A. A patient receiving a blood transfusion develops chills, dyspnea, and hypotension. What is the priority nursing action?

B. A patient with ARDS and refractory hypoxemia is already on high FiO₂ and PEEP. What is the priority intervention?

C. A patient post-thyroidectomy reports tingling in the lips and muscle cramping. Chvostek’s sign is positive. What is the priority nursing action?

D. A patient with a traumatic brain injury is on mechanical ventilation. ICP is 25 mmHg, and CPP is trending down. What is the next nursing action?

E. A patient with ARDS on mechanical ventilation has PaO₂ 50 mmHg despite FiO₂ 100% and PEEP of 15 cmH₂O. What is the priority nursing intervention?

F. A patient with acute pancreatitis develops increasing abdominal distension, oliguria, and hypotension. What is the priority concern?

G. A patient with diabetic ketoacidosis has glucose 190 mg/dL but the anion gap remains elevated. What is the priority intervention?

H. A patient with suspected stroke presents with slurred speech and right-sided weakness that began 2 hours ago. What is the priority intervention?

I. A patient refuses a recommended surgical procedure after risks and benefits have been explained. What should the nurse do first?

J. A patient with hepatic encephalopathy presents with confusion and asterixis. Ammonia is 150 µmol/L. What is the priority intervention?

K. A patient receiving TPN develops fever, chills, and hypotension. What is the priority nursing action?

L. A nurse notices a colleague giving a medication without verifying the patient’s identification. What is the nurse’s best action?

M. A patient on telemetry shows stable ventricular tachycardia. What is the priority action?

N. A patient after thyroid surgery reports numbness around the mouth and muscle cramping. What is the priority nursing intervention?

O. A patient with COPD exacerbation on nasal cannula shows worsening lethargy and PaCO₂ of 78 mmHg. What is the priority intervention?

P. During shift change, a nurse overhears a colleague discussing a patient’s condition loudly in the hallway. What is the most appropriate action?

Q. A patient undergoing chemotherapy expresses interest in speaking with others who have had similar experiences. What is the nurse’s best action?

R. A patient with a traumatic brain injury has ICP of 28 mmHg and CPP below 60 mmHg. What is the priority intervention?

S. A patient nearing end of life expresses fear of being alone. What should the nurse do?

T. A patient with heart failure is on telemetry with frequent PVCs and K⁺ 3.0 mEq/L, Mg²⁺ 1.2 mg/dL. What is the priority nursing action?

U. A patient with ARDS remains hypoxemic despite FiO₂ 100% and PEEP of 15 cmH₂O. What is the next step?

V. A patient with ARDS on mechanical ventilation has SpO₂ 82% despite FiO₂ 100% and PEEP 15 cmH₂O. What is the next step?

W. A patient from a cultural background unfamiliar to the nurse refuses hospital-provided meals. What is the best initial action?

X. A patient in the ICU develops confusion, muscle twitching, and a prolonged QT interval on ECG. Serum calcium is 6.8 mg/dL. What is the priority intervention?

Y. A patient with sepsis is receiving broad-spectrum antibiotics and norepinephrine. Despite 4 L of IV fluids, the MAP remains at 55 mmHg and lactate is increasing. What is the next best step?

Z. A patient receiving TPN develops fever, chills, and hypotension. What is the priority nursing action?

AA. A patient in the ICU suddenly develops wide complex tachycardia with a pulse and a blood pressure of 80/50 mmHg. What is the immediate nursing action?

AB. A patient in septic shock is receiving norepinephrine and aggressive fluid resuscitation. Despite these measures, lactate levels remain elevated, and the patient is cool and mottled. What is the priority intervention?

AC. A patient with septic shock is on norepinephrine and vasopressin. The MAP remains 58 mmHg, and urine output is 15 mL/hr. What is the next priority?

AD. A patient on a heparin infusion for PE develops gum bleeding and an aPTT of 110 seconds. What is the priority action?

AE. A patient with COPD exacerbation is on BiPAP but becomes increasingly somnolent with PaCO₂ rising to 95 mmHg. What is the next step?

AF. A patient in the progressive care unit expresses frustration, saying, “No one explains what is happening to me.” What is the nurse’s best response?

