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Gerontology Nursing Case Studies

100+ narratives for learning.

Donna J. Bowles, MSN, EdD, RN, CNE

Praise for the first edition:

"This is an excellent teaching guide and resource manual for instructors, gerontological nursing students, and practicing nurses and social workers who wish to learn more about geriatric concerns and care. It will be kept by nursing students long after they graduate as a guide to resources that will be valuable throughout their nursing careers. As a home care nurse working mainly with the geriatric community, I found the resources helpful in my practice. As an instructor, I found the book to be a very useful guide for teaching geriatrics." Score: 90, 4 Stars

óDoody's Medical Reviews

"[This] is a unique volume that effectively addresses the lack of gerontology case studies for use with undergraduate nursing students. Case studies are a pedagogically powerful approach to active learning that offer opportunities to apply content to clinical practice."

óThe Gerontologist

"The case narrative approach of this book promotes active learning that is more meaningful to students (and practicing nurses) and more likely to increase the transfer of evidence into practice. An excellent resource for faculty (staff educators) to facilitate critical learning skills."

óLiz Capezuti, PhD, RN, FAAN

Dr. John W. Rowe Professor in Successful Aging

Co-Director, Hartford Institute for Geriatric Nursing

New York University College of Nursing

Vivid case examples help guide nurses in developing appropriate interventions that include complementary and alternative health therapies and provide a basis for evaluating outcomes. Exercises interspersed throughout each case study include numerous open-ended and multiple-choice questions to facilitate learning and critical thinking. The text is unique in that some of the presented cases focus on psychosocial issues such as gambling addiction, hoarding behavior, emergency preparedness, and long-distance caregiving. Cases also depict geriatric clients who are living healthy, productive lives to counter myths and negative attitudes about older adults. Scenarios demonstrating ethical dilemmas prepare students to appropriately respond to "gray area" situations. The text is geared for AACN and NLN accreditation and is organized according to the needs of actual clinical settings. With cases that take place in the home and community or within primary, acute, and long-term care facilities, this book will be useful for courses specific to gerontology nursing or across any nursing curriculum.

New to the Second Edition:

  • A completely new section of Aging Issues Affecting the Family
  • New cases addressing health care disparities, aging in place, and prevention of catheter-associated urinary tract infection
  • Additional contemporary case studies
  • The addition of Quality for Safety in Nursing Education (QSEN) initiatives
  • A greater focus on prioritization and delegation of client's needs infused throughout exercises

Foreword Barbara Resnick, PhD, CRNP, FAAN, FAANP

Chapter 1. Political, Ethical, and Legal Issues of Older Adults

Case 1.1 Advance Directives

Case 1.2 Health Care Decision Making

Case 1.3 Physical Restraints

Case 1.4 Patient’s Bill of Rights (Long-Term Care)

