A. A patient with sepsis remains hypotensive despite fluids and norepinephrine. Urine output is <10 mL/hr, lactate is 6 mmol/L. What is the next nursing intervention?

B. During handoff, a nurse hears a colleague minimize a patient’s report of severe pain. What is the most appropriate action?

C. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

D. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

E. A patient with COPD exacerbation on BiPAP becomes unresponsive. ABG: pH 7.14, PaCO₂ 92 mmHg, PaO₂ 54 mmHg. What is the next nursing intervention?

F. A patient with inferior MI develops bradycardia, hypotension, and clear lung sounds. Atropine is ineffective. What is the next nursing intervention?

G. During rounds, a physical therapist raises a safety concern about ambulation, and the provider dismisses it. What should the nurse do?

H. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

I. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

J. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding persists and BP is 80/40 mmHg. What is the next nursing action?

K. A supervisor pressures the nurse to send home a patient who still needs 2 L/min O₂ at rest. What is the most appropriate action?

L. A patient recovering from surgery says, “I’m scared I’ll have complications at home.” What is the nurse’s best response?

M. A patient with severe COPD exacerbation on BiPAP becomes unresponsive. ABG: pH 7.11, PaCO₂ 96 mmHg, PaO₂ 49 mmHg. What is the next nursing action?

N. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

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

P. A patient with cirrhosis and portal hypertension presents with hematemesis. Endoscopic band ligation fails, and the patient remains hypotensive. What is the next nursing intervention?

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

R. A patient with advanced COPD states, “I don’t want to be placed on a ventilator.” What should the nurse do first?

S. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding persists and BP is 80/40 mmHg. What is the next nursing action?

T. A patient with anterior STEMI develops cardiogenic shock. BP 78/40 mmHg, cool extremities, crackles in lungs, EF 20%. What is the immediate nursing intervention?

U. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

V. A patient with severe pneumonia is intubated. Despite FiO₂ 100% and PEEP 16 cmH₂O, PaO₂ is 50 mmHg. Plateau pressure is 28 cmH₂O. What is the next nursing action?

W. A patient with septic shock remains hypotensive despite fluid resuscitation and norepinephrine. MAP is 55 mmHg, lactate 7 mmol/L. What is the next nursing intervention?

X. A patient with pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

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

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

AA. A novice nurse is unsure about programming a PCA pump. What is the safest action?

AB. A nurse discovers a mislabeled lab specimen that has already left the unit. What is the priority action?

AC. A patient with myxedema coma presents with hypothermia, bradycardia, and altered mental status. What is the nurse’s immediate action?

AD. A patient with severe COPD exacerbation on BiPAP becomes increasingly lethargic. ABG: pH 7.18, PaCO₂ 92 mmHg, PaO₂ 50 mmHg. What is the nurse’s next step?

AE. A patient with Addison’s disease presents with severe hypotension, sodium 117 mEq/L, potassium 7.0 mEq/L, and confusion. What is the priority nursing action?

AF. A charge nurse is deciding assignments. Which task is most appropriate for a nursing assistant?

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

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

AI. A patient with septic shock remains hypotensive despite fluid resuscitation and norepinephrine. MAP is 55 mmHg, lactate 7 mmol/L. What is the next nursing intervention?

AJ. A charge nurse must delegate tasks on a busy unit. Which task is appropriate for a licensed practical nurse (LPN)?

AK. A patient with inferior MI develops complete heart block, HR 32 bpm, BP 78/40 mmHg. Atropine fails. What is the nurse’s immediate action?

AL. 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 intervention?

AM. A patient with pneumonia on mechanical ventilation has PaO₂ 48 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 26 cmH₂O. What is the next nursing action?

AN. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

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

AP. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 116 mEq/L, and potassium 7.0 mEq/L. What is the immediate nursing intervention?

AQ. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding persists and BP is 80/40 mmHg. What is the next nursing action?

AR. A patient with severe pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

AS. A patient with traumatic brain injury suddenly develops unequal pupils, hypertension, and bradycardia. ICP monitor reads 42 mmHg. What is the immediate nursing action?

AT. A patient with traumatic brain injury suddenly develops decorticate posturing, bradycardia, and hypertension. ICP monitor shows 42 mmHg. What is the next intervention?

AU. A patient with end-stage renal disease presents with K⁺ 7.7 mEq/L and wide QRS complexes. Calcium gluconate was administered. What is the next nursing action?

