Purpose and Value
These weekly case studies are a vital part of your growth as a nurse. They give you the chance to apply clinical reasoning to realistic patient situations, mirroring the thinking you’ll be expected to demonstrate in both practice and on licensure exams.
Each case is designed to help you:
· Strengthen your clinical judgment using the NCJMM framework
· Practice prioritizing interventions in urgent scenarios
· Build confidence in making and explaining nursing decisions
· Experience the value of learning in community with your peers
You’ll complete each case in two parts:
1.
Individually, you will work through the case using the NCJMM steps and submit your response.
2.
In your assigned group, you will compare answers and discuss your reasoning. These discussions are strongly encouraged and should focus on how your group members approached the six steps differently—and what you can learn from that.
This is not a graded assignment, but it is essential scaffolding for your success. Consistent, thoughtful participation will help you not only prepare for exams, but also feel more connected to your classmates and more confident in your clinical role.
Case Scenario
A nurse is preparing to administer morphine IV to a 70 kg post-operative patient for pain management. The provider’s order is for morphine 0.1 mg/kg. The nurse draws 7 mg of morphine from a multi-dose vial labeled 10 mg/mL. Just before administration, the nurse is interrupted by a call from another department. When the nurse returns, they continue the process without a second check.
Question
Which of the following interventions should the nurse implement first?
(Select all that apply.)
A. Ask another nurse to independently verify the dosage and vial before administration.
B. Confirm the safe dosing range using a drug reference or formulary.
C. Discard the prepared syringe and draw a new dose to avoid potential errors.
D. Immediately administer the morphine, trusting the original calculation.
E. Notify the provider that the ordered dose may exceed the usual therapeutic range.
F. Document the medication administration as completed and return to the interruption.
Instructions
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Individual Response:
Submit your answer by applying all six steps of the NCJMM clinical judgment model:
1.
Recognize Cues – Identify 2–3 key cues (explicit or subtle).
2.
Analyze Cues – What do these cues suggest?
3.
Prioritize Hypotheses – List and rank 3–4 clinical concerns.
4.
Generate Solutions – Which of the answer options (A–F) address those concerns?
5.
Take Action – Which 1–2 interventions would you perform first?
6.
Evaluate Outcomes – How would you know your intervention is working?
Then include:
·
Selected Answers (e.g., A, C)
·
Rationale: For each selected choice, explain your reasoning in 1–2 sentences. Reference the NCJMM step that supports your decision (e.g., “In Prioritize Hypotheses, fluid resuscitation took priority due to hypotension and oliguria, making A the logical first step.”)
Group Discussion:
· After you’ve submitted your response, engage in dialogue with your group. Compare how each of you applied the NCJMM steps. Pay special attention to areas where your approaches differ, and talk through your reasoning. This is your opportunity to strengthen clinical thinking together—just as you will be expected to do in real-life nursing teams.