Case 1.5 The Older Driver

Case 1.6 Iatrogenesis and the Elderly

Chapter 2. Loss and End-of-Life Issues

Case 2.1 Death of a Spouse

Case 2.2 Prolonged Grief

Case 2.3 Death With Dignity

Chapter 3. Mistreatment of Older Adults

Case 3.1 Physical Abuse

Case 3.2 Physical Neglect

Case 3.3 Consumer Fraud and the Elderly

Case 3.4 Financial Mistreatment

Case 3.5 Health Care Disparities and the Elderly

Chapter 4. Depression, Addiction, and Suicide

Case 4.1 Alcoholism

Case 4.2 Prescription Pain Medication Misuse

Case 4.3 Depression

Case 4.4 Gambling Disorder

Case 4.5 Risk for Suicide

Chapter 5. Assessment and Management of Individual Issues

Case 5.1 Spirituality and Aging

Case 5.2 Frailty

Case 5.3 Functional Decline in the Hospitalized Elderly

Case 5.4 Aging in Place

Case 5.5 Hoarding Behavior

Case 5.6 Health Promotion for the Elderly Client

Case 5.7 Overview of Medicare Services

Chapter 6. Sexuality

Case 6.1 Erectile Dysfunction

Case 6.2 Vaginal Dryness and Dyspareunia

Case 6.3 Sexual Problems Due to Physical Limitations

Case 6.4 Sexual Expression for Institutionalized Older Adults

Chapter 7. The Aging Sensory System

Case 7.1 Gustatory and Olfactory Disturbance

Case 7.2 Hearing Loss

Case 7.3 Somatosensory Disturbance

Case 7.4 Macular Degeneration

Case 7.5 Visual Alterations

Chapter 8. Integumentary Disorders and Infectious Diseases of the Elderly

Case 8.1 Venous Insufficiency in a Homebound Elder

Case 8.2 Pressure Ulcer in an Acute Care Setting

Case 8.3 Burns and the Elderly

Case 8.4 Dermatologic Drug Reaction

Case 8.5 Postoperative Infection ( Clostridium difficile )

Case 8.6 Herpes Zoster (Shingles)

Chapter 9. The Aging Musculoskeletal System

Case 9.1 Osteoarthritis

Case 9.2 Hip Fracture

Case 9.3 Falls: Home Environment

Case 9.4 Fall Prevention in a Hospital Setting

Case 9.5 Immobility

Case 9.6 Osteoporosis

Case 9.7 Foot Problems in the Elderly

Chapter 10. The Aging Neurologic System

Case 10.1 Cerebrovascular Accident (CVA) (Acute Phase)

Case 10.2 CVA Rehabilitation Phase

Case 10.3 Parkinson’s Disease

Case 10.4 Alzheimer’s Disease

Case 10.5 Dizziness/Vertigo

Chapter 11. The Aging Cardiovascular System

Case 11.1 Coronary Artery Disease: Living With Chronic Stable Angina

Case 11.2 Congestive Heart Failure

Case 11.3 Chronic Atrial Fibrillation

Case 11.4 Peripheral Vascular Disease

Case 11.5 Hyperlipidemia

Case 11.6 Abdominal Aortic Aneurysm

Case 11.7 Anemia

Case 11.8 Pacemaker Implantation

Chapter 12. The Aging Pulmonary System

Case 12.1 Pneumonia

Case 12.2 Lung Cancer

Case 12.3 Chronic Obstructive Pulmonary Disease

Case 12.4 Tuberculosis

Case 12.5 Pulmonary Embolism

Case 12.6 Influenza Prevention in the Elderly

Chapter 13. The Aging Endocrine System

Case 13.1 Diabetes Mellitus (Screening)

Case 13.2 Diabetes Mellitus and Medication

Case 13.3 Diabetes Mellitus and Nutrition

Chapter 14. The Aging Genitourinary System

Case 14.1 Transient Urinary Incontinence

Case 14.2 Benign Prostatic Hypertrophy

Case 14.3 Functional Incontinence

Case 14.4 Acute Renal Insufficiency

Case 14.5 Pelvic Organ Prolapse

Case 14.6 Catheter-Associated Urinary Tract Infections

Chapter 15. Nutrition and the Aging Gastrointestinal System

Case 15.1 Mealtime Difficulties

Case 15.2 Oral Health

Case 15.3 Diverticular Disease

Case 15.4 Chronic Constipation

Case 15.5 Hiatal Hernia

Case 15.6 Hydration Management

Chapter 16. Cancer in the Older Adult

Case 16.1 Chemotherapy and the Aged

Case 16.2 Colorectal Cancer

Case 16.3 HIV/AIDS

Case 16.4 Hospice Care

Chapter 17. Cognitive Impairment in the Older Adult

Case 17.1 Acute Confusion (Delirium)

Case 17.2 Early Dementia

Case 17.3 Dementia (Late Stage)

