NURS701 S1 Exam Scenarios

Exam 2.5 hours made up of:

• 8 Multichoice Questions (MCQs) on medication administration calculations (LO1, 30 min).

Calculators allowed and formula provided.
• 2 scenarios with 3 questions each to cover LO5, LO6, LO7 (120 minutes; 30 min/short answer
question).
• 10 minutes reading time is in addition to the 2.5 hours

Learning Outcomes

LO1. Demonstrate professional responsibility and competency through accountability, advocacy,

safe practice (including legal, ethical and cultural safety) using reasoned judgment.

LO5. Analyse pathophysiology and physiological changes across the lifespan in relation to nursing
practice.

LO6. Critique the impact of cultural, ethical, legal, and socio-political contexts on nursing care and
patient experience.

LO7. Integrate evidence-based practice with nursing knowledge.

Case Study 1 Septic Shock

Presentation

Max is a 68-year-old man who was brought to the emergency department via ambulance from a
local nursing home where he was found by a Health Care Assistant to be very confused and restless.
Until this morning, Max has been orientated to time, place, and person.

Past Medical History

Max has type 1 diabetes and congestive heart failure, and a previous history of prostate cancer. He
has had an indwelling urinary catheter in place for 5 days because of difficulty voiding. His current
medications are digoxin, hydrochlorothiazide, isosorbide and insulin.

Social History

Max has been a resident of the nursing home for 3 years. He has one son living in Tauranga who tries
to visit every other month.

Assessment data

Neurologic: lethargic, confused, does not follow commands, moves all extremities in response to
verbal stimuli.

Cardiovascular: BP 80/60, HR 112 and regular, peripheral pulses weak and thready

Respiratory: RR 34 and shallow, SpO2 82%, breath sounds audible with bilateral crackles in lung
bases
GI/GU: abdomen soft, catheter draining scant purulent urine. Dipstick urine is positive for leukocytes
and nitrites.

Skin: warm, dry, flushed, T 39.4 C

Tentative diagnosis: septic shock

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Case Study 2 Diabetic Ketoacidosis (DKA)

Presentation

Sam is a 14-year-old admitted to your ward with symptoms of diabetic ketoacidosis (DKA), blood
ketone level of 5.7mmol/L and blood glucose of 18.2mmol/L. His symptoms on admission to ED
included drinking fluids excessively, increased urination, decreased weight (approx. 5 Kg in 3
months), and increased irritability.

Past medical history

Sam was diagnosed with type 1 diabetes 6 months ago at the age of 13 years. He presented to ED 3
months ago with symptoms of DKA that were treated with insulin only. During that admission, Sam’s
mother stated that she felt Sam would benefit from learning to cope with his diabetes on his own
and had declined additional structured education, feeling that they were managing themselves.

Social history

Sam lives with his mother, a single parent, and his 10-year-old sister. His mother works night shifts
for an industrial cleaning service, leaving Sam with the responsibility of getting his sister to bed at
night.

Assessment Data

Neurologic: alert, orientated to person, place and time

Cardiovascular: HR 108, BP 110/70 and regular, pulses strong

Respiratory: RR 24, SpO2 98%, breath sounds clear on auscultation, breath smells fruity

Gi/Gu: urine dipstick positive for ketones

Skin: skin turgor 3 sec, dry mucous membranes

Diagnosis: DKA

Management plan: IV therapy 0.9% sodium chloride with 40 mmol/L potassium chloride, hourly vital
signs, IV insulin

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Case Study 3 Traumatic Brain Injury (TBI)

Presentation

Sean, a 13-year-old, suffered a compound fracture to the skull and facial fractures in a bicycle
accident. On admission to hospital, he was immediately taken to surgery for evacuation of a right
subdural haematoma in the temporal region and repair of facial fractures. Sean has been transferred
to your ward from PICU and is on his 4th postoperative day.

Past Medical History

Sean has no previous medical history or hospitalisations.

Social history

Sean was riding his bike without his helmet. He had left his house upset after an argument with his
parents about the friends he has been hanging out with. His parents are at his bedside 24/7. They
have indicated they feel responsible for his accident and are fearful he will have a poor outcome.

You complete a set of vital signs and Glasgow Coma Scale at the beginning of your shift.

