeks. Currently 34 weeks. Smokes 1/2 PPD throughout pregnancy. Sudden 'board-like' abdominal pain with no relief between contractions. Significant vaginal bleeding. BP 168/114
Ms. Aaliyah Washington is a 28-year-old G1P0 who presented with acute right lower quadrant pain and a β-hCG of 4,820 mIU/mL. She underwent emergency right salpingectomy for confirmed ruptured ectopic pregnancy (the left adnexal mass seen on ultrasound was a hemorrhagic ovarian cyst). Estimated intra
Baby Marcus is a 12-day-old male born at 38 weeks gestation via prolonged labor with ruptured membranes for 22 hours. He was admitted to the NICU on day 1 with fever (38.6°C), poor feeding, and irritability. CSF analysis confirmed GBS (Group B Streptococcal) bacterial meningitis: CSF WBC 2,840, prot
[NURSE'S NOTES] Patient: Josephine Carter, 29-year-old female Setting: Labor and Delivery Unit Clinical Context: Josephine Carter is a 29-year-old G3P2 female at 34+4 weeks gestation admitted for painless vaginal bleeding. She reports waking from sleep with "a gush of bright red blood" that soaked t
[NURSE'S NOTES] [H&P] [VITALS] [LABS] [OB HISTORY] [ORDERS] [H&P] Ms. Dominique Washington is a 34-year-old Black woman, G4P3, at 36 weeks and 2 days gestation, admitted to Labor & Delivery for her scheduled repeat cesarean section. She has had three prior cesarean deliveries (the last two
Ms. Coleman, 26-year-old G1P0 at 35 weeks gestation, presents to L&D triage with a severe headache she rates 9/10, visual disturbances (flashing lights), and right upper quadrant pain. Her prenatal care was uncomplicated until today. Assessment: BP 168/112 mmHg (repeated x2), HR 96, RR 16, SpO2 98%.
Ms. Cruz, 27F with PID history, ruptured right tubal ectopic. Massive transfusion, emergency salpingectomy, Rh status, therapeutic communication.
A 33-year-old G3P2 at 32 weeks gestation presents to labor and delivery with painless bright red vaginal bleeding that began 2 hours ago — she has soaked through 2 perineal pads. She denies abdominal pain, contractions, or ruptured membranes. Obstetric history: 2 prior uncomplicated vaginal deliveries. A prenatal ultrasound 2 weeks ago documented a complete placenta previa covering the internal cervical os. Vital signs: HR 112 bpm, BP 100/64 mmHg (baseline 118/76), RR 18, SpO2 98% on room air. A
An 11-year-old child is brought to the emergency department by parents. History from parents: the child has been 'not himself' for about a week — losing weight despite eating a lot, drinking excessive water (finishing a large bottle every hour or two), urinating frequently including two episodes of bedwetting after being fully continent for years. Over the past 24 hours, increasing fatigue, two episodes of vomiting, and labored breathing. No known medical history, no medications. Family history:
A 32-year-old primigravida at 34 weeks gestation is brought to labor and delivery triage by her husband. She reports a 2-day history of worsening headache unresponsive to acetaminophen, blurred vision with "spots" in her visual field over the past 12 hours, and new right upper quadrant pain that began this morning. She also reports swelling of her face and hands over the past week. Prenatal history: unremarkable early pregnancy. Blood pressure trend: baseline 118/72 early in pregnancy; 140/88 a
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