A. A patient with an acute ischemic stroke received tPA 30 minutes ago. They now complain of a severe headache and have a sudden increase in blood pressure. What is the immediate action?

B. A patient post-carotid endarterectomy develops sudden unilateral facial droop and slurred speech. What is the immediate nursing action?

C. During a bedside handoff, a nurse notices a colleague skipping important safety checks. What is the most appropriate nursing action?

D. A nurse overhears a colleague joking about a patient’s accent at the nurses’ station. What is the most appropriate nursing action?

E. A patient with septic shock has received 4 liters of crystalloids and is on norepinephrine at 20 mcg/min. MAP is 54 mmHg, and lactate is 7 mmol/L. What is the next intervention?

F. A patient with acute GI bleeding has received fluids and two units of PRBCs. Blood pressure remains 82/50 mmHg, and the patient is increasingly lethargic. What is the next action?

G. A patient with septic shock remains hypotensive after fluids and norepinephrine. Cardiac index is low, and lactate levels are increasing. What is the next step?

H. A patient with gastrointestinal bleeding is receiving fluids and blood transfusions. Blood pressure remains 80/50 mmHg with tachycardia. What is the next nursing intervention?

I. A patient with ARDS is on low tidal volume ventilation and FiO₂ of 100%. SpO₂ is 82%, and PaO₂ is 50 mmHg. What is the most appropriate next intervention?

J. A patient with severe COPD exacerbation is on BiPAP but develops worsening hypercapnia, pH of 7.20, and decreased level of consciousness. What should the nurse do?

K. A patient with ARDS remains hypoxemic despite FiO₂ 100%, high PEEP, and sedation. Plateau pressures are 29 cmH₂O. What is the next step?

L. A patient with diabetic ketoacidosis is receiving insulin and fluids. The glucose is 140 mg/dL, potassium is 3.1 mEq/L, and the anion gap remains elevated. What is the next step?

M. During a staff meeting, a nurse interrupts a colleague who is presenting. What is the most appropriate action?

N. A family member caring for a patient with dementia says, “I feel exhausted and overwhelmed.” What is the nurse’s best response?

O. A patient with septic shock is on high-dose norepinephrine and vasopressin. MAP remains 54 mmHg, and urine output is <10 mL/hr. What is the next intervention?

P. A patient with upper GI bleeding is tachycardic and hypotensive despite initial boluses. Two large-bore IV lines are patent. What is the next priority action?

Q. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 140 mg/dL, potassium is 3.5 mEq/L, and the anion gap is still open. What is the appropriate intervention?

R. A patient with septic shock has been on norepinephrine for several hours. Despite adequate fluid resuscitation, MAP remains 55 mmHg, and urine output is 10 mL/hr. What is the priority intervention?

S. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 155 mg/dL, potassium is 3.4 mEq/L, and the anion gap remains elevated. What is the next step?

T. A family member says, “I don’t think my mother understands what’s happening.” What should the nurse do?

U. A patient with a traumatic brain injury develops sudden pupil dilation on the left side and decerebrate posturing. ICP is 32 mmHg. What is the priority action?

V. A patient with septic shock remains hypotensive after aggressive fluids and norepinephrine. The patient shows signs of hypoperfusion with cold extremities and delayed capillary refill. What is the priority intervention?

W. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 150 mg/dL, potassium is 2.9 mEq/L, and the anion gap remains elevated. What is the next nursing intervention?

X. A patient with a history of COPD presents with acute respiratory distress. ABG shows pH 7.21, PaCO₂ 80 mmHg, and PaO₂ 55 mmHg despite BiPAP therapy. What is the next nursing action?

Y. A patient with suspected mesenteric ischemia presents with severe abdominal pain, lactate of 6 mmol/L, and metabolic acidosis. What is the immediate nursing action?

Z. A patient with acute renal failure is receiving continuous renal replacement therapy (CRRT). The nurse notices a sudden drop in ultrafiltrate output and high transmembrane pressures on the machine. What is the appropriate action?

AA. A patient with severe asthma exacerbation is on continuous nebulized beta-agonists. ABG shows pH 7.18, PaCO₂ 72 mmHg, and worsening fatigue. What is the next step?

AB. A patient with septic shock is receiving norepinephrine and fluids. MAP remains 55 mmHg, and urine output is minimal. What is the priority nursing intervention?

AC. A patient in the ICU develops new-onset wide-complex tachycardia at 160 bpm. The patient is stable with BP 110/70 mmHg and no chest pain. What is the appropriate intervention?

AD. A patient with new-onset atrial fibrillation is hemodynamically unstable with hypotension and altered mental status. What is the priority nursing intervention?

