A. A nurse learns that staff on another shift routinely skips double-checking high-alert medications. What is the nurse’s best action?

B. A patient with Addison’s disease arrives with severe hypotension, Na⁺ 115 mEq/L, K⁺ 7.1 mEq/L, and confusion. What is the immediate nursing intervention?

C. A patient with end-stage renal disease presents with K⁺ 7.8 mEq/L and ECG showing wide QRS complexes. Calcium gluconate has been given. What is the next nursing action?

D. A patient with a tibial fracture develops severe pain unrelieved by opioids, pallor, paresthesia, and pain on passive stretch. What is the immediate nursing action?

E. A patient with Addison’s disease is admitted with severe hypotension, Na⁺ 114 mEq/L, K⁺ 7.1 mEq/L, and confusion. What is the immediate nursing intervention?

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

G. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 45 mmHg. What is the priority nursing action?

H. A nurse sees a provider obtaining consent from a sedated patient. What is the priority nursing action?

I. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP 82/42 mmHg. What is the next nursing action?

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

K. A patient with severe asthma exacerbation becomes suddenly quiet on auscultation. SpO₂ 80% despite high-flow oxygen. What is the next nursing intervention?

L. A nurse overhears a colleague mocking a patient’s appearance. What is the most appropriate action?

M. A patient with severe asthma exacerbation suddenly becomes silent on auscultation. SpO₂ 79% despite high-flow oxygen. What is the next nursing intervention?

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

O. A patient’s family is arguing about who should make healthcare decisions. What is the nurse’s best action?

P. A patient with Addison’s disease presents with severe hypotension, Na⁺ 116 mEq/L, K⁺ 7.3 mEq/L, and confusion. What is the immediate nursing intervention?

Q. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and a petechial rash on the chest. SpO₂ is 75% despite oxygen. What is the immediate nursing intervention?

R. A patient with severe pneumonia on mechanical ventilation has PaO₂ 45 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 26 cmH₂O. What is the next nursing intervention?

S. A patient with cirrhosis presents with hematemesis. Octreotide infusion is running, but bleeding continues. BP is 80/44 mmHg. What is the next nursing action?

T. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and petechiae on the chest. SpO₂ 74% despite oxygen. What is the next nursing action?

U. A patient with anterior MI develops acute pulmonary edema, hypotension, and cool extremities. Echocardiogram shows EF 20%. What is the nurse’s immediate action?

V. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP 82/40 mmHg. What is the next nursing action?

W. A patient with Addison’s disease arrives with BP 78/40 mmHg, Na⁺ 114 mEq/L, K⁺ 7.2 mEq/L, and confusion. What is the immediate nursing intervention?

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

Y. A patient with Addison’s disease arrives with BP 76/40 mmHg, Na⁺ 115 mEq/L, K⁺ 7.4 mEq/L, and confusion. What is the immediate nursing intervention?

Z. A patient with septic shock remains hypotensive despite 30 mL/kg fluids and norepinephrine infusion. MAP 54 mmHg, lactate 7.1 mmol/L. What is the next nursing action?

AA. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 46 mmHg. What is the priority nursing intervention?

AB. A patient’s family asks the nurse not to tell the patient about a poor prognosis. What is the nurse’s best response?

AC. A nurse discovers that a coworker posted a photo of a patient on social media without consent. What is the nurse’s best action?

AD. A patient with terminal cancer states, “I don’t want any more chemotherapy.” What should the nurse do first?

AE. A patient with end-stage renal disease presents with K⁺ 7.9 mEq/L and muscle weakness. ECG shows wide QRS complexes. Calcium gluconate has been given. What is the next nursing action?

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

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

AH. A nurse observes a colleague documenting care that was not provided. What is the most appropriate action?

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

AJ. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

AK. A new nurse feels pressured to perform a procedure they are not trained for. What is the most appropriate action?

AL. A patient with severe pneumonia on mechanical ventilation has PaO₂ 46 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 28 cmH₂O. What is the next nursing action?

AM. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 46 mmHg. What is the immediate nursing intervention?

AN. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine. MAP 54 mmHg, lactate 6.8 mmol/L. What is the next nursing action?

