Unfolding cases from every domain — pick one to begin.
Fundamentals Postoperative fall risk A 74-year-old client is on postoperative day 1 after a right total hip arthroplasty. It is 0800 and the nurse begins the…
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Med-Surg Acute chest pain A 58-year-old client comes to the emergency department reporting substernal chest pressure that began 45 minutes ago whi…
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Pharmacology Digoxin and the potassium connection A 70-year-old client with heart failure takes digoxin and furosemide daily. They come to the clinic reporting nausea, lo…
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Maternal-Newborn Rising pressures in labor A 29-year-old client at 38 weeks' gestation is admitted in early labor. On admission she reports a headache and 'seeing …
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Pediatrics The dehydrated infant An 8-month-old is brought to the clinic with a 2-day history of vomiting and diarrhea. The caregiver reports fewer wet d…
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Psychiatric "I don't see the point" A 34-year-old client is seen in the mental health clinic for worsening depression. During the interview the client says …
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Fundamentals Isolation precautions & early sepsis A 66-year-old client is on postoperative day 3 after abdominal surgery. The nurse is called because the client 'doesn't …
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Fundamentals Assignment & delegation A charge nurse is organizing care for the shift with a registered nurse (RN), a licensed practical/vocational nurse (LPN…
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Med-Surg Diabetic ketoacidosis A 22-year-old with type 1 diabetes is brought in with nausea, deep rapid breathing, and a fruity odor to the breath afte…
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Med-Surg Heart failure exacerbation A 79-year-old with chronic heart failure reports worsening shortness of breath, especially when lying flat, and a 5-poun…
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Pharmacology Anticoagulants & antidotes A client on the medical unit is receiving IV heparin for a deep vein thrombosis and is being transitioned to warfarin. T…
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Pharmacology Insulin and hypoglycemia A hospitalized client with diabetes received rapid-acting insulin before breakfast, but the breakfast tray was delayed. …
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Maternal-Newborn Postpartum hemorrhage Thirty minutes after a vaginal birth, a client saturates a perineal pad within 10 minutes. The nurse assesses the fundus…
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Maternal-Newborn Newborn assessment A nurse is assessing a term newborn 2 hours after birth. The parents ask what is normal and what should be reported.
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Pediatrics The child with respiratory distress A 3-year-old is brought to the emergency department drooling, sitting forward in a tripod position, with a high fever an…
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Pediatrics Fever and a rash A 4-year-old is seen for 5 days of high fever, red cracked lips, a strawberry tongue, red eyes, and swelling of the hand…
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Psychiatric Acute mania A client with bipolar disorder is admitted in an acute manic episode. They are hyperactive, speaking rapidly, have not s…
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Psychiatric Alcohol withdrawal A client admitted for surgery reports drinking heavily every day and had their last drink about 12 hours ago. They are n…
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Fundamentals Blood transfusion reaction A 68-year-old with symptomatic anemia is receiving 1 unit of packed red blood cells (PRBCs), started at 0900. The nurse …
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Maternal-Newborn Postpartum endometritis A 26-year-old is postpartum day 2 after a cesarean birth following prolonged rupture of membranes. She reports feeling f…
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Med-Surg COPD exacerbation A 72-year-old with COPD arrives at the emergency department with worsening dyspnea, a productive cough, and wheezing ove…
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Pediatrics Asthma exacerbation An 8-year-old with a history of asthma is brought to the clinic with wheezing, coughing, and difficulty breathing that b…
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Pharmacology Opioid-induced respiratory depression A 55-year-old is 6 hours after abdominal surgery and is using a morphine patient-controlled analgesia (PCA) pump. At 020…
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Psychiatric Neuroleptic malignant syndrome A 40-year-old on the inpatient psychiatric unit was started on an antipsychotic 5 days ago. Over the past day the client…
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