A. A patient with end-stage renal disease has potassium 7.2 mEq/L, ECG changes, and muscle weakness. Calcium gluconate has been given. What is the next nursing action?

B. A patient with severe COPD exacerbation on BiPAP becomes increasingly somnolent. ABG: pH 7.20, PaCO₂ 85 mmHg, PaO₂ 55 mmHg. What is the next intervention?

C. A nurse observes a provider preparing to insert a central line without obtaining consent. What is the priority nursing action?

D. A trauma patient with multiple fractures suddenly develops confusion, dyspnea, and a petechial rash. SpO₂ is 78% despite oxygen. What is the nurse’s priority intervention?

E. A patient with an inferior MI develops complete heart block. HR is 28 bpm, BP 80/40 mmHg, and atropine is ineffective. What is the nurse’s next action?

F. A patient with cirrhosis is receiving lactulose but remains confused and has asterixis. Ammonia is 185 µmol/L. What is the next nursing action?

G. A patient with traumatic brain injury develops abrupt posturing, hypertension, and bradycardia. ICP monitor shows 44 mmHg. What is the nurse’s priority intervention?

H. A patient refuses a recommended diagnostic test, saying, “I don’t trust the results.” What is the nurse’s best response?

I. A trauma patient with multiple fractures suddenly develops confusion, dyspnea, and petechial rash on the chest. SpO₂ is 78% despite oxygen. What is the priority nursing action?

J. A nurse is caring for a patient who suddenly becomes confused and agitated. What is the nurse’s best initial action?

K. A patient’s spouse says angrily, “You are not doing enough for my partner!” What is the nurse’s best response?

L. A patient with COPD exacerbation on high-flow oxygen develops drowsiness. ABG: pH 7.20, PaCO₂ 85 mmHg, PaO₂ 55 mmHg. What is the priority nursing action?

M. A patient with traumatic brain injury becomes increasingly confused and develops unilateral pupil dilation. ICP monitor shows 38 mmHg. What is the priority nursing action?

N. A patient with an anterior MI develops hypotension, pulmonary edema, and a new S3 gallop. What is the nurse’s immediate action?

O. A patient with cirrhosis has ongoing hematemesis despite octreotide infusion. BP 80/50 mmHg, HR 122 bpm. What is the next intervention?

P. A patient with traumatic brain injury develops a sudden spike in ICP to 42 mmHg, with bradycardia and hypertension. What is the priority nursing intervention?

Q. A patient with end-stage renal disease develops K⁺ 7.2 mEq/L, wide QRS complexes, and muscle weakness. Calcium gluconate has already been given. What is the next nursing intervention?

R. A patient with traumatic brain injury suddenly develops unequal pupils, hypertension, and bradycardia. ICP monitor shows 41 mmHg. What is the immediate nursing intervention?

S. A patient with severe COPD exacerbation on high-flow oxygen develops lethargy. ABG: pH 7.22, PaCO₂ 80 mmHg, PaO₂ 52 mmHg. What is the priority nursing action?

T. A nurse witnesses another nurse documenting care that was not provided. What is the priority action?

U. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 43 mmHg. What is the priority nursing intervention?

V. A patient with sepsis says, “I feel like I’m not going to make it.” What is the nurse’s best response?

W. A patient with Addison’s disease presents with severe hypotension, confusion, sodium 119 mEq/L, and potassium 7.1 mEq/L. What is the immediate nursing intervention?

X. A patient with Addison’s disease is admitted with severe hypotension, sodium 116 mEq/L, potassium 7.2 mEq/L, and lethargy. What is the immediate nursing intervention?

Y. A nurse notices a coworker giving medications without scanning patient wristbands. What is the most appropriate action?

Z. A patient with cirrhosis is on lactulose but continues to have confusion and asterixis. Ammonia is 190 µmol/L. What is the next nursing action?

AA. A nurse learns that a medication was given late but the provider was not notified. What is the best nursing action?

AB. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 118 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing intervention?

AC. A patient with cirrhosis undergoes paracentesis for tense ascites. Shortly after, the patient becomes dizzy and hypotensive. What is the next nursing action?

AD. A trauma patient with long bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 76% despite oxygen. What is the nurse’s priority action?

AE. A patient with traumatic brain injury develops unequal pupils, hypertension, and irregular respirations. ICP monitor reads 43 mmHg. What is the immediate nursing action?

AF. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 42 mmHg. What is the immediate nursing intervention?

AG. A patient with end-stage renal disease presents with K⁺ 7.3 mEq/L, muscle weakness, and peaked T waves. Calcium gluconate has been administered. What is the next nursing action?