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

AP. A patient with end-stage renal disease presents with K⁺ 7.9 mEq/L, muscle weakness, and peaked T waves. Calcium gluconate was already given. What is the next nursing action?

AQ. A patient asks the nurse for personal phone numbers to stay in touch after discharge. What is the most appropriate nursing response?

AR. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 45 mmHg. What is the immediate nursing action?

AS. A patient with pneumonia on mechanical ventilation has PaO₂ 47 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 26 cmH₂O. What is the next nursing intervention?

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

AU. A patient with Addison’s disease arrives with severe hypotension, Na⁺ 116 mEq/L, K⁺ 7.3 mEq/L, and confusion. What is the immediate nursing intervention?

AV. A patient says, “I don’t understand why I need these blood pressure medications if I feel fine.” What is the nurse’s best response?

AW. A nurse is told to continue aggressive treatment that conflicts with the patient’s stated wishes. What is the nurse’s priority action?

AX. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

AY. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

AZ. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and petechiae on the chest. SpO₂ 74% despite oxygen. What is the next nursing action?

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

BB. A charge nurse must assign tasks to the team. Which task is appropriate for a licensed practical nurse (LPN)?

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

BD. A nurse observes a provider preparing to perform a lumbar puncture without explaining the procedure. What is the priority nursing action?

BE. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine infusion. MAP 53 mmHg, lactate 7.1 mmol/L. What is the next nursing action?

BF. A patient with multiple fractures develops sudden confusion, dyspnea, and a petechial rash. SpO₂ 74% despite oxygen therapy. What is the next nursing action?

BG. A patient with severe pneumonia is intubated. PaO₂ remains 48 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 27 cmH₂O. What is the next nursing intervention?

BH. A patient with multiple fractures suddenly develops confusion, dyspnea, and petechial rash. SpO₂ is 75% despite oxygen therapy. What is the priority nursing action?

BI. During handoff, a nurse overhears a senior colleague belittling a junior nurse in front of the team. What is the most appropriate response?

BJ. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine. MAP 54 mmHg, lactate 6.9 mmol/L. What is the next nursing action?

BK. A patient with limited English proficiency is admitted for emergency surgery. What is the nurse’s best action?

BL. A patient with severe COPD exacerbation on BiPAP becomes progressively drowsy. ABG: pH 7.14, PaCO₂ 95 mmHg, PaO₂ 50 mmHg. What is the next nursing intervention?

BM. A patient’s family is loudly arguing about whether to continue treatment. What is the nurse’s best action?

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

BO. A patient with cirrhosis presents with hematemesis. Octreotide infusion is running, but bleeding continues. BP is 80/44 mmHg. What is the next nursing action?

BP. A patient with end-stage renal disease presents with potassium 7.8 mEq/L and ECG showing wide QRS complexes. Calcium gluconate has been given. What is the next nursing action?

BQ. A patient with end-stage renal disease presents with K⁺ 7.8 mEq/L and wide QRS complexes. Calcium gluconate was given. What is the next nursing action?

BR. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP is 82/42 mmHg. What is the next nursing action?

BS. A patient with severe pneumonia on mechanical ventilation has PaO₂ 45 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 26 cmH₂O. What is the next nursing intervention?

BT. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

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

BV. A patient with multiple fractures suddenly develops confusion, dyspnea, and a petechial rash. SpO₂ is 75% despite oxygen therapy. What is the priority nursing action?

BW. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine infusion. MAP 54 mmHg, lactate 7.1 mmol/L. What is the next nursing action?

BX. A patient says, “I don’t understand why I need this new heart medication.” What is the nurse’s best response?

BY. A patient with anterior MI develops acute pulmonary edema and hypotension. Echocardiogram shows EF 20%. What is the immediate nursing action?

BZ. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 44 mmHg. What is the nurse’s priority action?

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

CB. A patient asks, “Why do I need to use this walker after surgery?” What is the nurse’s best response?

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

CD. A patient with cirrhosis and portal hypertension presents with hematemesis. Despite octreotide infusion, bleeding persists. BP 80/42 mmHg. What is the next nursing action?

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

CF. A caregiver says, “I feel like I can’t keep doing this—it’s too much for me.” What is the nurse’s best response?

CG. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine infusion. MAP 54 mmHg, lactate 6.8 mmol/L. What is the next nursing action?

