A. A patient with acute coronary syndrome suddenly becomes unresponsive with a monitor showing ventricular fibrillation. What is the priority nursing action?

B. A patient receiving chemotherapy expresses sadness and begins to cry. What is the nurse’s best action?

C. A patient with traumatic brain injury develops unequal pupils, bradycardia, and irregular respirations. ICP is 36 mmHg. What is the priority intervention?

D. A patient with septic shock is receiving norepinephrine at 20 mcg/min but remains hypotensive with MAP of 54 mmHg. Cardiac output is adequate, but SVR is low. What is the next step?

E. A patient with acute decompensated heart failure presents with severe dyspnea, orthopnea, and bilateral pulmonary crackles. BP is 175/95 mmHg, and SpO₂ is 84% on high-flow oxygen. What is the priority nursing action?

F. A patient with a new tracheostomy develops sudden difficulty breathing and audible stridor. Oxygen saturation drops to 82%. What is the priority action?

G. A patient with septic shock has been resuscitated with 4 liters of crystalloids and is on norepinephrine at 25 mcg/min. MAP remains 55 mmHg, and urine output is 10 mL/hr. What is the next intervention?

H. A patient preparing for discharge after a stroke says, “I’m afraid I’ll forget what to do at home.” What is the nurse’s best response?

I. A patient’s family asks about hospice care options, but the patient has not expressed interest. What should the nurse do?

J. A patient with traumatic brain injury has ICP readings consistently above 30 mmHg despite sedation and hyperventilation. The patient becomes bradycardic and hypotensive. What is the priority nursing action?

K. A post-operative neurosurgical patient suddenly develops bradycardia, hypertension, and unequal pupils. ICP monitor shows pressures above 35 mmHg. What is the next step?

L. A patient post-thyroidectomy develops inspiratory stridor, severe dyspnea, and SpO₂ of 80%. What is the immediate nursing action?

M. A patient with septic shock is on norepinephrine at 30 mcg/min. MAP remains 55 mmHg, cardiac output is 2.9 L/min/m², and systemic vascular resistance is critically low. What is the next step?

N. A patient with a suspected intracerebral hemorrhage has systolic BP of 210 mmHg, confusion, and a Glasgow Coma Scale of 10. What is the priority nursing intervention?

O. A patient with diabetic ketoacidosis is on an insulin infusion. Glucose is 150 mg/dL, potassium is 3.0 mEq/L, and the anion gap remains elevated. What should the nurse do next?

P. A patient undergoing continuous renal replacement therapy (CRRT) shows a sharp drop in ultrafiltrate output, rising pressures across the filter, and alarms on the machine. What should the nurse do first?

Q. A patient with a massive pulmonary embolism develops sudden hypotension, tachycardia, and SpO₂ of 75% despite high-flow oxygen. What is the immediate action?

R. A patient with DKA is on insulin therapy. Glucose is 170 mg/dL, potassium is 3.4 mEq/L, and the anion gap is closing. What is the next appropriate step?

S. A patient with a history of heart failure presents with confusion, hypotension, and cool extremities. Pulmonary artery catheter readings show a cardiac index of 1.7 L/min/m² and wedge pressure of 25 mmHg. What is the priority intervention?

T. A patient with severe mitral regurgitation presents with hypotension, dyspnea, and pulmonary crackles. Echocardiography confirms acute valve dysfunction. What is the priority nursing action?

U. A patient with diabetic ketoacidosis (DKA) is on IV insulin. Glucose is 170 mg/dL, potassium is 3.5 mEq/L, and the anion gap is closing. What is the priority action?

V. A patient preparing for discharge after a hip replacement says, “I don’t think I can manage walking at home.” What is the nurse’s best response?

W. A patient recovering from heart surgery expresses difficulty understanding their new diet restrictions. What is the nurse’s best action?

X. A patient with septic shock on norepinephrine has a MAP of 55 mmHg and lactate of 8 mmol/L despite adequate volume resuscitation. Cardiac index is 2.8 L/min/m², and SVR is critically low. What should the nurse anticipate?