AH. A patient with anterior STEMI develops sudden hypotension, new crackles, and cool extremities. Echocardiogram shows ejection fraction 25%. What is the nurse’s immediate action?

AI. A patient’s spouse angrily says, “Nobody is telling me what’s going on!” What is the nurse’s best response?

AJ. A patient with anterior STEMI develops sudden hypotension, pulmonary edema, and a new harsh systolic murmur at the left sternal border. What is the nurse’s immediate action?

AK. A patient’s daughter says, “You are not telling us everything about my mother’s condition.” What is the nurse’s best response?

AL. A patient with severe pneumonia is on high-flow oxygen. ABG: pH 7.26, PaCO₂ 70 mmHg, PaO₂ 48 mmHg. The patient becomes increasingly somnolent. What is the next nursing action?

AM. A nurse realizes a near-miss error occurred but no harm came to the patient. What is the best action?

AN. A patient with severe pneumonia develops PaO₂ 48 mmHg despite FiO₂ 100% and PEEP 16 cmH₂O. Plateau pressures remain safe. What is the next nursing intervention?

AO. A patient with myxedema coma presents with hypothermia, bradycardia, and confusion. What is the nurse’s immediate intervention?

AP. A patient with traumatic brain injury develops decerebrate posturing, bradycardia, and hypertension. ICP monitor shows 45 mmHg. What is the immediate nursing intervention?

AQ. A patient with anterior STEMI develops acute shortness of breath, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate intervention?

AR. A patient’s family is arguing loudly about treatment decisions at the bedside. What is the nurse’s best action?

AS. A patient with cirrhosis and portal hypertension presents with massive hematemesis. Despite octreotide infusion, bleeding continues. What is the next nursing action?

AT. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 40 mmHg. What is the priority nursing action?

AU. A patient with severe pneumonia remains hypoxemic despite FiO₂ 100% and PEEP 16 cmH₂O. Plateau pressures are safe. What is the next nursing intervention?

AV. A patient with anterior MI develops severe hypotension, pulmonary edema, and a new harsh systolic murmur at the left sternal border. What is the nurse’s immediate intervention?

AW. A patient with Addison’s disease presents with severe hypotension, confusion, sodium 118 mEq/L, and potassium 6.9 mEq/L. What is the priority nursing action?

AX. A patient with an inferior wall MI develops complete heart block with HR 28 bpm, hypotension, and dizziness. Atropine is ineffective. What is the nurse’s immediate action?

AY. A patient with cirrhosis and portal hypertension presents with hematemesis and hypotension. Despite endoscopic band ligation and octreotide infusion, bleeding continues. What is the next nursing action?

AZ. A patient with an acute inferior MI becomes hypotensive, has clear lungs, and elevated jugular venous pressure. What is the nurse’s immediate intervention?

BA. A patient with limited English proficiency is scheduled for discharge teaching. What is the nurse’s best action?

BB. A patient with Addison’s disease presents with severe hypotension, sodium 119 mEq/L, and potassium 7.0 mEq/L. What is the nurse’s immediate action?

BC. A patient with septic shock remains hypotensive despite 30 mL/kg fluids and norepinephrine. Lactate is 6 mmol/L, urine output is <10 mL/hr. What is the next intervention?

BD. A patient’s family begins yelling at staff during visiting hours, saying they feel ignored. What is the nurse’s best action?

BE. A patient with cirrhosis is receiving lactulose but remains confused and has asterixis. Ammonia level is 182 µmol/L. What should the nurse anticipate?

BF. A patient with an anterior STEMI suddenly develops hypotension, pulmonary edema, and a new systolic murmur. What is the nurse’s immediate action?

BG. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 119 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing action?

BH. A new nurse is unsure about how to use a central line for medication administration. What is the best action?

BI. A patient with an anterior MI develops sudden hypotension, crackles, and cold extremities. What is the nurse’s immediate action?

BJ. A patient with cirrhosis and portal hypertension presents with hematemesis. Despite fluids and octreotide infusion, bleeding continues. What is the next nursing intervention?

BK. A patient with an anterior MI develops pulmonary edema, hypotension, and a new S3 gallop. What is the priority nursing intervention?

BL. A patient with severe asthma exacerbation suddenly becomes quiet with minimal chest movement and SpO₂ 80% despite oxygen. What is the priority nursing action?

BM. A trauma patient with multiple fractures develops confusion, dyspnea, and petechial rash on the chest. SpO₂ is 76% despite oxygen. What is the priority nursing action?