AE. A patient with upper GI bleeding is hypotensive and tachycardic despite initial fluid resuscitation. What should the nurse do next?

AF. A patient refuses a blood transfusion due to religious beliefs. What is the nurse’s priority action?

AG. A patient with severe sepsis has a central venous pressure of 12 mmHg, MAP of 60 mmHg, and persistent elevated lactate despite norepinephrine. What is the next step?

AH. A patient with acute pancreatitis develops hypocalcemia with positive Chvostek and Trousseau signs. What is the priority nursing intervention?

AI. A patient with acute GI bleeding presents with hematemesis and hypotension. Two large-bore IV lines are placed, and fluids are running. What is the next action?

AJ. A patient with ARDS is ventilated with low tidal volume and high PEEP. Oxygen saturation remains at 80% despite FiO₂ 100%. What should the nurse anticipate?

AK. A trauma patient presents with multiple fractures, hypotension, tachycardia, and abdominal distension. FAST exam shows intra-abdominal bleeding. What should the nurse do first?

AL. A patient with end-stage liver disease expresses the desire to stop treatment. What should the nurse do first?

AM. A patient with a traumatic brain injury has an ICP of 31 mmHg, unequal pupils, and decerebrate posturing. What is the priority intervention?

AN. A patient with severe sepsis is on fluids and norepinephrine but continues to show signs of hypoperfusion. Cardiac output is normal, but SVR is low. What is the next step?

AO. A patient with septic shock remains hypotensive despite fluids and norepinephrine. Cardiac index is 1.8 L/min/m², and extremities are cold and mottled. What is the next step?

AP. A patient with severe pneumonia on high-flow oxygen suddenly becomes hypotensive and tachycardic with tracheal deviation to the left and absent breath sounds on the right. What is the priority intervention?

AQ. A patient with a traumatic brain injury develops hypertension, bradycardia, and irregular respirations. ICP is 31 mmHg. What is the priority nursing intervention?

AR. A patient admitted with myxedema coma is bradycardic, hypotensive, and hypothermic. What is the priority nursing intervention?

AS. A patient with a traumatic brain injury has ICP of 31 mmHg, unequal pupils, and decorticate posturing. What is the priority action?

AT. A patient post-laparotomy develops sudden tachycardia, hypotension, and a firm, distended abdomen. What is the immediate nursing action?

AU. A patient with a traumatic brain injury has ICP of 33 mmHg, a dilated right pupil, and decerebrate posturing. What is the priority action?

AV. A patient’s son asks for detailed information about his father’s diagnosis, but the patient has not given permission to share. What should the nurse do?

AW. A patient with a massive upper GI bleed is hypotensive despite receiving blood transfusions. The patient is pale and diaphoretic. What is the priority intervention?

AX. A patient with acute pancreatitis develops persistent hypotension and rising hematocrit despite IV fluids. What is the priority nursing intervention?

AY. A patient with upper GI bleeding is hypotensive and tachycardic despite aggressive fluid boluses and one unit of PRBCs. What is the next step?

AZ. A patient tells the nurse, “I don’t want to keep living like this on machines.” What is the best nursing action?

BA. A patient recovering from a myocardial infarction says, “I’m afraid this will happen again.” What is the nurse’s best response?

BB. A patient with a traumatic brain injury has ICP of 30 mmHg and worsening bradycardia. What is the priority nursing intervention?

BC. A patient with diabetic ketoacidosis is receiving IV insulin. Glucose is 150 mg/dL, potassium is 3.2 mEq/L, and the anion gap remains open. What is the next step?

BD. A patient with acute upper GI bleeding is hypotensive and tachycardic despite initial fluid boluses. What is the next nursing action?

BE. A patient with upper GI bleeding presents with hypotension and tachycardia despite 3 liters of crystalloids and two units of PRBCs. What should the nurse do next?

BF. A patient with massive upper GI bleeding remains hypotensive despite 2 units of packed RBCs and fluids. What is the next step?

BG. A patient with cirrhosis presents with confusion, tremors, and a serum ammonia of 130 mcg/dL. What is the appropriate nursing intervention?

BH. A patient post-thyroidectomy develops sudden inspiratory stridor, dyspnea, and cyanosis. What is the immediate priority action?

BI. A nurse witnesses a provider attempting to rush a patient into signing a consent form without explanation. What should the nurse do first?

BJ. A patient with ARDS is on low tidal volume ventilation and high PEEP. SpO₂ is 79% and PaO₂ is 48 mmHg despite FiO₂ of 100%. What should the nurse anticipate?

BK. A patient recently diagnosed with type 2 diabetes says, “I’ll never be able to manage all of this.” What is the nurse’s best response?

