A. A patient in septic shock is on norepinephrine at 30 mcg/min but remains hypotensive with a MAP of 54 mmHg. Cardiac output is low at 2.0 L/min/m² and urine output is minimal. What is the next intervention?

B. A nurse overhears a colleague making a rude comment about a patient’s hygiene. What is the most appropriate action?

C. A patient with acute decompensated heart failure presents with severe dyspnea, pulmonary crackles, and SpO₂ 78% on high-flow oxygen. BP is 185/100 mmHg. What is the priority nursing action?

D. A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Glucose is 150 mg/dL, potassium is 3.1 mEq/L, and the anion gap is closing. What should the nurse do next?

E. A patient with acute pulmonary edema presents with severe dyspnea, pink frothy sputum, and SpO₂ 78% on high-flow oxygen. BP is 190/105 mmHg. What is the priority nursing action?

F. A patient in septic shock is on norepinephrine at 28 mcg/min but remains hypotensive with a MAP of 54 mmHg and a cardiac index of 2.0 L/min/m². Urine output is less than 15 mL/hr. What is the next intervention?

G. A patient with a massive gastrointestinal bleed presents with hypotension, tachycardia, and cool extremities. Hemoglobin is 6.8 g/dL, and the patient is pale and diaphoretic. What is the priority nursing action?

H. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

I. A patient with traumatic brain injury suddenly becomes unresponsive, with unequal pupils and irregular respirations. ICP monitor reads 40 mmHg. What is the immediate nursing action?

J. A patient with a subarachnoid hemorrhage becomes acutely hypertensive and complains of severe headache and photophobia. What is the immediate nursing action?

K. A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Glucose is 160 mg/dL, potassium is 2.8 mEq/L, and the anion gap is still elevated. What is the priority intervention?

L. A patient with acute decompensated heart failure presents with severe dyspnea, pink frothy sputum, and SpO₂ 76% on high-flow oxygen. BP is 185/100 mmHg. What is the priority nursing action?

M. A patient with an acute myocardial infarction develops new-onset complete heart block with a ventricular rate of 30 bpm and hypotension. What is the priority nursing action?

N. A patient with acute decompensated heart failure presents with severe dyspnea, orthopnea, and crackles in all lung fields. BP is 185/100 mmHg, and SpO₂ is 82% despite high-flow oxygen. What is the priority nursing action?

O. A patient with acute pulmonary edema is in severe respiratory distress. SpO₂ is 78% on high-flow oxygen, and pink frothy sputum is present. BP is 180/95 mmHg. What is the priority nursing action?

P. A patient with septic shock is intubated and mechanically ventilated. Despite adequate fluid resuscitation, MAP remains 54 mmHg, and lactate is 7 mmol/L. What should the nurse anticipate next?

Q. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 40 mmHg. What is the immediate nursing intervention?

R. A patient with acute myocardial infarction develops severe hypotension, jugular venous distention, and clear lung fields. What is the immediate nursing intervention?

S. A patient’s spouse says, “I don’t think I can continue caring for my partner at home.” What is the nurse’s best response?

T. A patient with DKA is on an insulin drip. Blood glucose is 150 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still elevated. What should the nurse do first?

U. A patient becomes tearful after learning their illness is not responding to treatment. What is the most appropriate nursing action?

V. A patient with traumatic brain injury becomes bradycardic and hypertensive with irregular respirations. ICP monitor reads 40 mmHg. What is the immediate nursing intervention?

W. A nurse observes a staff member laughing about a patient’s speech difficulties after a stroke. What is the best nursing action?

X. A patient with traumatic brain injury suddenly becomes unresponsive with unequal pupils and bradycardia. ICP monitor shows 38 mmHg. What is the immediate nursing action?

Y. A patient with severe bradycardia (heart rate 28 bpm) presents with hypotension, cool extremities, and altered mental status. What is the priority nursing intervention?

Z. A patient in septic shock is receiving norepinephrine at 28 mcg/min with MAP at 55 mmHg. Cardiac output is 2.0 L/min/m², and urine output is <10 mL/hr. What is the next step?

AA. A patient with DKA is on an insulin drip. Glucose is 180 mg/dL, potassium is 3.3 mEq/L, and the anion gap remains elevated. What should the nurse do next?

AB. A patient with diabetic ketoacidosis is receiving an insulin drip. Blood glucose is 165 mg/dL, potassium is 2.9 mEq/L, and the anion gap is not closed. What should the nurse do first?

AC. A patient with a basilar skull fracture presents with clear nasal drainage, periorbital ecchymosis, and headache. What is the priority nursing intervention?

AD. A patient’s spouse says, “I feel overwhelmed caring for my partner with dementia.” What is the nurse’s best response?