CH. A patient with Addison’s disease arrives with severe hypotension, Na⁺ 116 mEq/L, K⁺ 7.2 mEq/L, and confusion. What is the immediate nursing intervention?

CI. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP 78/42 mmHg. What is the next nursing action?

CJ. A patient with Addison’s disease arrives with severe hypotension, Na⁺ 116 mEq/L, K⁺ 7.2 mEq/L, and confusion. What is the immediate nursing intervention?

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

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

CM. A patient with severe pneumonia on mechanical ventilation has PaO₂ 45 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure is 26 cmH₂O. What is the next nursing intervention?

CN. A patient with septic shock remains hypotensive despite 30 mL/kg fluids and norepinephrine infusion. MAP 53 mmHg, lactate 7.1 mmol/L. What is the next nursing action?

CO. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

CP. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 45 mmHg. What is the priority nursing intervention?

CQ. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and petechial rash. SpO₂ is 74% despite oxygen therapy. What is the immediate nursing intervention?

CR. A patient with severe COPD exacerbation on BiPAP becomes increasingly drowsy. ABG: pH 7.16, PaCO₂ 92 mmHg, PaO₂ 51 mmHg. What is the next nursing intervention?

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

CT. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 45 mmHg. What is the priority nursing action?

CU. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 43 mmHg. What is the immediate nursing action?

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

CW. A patient with end-stage renal disease presents with potassium 7.6 mEq/L and wide QRS complexes. Calcium gluconate was given. What is the next nursing action?

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

CY. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new loud systolic murmur. What is the immediate nursing action?

CZ. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and petechial rash. SpO₂ is 75% despite oxygen. What is the next nursing intervention?

DA. A trauma patient with a femur fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain worsens with passive stretch. What is the priority nursing action?

DB. A patient with end-stage renal disease presents with potassium 7.9 mEq/L and peaked T waves. Calcium gluconate was administered. What is the next nursing action?

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

DD. A patient with severe COPD exacerbation on BiPAP becomes unresponsive. ABG: pH 7.12, PaCO₂ 96 mmHg, PaO₂ 49 mmHg. What is the next nursing intervention?

DE. A patient with septic shock remains hypotensive after 30 mL/kg fluids and norepinephrine. MAP is 55 mmHg, lactate 7 mmol/L. What is the next nursing action?

DF. A patient with cirrhosis develops massive hematemesis. Octreotide and endoscopic therapy have failed. BP 80/42 mmHg, HR 128 bpm. What is the next nursing action?

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

DH. A caregiver says, “I can’t keep up with everything; I feel like I’m failing.” What is the nurse’s best response?

DI. In the ICU, two critically ill patients require the same type of specialized equipment, but only one is available. What is the nurse’s best action?

DJ. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

DK. A patient with cirrhosis presents with hematemesis. Despite octreotide infusion and endoscopic therapy, bleeding persists. BP is 78/42 mmHg. What is the next nursing action?

DL. A patient with severe COPD exacerbation on BiPAP becomes progressively drowsy. ABG: pH 7.14, PaCO₂ 95 mmHg, PaO₂ 50 mmHg. What is the next nursing intervention?

DM. A patient with end-stage renal disease presents with potassium 7.8 mEq/L and ECG showing wide QRS complexes. Calcium gluconate has been given. What is the next nursing action?

DN. A patient with multiple long-bone fractures suddenly develops confusion, dyspnea, and petechial rash. SpO₂ 74% despite oxygen therapy. What is the immediate nursing action?

DO. A patient with Addison’s disease arrives with severe hypotension, Na⁺ 116 mEq/L, K⁺ 7.2 mEq/L, and confusion. What is the immediate nursing intervention?

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

DQ. A patient with septic shock remains hypotensive despite 30 mL/kg IV fluids and norepinephrine infusion. MAP 54 mmHg, lactate 7.1 mmol/L. What is the next nursing action?

DR. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP is 82/42 mmHg. What is the next nursing action?

DS. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 46 mmHg. What is the immediate nursing intervention?

DT. A patient with anterior MI develops acute pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

DU. A nurse witnesses a provider refusing to address a patient’s question about treatment risks. What is the priority nursing action?