BL. A patient with septic shock is on norepinephrine and fluids. MAP remains at 55 mmHg, and lactate is rising. What is the next intervention?

BM. A patient with acute liver failure presents with altered mental status, hypotension, and evidence of coagulopathy. What is the priority nursing intervention?

BN. A patient with ARDS is on mechanical ventilation with low tidal volume and high PEEP. SpO₂ remains 82%, and PaO₂ is 50 mmHg despite FiO₂ of 100%. What is the next step?

BO. A patient with suspected adrenal crisis presents with hypotension, hyperkalemia, and hyponatremia. What is the priority intervention?

BP. A patient with septic shock remains hypotensive after 3 liters of crystalloids and norepinephrine. Cardiac output is low, and extremities are cool. What is the next nursing action?

BQ. A patient with diabetic ketoacidosis is receiving IV insulin. The glucose is 165 mg/dL, potassium is 3.2 mEq/L, and the anion gap remains open. What is the next nursing intervention?

BR. A patient with diabetic ketoacidosis is receiving insulin. Glucose is 150 mg/dL, potassium is 2.9 mEq/L, and the anion gap remains open. What is the next nursing action?

BS. A patient with sepsis develops mottled skin, cold extremities, and a lactate of 6 mmol/L despite aggressive fluids and norepinephrine. Cardiac output is critically low. What is the next step?

BT. A patient’s spouse expresses concern about managing multiple new medications at home. What is the nurse’s best action?

BU. A nurse observes a staff member making a dismissive comment when a patient requests pain medication. What is the nurse’s best action?

BV. A patient with acute kidney injury has rising creatinine, oliguria, and potassium of 6.8 mEq/L with peaked T waves on ECG. What is the priority action?

BW. A patient with traumatic brain injury has an ICP of 30 mmHg and worsening bradycardia. What is the priority nursing action?

BX. A patient with acute pancreatitis has increasing abdominal pain, hypotension, and abdominal distention. Bladder pressure is 28 mmHg. What is the priority nursing action?

BY. A patient with massive GI bleeding is tachycardic and hypotensive despite fluid boluses and two units of PRBCs. What is the next step?

BZ. A patient with ARDS is ventilated with low tidal volume and high PEEP. Oxygen saturation remains 80% with FiO₂ 100%. What is the next step?

CA. A patient with multiple traumatic injuries is receiving rapid transfusion during resuscitation. The nurse notes hypocalcemia on labs and QT prolongation on the monitor. What is the appropriate intervention?

CB. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 155 mg/dL, potassium is 3.0 mEq/L, and the anion gap remains open. What is the next intervention?

CC. A patient receiving palliative care says, “I feel scared about what will happen next.” What is the nurse’s best response?

CD. A patient with ARDS is ventilated with low tidal volume and high PEEP. SpO₂ remains at 80% despite FiO₂ 100%. What is the next step?

CE. A patient with severe hypovolemic shock after major trauma has weak pulses, tachycardia, and a blood pressure of 70/40 mmHg. What is the next step?

CF. A patient in septic shock is receiving aggressive fluids and norepinephrine. Urine output remains <15 mL/hr, and lactate is 7 mmol/L. What should the nurse anticipate next?

CG. A patient asks, “Why do I need to sign an advance directive?” What is the nurse’s best response?

CH. A patient with diabetic ketoacidosis is on an insulin drip. Glucose is 165 mg/dL, and the anion gap is still elevated. Potassium level is 3.0 mEq/L. What is the priority intervention?

CI. A nurse notices that another staff member consistently ignores a patient’s call light. What is the nurse’s best response?

CJ. A patient with acute kidney injury is oliguric and shows ECG changes consistent with hyperkalemia. What is the next step?

CK. A patient preparing for discharge after heart surgery says, “I’m afraid I won’t remember all these instructions.” What is the best nursing response?

CL. A patient who recently had a stroke becomes tearful when struggling with mobility exercises. What should the nurse do?

CM. A nurse notices a colleague ignoring a patient’s request for assistance with toileting. What is the most appropriate action?

CN. A patient with acute decompensated heart failure presents with pulmonary edema, pink frothy sputum, and SpO₂ of 82% on 15 L via non-rebreather mask. What is the priority nursing intervention?

CO. A patient is scheduled for a high-risk procedure but expresses fear of complications. What should the nurse do first?

CP. A patient with septic shock is receiving norepinephrine and vasopressin. The MAP is 56 mmHg, cardiac output is 3.0 L/min, and lactate is 5.8 mmol/L. What is the next step?