AE. A patient with diabetic ketoacidosis is on an insulin infusion. Blood glucose is 170 mg/dL, potassium is 2.7 mEq/L, and the anion gap is still open. What should the nurse do first?

AF. A nurse observes a staff member making fun of a patient’s difficulty with speech after a stroke. What is the most appropriate action?

AG. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What should the nurse anticipate?

AH. A patient in septic shock is on norepinephrine at 30 mcg/min with a MAP of 54 mmHg. Cardiac output is normal, but SVR is critically low. What is the next nursing intervention?

AI. A patient with sepsis develops new confusion, rising creatinine, and urine output of 10 mL/hr despite fluid resuscitation. What is the priority action?

AJ. A patient in septic shock is receiving norepinephrine at 30 mcg/min, but MAP remains at 54 mmHg. Cardiac output is low at 2.1 L/min/m², and urine output is minimal. What is the next step?

AK. A patient in septic shock remains hypotensive after aggressive fluids and norepinephrine at 25 mcg/min. Cardiac index is adequate, but SVR remains critically low. What is the next step?

AL. A patient asks, “Why do I need to use this walker before going home?” What is the nurse’s best response?

AM. A patient in septic shock remains hypotensive with MAP 55 mmHg despite norepinephrine at 28 mcg/min and adequate fluids. Cardiac output is 2.0 L/min/m², and lactate is rising. What is the next step?

AN. A patient in septic shock is on norepinephrine at 30 mcg/min but remains hypotensive with MAP of 54 mmHg. Cardiac output is 2.3 L/min/m², and lactate is 7 mmol/L. What is the next step?

AO. A patient with acute decompensated heart failure is on IV diuretics. Suddenly, the patient develops hypotension, weak pulses, and a narrow QRS tachycardia. What is the immediate nursing intervention?

AP. A patient becomes tearful after learning their cancer has progressed. What is the most appropriate nursing action?

AQ. A patient with acute inferior wall myocardial infarction develops complete heart block with a ventricular rate of 28 bpm and hypotension. What is the priority nursing action?

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

AS. A patient on mechanical ventilation suddenly develops hypotension, tachycardia, and absent breath sounds on the left. The trachea is deviated to the right. What is the immediate nursing action?

AT. A patient with chronic kidney disease tells the nurse, “I don’t want to continue dialysis anymore.” What should the nurse do first?

AU. A patient with septic shock has persistent hypotension despite aggressive fluids. Cardiac output is low at 2.0 L/min/m², and urine output is minimal. What is the next step?

AV. A patient in septic shock is receiving norepinephrine but remains hypotensive with MAP 55 mmHg. Cardiac output is low at 2.1 L/min/m² and urine output is <15 mL/hr. What should the nurse do next?

AW. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 160 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still elevated. What is the priority nursing action?

AX. A patient in septic shock is receiving norepinephrine at 25 mcg/min but remains hypotensive with MAP of 55 mmHg. Cardiac output is low at 2.1 L/min/m². What is the next nursing step?

AY. A patient with traumatic brain injury develops bradycardia, irregular respirations, and hypertension. ICP monitor reads 40 mmHg. What is the immediate nursing intervention?

AZ. A patient in septic shock is receiving norepinephrine but remains hypotensive with a MAP of 55 mmHg. Cardiac output is 2.1 L/min/m², and urine output is <10 mL/hr. What should the nurse do next?

BA. A patient preparing for discharge after surgery says, “I feel too weak to care for myself.” What is the nurse’s best response?

BB. A patient with traumatic brain injury develops bradycardia, irregular respirations, and hypertension. ICP monitoring shows a pressure of 36 mmHg. What is the next nursing action?

BC. A nurse observes a provider attempting to obtain consent quickly without explaining the risks. What is the nurse’s priority action?

BD. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

BE. A patient with acute inferior wall myocardial infarction presents with hypotension, jugular venous distention, and clear lung fields. What is the priority intervention?

BF. A patient with severe ARDS is on mechanical ventilation with high PEEP and FiO₂ 100%. SpO₂ remains 74% despite paralysis and prone positioning. Plateau pressures are 29 cmH₂O. What is the next step?

BG. A patient with severe hypovolemic shock after a motor vehicle accident is unresponsive, with a BP of 60/40 mmHg and weak, thready pulses. What is the priority nursing action?

BH. A patient with traumatic brain injury becomes unresponsive with bradycardia and unequal pupils. ICP monitor shows 39 mmHg. What is the immediate intervention?

BI. A patient post-trauma develops abdominal distension, hypotension, and oliguria. Bladder pressure is 28 mmHg. What is the next nursing action?