Case 17.4 Wandering/Need for Movement

Case 17.5 Agitation and Aggression

Chapter 18. Cultural Diversity

Case 18.1 Culturally Specific Care—Part I

Case 18.2 Culturally Specific Care—Part II

Case 18.3 The Homeless Aging

Case 18.4 The Baby Boomer Culture

Chapter 19. Pain Management in the Older Adult

Case 19.1 Undertreatment of Pain

Case 19.2 Side Effects of Opioids

Case 19.3 Adjuvants for Pain Control

Case 19.4 Noninvasive Interventions for Pain

Chapter 20. Sleep Disturbances in the Older Adult

Case 20.1 Restless Legs Syndrome

Case 20.2 Insomnia

Case 20.3 Hypersomnia

Chapter 21. Aging Issues Affecting the Family

Case 21.1 Caregiver Burden

Case 21.2 Ineffective Family Coping

Case 21.3 Emergency Preparedness for the Elderly and Their Families

Case 21.4 Leaving the Homestead: Challenges and Solutions

Case 21.5 Long-Distance Caregiving

Case 21.6 Relationships and Aging

Case 21.7 Geriatric Specialists for the Family

Donna J. Bowles, MSN, EdD, RN, CNE, is Associate Professor of Nursing, Indiana University Southeast, New Albany, IN and Instructor of NCLEX-RN Review Courses for Kaplan Education, Inc.

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  • Release Date: April 8, 2015
  • Paperback / softback
  • Trim Size: 7in x 10in
  • ISBN: 9780826194046
  • eBook ISBN: 9780826194053

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gerontology nursing case studies with questions and answers

The Exam Preparation Guide

APRN Gerontological Specialist Certification Preparation Guide, 1st. Edition

The Preparation Guide offers information and guidelines that may be helpful in assisting you to prepare for the Gerontological Specialists Certification (GS-C) exam. The preparation guide has been designed to help focus your attention on areas of particular emphasis as determined by practice analyses and is not meant to be all-inclusive.

Use of this preparation guide as a study resource does not imply that its use will guarantee passing on the certification examination. There are multiple other resources that are available to assist you in your preparation.

View/download the  APRN Gerontological Specialist Certification Preparation Guide, 1st. Edition

  • Halter, J.B., Ouslander, J.G., Studenski, S., High, K.P., Asthana, S., Supiano, M.A., Ritchie, C. (Eds.). (2017). Hazzard's Geriatric Medicine and Gerontology , 7th ed., New York: McGraw-Hill Education.
  • Ham, R.J., Sloane, P.D., Warshaw, G.A., Potter, J.F., & Flaherty, E. (Eds.). (2014). Ham's Primary Care Geriatrics: A Case-Based Approach , 6th ed. Philadelphia: Saunders/ Elsevier.
  • Harper GM, Lyons WL, Potter JF. (Eds). (2019) Geriatrics Review Syllabus: A Core Curriculum in Geriatric Medicine . 10th ed. New York: American Geriatrics Society.
  • Ferrell, B.R., Coyle, N., & Paice, J. (Eds). (2015). Oxford Textbook of Palliative Nursing , 4th ed.  New York: Oxford University Press.
  • Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (Eds.). (2019).  Advanced practice nursing in the care of older adults (2nd ed.). Philadelphia, PA: F.A. Davis Company.
  • Morley, J.E., Ouslander, J.G., Tolson, D., & Velias, B. (2013). Nursing Home Care . New York: McGraw-Hill Education.
  • Reuben, D.B., Herr, K.A., Pacala, J.T., Pollock, B.G., Potter, J.F., & Semla, T.P. (2018).  Geriatrics at Your Fingertips , (20th ed.). New York: American Geriatrics Society.
  • Semla, T.P., Belzer, J.L., & Higbee, M.D. (Eds.). (2016). Geriatric Dosage Handbook , 21st ed. Hudson, OH: Lexicomp/ Wolters Kluwer Clinical Drug Information.
  • Singelton, J.K., DiGregorio, R.W., Green-Hernandex, C, Holzemer, S.P., Faber, E.S., Ferrara, L.R., & Slyer, J.T. (Eds.) (2015). Primary Care: An Interprofessional Perspective , 2nd ed. New York: Springer Publishing company.

Other references - Examples

  • American Geriatrics Society. (2015) Updated Beers criteria for potentially inappropriate medication use in older adults.
  • Medicare Benefit Policy Manual
  • Quality Assurance & Performance Improvement
  • The National Long-Term Care Ombudsman Resource Center
  • Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System (2016)

The APRN Gerontological Specialist Certification Study Guide 1st. Edition The Examination Preparation Guide includes:

  • Exam Blueprint  
  • GAPNA Section Articles with case studies in Geriatric Nursing , based on 12 Nursing Proficiencies
  • Suggested Reading Material
  • Sample Questions and Answer Key with Rationale

This booklet offers you references and information which can be used to prepare yourself to take the APRN Gerontological Specialist Certification exam. The contents does not imply successful performance on the examination. Purchase in the GAPNA Store.

