NGN Bowtie Questions: Clinical Reasoning Quiz

1. A patient with pneumonia has consolidation on X-ray and productive cough. What nursing diagnosis connects these findings?

Ineffective airway clearance related to excessive secretions

Anxiety related to hospitalization

Activity intolerance related to fatigue

Imbalanced nutrition related to anorexia

2. A patient with acute glomerulonephritis has hematuria, proteinuria, and hypertension. What is the nursing intervention priority?

Monitor I&O, fluid restriction, and BP control

Encourage high-protein diet

Administer diuretics liberally

Encourage strenuous exercise

3. A patient with heart failure has orthopnea, paroxysmal nocturnal dyspnea, and cardiomegaly on X-ray. Which pathophysiology links these findings?

Decreased cardiac output causing pulmonary and venous congestion

Primary pulmonary disease

Severe anemia

Thyroid dysfunction

4. A patient in DKA has Kussmaul respirations, fruity breath odor, and pH 7.2. What is the immediate nursing action?

Establish IV access, begin fluid and insulin therapy, monitor labs

Administer sodium bicarbonate to raise pH

Restrict fluids to prevent cerebral edema

Place on mechanical ventilation

5. A patient with hyperthyroidism has tachycardia, tremor, and heat intolerance. What medication class addresses the sympathetic symptoms?

Beta-blockers

Antithyroid drugs

Corticosteroids

Calcium channel blockers

6. A patient with ulcerative colitis has bloody diarrhea, abdominal cramping, and weight loss. What complication must be monitored?

Toxic megacolon and perforation

Appendicitis

Gastric ulcers

Hepatitis

7. A patient with pancreatitis has severe epigastric pain radiating to the back and elevated amylase. What is the priority intervention?

NPO status, IV fluids, and pain management

Encourage oral feeding to stimulate pancreas

Administer fat-soluble vitamins

Give high-protein diet

8. A patient with severe burns has deep tissue injury, minimal pain, and leathery eschar. What burn depth is this?

Full-thickness (fourth degree)

Partial-thickness (second degree)

Superficial (first degree)

Superficial partial-thickness

9. A stroke patient has right-sided weakness and expressive aphasia. What vessel is likely occluded?

Left middle cerebral artery

Right anterior cerebral artery

Basilar artery

Vertebral artery

10. A patient on metformin develops lactic acidosis. What is the underlying mechanism?

Accumulation in renal impairment leading to anaerobic metabolism

Direct beta-cell stimulation

Hyperglycemia-induced cellular damage

Allergic reaction to the drug

11. A patient presents with dyspnea, crackles on auscultation, and elevated JVD. Which nursing action addresses the primary problem?

Elevate head of bed and administer diuretics

Place patient supine and increase IV fluids

Administer oxygen and monitor urine output

Apply compression stockings and restrict sodium

12. A patient with cirrhosis has ascites, spider angiomas, and hepatic encephalopathy. What is the pathophysiologic link?

Portal hypertension causing shunting of ammonia-rich blood

Decreased albumin production alone

Bacterial peritonitis only

Renal failure secondary to infection

13. A patient with acute kidney injury has potassium of 6.8 mEq/L and peaked T waves. What intervention is urgent?

Calcium gluconate, insulin with glucose, and sodium polystyrene

Fluid restriction and diuretics

Potassium supplementation

Sodium bicarbonate only

14. A patient with acute MI has chest pain and elevated troponin. What medication should NOT be given?

Aspirin

Beta-blocker

NSAIDs for pain relief

ACE inhibitor

15. A patient with COPD has a respiratory rate of 28, using accessory muscles, and SpO2 of 88%. What is the priority action?

Administer oxygen and assess for acute exacerbation

Position supine to ease breathing

Administer sedatives to reduce anxiety

Restrict fluids to prevent overload

16. A post-operative patient has increasing abdominal distension, absent bowel sounds, and nausea. What is the likely diagnosis?

Paralytic ileus

Bowel obstruction

Peritonitis

Gastroenteritis

17. A diabetic patient reports blurred vision, headache, and blood glucose of 450 mg/dL. What complication is likely occurring?

Hyperosmolar hyperglycemic state

Hypoglycemia

Diabetic ketoacidosis

Dawn phenomenon

18. A patient on warfarin has an INR of 8.5 and minor bleeding. What intervention is most appropriate?

Administer vitamin K and hold next dose

Administer fresh frozen plasma immediately

Increase INR monitoring frequency

Administer protamine sulfate

19. A patient with sepsis has a temperature of 39.5°C, WBC 15,000, and hypotension. What is the nursing priority?

Administer antibiotics and initiate fluid resuscitation

Apply cooling measures and monitor temperature

Obtain blood cultures before antibiotics

Administer antipyretics and increase room temperature

NGN Bowtie Quiz: Can You Connect the Clinical Dots?