AG. A patient with advanced COPD states that they no longer want to be placed on a ventilator if their condition worsens. What should the nurse do first?

AH. A patient with COPD exacerbation is receiving high-flow oxygen. ABG shows pH 7.28, PaCO₂ 85 mmHg, PaO₂ 58 mmHg. What is the next step?

AI. A patient on a heparin drip for PE has aPTT of 120 seconds (goal 60–80) and mild bleeding. What is the priority action?

AJ. A patient with COPD on home oxygen presents with worsening dyspnea and somnolence. ABG shows pH 7.25, PaCO₂ 88 mmHg, PaO₂ 58 mmHg. What is the priority intervention?

AK. A patient with DKA is on an insulin infusion. Glucose is 160 mg/dL, anion gap has closed, and the patient is alert and tolerating oral intake. What is the next step?

AL. A patient recently started dialysis and is overwhelmed by lifestyle changes. Which nursing intervention best demonstrates caring practice?

AM. A patient with septic shock is receiving norepinephrine and vasopressin. The MAP remains 58 mmHg, and urine output is 12 mL/hr despite adequate fluid resuscitation. What is the next best step?

AN. A patient with ARDS is sedated and mechanically ventilated. Plateau pressures are rising, and compliance is worsening. What is the most appropriate action?

AO. A patient with suspected sepsis presents with a lactate of 5.2 mmol/L, hypotension, and tachycardia. What is the priority nursing intervention?

AP. A patient with diabetic ketoacidosis (DKA) is improving, but the potassium level drops to 2.8 mEq/L. What is the priority intervention?

AQ. A patient with traumatic brain injury has persistent ICP >22 mmHg. What is the priority nursing intervention?

AR. A patient with severe sepsis is on norepinephrine and vasopressin. Despite therapy, MAP is 58 mmHg and lactate is 6 mmol/L. What is the next best intervention?

AS. A patient post-abdominal surgery has a distended abdomen, hypotension, and decreasing urine output. Intra-abdominal pressure is 25 mmHg. What is the priority action?

AT. A patient with suspected pulmonary embolism suddenly develops hypotension and pulseless electrical activity (PEA). What is the immediate nursing action?

AU. A patient with severe sepsis is on norepinephrine and mechanical ventilation. The MAP is 58 mmHg, and lactate is rising despite fluids. What is the next step?

AV. A patient receiving IV potassium reports burning at the IV site. What is the priority action?

AW. A patient receiving a transfusion develops dyspnea, crackles, and hypertension during the infusion. What is the most likely complication?

AX. A nurse notices a patient with sepsis is rapidly deteriorating and the provider has not yet arrived. What is the nurse’s best action?

AY. A patient with COPD exacerbation shows pH 7.20, PaCO₂ 95 mmHg, PaO₂ 50 mmHg, and altered mental status. What is the immediate nursing action?

AZ. A patient with ARDS on mechanical ventilation has SpO₂ 82% and PaO₂ 50 mmHg despite FiO₂ 100% and PEEP 15 cmH₂O. What is the priority action?

BA. A patient post-craniotomy develops severe headache, projectile vomiting, and BP 200/100. What is the priority intervention?

BB. A COPD patient is on high-flow oxygen and now has PaCO₂ 80 mmHg and pH 7.28. What is the priority nursing action?

BC. A patient receiving norepinephrine through a peripheral line develops swelling and blanching at the site. What is the priority intervention?

BD. A patient with subarachnoid hemorrhage develops sudden confusion and unequal pupils. What is the priority action?

BE. A patient with heart failure on telemetry has frequent PVCs. Potassium is 2.8 mEq/L. What is the priority action?

BF. A patient receiving a transfusion develops fever, chills, and hypotension within minutes. What is the priority action?

BG. A patient on mechanical ventilation for ARDS develops subcutaneous emphysema and a sudden drop in SpO₂. What is the priority nursing action?

BH. A patient on mechanical ventilation develops sudden hypotension, absent breath sounds on the right side, and tracheal deviation to the left. What is the priority intervention?

BI. A patient in septic shock is on norepinephrine. Site inspection reveals swelling, pain, and blanching. What is the priority action?

BJ. A patient in septic shock has lactate of 7 mmol/L and MAP of 55 mmHg despite fluids. What is the next step?

