A. A patient with acute pancreatitis develops hypotension, tachycardia, and severe abdominal distension. What is the priority nursing action?

B. A patient with severe acute cholangitis develops high fever, jaundice, and hypotension despite antibiotics. What should the nurse anticipate?

C. A nurse overhears a colleague criticizing a patient’s cultural practices. What is the most appropriate nursing action?

D. A patient says, “I don’t understand why I need to take all these medications.” What is the nurse’s best response?

E. A patient with chronic kidney disease develops muscle weakness, flattened T waves, and a potassium level of 2.6 mEq/L after aggressive diuresis. What is the appropriate nursing intervention?

F. A patient preparing for discharge says, “I’m worried I won’t remember how to manage my new medications.” What is the nurse’s best response?

G. A patient with chronic kidney disease has muscle weakness, flattened T waves on ECG, and a potassium level of 2.5 mEq/L. What should the nurse do first?

H. A patient asks, “Why do I need to use the incentive spirometer?” What is the nurse’s best response?

I. A patient develops severe metabolic acidosis following crush syndrome with rhabdomyolysis. Potassium is 6.5 mEq/L, and creatinine is rapidly rising. What is the priority nursing intervention?

J. A patient with decompensated cirrhosis develops confusion, asterixis, and ammonia level of 185 µmol/L despite regular lactulose therapy. What is the next nursing action?

K. A patient with type 2 diabetes presents with altered mental status, glucose of 950 mg/dL, and serum osmolality of 340 mOsm/kg. No significant ketones are detected. What is the priority nursing action?

L. A patient with advanced illness states, “I don’t want to continue aggressive treatments.” What should the nurse do first?

M. A patient with a femur fracture after a motor vehicle accident develops sudden dyspnea, confusion, and petechiae on the chest. What is the immediate nursing action?

N. A patient with a pelvic fracture complains of severe pelvic pain, inability to move the legs, and numbness in the perineal area. What is the priority nursing action?

O. A patient recovering from orthopedic surgery develops sudden shortness of breath, confusion, and SpO₂ of 82% on room air. What is the priority nursing action?

P. A patient with suspected adrenal insufficiency develops dizziness, severe hypotension, and hyperpigmented skin patches. What is the immediate nursing intervention?

Q. A patient with acute cholangitis develops persistent fever, hypotension, and confusion despite IV antibiotics. What is the priority nursing intervention?

R. A patient with acute kidney injury has serum potassium of 6.8 mEq/L and wide QRS complexes on the ECG. What is the immediate nursing action?

S. A patient with diabetic ketoacidosis is receiving an insulin infusion. Blood glucose is 140 mg/dL, potassium is 3.4 mEq/L, and the anion gap is closing. What is the next nursing step?

T. A patient with hyperthyroidism develops agitation, tremors, tachycardia at 160 bpm, and a temperature of 103°F (39.4°C). What is the priority nursing action?

U. A patient with advanced chronic kidney disease is confused, with a serum potassium level of 7.2 mEq/L and widening QRS complexes on ECG. What is the priority nursing action?

V. A patient with post-operative acute kidney injury has urine output <10 mL/hr despite fluids, rising creatinine, and metabolic acidosis. What is the next nursing step?

W. A patient on continuous renal replacement therapy (CRRT) suddenly develops hypotension and MAP of 50 mmHg. What is the first nursing action?

X. A patient with a crush injury to the lower extremity develops dark urine, rising creatinine, and hyperkalemia. What is the priority intervention?

Y. A patient with multiple rib fractures is experiencing progressive hypoxia and respiratory distress despite high-flow oxygen. Breath sounds are absent on the left, and tracheal deviation is noted. What is the priority nursing intervention?

Z. A patient with acute upper gastrointestinal bleeding is receiving rapid blood transfusions. Suddenly, the patient develops dyspnea, fever, and hypotension. What is the immediate nursing action?

AA. A patient’s daughter says, “I feel overwhelmed trying to care for my mother at home.” What is the nurse’s best response?

AB. A patient with a pelvic fracture develops severe back pain, hypotension, and numbness in the lower extremities. What is the priority nursing intervention?

AC. A patient with an upper GI bleed has hematemesis, BP 88/60 mmHg, and HR 125 bpm. What is the immediate nursing action?

AD. A patient presents with severe abdominal pain, hypotension, and a rigid abdomen after recent blunt trauma. What is the priority nursing action?