Sample Exam Questions

The sample questions are provided by GNCC to familiarize applicants with the type of questions on the exam. The questions in this quiz do not represent the actual exam in format, length or content coverage.

Applicants should not equate success or failure in answering these questions as a measure of readiness for the GS-C exam, nor does it guarantee passing the examination.

View/download the Sample GS-C Examination Questions

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Gerontology Nursing Case Studies: 100+ Narratives for Learning

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Gerontology Nursing Case Studies: 100+ Narratives for Learning 2nd Edition

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  • Book Description
  • Editorial Reviews

Praise for the first edition:

"This is an excellent teaching guide and resource manual for instructors, gerontological nursing students, and practicing nurses and social workers who wish to learn more about geriatric concerns and care. It will be kept by nursing students long after they graduate as a guide to resources that will be valuable throughout their nursing careers. As a home care nurse working mainly with the geriatric community, I found the resources helpful in my practice. As an instructor, I found the book to be a very useful guide for teaching geriatrics." Score: 90, 4 Stars

óDoody's Medical Reviews

"[This] is a unique volume that effectively addresses the lack of gerontology case studies for use with undergraduate nursing students. Case studies are a pedagogically powerful approach to active learning that offer opportunities to apply content to clinical practice."

óThe Gerontologist

"The case narrative approach of this book promotes active learning that is more meaningful to students (and practicing nurses) and more likely to increase the transfer of evidence into practice. An excellent resource for faculty (staff educators) to facilitate critical learning skills."

óLiz Capezuti, PhD, RN, FAAN

Dr. John W. Rowe Professor in Successful Aging

Co-Director, Hartford Institute for Geriatric Nursing

New York University College of Nursing

Vivid case examples help guide nurses in developing appropriate interventions that include complementary and alternative health therapies and provide a basis for evaluating outcomes. Exercises interspersed throughout each case study include numerous open-ended and multiple-choice questions to facilitate learning and critical thinking. The text is unique in that some of the presented cases focus on psychosocial issues such as gambling addiction, hoarding behavior, emergency preparedness, and long-distance caregiving. Cases also depict geriatric clients who are living healthy, productive lives to counter myths and negative attitudes about older adults. Scenarios demonstrating ethical dilemmas prepare students to appropriately respond to "gray area" situations. The text is geared for AACN and NLN accreditation and is organized according to the needs of actual clinical settings. With cases that take place in the home and community or within primary, acute, and long-term care facilities, this book will be useful for courses specific to gerontology nursing or across any nursing curriculum.

New to the Second Edition:

  • A completely new section of Aging Issues Affecting the Family
  • New cases addressing health care disparities, aging in place, and prevention of catheter-associated urinary tract infection
  • Additional contemporary case studies
  • The addition of Quality for Safety in Nursing Education (QSEN) initiatives
  • A greater focus on prioritization and delegation of client's needs infused throughout exercises

About the Author

Donna J. Bowles, MSN, EdD, RN, CNE, is Associate Professor of Nursing, Indiana University Southeast, New Albany, IN and Instructor of NCLEX-RN Review Courses for Kaplan Education, Inc.

  • ISBN-10 0826194044
  • ISBN-13 978-0826194046
  • Edition 2nd
  • Publisher Springer Publishing Company
  • Publication date April 8, 2015
  • Language English
  • Dimensions 7 x 0.66 x 10 inches
  • Print length 290 pages
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  • Publisher ‏ : ‎ Springer Publishing Company; 2nd edition (April 8, 2015)
  • Language ‏ : ‎ English
  • Paperback ‏ : ‎ 290 pages
  • ISBN-10 ‏ : ‎ 0826194044
  • ISBN-13 ‏ : ‎ 978-0826194046
  • Item Weight ‏ : ‎ 1.18 pounds
  • Dimensions ‏ : ‎ 7 x 0.66 x 10 inches
  • #118 in Nursing Gerontology (Books)
  • #245 in Geriatrics (Books)
  • #977 in Coping with Suicide Grief