BK. A nurse witnesses a provider speaking harshly to a patient, causing the patient to cry. What is the nurse’s most appropriate action?

BL. A nurse is teaching a patient with heart failure how to monitor daily weights at home. Which teaching approach is best?

BM. A patient with COPD exacerbation shows worsening drowsiness. ABG: pH 7.28, PaCO₂ 82 mmHg, PaO₂ 55 mmHg. What is the priority action?

BN. A patient with septic shock has a MAP of 55 mmHg after fluids. What is the next step?

BO. A patient with traumatic brain injury has ICP of 28 mmHg. What is the priority intervention?

BP. A patient with ARDS is receiving high PEEP and FiO₂ 100% but remains hypoxemic. What is the next step?

BQ. A patient receiving a massive blood transfusion develops hypocalcemia. Which finding requires immediate intervention?

BR. A patient receiving a blood transfusion develops fever, chills, and back pain within 15 minutes of starting the transfusion. What is the priority action?

BS. A patient on mechanical ventilation for ARDS becomes hypotensive after an increase in PEEP from 10 to 15 cmH₂O. What is the priority action?

BT. A patient with COPD exacerbation is receiving 4 L/min oxygen. ABG shows pH 7.28, PaCO₂ 80 mmHg, PaO₂ 60 mmHg. What is the priority nursing action?

BU. A nurse caring for a patient with end-stage renal disease hears the patient say, “I feel like a burden to my family.” What is the most therapeutic response?

BV. A patient with ARDS remains hypoxemic despite maximum ventilatory support. The team decides to initiate prone positioning. What is the priority nursing action before proning?

BW. A patient with chest pain and elevated troponins develops ventricular tachycardia with a pulse and BP 110/70. What is the priority action?

BX. A patient with acute pancreatitis develops severe abdominal distention, oliguria, and bladder pressure of 25 mmHg. What is the priority intervention?

BY. A patient with diabetic ketoacidosis is on IV insulin. The glucose is 180 mg/dL but the anion gap remains elevated. What is the next step?

BZ. A patient recently diagnosed with cancer asks the nurse, “Am I going to die soon?” What is the most therapeutic response?

CA. A patient receiving norepinephrine develops pain, pallor, and blanching at the IV site. What is the priority nursing action?

CB. A nurse overhears a colleague making negative comments about a patient’s cultural beliefs. What is the most appropriate nursing action?

CC. A patient in septic shock has a MAP of 50 mmHg despite fluids, norepinephrine, and vasopressin. What is the priority action?

CD. A patient with COPD becomes lethargic while on 4 L/min of oxygen. ABG shows pH 7.28, PaCO₂ 80 mmHg, PaO₂ 60 mmHg. What is the priority intervention?

CE. A patient post-CABG surgery becomes hypotensive, with jugular venous distention and muffled heart sounds. What is the priority nursing action?

CF. A patient tells the nurse, “I feel hopeless about my recovery.” What is the nurse’s best therapeutic response?

CG. A patient with COPD exacerbation is on 2 L O₂. ABG shows pH 7.31, PaCO₂ 68 mmHg, PaO₂ 60 mmHg, HCO₃⁻ 32. What is the priority action?

CH. A patient with ARDS remains hypoxemic despite high FiO₂, high PEEP, and prone positioning. What is the next best intervention?

CI. A patient on telemetry develops ventricular tachycardia at 160 bpm but remains alert and stable. What is the priority action?

CJ. During a family meeting about palliative care, the nurse notices one family member appears distressed and avoids speaking. What is the best nursing action?

CK. A patient with ARDS has been ventilated with high FiO₂ and PEEP. The PaO₂ is 48 mmHg, and SpO₂ is 82%. What is the next best step?

CL. A patient with diabetic ketoacidosis has a glucose level of 200 mg/dL, a closed anion gap, and is tolerating oral intake. What is the next step?

CM. A patient’s spouse expresses guilt, saying, “I should have noticed the symptoms earlier.” What is the nurse’s best therapeutic response?

CN. A patient with suspected sepsis presents with fever, hypotension, and tachycardia. Initial lactate is 4.5 mmol/L. What is the priority initial intervention?