Y. A patient with septic shock remains hypotensive despite aggressive fluids and norepinephrine. The cardiac index is 3.5 L/min/m², and systemic vascular resistance is critically low. What is the next step?

Z. A patient receiving mechanical ventilation develops sudden hypotension, tachycardia, and absent breath sounds on the left side. Peak airway pressures are elevated. What is the immediate action?

AA. A patient in septic shock is on high-dose norepinephrine and vasopressin. The MAP is 54 mmHg, cardiac index is 1.8 L/min/m², and lactate is rising. What is the next intervention?

AB. A patient with suspected pulmonary embolism develops sudden chest pain, severe dyspnea, and hypotension. What is the immediate nursing intervention?

AC. A patient with newly diagnosed heart failure says, “I’m scared I’ll end up back in the hospital.” What is the nurse’s best response?

AD. A patient post-thyroidectomy develops tingling around the mouth, muscle twitching, and a positive Chvostek sign. What is the next nursing intervention?

AE. A patient with chronic kidney disease expresses difficulty following dietary restrictions. What is the nurse’s best intervention?

AF. A patient with severe sepsis has received 3 liters of crystalloids but remains hypotensive on norepinephrine. Cardiac output is low, and lactate is rising. What is the next step?

AG. A patient in the ICU develops bradycardia, hypotension, and altered mental status after initiation of a beta-blocker drip for rate control. What is the immediate nursing intervention?

AH. A patient with acute decompensated heart failure presents with severe dyspnea, orthopnea, and pink frothy sputum. BP is 160/90 mmHg, and SpO₂ is 84% on high-flow oxygen. What is the priority intervention?

AI. A patient asks, “Why do I need to complete a pain diary?” What is the nurse’s best response?

AJ. A post-operative trauma patient suddenly develops chest pain, hypotension, and SpO₂ of 78%. The nurse notes distended neck veins and muffled heart sounds. What is the immediate action?

AK. A patient presents with diabetic ketoacidosis (DKA) and is started on an insulin infusion. Glucose is 160 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still elevated. What is the next step?

AL. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 165 mg/dL, potassium is 3.0 mEq/L, and the anion gap is still elevated. What should the nurse do?

AM. A patient with suspected adrenal crisis presents with severe hypotension, confusion, hyponatremia, and hyperkalemia. What is the priority nursing intervention?

AN. A patient in the ICU develops polymorphic ventricular tachycardia (torsades de pointes) with a pulse. The ECG shows prolonged QT interval. What is the priority nursing intervention?

AO. A patient with severe ARDS is ventilated with low tidal volumes and high PEEP. SpO₂ remains at 78% despite FiO₂ of 100% and paralysis. What should the nurse anticipate next?

AP. A patient with diabetic ketoacidosis (DKA) is on IV insulin. The glucose is 180 mg/dL, potassium is 3.3 mEq/L, and the anion gap remains elevated. What is the priority intervention?

AQ. A patient with septic shock is receiving norepinephrine and vasopressin. The MAP is 56 mmHg, cardiac index is 2.0 L/min/m², and lactate is 6 mmol/L. What is the next step?

AR. A patient with acute intracranial hypertension develops unequal pupils, bradycardia, and hypertension. ICP is 36 mmHg. What is the priority nursing action?

AS. A post-operative patient suddenly develops severe abdominal pain, tachycardia, and hypotension. The abdomen is firm and distended. What is the immediate nursing action?

AT. A patient with aortic stenosis presents with syncope, hypotension, and a new systolic murmur. The nurse notes cool extremities and delayed capillary refill. What is the priority intervention?

AU. A patient with suspected myasthenic crisis develops respiratory distress, weak cough, and shallow breathing. Negative inspiratory force (NIF) is –15 cmH₂O. What is the immediate nursing action?

AV. A patient with Guillain-Barré syndrome presents with shallow respirations, weak cough, and a negative inspiratory force (NIF) of –18 cmH₂O. What is the next nursing action?