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Dementia case study with questions and answers

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Dementia case study with questions and answers

Common dementia exam questions for medical finals, OSCEs and MRCP PACES

The case below illustrates the key features in the assessment of a patient with dementia or undiagnosed memory decline. It works through history, examination and investigations – click on the plus symbols to see the answers to each question

Part 1: Mavis

  • Mavis is an 84-year old lady, referred to you in the memory clinic for assessment of memory impairment. She attends in the company of her son and daughter-in-law.
  • On the pre-clinic questionnaire her son has reported a severe deterioration in all aspects of her cognition over the past 12 months.
  • The patient herself acknowledges that there have been memory problems, but feels it is just her short term memory that is an issue.

Question 1.

  • To begin the history, start broadly. Build rapport and establish both the patient’s view on memory impairment (if any) and the family’s (or other collateral history).
  • Patient’s (and collateral) view of memory decline
  • Biographical history
  • Objective view of memory decline (e.g. knowledge of current affairs)
  • Impact of memory decline on day-to-day living and hobbies
  • Social history, including safety and driving
  • General medical history (especially medications)
  • See below for details on these…

Question 2.

  • Is it for everything or are specific details missed out/glossed over?
  • Try to pin down specific details (e.g. names of people/places).
  • At what time in chronological order do things start to get hazy?

Question 3.

  • If under 12 years this will lead to additional point being awarded on some cognitive tests
  • Ask about long term memories, e.g. wedding day or different jobs
  • Then move on to more recent memories, e.g. last holiday

Question 4.

  • If your patient watches the news/read newspapers on a regular basis, ask them to recount the headlines from the past few days.
  • Be sure to look for specifics to prevent your patient masking memory deficiencies with broad statements. For example: “The government are incompetent, aren’t they?!” should be clarified by pinning down exactly why they are incompetent, for example: “Jeremy Hunt”.
  • If they like to read, can they recall plotlines from current books or items from magazines?
  • If they watch TV, can they recount recent plot lines from soaps, or formats of quiz shows?

Question 5.

  • Ask about hobbies and other daily activities, and whether or not these have declined recently.
  • If your patient no longer participates in a particular hobby, find out why: is it as a result of a physical impairment (e.g. arthritis making cooking difficult), or as the result of a loss of interest/ability to complete tasks (e.g. no longer able to complete crosswords/puzzles).
  • Once you have a good idea of the memory decline itself, begin to ask about other features. Including a social and general medical history.

Question 6.

  • Review their social history and current set-up, and also subjective assessments from both patient and family over whether or not the current arrangements are safe and sustainable as they are.
  • Previous and ongoing alcohol intake
  • Smoking history
  • Still driving (and if so, how safe that is considered to be from collateral history)
  • Who else is at home
  • Any package of care
  • Upstairs/downstairs living
  • Meal arrangements (and whether weight is being sustained).
  • Of all these issues, that of driving is perhaps one of the most important, as any ultimate diagnosis of dementia must be informed (by law) to both the DVLA and also the patient’s insurers. If you feel they are still safe to drive despite the diagnosis, you may be asked to provide a report to the DVLA to support this viewpoint.

Now perform a more generalised history, to include past medical history and – more importantly – a drug history.

Question 7.

  • Oxybutynin, commonly used in primary care for overactive bladder (anticholinergic side effects)
  • Also see how the medications are given (e.g. Dossett box)
  • Are lots of full packets found around the house?

Part 2: The History

On taking a history you have found:

  • Mavis was able to give a moderately detailed biographical history, but struggled with details extending as far back as the location of her wedding, and also her main jobs throughout her life.
  • After prompting from her family, she was able to supply more information, but it was not always entirely accurate.
  • Her main hobby was knitting, and it was noted that she had been able to successfully knit a bobble hat for her great-grand child as recently as last month, although it had taken her considerably longer to complete than it might have done a few years previously, and it was a comparatively basic design compared to what she has been able to create previously.
  • She has a few children living in the area, who would frequently pop in with shopping, but there had been times when they arrived to find that she was packed and in her coat, stating that she was “just getting ready to go home again”.
  • She had been helping occasionally with the school run, but then a couple of weekends ago she had called up one of her sons – just before she was due to drive over for Sunday lunch – and said that she could not remember how to drive to his house.
  • Ever since then, they had confiscated her keys to make sure she couldn’t drive. Although she liked to read the paper every day, she could not recall any recent major news events.  Before proceeding to examine her, you note that the GP referral letter has stated that her dementia screen investigations have been completed.