BN. A patient with cirrhosis undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and tachycardic. What is the immediate nursing intervention?

BO. A charge nurse must assign tasks to a newly licensed nurse. Which task is most appropriate to delegate?

BP. A patient with subarachnoid hemorrhage develops acute severe headache, vomiting, and new pupillary dilation. What is the immediate nursing action?

BQ. A patient with pneumonia develops worsening hypoxemia despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressures remain <30 cmH₂O. What is the next intervention?

BR. A trauma patient with a tibia fracture reports severe pain unrelieved by opioids, pallor, and numbness in the limb. Pain worsens with passive stretch. What is the priority nursing intervention?

BS. A patient with type 1 diabetes presents with confusion, diaphoresis, and glucose 38 mg/dL. IV access is not available. What is the immediate nursing action?

BT. A patient with severe pneumonia on mechanical ventilation has PaO₂ 48 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 27 cmH₂O. What is the next nursing action?

BU. A nurse is caring for a patient who speaks a language the nurse does not understand. What is the best nursing action?

BV. A patient with end-stage renal disease reports chest pain and dyspnea. A pericardial friction rub is heard, and potassium is 7.0 mEq/L. What is the nurse’s next action?

BW. A patient refuses a blood transfusion due to religious beliefs, despite being severely anemic. What should the nurse do first?

BX. A trauma patient with a tibia fracture reports severe leg pain unrelieved by opioids, pallor, and paresthesia. Pain worsens with passive stretch. What is the nurse’s priority intervention?

BY. A patient with severe pneumonia remains hypoxemic despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressures are 28 cmH₂O. What is the next intervention?

BZ. A nurse observes a colleague leaving a patient unattended in the shower. What is the most appropriate nursing action?

CA. A patient with severe pneumonia is receiving high-flow oxygen. ABG: pH 7.25, PaCO₂ 72 mmHg, PaO₂ 50 mmHg. The patient is lethargic. What is the priority nursing intervention?

CB. A charge nurse is delegating assignments. Which task is most appropriate for a nursing assistant?

CC. A patient with an inferior MI develops hypotension, jugular venous distension, and clear lungs. What is the immediate nursing action?

CD. A patient with severe pneumonia is intubated. Despite FiO₂ 100% and PEEP 18 cmH₂O, PaO₂ is 52 mmHg. Plateau pressure is 28 cmH₂O. What is the next intervention?

CE. A patient with septic shock remains hypotensive despite 30 mL/kg fluids and norepinephrine. Urine output is <10 mL/hr, and lactate is rising. What is the next intervention?

CF. A patient with COPD exacerbation suddenly becomes unresponsive. ABG: pH 7.15, PaCO₂ 90 mmHg, PaO₂ 52 mmHg. What is the priority nursing action?

CG. A patient with traumatic brain injury develops sudden pupillary dilation, hypertension, and bradycardia. ICP is 40 mmHg. What is the priority nursing intervention?

CH. A patient with an anterior MI develops sudden dyspnea, hypotension, and crackles. A new S3 is present. What is the nurse’s immediate intervention?

CI. A patient with traumatic brain injury suddenly develops hypertension, bradycardia, and irregular respirations. ICP monitor shows 41 mmHg. What is the nurse’s immediate action?

CJ. A patient with cirrhosis and portal hypertension presents with massive hematemesis. Octreotide infusion is ongoing, but bleeding continues. What is the next nursing action?

CK. A patient with pneumonia is receiving high-flow oxygen. ABG: pH 7.24, PaCO₂ 74 mmHg, PaO₂ 50 mmHg. The patient becomes drowsy. What is the next nursing action?

CL. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 118 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing action?

CM. A nurse overhears a colleague discussing a patient’s diagnosis in the cafeteria. What is the most appropriate nursing action?

CN. A patient with Addison’s disease is admitted with severe hypotension, sodium 117 mEq/L, potassium 7.0 mEq/L, and confusion. What is the priority intervention?

CO. A patient with an inferior MI develops complete heart block, HR 30 bpm, BP 78/40 mmHg. Atropine is ineffective. What is the nurse’s next action?

CP. A patient with an anterior MI develops hypotension, pulmonary edema, and a new S3 gallop. What is the nurse’s immediate intervention?

CQ. A patient with severe COPD exacerbation on BiPAP becomes increasingly somnolent. ABG: pH 7.19, PaCO₂ 88 mmHg, PaO₂ 52 mmHg. What is the next nursing action?