AW. A patient with severe sepsis is receiving norepinephrine. Despite fluids, the MAP remains at 55 mmHg, and systemic vascular resistance is critically low. What is the next intervention?

AX. A patient with a suspected stroke presents with right-sided weakness, facial droop, and slurred speech. Blood glucose is 120 mg/dL, and CT scan shows no hemorrhage. What is the priority intervention?

AY. A patient post-thyroidectomy suddenly develops hoarseness, inspiratory stridor, and severe dyspnea. What is the immediate action?

AZ. A patient with a subarachnoid hemorrhage develops acute hypertension, severe headache, and decreased level of consciousness. What is the immediate nursing intervention?

BA. A patient with cardiogenic shock after a large anterior myocardial infarction presents with hypotension, cool extremities, and low urine output. Pulmonary artery catheter shows a cardiac index of 1.6 L/min/m² and wedge pressure of 24 mmHg. What is the priority nursing intervention?

BB. A patient with acute pulmonary edema presents with severe dyspnea, pink frothy sputum, and SpO₂ of 78% despite non-rebreather oxygen. What is the priority nursing action?

BC. A patient with COPD exacerbation is on BiPAP but remains hypercapnic with worsening pH of 7.18 and altered mental status. What is the next nursing intervention?

BD. A patient’s spouse says, “I feel like I’m failing as a caregiver.” What is the nurse’s best response?

BE. A patient with advanced lung disease requests no resuscitation if their heart stops. What should the nurse do first?

BF. A nurse observes a provider pressuring a patient to sign a procedure consent form without explaining the risks. What is the nurse’s priority action?

BG. A patient on mechanical ventilation suddenly develops high airway pressures, hypotension, and absent breath sounds on the left side. What is the priority action?

BH. A patient with suspected pulmonary embolism presents with sudden dyspnea, tachycardia, and SpO₂ 78% on a non-rebreather mask. What is the immediate nursing intervention?

BI. A patient presents with signs of adrenal crisis: severe hypotension, confusion, and hyperkalemia. What is the immediate priority?

BJ. A patient with suspected adrenal crisis presents with severe hypotension, confusion, and potassium of 6.5 mEq/L. What is the priority intervention?

BK. A nurse overhears a colleague making a negative remark about a patient’s appearance. What is the best nursing action?

BL. A patient in the ICU develops wide-complex tachycardia with a pulse. The blood pressure is stable, and the patient is alert but symptomatic with palpitations. What is the next nursing action?

BM. A patient with an inferior wall myocardial infarction develops complete heart block with a ventricular rate of 30 bpm and hypotension. What is the priority nursing action?

BN. A patient develops sudden hypotension and a narrow QRS complex tachycardia at 180 bpm. Carotid massage is unsuccessful. What is the next nursing intervention?

BO. A patient with septic shock has received aggressive fluid resuscitation and is on norepinephrine. Cardiac output is low, and urine output is 10 mL/hr. What is the next nursing action?

BP. A patient with ARDS on mechanical ventilation has FiO₂ 100% and PEEP 20 cmH₂O but remains hypoxemic. SpO₂ is 76% and plateau pressure is 32 cmH₂O. What should the nurse anticipate?

BQ. A patient with septic shock is receiving norepinephrine and fluids. The MAP remains 55 mmHg, and urine output is <15 mL/hr. Cardiac index is low. What is the next nursing intervention?

BR. A patient with ARDS is mechanically ventilated. Plateau pressure is 30 cmH₂O, FiO₂ is 100%, and SpO₂ is 75%. What is the next appropriate action?

BS. A nurse observes a staff member rushing through patient education without confirming understanding. What is the best action?

BT. A patient recovering from surgery develops sudden chest pain, dyspnea, and SpO₂ of 82% despite supplemental oxygen. What is the priority nursing action?

BU. A patient with acute decompensated heart failure presents with severe dyspnea, SpO₂ 78% on high-flow oxygen, and bilateral pulmonary crackles. BP is 170/95 mmHg. What is the priority nursing intervention?