Question 8.

  • Raised WCC suggests infection as a cause of acute confusion
  • Uraemia and other electrolyte disturbances can cause a persistent confusion.
  • Again, to help rule out acute infection/inflammatory conditions
  • Liver failure can cause hyperammonaemia, which can cause a persistent confusion.
  • Hyper- or hypothyroidism can cause confusion.
  • B12 deficiency is an easily missed and reversible cause of dementia.
  • This looks for space occupying lesions/hydrocephalus which may cause confusion.
  • This can also help to determine the degree of any vascular component of an ultimately diagnosed dementia.

Part 3: Examination

  • With the exception of age-related involutional changes on the CT head (noted to have minimal white matter changes/small vessel disease), all the dementia screen bloods are reassuring.
  • You next decide to perform a physical examination of Mavis.

Question 9.

  • Important physical findings that are of particular relevance to dementia, are looking for other diseases that may have an effect on cognition.
  • To look for evidence of stroke – unlikely in this case given the CT head
  • Gait (shuffling) and limb movements (tremor, rigidity, bradykinesia)
  • Affect is also important here and may also point to underlying depression
  • Pay attention to vertical gaze palsy, as in the context of Parkinsonism this may represent a Parkinson plus condition (e.g. progressive supranuclear palsy).
  • It is also useful to look at observations including blood pressure (may be overmedicated and at risk of falls from syncope) and postural blood pressure (again, may indicate overmedication but is also associated with Parkinson plus syndromes e.g. MSA)

Part 4: Cognitive Testing

  • On examination she is alert and well, mobilising independently around the clinic waiting room area.  A neurological examination was normal throughout, and there were no other major pathologies found on a general examination.
  • You now proceed to cognitive testing:

Question 10.

  • Click here for details on the MOCA
  • Click here for details on the MMSE
  • Click here for details on the CLOX test

Part 5: Diagnosis

  • Mavis scores 14/30 on a MOCA, losing marks throughout multiple domains of cognition.

Question 11.

  • Given the progressive nature of symptoms described by the family, the impairment over multiple domains on cognitive testing, and the impact on daily living that this is starting to have (e.g. packing and getting ready to leave her own home, mistakenly believing she is somewhere else), coupled with the results from her dementia screen, this is most likely an Alzheimer’s type dementia .

Question 12.

  • You should proceed by establishing whether or not Mavis would like to be given a formal diagnosis, and if so, explain the above.
  • You should review her lying and standing BP and ECG, and – if these give no contraindications – suggest a trial of treatment with an acetylcholinesterase inhibitor, such as donepezil.
  • It is important to note the potential side effects – the most distressing of which are related to issues of incontinence.
  • If available, put her in touch with support groups
  • Given the history of forgetting routes before even getting into the care, advise the patient that she should stop driving and that they need to inform the DVLA of this (for now, we will skip over the depravation of liberty issues that the premature confiscation of keys performed by the family has caused…)
  • The GP should be informed of the new diagnosis, and if there are concerns over safety, review by social services for potential support should be arranged.
  • Follow-up is advisable over the next few months to see whether the trial of treatment has been beneficial, and whether side effects have been well-tolerated.

Now click here to learn more about dementia

Perfect revision for medical students, finals, osces and mrcp paces, …or  click here to learn about the diagnosis and management of delirium.

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Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

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This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

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Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

  • The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
  • Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
  • Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
  • Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

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When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

Nurse Sarah’s Notes and Merch

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Just released is “ Fluid and Electrolytes Notes, Mnemonics, and Quizzes by Nurse Sarah “. These notes contain 84 pages of Nurse Sarah’s illustrated, fun notes with mnemonics, worksheets, and 130 test questions with rationales.

You can get an eBook version here or a physical copy of the book here.

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