Unfolding Case Study • Physiological Adaptation
68-year-old female • Medical-Surgical Unit
A 68-year-old female client with a history of hypertension and heart failure with reduced ejection fraction (HFrEF) is admitted to the medical-surgical unit. She presents with increasing shortness of breath, 3+ pitting edema in the lower extremities, and weight gain of 4 kg (8.8 lb) over the past 5 days. Vital signs on admission: BP 162/94 mmHg, HR 108 bpm (irregular), RR 28 breaths/min, SpO₂ 89% on room air, temperature 37.2°C (99°F). She reports fatigue and orthopnea. Current medications include furosemide 40 mg PO daily, lisinopril 20 mg PO daily, and metoprolol 50 mg PO twice daily. The client is alert and oriented but anxious.
The client’s respiratory status worsens. She is now using accessory muscles, RR 32 breaths/min, SpO₂ 84% on 2 L nasal cannula, and lung sounds show crackles in the bilateral lower lobes. A repeat weight is 2 kg higher than admission. BNP level is 1,250 pg/mL (elevated).
You will complete 6 clinical judgment questions based on the client scenario. Questions appear one at a time. You cannot go back.
This simulates real NGN unfolding case study format
Your clinical judgment score