CO. A patient post-CABG develops sudden hypotension, muffled heart sounds, and jugular vein distention. What is the priority action?

CP. A patient in septic shock is on norepinephrine. The nurse notes swelling and pain at the IV site. What is the priority action?

CQ. A nurse observes that a new staff member is consistently late in responding to call lights. What is the best action?

CR. A patient with septic shock is hypotensive with MAP 55 mmHg after fluids. What is the next step?

CS. A patient with heart failure on telemetry develops frequent PVCs. Potassium is 2.7 mEq/L. What is the priority nursing action?

CT. A patient with acute coronary syndrome develops chest pain and ST-segment elevation in leads II, III, and aVF. What is the priority intervention?

CU. A patient post-stroke on tube feeding coughs and chokes during administration. What is the priority action?

CV. A patient with acute myocardial infarction is receiving a nitroglycerin infusion. BP drops to 70/40 mmHg, and the patient becomes pale and diaphoretic. What is the priority nursing action?

CW. A patient post-craniotomy suddenly becomes restless, hypertensive, and vomits. ICP monitor shows a rapid rise in pressure. What is the next best action?

CX. A patient in the progressive care unit becomes increasingly confused at night. What should the nurse do first to maintain safety?

CY. A patient with COPD exacerbation has SpO₂ 84% on 4 L oxygen and PaCO₂ 80 mmHg. What is the priority action?

CZ. A patient receiving vancomycin develops flushing, pruritus, and mild hypotension during infusion. What is the appropriate nursing action?

DA. A patient with acute coronary syndrome is on a nitroglycerin drip. After 30 minutes, BP drops to 78/42 mmHg, and the patient is dizzy. What is the priority action?

DB. A patient receiving a blood transfusion develops chills, fever, and hypotension within 15 minutes. What is the priority nursing action?

DC. A patient receiving TPN develops chills, fever, and hypotension. What is the priority nursing action?

DD. A patient post-thyroidectomy develops perioral tingling and hand cramps. What is the priority action?

DE. A patient with heart failure on telemetry has frequent PVCs. K⁺ is 3.0 mEq/L and Mg²⁺ is 1.2 mg/dL. What is the priority nursing action?

DF. A nurse is caring for a patient in palliative care who expresses a desire to stop all aggressive treatments. What is the nurse’s priority action?

DG. A patient receiving vancomycin develops flushing and hypotension. What is the priority nursing action?

DH. A nurse is planning discharge for a patient with limited mobility. Which action demonstrates systems thinking?

DI. A patient newly diagnosed with diabetes must learn insulin self-administration. Which teaching method is most effective?

DJ. A patient in the progressive care unit asks about the side effects of a new medication. What should the nurse do?

DK. A patient receiving vancomycin develops flushing and mild hypotension during infusion. What is the priority nursing action?

DL. A patient says, “I don’t want to complain, but my pain is getting worse.” What is the nurse’s best response?

DM. A patient with DKA is on IV insulin. Glucose is 180 mg/dL, but the anion gap remains open. What is the priority intervention?

DN. A patient receiving mechanical ventilation for ARDS remains hypoxemic despite FiO₂ 100% and PEEP 15 cmH₂O. What is the priority intervention?

DO. A patient in septic shock has urine output of 10 mL/hr and rising creatinine despite fluids and norepinephrine. What is the priority action?

DP. A patient with suspected pulmonary embolism (PE) presents with sudden dyspnea, tachycardia, and chest pain. What is the priority initial intervention?

DQ. A patient receiving a blood transfusion suddenly develops wheezing, dyspnea, and hypotension. What is the priority nursing action?

DR. A patient with sepsis is receiving norepinephrine. The nurse notes decreased urine output and rising creatinine. What is the priority intervention?

DS. A patient with COPD on home oxygen presents with worsening dyspnea and confusion. ABG: pH 7.30, PaCO₂ 78 mmHg, PaO₂ 60 mmHg. What is the priority nursing action?

DT. A patient with septic shock is on norepinephrine. Urine output drops to 10 mL/hr and creatinine rises. What is the priority nursing action?

DU. A patient with a massive pulmonary embolism is receiving tPA infusion. The nurse notices bright red bleeding from the IV site and blood in the urine. What is the priority intervention?