BV. A patient with acute renal failure has rising creatinine, hyperkalemia, and ECG changes showing peaked T waves. What is the immediate nursing intervention?

BW. A patient in septic shock develops refractory hypotension despite maximum doses of norepinephrine and vasopressin. Cardiac index is 3.5 L/min/m². What is the next intervention?

BX. A patient with severe sepsis is receiving norepinephrine and fluids. The MAP is 55 mmHg, cardiac output is 1.9 L/min/m², and lactate is 7 mmol/L. What is the next step?

BY. A patient with severe hypothermia (core temperature 28°C/82°F) is found pulseless. What is the appropriate nursing intervention?

BZ. A patient with a traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 32 mmHg. What is the priority intervention?

CA. A patient receiving continuous renal replacement therapy (CRRT) develops a sudden alarm indicating high transmembrane pressures and a sharp decrease in ultrafiltrate output. What is the priority nursing action?

CB. A patient in the ICU develops sudden bradycardia and hypotension after suctioning through the endotracheal tube. What is the priority nursing action?

CC. A patient with acute upper GI bleeding is receiving massive transfusion. The nurse notes a prolonged QT interval and positive Trousseau’s sign. What is the immediate intervention?

CD. A patient with severe community-acquired pneumonia is on high-flow nasal cannula. Despite therapy, PaO₂ is 50 mmHg and SpO₂ is 80%. What is the priority nursing intervention?

CE. A patient with traumatic brain injury has ICP of 34 mmHg despite sedation and hyperventilation. The patient becomes unresponsive with fixed, dilated pupils. What is the immediate action?

CF. A patient with septic shock is on norepinephrine and vasopressin. The MAP is 55 mmHg, and urine output is <10 mL/hr despite adequate preload. Cardiac index is 2.1 L/min/m². What should the nurse do next?

CG. A patient recently discharged with new medications calls the nurse line stating, “I don’t understand what these are for.” What is the best nursing action?

CH. A patient post-liver transplant develops sudden hypotension, tachycardia, and abdominal distension. What is the immediate nursing action?

CI. A patient’s spouse says, “I don’t know if I can handle this responsibility at home.” What is the nurse’s best response?

CJ. A patient in the ICU develops wide-complex tachycardia with a pulse. Blood pressure is stable at 110/70 mmHg, and the patient is alert. What is the appropriate intervention?

CK. A patient with acute pancreatitis develops hypocalcemia with muscle twitching and prolonged QT on ECG. What is the appropriate nursing action?

CL. A patient with septic shock is on high-dose norepinephrine and vasopressin. MAP is 54 mmHg, cardiac output is normal, but systemic vascular resistance remains low. What is the next step?

CM. A nurse notices a provider attempting to perform a procedure without obtaining informed consent. What should the nurse do first?

CN. A patient post-craniotomy becomes suddenly unresponsive with unequal pupils, bradycardia, and hypertension. ICP monitor reads 40 mmHg. What is the immediate nursing action?

CO. A patient on mechanical ventilation becomes suddenly hypotensive and tachycardic. The ventilator shows high peak airway pressures, and breath sounds are absent on the right. What is the priority action?

CP. A patient expresses sadness about being unable to return to work after a stroke. What is the most appropriate nursing response?

CQ. A patient with a traumatic brain injury develops ICP of 32 mmHg despite sedation and hyperventilation. Pupils are dilated and unreactive, and systolic BP is 180 mmHg. What is the priority action?

CR. A patient post-carotid endarterectomy develops sudden right-sided weakness and facial droop. BP is 160/85 mmHg, and SpO₂ is 96% on room air. What is the priority nursing action?

CS. A mechanically ventilated patient suddenly becomes hypotensive and tachycardic. Breath sounds are absent on the right side, and the trachea deviates to the left. What is the immediate nursing action?

CT. A nurse notices that a colleague is speaking harshly to a patient during morning care. What is the most appropriate action?

CU. A patient with wide-complex tachycardia is pulseless. What is the priority nursing action?