AE. A patient with acute kidney injury develops confusion, nausea, and a potassium level of 6.8 mEq/L. ECG shows wide QRS complexes and peaked T waves. What is the immediate nursing action?

AF. A patient with terminal cancer says, “I don’t want to continue chemotherapy.” What should the nurse do first?

AG. A patient post–gastric bypass reports severe abdominal pain, tachycardia, and signs of peritonitis. What is the priority nursing action?

AH. A patient with liver cirrhosis presents with new confusion and a serum ammonia level of 160 µmol/L. What is the priority intervention?

AI. A patient with decompensated liver failure presents with massive ascites, hypotension, and rising creatinine. What is the priority nursing intervention?

AJ. A trauma patient with multiple long-bone fractures develops dyspnea, confusion, and hypoxemia. Petechial rash is noted on the upper chest. What is the priority action?

AK. A patient recovering from a spinal cord injury reports severe back pain, loss of sensation below the injury site, and hypotension. What is the immediate nursing action?

AL. A patient with advanced cirrhosis presents with confusion, asterixis, and serum ammonia of 200 µmol/L despite lactulose therapy. What should the nurse anticipate next?

AM. A patient with poorly controlled type 2 diabetes becomes diaphoretic and confused. Bedside glucose is 28 mg/dL. What is the immediate nursing intervention?

AN. A patient with hyperosmolar hyperglycemic state (HHS) presents with lethargy, dry mucous membranes, and a glucose level of 980 mg/dL. Serum potassium is 4.2 mEq/L. What is the first nursing action?

AO. A nurse overhears a colleague making a sarcastic remark about a patient’s weight. What is the most appropriate nursing action?

AP. A patient with type 1 diabetes presents with confusion, diaphoresis, and tremors. Bedside glucose is 42 mg/dL, and IV access is not available. What is the immediate nursing intervention?

AQ. A patient on high-dose insulin therapy becomes diaphoretic, confused, and has a glucose level of 38 mg/dL. What is the immediate nursing action?

AR. A patient with known hypothyroidism is found unresponsive, hypothermic, and bradycardic. What is the immediate nursing intervention?

AS. A patient with a femur fracture develops increasing leg pain unrelieved by opioids, swelling, and paresthesia. Pedal pulses are present but weak. What is the priority nursing action?

AT. A patient with advanced illness tells the nurse, “I don’t want aggressive treatment anymore.” What should the nurse do first?

AU. A patient with cirrhosis presents with new confusion, asterixis, and an ammonia level of 150 µmol/L. What is the priority nursing action?

AV. A patient with severe dehydration has sodium of 160 mEq/L, confusion, and seizures. What is the priority nursing action?

AW. A patient with a spinal cord injury suddenly develops severe headache, hypertension, and bradycardia. What is the priority nursing action?

AX. A patient with multiple rib fractures after a motor vehicle accident complains of severe chest pain and dyspnea. Breath sounds are diminished on the right side, and tracheal deviation to the left is noted. What is the priority action?

AY. A patient says, “I don’t understand why I need these follow-up tests.” What is the nurse’s best response?

AZ. A patient with suspected adrenal crisis arrives with profound hypotension, severe weakness, and hyperpigmented skin. What is the immediate nursing action?

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

BB. A patient with suspected thyroid storm presents with fever of 105°F (40.5°C), tachycardia at 180 bpm, and agitation. What is the priority intervention?

BC. A patient with a pelvic fracture develops tachycardia, hypotension, and cool, clammy skin. What is the immediate nursing action?

BD. During rounds, a nurse overhears a colleague making a dismissive remark about a patient’s cultural food preferences. What is the most appropriate action?

BE. A patient in thyroid storm has fever of 104°F (40°C), tachycardia at 180 bpm, and severe agitation. What is the next priority intervention?

BF. A patient with diabetic ketoacidosis has glucose 250 mg/dL, potassium 3.2 mEq/L, and a closing anion gap. What is the next nursing step?

BG. A patient with end-stage renal disease is receiving hemodialysis when the nurse notes severe hypotension and dizziness. What is the nurse’s first action?

BH. A patient with Addison’s disease is admitted with hypotension, severe fatigue, and serum sodium of 124 mEq/L. What is the appropriate intervention?

BI. A patient with COPD says, “I don’t think I can handle living alone after discharge.” What is the nurse’s best response?

BJ. A patient with severe acute pancreatitis develops abdominal distension, hypotension, and decreased urine output. Intra-abdominal pressure is measured at 28 mmHg. What is the priority nursing action?