CR. A patient with traumatic brain injury suddenly develops unequal pupils, hypertension, and bradycardia. ICP monitor shows 40 mmHg. What is the nurse’s immediate action?

CS. A patient with severe COPD exacerbation on high-flow oxygen becomes increasingly drowsy. ABG: pH 7.22, PaCO₂ 82 mmHg, PaO₂ 50 mmHg. What is the next nursing intervention?

CT. A patient with cirrhosis presents with hematemesis and hypotension. Despite octreotide infusion, bleeding continues. What is the next nursing intervention?

CU. A patient with traumatic brain injury develops unequal pupils, hypertension, and bradycardia. ICP monitor shows 39 mmHg. What is the priority nursing action?

CV. A patient with pneumonia on high-flow oxygen has ABG: pH 7.23, PaCO₂ 72 mmHg, PaO₂ 48 mmHg. The patient is drowsy. What is the immediate nursing intervention?

CW. A patient refuses a recommended blood test, saying, “I don’t want any more needles.” What is the nurse’s best response?

CX. A patient with cirrhosis on lactulose therapy remains confused with ammonia 190 µmol/L. What is the next nursing intervention?

CY. A patient with an anterior MI develops hypotension, pulmonary edema, and a new harsh systolic murmur. What is the priority nursing action?

CZ. A patient with traumatic brain injury suddenly develops unequal pupils, hypertension, and bradycardia. ICP monitor shows 41 mmHg. What is the immediate nursing intervention?

DA. A patient with acute kidney injury has potassium 7.4 mEq/L and ECG showing widened QRS complexes. Calcium gluconate was already given. What is the next nursing intervention?

DB. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 117 mEq/L, and potassium 7.1 mEq/L. What is the immediate nursing intervention?

DC. A patient with cirrhosis undergoes paracentesis for ascites. Shortly after, the patient develops hypotension and tachycardia. What is the next nursing intervention?

DD. A patient with cirrhosis undergoes paracentesis for tense ascites. Shortly after, the patient becomes hypotensive and dizzy. What is the next nursing intervention?

DE. A patient with end-stage renal disease presents with K⁺ 7.5 mEq/L, muscle weakness, and wide QRS complexes. Calcium gluconate was already given. What is the next nursing intervention?

DF. A patient with Addison’s disease is admitted with severe hypotension, sodium 115 mEq/L, potassium 7.1 mEq/L, and lethargy. What is the immediate nursing action?

DG. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 118 mEq/L, and potassium 6.8 mEq/L. What is the priority nursing action?

DH. A trauma patient with a femur fracture develops severe leg pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive movement. What is the priority nursing action?

DI. A nurse feels pressured by a supervisor to discharge a patient who is not clinically stable. What is the most appropriate action?

DJ. A nurse overhears a colleague making a negative comment about a patient’s socioeconomic status. What is the most appropriate action?

DK. A patient with cirrhosis undergoes paracentesis for tense ascites. Shortly after, the patient becomes dizzy and hypotensive. What is the nurse’s next action?

DL. A patient with septic shock has received fluids and norepinephrine. MAP is 55 mmHg, lactate is rising, and urine output is <15 mL/hr. What is the next nursing intervention?

DM. A patient with an inferior MI develops sudden hypotension, jugular venous distension, and clear lungs. What is the nurse’s immediate action?

DN. A patient with septic shock is receiving norepinephrine. MAP is 65 mmHg, but lactate remains elevated, and extremities are mottled. Cardiac index is normal, but ScvO₂ is low. What should the nurse anticipate?

DO. A patient with an inferior MI develops jugular venous distension, hypotension, and clear lung sounds. What is the nurse’s immediate action?

DP. A patient with end-stage renal disease develops K⁺ 7.2 mEq/L, muscle weakness, and ECG showing wide QRS complexes. IV calcium gluconate has already been given. What is the next nursing intervention?

DQ. A patient with traumatic brain injury suddenly develops unequal pupils, hypertension, and bradycardia. ICP monitor shows 41 mmHg. What is the immediate nursing intervention?

DR. A patient with severe COPD exacerbation on BiPAP becomes increasingly somnolent. ABG: pH 7.21, PaCO₂ 82 mmHg, PaO₂ 55 mmHg. What is the next nursing action?

DS. A nurse observes a provider about to perform a procedure without explaining the risks. What is the nurse’s priority action?

DT. A patient with Addison’s disease presents with severe hypotension, confusion, sodium 118 mEq/L, and potassium 7.0 mEq/L. What is the nurse’s immediate action?

DU. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 42 mmHg. What is the priority nursing action?