CV. A patient with severe ARDS remains hypoxemic despite low tidal volume ventilation, high PEEP, and paralysis. Plateau pressure is 30 cmH₂O, and FiO₂ is 100%. What is the next intervention?

CW. A patient with ARDS on mechanical ventilation has plateau pressures of 28 cmH₂O, FiO₂ 100%, and PEEP 20 cmH₂O. SpO₂ remains 76%. What is the next appropriate action?

CX. A patient asks, “Why do I need to complete these breathing exercises every hour?” What is the nurse’s best response?

CY. A patient presents with massive upper GI bleeding and hypotension. Despite 2 units of PRBCs and IV fluids, blood pressure remains 80/40 mmHg. What is the next step?

CZ. A patient tells the nurse, “I don’t want any life-sustaining treatment if my condition worsens.” What should the nurse do first?

DA. A nurse overhears a colleague making a sarcastic remark to a patient struggling with self-feeding. What is the most appropriate action?

DB. A patient post-craniotomy suddenly develops severe headache, vomiting, and pupillary asymmetry. ICP monitor shows pressures above 35 mmHg. What is the priority nursing intervention?

DC. A patient with chronic obstructive pulmonary disease (COPD) says, “I’m worried about living alone after discharge.” What is the nurse’s best response?

DD. A patient recovering from surgery develops sudden shortness of breath, chest pain, and SpO₂ of 82% on 6 L nasal cannula. What is the priority nursing action?

DE. A patient with an acute ischemic stroke presents 2 hours after symptom onset with left-sided weakness and slurred speech. CT scan is negative for hemorrhage. What is the priority intervention?

DF. A patient with severe community-acquired pneumonia is intubated and mechanically ventilated. Despite appropriate sedation, peak airway pressures suddenly rise, and breath sounds are diminished on the right. What is the next nursing intervention?

DG. A patient with severe ARDS on mechanical ventilation has plateau pressures of 28 cmH₂O, FiO₂ 100%, and SpO₂ 75%. The patient is already proned. What is the next appropriate intervention?

DH. A post-operative patient develops sudden chest pain, shortness of breath, and SpO₂ of 82% on 6 L nasal cannula. What is the immediate nursing action?

DI. A post-operative patient develops sudden abdominal distension, hypotension, and tachycardia. What is the next nursing intervention?

DJ. A patient in the ICU develops sudden hypotension, distended neck veins, and muffled heart sounds. What is the priority nursing action?

DK. A patient with septic shock is on norepinephrine and vasopressin, but MAP remains 55 mmHg. Cardiac index is adequate, but systemic vascular resistance is low. What is the next intervention?

DL. A patient with a traumatic brain injury suddenly becomes bradycardic, hypertensive, and unresponsive. ICP monitor shows a pressure of 38 mmHg. What is the next nursing intervention?

DM. A nurse sees a provider attempting to rush a patient into signing consent for a risky procedure without explanation. What should the nurse do?

DN. A family member says, “I feel guilty for not being here when my father got sick.” What is the nurse’s best response?

DO. A patient with DKA is on an insulin infusion. Glucose is 180 mg/dL, potassium is 3.4 mEq/L, and the anion gap is still open. What is the next appropriate intervention?

DP. A patient with severe heart failure presents with dyspnea, pulmonary crackles, and hypotension. Pulmonary artery catheter shows a cardiac index of 1.5 L/min/m² and wedge pressure of 26 mmHg. What is the next step?

DQ. A patient develops acute shortness of breath, tachycardia, and hypoxemia shortly after insertion of a central venous catheter. What is the priority action?

DR. A patient begins to cry after hearing that chemotherapy may not be effective. What is the most appropriate nursing action?

DS. A patient develops sudden dyspnea, hypotension, and jugular vein distension after central line removal. What is the immediate action?

DT. A patient with septic shock is on norepinephrine and fluids. The MAP remains at 58 mmHg, and the cardiac index is low. What is the next intervention?

DU. A patient with severe sepsis is on norepinephrine and vasopressin. Cardiac output is 2.0 L/min/m², and lactate is 6 mmol/L. What is the next intervention?