A. A patient with severe pneumonia on mechanical ventilation has PaO₂ 44 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 25 cmH₂O. What is the next nursing action?

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

C. A patient with severe COPD exacerbation on BiPAP becomes progressively lethargic. ABG: pH 7.15, PaCO₂ 90 mmHg, PaO₂ 52 mmHg. What is the next nursing intervention?

D. A nurse suspects a colleague is coming to work impaired. What is the nurse’s best action?

E. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

F. A charge nurse must delegate tasks during a code situation. Which is most appropriate for a nursing assistant?

G. A patient who speaks limited English is about to receive discharge instructions. What is the nurse’s best action?

H. A patient with severe pneumonia on mechanical ventilation has PaO₂ 43 mmHg despite FiO₂ 100% and PEEP 20 cmH₂O. Plateau pressure 28 cmH₂O. What is the next nursing action?

I. A patient with advanced heart failure says, “I don’t want CPR if my heart stops.” What should the nurse do first?

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

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

L. A nurse is instructed to float to another unit and care for patients outside their usual specialty. What is the safest nursing action?

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

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

O. A patient with cirrhosis presents with massive hematemesis. Despite octreotide, bleeding continues. BP 76/40 mmHg. What is the next nursing action?

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

Q. A family member insists on remaining in the room during a sterile procedure despite repeated explanations of infection control. What is the nurse’s best response?

R. A patient with cirrhosis presents with massive hematemesis. Despite octreotide, bleeding persists. BP 78/40 mmHg, HR 128 bpm. What is the next nursing action?

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

T. A nurse sees a coworker ignoring fall precautions for a high-risk patient. What is the most appropriate response?

U. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

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

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

X. A patient with anterior MI develops sudden hypotension, jugular venous distension, and clear lung fields. What is the nurse’s immediate action?

Y. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP 76/40 mmHg. What is the next nursing action?

Z. A family insists on “everything possible” for a terminally ill patient despite clear signs of decline. What is the nurse’s best action?

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

AB. A patient with traumatic brain injury becomes unresponsive, with unequal pupils and extensor posturing. ICP is 50 mmHg. What is the priority nursing action?

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

AD. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

AE. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 47 mmHg. What is the priority nursing action?

AF. A patient with severe pneumonia on mechanical ventilation has PaO₂ 42 mmHg despite FiO₂ 100% and PEEP 20 cmH₂O. Plateau pressure 28 cmH₂O. What is the next nursing action?

AG. A nurse observes a senior colleague intimidating a new nurse during handoff. What is the most appropriate action?

AH. A patient with severe pneumonia on mechanical ventilation has PaO₂ 44 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 25 cmH₂O. What is the next nursing action?

AI. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 46 mmHg. What is the priority nursing action?

AJ. A patient says, “I don’t want my family to know about my diagnosis.” What should the nurse do?

AK. A patient with cirrhosis presents with massive hematemesis. Despite octreotide, bleeding continues. BP 76/40 mmHg. What is the next nursing action?

AL. A patient with anterior MI develops acute pulmonary edema, hypotension, and cool extremities. Echocardiogram shows EF 19%. What is the nurse’s immediate action?

AM. A patient with traumatic brain injury shows unequal pupils, bradycardia, and irregular respirations. ICP monitor shows 48 mmHg. What is the priority nursing intervention?

AN. A patient with Addison’s disease presents with BP 78/42 mmHg, Na⁺ 114 mEq/L, K⁺ 7.1 mEq/L, and confusion. What is the immediate nursing intervention?

AO. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing action?

AP. A patient with Addison’s disease presents with BP 74/42 mmHg, Na⁺ 114 mEq/L, K⁺ 7.3 mEq/L, and confusion. What is the immediate nursing intervention?

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

AR. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

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

AT. A patient with severe pneumonia on mechanical ventilation has PaO₂ 44 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 25 cmH₂O. What is the next nursing action?

AU. A patient with Addison’s disease presents with BP 74/40 mmHg, Na⁺ 114 mEq/L, K⁺ 7.2 mEq/L, and confusion. What is the immediate nursing intervention?

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

AW. A patient with cirrhosis presents with massive hematemesis. Despite octreotide, bleeding continues. BP 76/40 mmHg. What is the next nursing action?

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

AY. A patient with traumatic brain injury becomes unresponsive with extensor posturing. ICP is 50 mmHg. What is the priority nursing action?

AZ. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

BA. A patient with traumatic brain injury develops unequal pupils, bradycardia, and irregular respirations. ICP is 49 mmHg. What is the priority nursing intervention?

BB. A patient with severe pneumonia on mechanical ventilation has PaO₂ 41 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 27 cmH₂O. What is the next nursing action?

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

BD. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

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

BF. 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?

BG. A patient with cirrhosis presents with massive hematemesis. Despite octreotide infusion, bleeding continues. BP 80/40 mmHg, HR 130 bpm. What is the next nursing action?

BH. A charge nurse must decide assignments. Which task is most appropriate for an experienced nursing assistant?

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

BJ. A patient with Addison’s disease presents with severe hypotension, Na⁺ 113 mEq/L, K⁺ 7.4 mEq/L, and confusion. What is the immediate nursing action?