AV. A patient with sepsis remains hypotensive despite fluids and norepinephrine. Urine output is <10 mL/hr, lactate is 6 mmol/L. What is the next nursing intervention?

AW. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

AX. A patient with anterior MI develops hypotension, pulmonary edema, and cool extremities. Echocardiogram shows severe LV dysfunction. What is the immediate nursing action?

AY. A patient with severe COPD exacerbation on BiPAP becomes increasingly lethargic. ABG: pH 7.18, PaCO₂ 92 mmHg, PaO₂ 50 mmHg. What is the nurse’s next step?

AZ. A patient with COPD exacerbation on BiPAP becomes increasingly somnolent. ABG: pH 7.20, PaCO₂ 84 mmHg, PaO₂ 54 mmHg. What is the next nursing intervention?

BA. A patient with advanced illness says, “I want to focus on comfort only.” What should the nurse do first?

BB. A patient with severe asthma exacerbation has SpO₂ 80% despite high-flow oxygen. The patient is now silent on auscultation. What is the priority nursing intervention?

BC. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

BD. A patient with septic shock remains hypotensive despite fluids and norepinephrine. MAP is 55 mmHg, lactate 7 mmol/L. What is the next nursing intervention?

BE. 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 intervention?

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

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

BH. A patient with severe pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

BI. A patient with newly diagnosed diabetes says, “There’s too much to learn; I can’t keep up.” What is the nurse’s best response?

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

BK. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding persists and BP is 80/40 mmHg. What is the next nursing action?

BL. A patient with end-stage renal disease presents with K⁺ 7.9 mEq/L, muscle weakness, and wide QRS complexes. Calcium gluconate was already given. What is the next nursing intervention?

BM. A patient with pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

BN. A patient with severe asthma exacerbation suddenly becomes silent on auscultation. SpO₂ drops to 82% despite high-flow oxygen. What is the priority nursing action?

BO. A patient with severe COPD exacerbation on BiPAP becomes unresponsive. ABG: pH 7.12, PaCO₂ 95 mmHg, PaO₂ 50 mmHg. What is the priority nursing intervention?

BP. A nurse observes a provider attempting to obtain consent from a patient who is visibly confused. What is the nurse’s priority action?

BQ. A patient with end-stage renal disease presents with K⁺ 7.6 mEq/L and peaked T waves. Calcium gluconate was already given. What is the next nursing action?

BR. A patient with end-stage renal disease has potassium 7.4 mEq/L and ECG showing wide QRS complexes. IV calcium gluconate has been given. What is the next nursing action?

BS. A patient with severe COPD exacerbation on BiPAP becomes increasingly drowsy. ABG: pH 7.19, PaCO₂ 90 mmHg, PaO₂ 52 mmHg. What is the next nursing action?

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

BU. A patient with pneumonia says, “I don’t think I’ll ever get back to normal.” What is the nurse’s best response?

BV. A patient with end-stage renal disease has potassium 7.4 mEq/L and wide QRS complexes. IV calcium gluconate has been given. What is the next nursing action?

BW. A patient with septic shock remains hypotensive despite fluid resuscitation and norepinephrine. MAP is 55 mmHg, lactate 7 mmol/L. What is the next nursing intervention?

BX. A provider starts prepping for a procedure while the patient says they don’t understand the risks. What is the nurse’s priority action?

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

BZ. A patient with end-stage renal disease presents with K⁺ 7.6 mEq/L and peaked T waves. Calcium gluconate was administered. What is the next nursing action?

CA. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

CB. A patient with multiple trauma develops hypotension, tachycardia, and mottled skin despite 30 mL/kg IV fluids. MAP is 55 mmHg on norepinephrine. What is the next nursing action?

CC. A patient with end-stage renal disease presents with K⁺ 7.5 mEq/L and ECG showing wide QRS complexes. Calcium gluconate was already given. What is the next nursing action?

CD. A patient with sepsis remains hypotensive despite fluids and norepinephrine. Urine output is <10 mL/hr, lactate is 6 mmol/L. What is the next nursing intervention?

CE. A patient with anterior MI develops hypotension, pulmonary edema, and cool extremities. Echocardiogram shows EF 22%. What is the nurse’s immediate action?

CF. A caregiver says, “I feel guilty because I sometimes lose patience with my loved one.” What is the nurse’s best response?

CG. A patient with traumatic brain injury suddenly develops unequal pupils, bradycardia, and hypertension. ICP is 43 mmHg. What is the immediate nursing intervention?