BK. A patient post–colectomy reports severe abdominal pain, distension, and absence of bowel sounds. What is the priority intervention?

BL. A patient with a femur fracture reports severe, unrelenting pain despite opioid administration. The leg is tense, and passive stretching worsens the pain. What is the priority nursing intervention?

BM. A patient with rhabdomyolysis after a crush injury develops dark urine, creatine kinase of 25,000 U/L, and rising creatinine. What is the priority intervention?

BN. A patient’s spouse says, “I don’t think I can keep caring for him at home.” What is the nurse’s best response?

BO. A patient admitted for gastrointestinal bleeding develops sudden hypotension, tachycardia, and cool clammy skin. What is the priority nursing intervention?

BP. A patient becomes tearful after learning that their chronic illness has worsened. What is the most appropriate nursing action?

BQ. A patient with acute kidney injury has potassium of 7.0 mEq/L and ECG showing widened QRS complexes. What is the immediate nursing action?

BR. A patient with a long-bone fracture develops intense pain, paresthesia, and swelling despite immobilization. The leg is tense, and pulses are weak. What is the priority nursing intervention?

BS. A patient with a history of thyroidectomy presents with perioral tingling, muscle cramps, and a positive Chvostek’s sign. What is the immediate nursing intervention?

BT. A patient with uncontrolled type 1 diabetes presents with confusion, rapid breathing, and fruity breath odor. Blood glucose is 620 mg/dL, and arterial pH is 7.12. What is the priority nursing action?

BU. A patient with severe hypoglycemia is found unresponsive with a glucose level of 35 mg/dL. IV access is not available. What should the nurse do next?

BV. A patient with pheochromocytoma is undergoing surgery and develops sudden severe hypertension and tachyarrhythmias. What is the priority intervention?

BW. A patient with severe sepsis is receiving vasopressors and broad-spectrum antibiotics. Lactate remains elevated, and ScvO₂ is 50%. What should the nurse anticipate next?

BX. A patient on hemodialysis develops severe chest pain and shortness of breath during the procedure. ECG shows peaked T waves. What is the priority nursing action?

BY. A patient admitted for acute liver failure develops confusion, asterixis, and an ammonia level of 145 µmol/L. What is the priority nursing action?

BZ. A patient with acute pancreatitis develops hypocalcemia, presenting with perioral tingling, muscle cramps, and a positive Chvostek’s sign. What is the immediate nursing action?

CA. A patient with a femur fracture reports increasing pain unrelieved by opioids, paresthesia, and pallor of the limb. Passive stretch increases the pain. What is the nurse’s priority action?

CB. A patient begins crying after learning their disease is progressing. What is the most appropriate nursing action?

CC. A patient with advanced renal failure presents with confusion, pericardial friction rub, and K⁺ of 7.4 mEq/L. What is the priority nursing action?

CD. A patient in thyroid storm is febrile at 104°F (40°C), tachycardic at 170 bpm, and agitated. What is the immediate nursing intervention?

CE. A patient with a history of chronic pancreatitis presents with severe epigastric pain radiating to the back, hypotension, and a distended abdomen. What is the priority nursing intervention?

CF. A patient with hyperthyroidism presents with a temperature of 104°F (40°C), tachycardia of 160 bpm, and agitation. What is the priority intervention?

CG. A patient with severe pancreatitis develops hypocalcemia, hypotension, and prolonged QT interval on ECG. What is the immediate nursing intervention?

CH. A patient with post-obstructive acute kidney injury has serum sodium of 118 mEq/L and is experiencing confusion and seizures. What is the priority nursing intervention?

CI. A nurse sees a provider asking a patient to sign consent without explanation. What is the nurse’s priority action?

CJ. A patient with a hip fracture post-surgery develops confusion, hypoxia, and a new low-grade fever. What should the nurse suspect and do first?

CK. A patient with a crush injury to the leg develops severe pain, tense swelling, and pain out of proportion to the injury. Pedal pulses are weak. What is the priority nursing intervention?

CL. A patient with type 1 diabetes presents with rapid breathing, abdominal pain, and fruity breath. Glucose is 580 mg/dL, and arterial pH is 7.10. What is the immediate nursing action?

CM. A patient with decompensated liver failure is scheduled for paracentesis. What is the priority nursing action before the procedure?

CN. A patient with diabetic ketoacidosis develops profound weakness, potassium of 2.5 mEq/L, and U waves on the ECG. What is the priority nursing action?