BJ. A patient with new-onset heart failure says, “I’ll never be able to manage this at home.” What is the nurse’s best response?

BK. A nurse observes a provider beginning a procedure without explaining it to the patient. What should the nurse do first?

BL. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next appropriate step?

BM. A patient with acute pulmonary edema presents with severe dyspnea, pink frothy sputum, and SpO₂ 78% on high-flow oxygen. BP is 190/105 mmHg. What is the priority nursing intervention?

BN. A patient with severe ARDS is on mechanical ventilation with high PEEP and FiO₂ 100%. SpO₂ remains 75%, and plateau pressures are 28 cmH₂O despite paralysis and proning. What is the next step?

BO. A patient with acute anterior wall myocardial infarction develops ventricular fibrillation. What is the immediate nursing intervention?

BP. A patient with acute inferior wall myocardial infarction presents with hypotension, jugular venous distention, and clear lung fields. What is the immediate nursing action?

BQ. A patient with traumatic brain injury becomes bradycardic and hypertensive with irregular respirations. ICP monitoring shows 39 mmHg. What is the immediate nursing action?

BR. A patient with diabetic ketoacidosis is receiving an insulin drip. Blood glucose is 165 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still present. What should the nurse do first?

BS. A patient in septic shock is receiving norepinephrine but remains hypotensive with a MAP of 55 mmHg. Cardiac output is low, and urine output is <10 mL/hr. What is the next intervention?

BT. A patient with septic shock is receiving norepinephrine at 30 mcg/min. MAP remains at 54 mmHg, cardiac output is 3.0 L/min/m², and lactate is rising. What is the next step?

BU. A patient in septic shock is on norepinephrine at 25 mcg/min, but MAP is 54 mmHg. Cardiac output is 2.1 L/min/m², and urine output is <15 mL/hr. What is the next step?

BV. A patient in septic shock remains hypotensive despite norepinephrine at 25 mcg/min and adequate fluid resuscitation. Cardiac output is low at 2.2 L/min/m², and lactate continues to rise. What is the next step?

BW. A nurse overhears a colleague using a disrespectful tone toward a patient with limited mobility. What is the best nursing action?

BX. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 160 mg/dL, potassium is 3.0 mEq/L, and the anion gap remains elevated. What should the nurse do?

BY. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

BZ. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, and paralysis. SpO₂ is 76% and plateau pressures are 30 cmH₂O. What is the next intervention?

CA. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and prone positioning. Plateau pressures are stable at 28 cmH₂O. What should the nurse anticipate?

CB. A patient says, “I feel anxious about going home after this hospitalization.” What is the nurse’s best response?

CC. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 170 mg/dL, potassium is 3.0 mEq/L, and the anion gap is still open. What should the nurse do first?

CD. A patient with acute coronary syndrome develops ventricular tachycardia without a pulse. What is the immediate nursing intervention?

CE. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 160 mg/dL, potassium is 2.8 mEq/L, and the anion gap remains open. What is the priority intervention?

CF. A patient with severe ARDS on mechanical ventilation has plateau pressures of 28 cmH₂O and SpO₂ of 78% despite prone positioning and paralysis. The patient is also developing metabolic acidosis with rising lactate. What is the next step?

CG. A patient with traumatic brain injury becomes unresponsive, with bradycardia and irregular respirations. ICP monitor shows 39 mmHg. What is the priority nursing action?

CH. A patient in septic shock is on norepinephrine at 30 mcg/min, but MAP remains at 54 mmHg. Cardiac output is low at 2.1 L/min/m², and urine output is minimal. What is the next step?

CI. A patient asks, “Why do I need to practice using the walker before going home?” What is the nurse’s best response?

CJ. A patient with septic shock has received 4 liters of crystalloids and is on norepinephrine at 25 mcg/min. MAP remains 54 mmHg, cardiac output is 2.0 L/min/m², and urine output is <10 mL/hr. What is the next step?

CK. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

CL. A patient recovering from cardiac surgery develops sudden hypotension, muffled heart sounds, and jugular venous distention. What is the immediate nursing action?

CM. A patient with diabetic ketoacidosis is receiving an insulin drip. Blood glucose is 165 mg/dL, potassium is 2.9 mEq/L, and the anion gap is not closed. What should the nurse do first?

CN. A patient says, “I don’t understand why I need to attend pulmonary rehab.” What is the nurse’s best response?

CO. A patient with acute pulmonary edema presents with severe dyspnea, pink frothy sputum, and SpO₂ 76% on high-flow oxygen. BP is 185/100 mmHg. What is the priority nursing action?