BK. A nurse witnesses a provider attempting to perform a surgical procedure without consent. What is the priority action?

BL. A nurse witnesses a provider attempting to start a high-risk procedure without verifying consent. What is the priority nursing action?

BM. 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?

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

BO. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 47 mmHg. What is the priority nursing action?

BP. A patient with traumatic brain injury presents with bradycardia, hypertension, and irregular respirations. ICP monitor reads 46 mmHg. What is the immediate nursing action?

BQ. A patient becomes agitated when told they must be NPO for testing. What is the nurse’s best action?

BR. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

BS. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

BT. A nurse notices a colleague frequently leaving the unit during shifts, delaying medication administration. What is the nurse’s best action?

BU. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

BV. A patient with anterior MI develops acute pulmonary edema, hypotension, and cool extremities. Echocardiogram shows EF 19%. What is the nurse’s immediate action?

BW. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

BX. A patient with severe pneumonia on mechanical ventilation has PaO₂ 42 mmHg despite FiO₂ 100% and PEEP 18 cmH₂O. Plateau pressure 26 cmH₂O. What is the next nursing action?

BY. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

BZ. A patient’s daughter says, “I think you’re not telling us the full truth about my father’s condition.” What is the nurse’s best response?

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

CB. A patient with anterior MI develops acute pulmonary edema, hypotension, and cool extremities. Echocardiogram shows EF 19%. What is the nurse’s immediate action?

CC. A trauma 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?

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

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

CF. A trauma 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?

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

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

CI. A patient with acute anterior MI develops chest pain, hypotension, and tachycardia. ST elevation is noted in V2–V4. What is the nurse’s immediate action?

CJ. A patient with severe pneumonia on mechanical ventilation has PaO₂ 42 mmHg despite FiO₂ 100% and PEEP 20 cmH₂O. Plateau pressure is 28 cmH₂O. What is the next nursing intervention?

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

CL. A patient’s spouse asks for a detailed update during physician rounds, but the physician dismisses the question. What is the most appropriate nursing action?

CM. A patient with anterior MI develops acute pulmonary edema, hypotension, and cool extremities. Echocardiogram shows EF 18%. What is the immediate nursing action?

CN. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

CO. A charge nurse must delegate tasks during a busy shift. Which is most appropriate for a licensed practical nurse (LPN)?

CP. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 48 mmHg. What is the priority nursing action?

CQ. A trauma patient with a femoral fracture suddenly develops confusion, dyspnea, and petechiae on the chest. SpO₂ is 74% despite oxygen. What is the priority nursing action?

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

CS. A patient with severe asthma attack has audible wheezing, SpO₂ 82% despite oxygen, and becomes increasingly drowsy. What is the next nursing intervention?

CT. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

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

CV. A nurse observes a colleague consistently arriving late, leaving patient care tasks incomplete. What is the best action?

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

CX. A patient with end-stage renal disease says, “I don’t want to continue dialysis anymore.” What is the nurse’s best action?

CY. A patient with cirrhosis presents with hematemesis and BP 76/40 mmHg. Octreotide and endoscopy failed to control bleeding. What is the next nursing intervention?

CZ. A patient with multiple fractures suddenly develops confusion, dyspnea, and a petechial rash. SpO₂ is 76% despite oxygen therapy. What is the next nursing action?

DA. A trauma 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?

DB. A 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?

DC. A patient tells the nurse, “I don’t want my children to know about my HIV diagnosis.” What is the nurse’s best action?

DD. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

DE. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

DF. A patient with Addison’s disease presents with BP 72/40 mmHg, Na⁺ 112 mEq/L, K⁺ 7.6 mEq/L, and confusion. What is the immediate nursing intervention?

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

DH. A nurse is assigned more patients than is safe and worries about missing critical care. What is the best action?

DI. A patient with severe asthma exacerbation suddenly develops a silent chest. SpO₂ 77% despite oxygen therapy. What is the next nursing intervention?

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

DK. During a family meeting, a physician uses complex medical terms that the patient clearly does not understand. What is the most appropriate nursing action?

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

DM. A patient with COPD exacerbation becomes progressively drowsy on BiPAP. ABG: pH 7.18, PaCO₂ 88 mmHg, PaO₂ 49 mmHg. What is the next nursing action?

DN. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor reads 47 mmHg. What is the priority nursing intervention?

DO. A patient with traumatic brain injury develops unequal pupils, bradycardia, and irregular respirations. ICP is 50 mmHg. What is the priority nursing intervention?

DP. A nurse discovers that a patient’s medication was missed on the previous shift and not reported. What is the nurse’s best action?

DQ. A patient with traumatic brain injury becomes unresponsive with unequal pupils and extensor posturing. ICP monitor shows 52 mmHg. What is the priority nursing action?

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

DS. A patient with severe pneumonia on mechanical ventilation has PaO₂ 43 mmHg despite FiO₂ 100% and PEEP 20 cmH₂O. Plateau pressure 27 cmH₂O. What is the next nursing action?

DT. A nurse feels distressed about continuing aggressive care for a patient with no expected recovery. What is the best step?

DU. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 48 mmHg. What is the priority nursing action?