CO. A patient with multiple fractures from a motor vehicle crash develops sudden hypoxemia, confusion, and a petechial rash on the upper chest. What is the priority nursing intervention?

CP. A patient with severe acute pancreatitis suddenly develops hypotension, a rigid abdomen, and falling hematocrit. What is the priority nursing action?

CQ. A nurse witnesses a provider attempting to perform a procedure without explaining it to the patient. What should the nurse do first?

CR. A patient with a new tracheostomy says, “I feel anxious about going home with this tube.” What is the nurse’s best response?

CS. A patient admitted with confusion and tremors has blood glucose of 40 mg/dL. IV access is established. What is the next nursing action?

CT. A patient with a known history of Addison’s disease develops vomiting, abdominal pain, hypotension, and confusion after a stressful event. What is the priority intervention?

CU. A patient receiving loop diuretics develops muscle cramps, flattened T waves on ECG, and a potassium level of 2.8 mEq/L. What should the nurse do first?

CV. A patient with suspected myxedema coma presents with hypothermia, bradycardia, and altered mental status. What is the priority nursing intervention?

CW. A patient asks, “Why do I need to wear these compression stockings?” What is the nurse’s best response?

CX. A patient with acute liver failure presents with confusion, jaundice, and a rapidly rising INR. What is the priority nursing action?

CY. A patient with acute tubular necrosis after major surgery has rising creatinine and minimal urine output despite aggressive fluid resuscitation. What is the priority intervention?

CZ. A patient with an upper gastrointestinal bleed has hematemesis, BP 80/60 mmHg, and HR 135 bpm. What is the immediate nursing intervention?

DA. A patient in acute adrenal crisis presents with severe hypotension, confusion, and hyperkalemia after missing multiple doses of hydrocortisone. What is the priority intervention?

DB. A patient with advanced chronic kidney disease presents with confusion, nausea, and a serum potassium level of 6.9 mEq/L. ECG shows tall peaked T waves. What is the immediate nursing action?

DC. A patient with end-stage renal disease on hemodialysis develops muscle weakness, peaked T waves on ECG, and a serum potassium of 7.0 mEq/L. What is the immediate nursing action?

DD. A nurse observes a staff member ignoring a patient’s call light. What is the best nursing action?

DE. A patient with advanced chronic kidney disease has severe uremic symptoms, confusion, and pericardial friction rub. What should the nurse anticipate?

DF. A patient with decompensated liver cirrhosis and massive ascites suddenly develops shortness of breath and hypoxia. What is the immediate nursing intervention?

DG. A patient with multiple pelvic fractures reports severe pain, numbness in the lower extremities, and urinary retention. What is the nurse’s priority action?

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

DI. A patient receiving continuous renal replacement therapy (CRRT) suddenly develops hypotension and a MAP of 55 mmHg. What is the nurse’s first action?

DJ. A patient with a history of cirrhosis develops coffee-ground emesis, hypotension, and tachycardia. What is the priority nursing intervention?

DK. A patient with cirrhosis develops sudden hematemesis, hypotension, and tachycardia. What is the priority nursing action?

DL. A patient with acute kidney injury from dehydration has a potassium level of 6.5 mEq/L and tall, peaked T waves on the ECG. What is the priority intervention?

DM. A patient with known Addison’s disease presents with severe hypotension, confusion, and hyperkalemia after missing doses of hydrocortisone. What is the immediate nursing action?

DN. A patient with a pelvic fracture is immobilized for several days. The nurse notes calf pain, swelling, and warmth in the right leg. What is the priority nursing action?

DO. A patient with acute renal failure following contrast dye exposure has rising creatinine, hyperkalemia of 6.2 mEq/L, and peaked T waves on ECG. What is the immediate nursing action?

DP. A patient recovering from pneumonia says, “I’m worried about getting sick again when I go home.” What is the nurse’s best response?

DQ. A patient with severe acute pancreatitis develops abdominal distension, hypotension, and a bladder pressure of 28 mmHg. What should the nurse anticipate?

DR. A nurse observes a staff member rushing a patient through discharge teaching. What is the best nursing action?

DS. A patient on chronic hemodialysis reports muscle weakness, confusion, and an ECG showing prolonged QT intervals. Serum calcium is 6.5 mg/dL. What is the immediate nursing action?

DT. A patient newly diagnosed with diabetes says, “I’ll never be able to manage all these changes.” What is the nurse’s best response?

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