CP. A patient’s spouse says, “I’m exhausted caring for my partner with Parkinson’s disease.” What is the nurse’s best response?

CQ. A patient preparing for discharge after heart surgery says, “I’m nervous I’ll make a mistake with my care.” What is the nurse’s best response?

CR. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

CS. A patient with traumatic brain injury becomes unresponsive with bradycardia and irregular respirations. ICP monitor shows 40 mmHg. What is the immediate nursing action?

CT. A patient with traumatic brain injury becomes unresponsive with unequal pupils and bradycardia. ICP monitor shows 36 mmHg. What is the priority nursing intervention?

CU. A patient with septic shock is receiving norepinephrine at 25 mcg/min but remains hypotensive with a MAP of 55 mmHg. Cardiac output is 2.5 L/min/m², and lactate remains elevated. What should the nurse do next?

CV. A patient with diabetic ketoacidosis is on an insulin infusion. Glucose is 150 mg/dL, potassium is 2.8 mEq/L, and the anion gap remains open. What is the priority nursing action?

CW. A patient with diabetic ketoacidosis is receiving an insulin drip. Blood glucose is 170 mg/dL, potassium is 3.0 mEq/L, and the anion gap is still open. What should the nurse do first?

CX. A patient with acute inferior wall myocardial infarction presents with hypotension, jugular venous distention, and clear lung fields. What is the immediate nursing action?

CY. A patient becomes tearful when discussing the impact of chronic illness on their family. What is the most appropriate nursing action?

CZ. A patient with acute pancreatitis develops hypocalcemia with muscle twitching and a prolonged QT interval on ECG. What is the appropriate intervention?

DA. A patient with diabetic ketoacidosis is on an insulin infusion. Blood glucose is 170 mg/dL, potassium is 2.8 mEq/L, and the anion gap is still present. What is the appropriate nursing action?

DB. A patient post-craniotomy suddenly develops unequal pupils, bradycardia, and hypertension. ICP monitoring shows a reading of 38 mmHg. What is the priority nursing action?

DC. A patient tells the nurse, “I don’t want to continue dialysis.” What should the nurse do first?

DD. A patient with traumatic brain injury suddenly develops bradycardia, hypertension, and irregular respirations. ICP is 39 mmHg. What is the immediate nursing intervention?

DE. A patient presents with severe hypocalcemia after multiple blood transfusions. They exhibit tetany, tingling around the mouth, and a prolonged QT interval. What is the immediate action?

DF. A patient with diabetic ketoacidosis is receiving IV insulin. Blood glucose is 165 mg/dL, potassium is 2.8 mEq/L, and the anion gap remains open. What is the immediate nursing action?

DG. A patient with traumatic brain injury becomes unresponsive with bradycardia and unequal pupils. ICP monitoring shows 38 mmHg. What is the immediate nursing intervention?

DH. A patient with ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, and prone positioning. Plateau pressures are stable at 30 cmH₂O. What is the next intervention?

DI. A patient with myasthenic crisis is admitted with severe respiratory muscle weakness, shallow respirations, and SpO₂ 84% on room air. What is the immediate nursing intervention?

DJ. A nurse witnesses a provider starting a procedure without explaining it to the patient. What should the nurse do first?

DK. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, proning, and paralysis. Plateau pressures are stable at 28 cmH₂O. What is the next step?

DL. A patient with acute decompensated heart failure is receiving high-dose IV diuretics. The nurse notes muscle weakness, PVCs on the monitor, and a potassium level of 2.8 mEq/L. What is the priority nursing intervention?

DM. A patient post-craniotomy develops sudden hypertension, bradycardia, and irregular respirations. ICP is 38 mmHg. What is the immediate nursing action?

DN. A patient with status epilepticus remains unresponsive after two doses of IV lorazepam. What should the nurse do next?

DO. A patient with acute inferior wall myocardial infarction presents with hypotension, jugular venous distention, and clear lung fields. What is the priority nursing intervention?

DP. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and prone positioning. Plateau pressures are stable at 28 cmH₂O. What is the next nursing step?

DQ. A patient says, “I don’t understand why I have to attend cardiac rehab.” What is the nurse’s best response?

DR. A patient with a history of chronic alcohol use presents with altered mental status, ataxia, and nystagmus. What is the priority nursing intervention?

DS. A patient with Guillain-Barré syndrome develops ascending paralysis and a respiratory rate of 8/min with shallow breathing. What is the immediate nursing action?

DT. A patient says, “I don’t understand why I have to keep coming for follow-up visits.” What is the nurse’s best response?

DU. A patient with traumatic brain injury presents with bradycardia, irregular respirations, and hypertension. ICP monitor shows 38 mmHg. What is the immediate nursing action?