Assessment data

Neurological: Glasgow Coma Scale 10 (reduced from 12 recorded yesterday)

Vital signs: Temp 37.4° C, HR 66, RR 12 and slightly irregular, BP 120/60

Diagnosis: TBI with subdural haematoma, postop day 4

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Case Study 4 Pancreatitis

Presentation

Aneru is a 55-year-old admitted to hospital with acute pancreatitis. He is complaining of severe

abdominal pain in the LUQ, radiating to his mid-back. He is also nauseated and has vomited 4 times
over the past 12 hours. Vomit is bile coloured.

Past Medical History

History of excessive alcohol. BMI 30. Attempts to lose weight have been unsuccessful.

Social History

Lives alone. Made redundant 3 months ago when the construction company he worked for went
into receivership.

Assessment data:

Vital signs: T 38.3°C, HR 124, RR 26, BP 100/58, SpO2 95%, pain score 7/10.

Neurological: alert, orientated to person, place and time.

Cardiovascular: Heart sounds regular, tachycardic.

Respiratory: tachypnoea, air entry audible to lung bases

Abdomen: rounded, guarding on palpation LUQ

Skin: Jaundice noted in sclera

Lab values:

Serum amylase 400 U/L (28-100 U/L)

 Serum Lipase 210 U/L (10-60 U/L)

WBC 20 x 103/µL (4-11 x 103/µL)

Tentative Diagnosis: Acute Pancreatitis

Management plan: NPO, NG tube to low intermittent suction, IV therapy, Meperidine (Demerol)
IVPB, Ranitidine (Zantac) IVPB, 2 hourly vital signs

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Case Study 5 Bronchiolitis and dehydration

Presentation

Courtney, 6-months-old, has just been admitted to the ward with a 4-day history of wheeze, cough,
fevers, and coryza. She presented to CED with tachypnoea, tracheal tug and intercostal recessions.
Courtney is formula fed but has had reduced oral intake. Courtney’s mother is unsure how long her
intake has been reduced. She has had only one wet nappy in the last 24 hours. Mother seems
distracted and is wanting to go home.
Past Health History:

Normal pregnancy, labour and delivery. APGAR scores 9 and 10. Has had one previous admission
with bronchiolitis at 3 months of age.

4-year-old sister attends Day Care and has a viral illness presently. She is home with a 17-year-old
cousin looking after her while his mother and Courtney are in hospital.

Assessment Data

When you arrive in Courtney’s room after handover, you find her looking drowsy and clammy. You
complete a quick assessment.

Vital signs: HR 162 bpm, RR 50 rpm, BP 79/40, Temp 39.1C tympanic, SpO2 92%.

Cardiovascular: extremities cool to touch, capillary refill > 3 seconds

Respiratory: tracheal tug and nasal flaring, inspiratory and expiratory wheeze and widespread
crackles on auscultation

Skin: mottling in legs, poor skin turgor

Weight recorded on admission: 9.4 kg.

Tentative diagnosis: Bronchiolitis and dehydration

Management Plan: NGT for feeds, q1h vital sign monitoring

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Case Study 6 Pre-Eclampsia

Presentation

Helen is a 38-year-old G4P0 woman who came to ED following sudden onset of facial and extremity
oedema and a severe headache. She is 30+5 weeks gestation.
Past history

This pregnancy has been managed by her community midwife with once per trimester visits to her
GP. Helen’s previous maternal history includes 2 miscarriages at 12 and 16 weeks. Her third
pregnancy ended with an ectopic pregnancy at 10 weeks which she miscarried naturally.

Helen has seasonal allergies and asthma which she manages with a salbutamol inhaler. Both parents
have hypertension. She works as a teacher’s aide and lives with her partner. She has never smoked
and has not drunk alcohol since the second miscarriage.

Assessment data

Vital signs: Temp 36.4°C, RR 22, HR 81, BP 150/107 mmHg,

Neurological: alert, orientated to person and time, photophobia evident

Cardiovascular: Heart sounds regular.

Respiratory: lung sounds clear to bases.

Abdomen: distended, fundal height 38 cm, no contractions noted.

Skin: Oedema evident in face, pitting oedema in legs and arms.

Dipstick urine ++2 proteinuria

Foetal HR via electronic monitoring is 135 bpm.

Tentative Diagnosis: Pre-eclampsia