CQ. A patient with ARDS on mechanical ventilation has a plateau pressure of 28 cmH₂O and FiO₂ 100%, but SpO₂ remains 78%. What should the nurse anticipate?

CR. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 145 mg/dL, potassium is 3.4 mEq/L, and the anion gap is still open. What should the nurse do?

CS. A patient with hypertensive emergency presents with BP 230/120 mmHg, severe headache, and confusion. What is the priority nursing intervention?

CT. A patient with diabetic ketoacidosis is receiving insulin and fluids. The glucose is 150 mg/dL, but the anion gap is still elevated. Potassium is 3.4 mEq/L. What is the next step?

CU. A patient in the ICU develops sudden wide-complex tachycardia at 180 bpm with no palpable pulse. What is the priority nursing action?

CV. A patient becomes distressed after hearing their new cancer diagnosis. What is the most appropriate action for the nurse?

CW. A patient with a traumatic brain injury develops sudden hypertension, bradycardia, and irregular respirations. ICP monitor shows a pressure of 32 mmHg. What is the priority nursing action?

CX. A patient with diabetic ketoacidosis is on an insulin infusion. Glucose is 160 mg/dL, the anion gap is still open, and potassium is 2.9 mEq/L. What is the priority intervention?

CY. A patient with an acute ischemic stroke develops new-onset atrial fibrillation with rapid ventricular response. Blood pressure is stable. What is the initial nursing action?

CZ. A patient recovering from major abdominal surgery develops sudden shortness of breath, chest pain, and tachycardia. SpO₂ drops to 84% despite supplemental oxygen. What is the priority nursing action?

DA. A nurse observes a provider failing to wash hands before entering a patient’s room. What is the nurse’s priority action?

DB. A patient develops compartment syndrome after a crush injury. The extremity is swollen, firm, and has severe pain unrelieved by opioids, with weak distal pulses. What is the priority intervention?

DC. A patient in septic shock is on norepinephrine and vasopressin. Cardiac output remains low, and lactate is 6 mmol/L. What is the priority nursing intervention?

DD. A patient with severe ARDS is on mechanical ventilation with FiO₂ 100% and PEEP 18 cmH₂O. SpO₂ is 76% and plateau pressures are 30 cmH₂O. What is the next step?

DE. A patient with a traumatic brain injury presents with ICP of 31 mmHg, fixed pupils, and extensor posturing. What is the immediate priority?

DF. A patient with ARDS on mechanical ventilation remains hypoxemic despite FiO₂ 100%, PEEP 18 cmH₂O, and paralysis. What is the next nursing intervention?

DG. A patient with ARDS on mechanical ventilation remains hypoxemic despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressures are stable at 28 cmH₂O. What should the nurse anticipate?

DH. A patient with traumatic brain injury has ICP of 32 mmHg, bradycardia, and irregular respirations. What is the immediate nursing action?

DI. A patient with suspected fat embolism after a femur fracture presents with dyspnea, confusion, and petechial rash on the chest. What is the priority action?

DJ. A patient with a traumatic brain injury has ICP of 29 mmHg, bradycardia, and hypertension. What is the priority action?

DK. A patient with acute coronary syndrome develops chest pain unrelieved by nitroglycerin and morphine. ECG shows persistent ST elevation in leads II, III, and aVF. What is the priority action?

DL. A patient with heart failure expresses concern about managing diet restrictions at home. What is the best nursing action?

DM. A patient with rhabdomyolysis after prolonged immobility presents with dark urine, creatinine of 2.8 mg/dL, and potassium of 5.9 mEq/L. What is the next nursing intervention?

DN. A patient recovering from surgery says, “I don’t remember anything the surgeon told me.” What is the nurse’s best response?

DO. A patient with a gastrointestinal bleed is hypotensive and tachycardic despite receiving 2 liters of fluids. What is the priority nursing action?

DP. A patient with acute decompensated heart failure presents with severe dyspnea, pulmonary crackles, and BP 190/100 mmHg. What is the priority nursing action?

DQ. A patient with septic shock remains hypotensive after fluids and norepinephrine. The cardiac index is low, and the patient has delayed capillary refill. What is the next intervention?

DR. A patient with ARDS is ventilated with low tidal volume and high PEEP. Despite these settings, SpO₂ is 78% and PaO₂ is 48 mmHg. What should the nurse do next?

DS. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 145 mg/dL, potassium is 2.8 mEq/L, and the anion gap is still open. What is the priority action?

DT. A patient in the ICU develops a new fever and hypotension while on a central venous catheter. Blood cultures are drawn. What is the priority intervention?

DU. A patient with multiple long-bone fractures develops sudden dyspnea, confusion, and a petechial rash on the chest. What is the priority action?