CH. A patient with cirrhosis and ascites undergoes large-volume paracentesis. Shortly after, BP drops to 78/40 mmHg, HR 118 bpm. What is the next nursing intervention?

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

CJ. A caregiver says, “I can’t manage nights anymore; I’m exhausted.” What is the nurse’s best response?

CK. A trauma patient with long-bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 75% despite oxygen. What is the nurse’s immediate action?

CL. A patient asks, “Why do I need to wear this abdominal binder?” What is the nurse’s best response?

CM. A patient with severe COPD exacerbation on BiPAP becomes increasingly lethargic. ABG: pH 7.18, PaCO₂ 92 mmHg, PaO₂ 50 mmHg. What is the nurse’s next step?

CN. A patient with severe pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

CO. A patient with cirrhosis presents with hematemesis. Despite endoscopic band ligation and octreotide infusion, bleeding persists. BP is 82/40 mmHg. What is the next nursing intervention?

CP. A patient with end-stage renal disease presents with K⁺ 7.7 mEq/L and wide QRS complexes. Calcium gluconate was administered. What is the next nursing action?

CQ. A nurse sees a colleague about to administer medication without verifying the patient’s identification. What is the most appropriate action?

CR. A patient with pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 25 cmH₂O. What is the next nursing intervention?

CS. A trauma patient with long-bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 75% despite oxygen. What is the nurse’s immediate action?

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

CU. A trauma patient with a tibial fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive stretch. What is the immediate nursing action?

CV. A charge nurse is prioritizing care for four patients. Which action should occur first?

CW. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 44 mmHg. What is the priority nursing action?

CX. A trauma patient with long-bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 76% despite oxygen. What is the next nursing action?

CY. A patient with inferior MI develops bradycardia, hypotension, and clear lung sounds. Atropine is ineffective. What is the next nursing intervention?

CZ. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

DA. A patient with inferior MI develops bradycardia, hypotension, and clear lung sounds. Atropine is ineffective. What is the next nursing intervention?

DB. A nurse observes a colleague preparing to administer medication without performing hand hygiene. What is the best action?

DC. A trauma patient with long-bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 75% despite oxygen. What is the nurse’s immediate action?

DD. A patient with severe asthma exacerbation becomes suddenly quiet on auscultation. SpO₂ 81% despite oxygen therapy. What is the immediate nursing intervention?

DE. A patient with limited English proficiency is scheduled for consent discussion. What is the nurse’s best action?

DF. A trauma patient with long-bone fractures develops confusion, dyspnea, and petechial rash. SpO₂ is 76% despite oxygen. What is the next nursing action?

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

DH. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion and endoscopic band ligation, bleeding persists and BP is 78/40 mmHg. What is the next nursing intervention?

DI. A patient’s family disagrees about whether to pursue hospice care. What is the nurse’s best action?

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

DK. A patient with multiple trauma develops hypotension, tachycardia, and mottled skin despite 30 mL/kg IV fluids. MAP is 55 mmHg on norepinephrine. What is the next nursing action?

DL. A nurse overhears a colleague making a dismissive remark about a patient with limited mobility. What is the most appropriate action?

DM. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues and BP is 80/40 mmHg. What is the next nursing action?

DN. A patient with severe COPD exacerbation on BiPAP becomes unresponsive. ABG: pH 7.12, PaCO₂ 95 mmHg, PaO₂ 50 mmHg. What is the priority nursing intervention?

DO. A patient with end-stage renal disease presents with potassium 7.6 mEq/L and peaked T waves. Calcium gluconate was already given. What is the next nursing intervention?

DP. A trauma patient with multiple fractures develops confusion, dyspnea, and a petechial rash. SpO₂ is 76% despite oxygen. What is the priority nursing intervention?

DQ. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding persists and BP is 80/40 mmHg. What is the next nursing action?

DR. A patient with inferior MI develops complete heart block, HR 30 bpm, BP 82/40 mmHg. Atropine is ineffective. What is the nurse’s next action?

DS. A patient with anterior MI develops pulmonary edema, hypotension, and a new holosystolic murmur. What is the nurse’s immediate action?

DT. A patient with end-stage renal disease presents with K⁺ 7.7 mEq/L and wide QRS complexes. Calcium gluconate was administered. What is the next nursing action?

DU. A nurse overhears a colleague making a disrespectful comment about a patient’s mental health diagnosis. What is the most appropriate action?