A. A patient with severe asthma exacerbation has a silent chest on auscultation. What does this finding most likely indicate?

B. A patient with Addisonian crisis presents with hypotension, hyponatremia, and hyperkalemia. Which therapy is most urgent?

C. A patient asks, “Why do I need to wear this sling after shoulder surgery?” What is the nurse’s best response?

D. A patient with subarachnoid hemorrhage develops acute severe headache and nuchal rigidity. Which diagnostic test is most sensitive in the first 24 hours?

E. A patient with acute myocardial infarction develops new onset systolic murmur and pulmonary edema. Which complication is most likely?

F. A charge nurse is delegating assignments. Which is appropriate for a licensed practical nurse (LPN)?

G. A patient with limited English proficiency is about to receive complex medication teaching. What is the nurse’s best action?

H. A nurse overhears a colleague sharing a patient’s diagnosis in the elevator with visitors present. What is the most appropriate action?

I. A patient’s son becomes upset, saying, “You’re not telling us the whole story about my mother’s prognosis.” What is the nurse’s best response?

J. A patient with cirrhosis and ascites has fever, abdominal pain, PMN count ≥250 cells/mm³ in ascitic fluid. Best initial therapy?

K. A patient with community-acquired pneumonia is hospitalized. Which factor most strongly indicates the need for ICU admission?

L. A patient with diabetic ketoacidosis is treated with insulin infusion. Later, he develops lethargy, seizures, and serum sodium of 118 mmol/L. What is the most likely cause?

M. A patient with acute kidney injury has oliguria, rising creatinine, and pulmonary edema. Which therapy is indicated?

N. A patient with acute COPD exacerbation shows increasing PaCO₂ and drowsiness. Which intervention is most appropriate?

O. A patient presents with severe upper GI bleeding and hypotension. What is the priority nursing action?

P. A patient with septic shock remains hypotensive despite fluid resuscitation. What is the first-line vasopressor recommended?

Q. A patient with traumatic spinal cord injury develops bradycardia, hypotension, and warm extremities. What is the underlying shock type?

R. A patient with sepsis has lactic acidosis and requires additional monitoring after fluid resuscitation. Which invasive device provides the most accurate assessment of preload and cardiac output?

S. A patient admitted with traumatic brain injury has ICP of 28 mmHg. Which intervention is most appropriate?

T. An adult in generalized convulsive status epilepticus continues seizing on arrival. What is the first-line medication?

U. A patient with suspected upper GI bleed is hypotensive and tachycardic. After stabilization, which medication should be started?

V. A patient with acute decompensated heart failure has pulmonary edema and oxygen saturation of 84% despite supplemental O₂. Which therapy should be initiated?

W. A patient develops sudden right-sided weakness and facial droop. CT scan shows no hemorrhage. What is the next immediate step in management?

X. A patient with cirrhosis presents with confusion, asterixis, and elevated ammonia levels. What is the primary pharmacologic treatment?

Y. A patient with terminal illness says, “I want comfort only, no more aggressive treatments.” What is the nurse’s best action?

Z. A patient with diabetic ketoacidosis is being treated with insulin infusion. Glucose is now 190 mg/dL, but acidosis persists. What is the next step in management?

AA. A provider begins preparing to perform a bedside procedure without verifying the patient’s consent. What is the priority nursing action?

AB. A patient becomes frustrated when told they must remain NPO before surgery. What is the nurse’s best response?

AC. A patient with upper GI bleed presents with hematemesis and is hemodynamically stabilized. Which medication should be initiated before endoscopy?

AD. A nurse notices that a patient’s blood glucose result indicating severe hypoglycemia has not been reported to the provider. What is the best action?

AE. A patient with acute pulmonary edema due to decompensated heart failure is in severe respiratory distress. Which intervention provides the fastest symptomatic relief?

AF. A nurse notices that a critical lab result was entered into the system but not communicated to the provider. What is the best action?

AG. A patient with acute coronary syndrome is started on heparin infusion. The nurse notes a drop in platelet count from 220,000 to 90,000 within 5 days. What is the most likely complication?

AH. A patient with severe asthma exacerbation has not responded to inhaled beta-agonists and IV steroids. Which therapy is the next appropriate step?

AI. A patient presents with sudden left-sided weakness and arrives within 2 hours of symptom onset. CT scan shows no hemorrhage. What is the best treatment?

AJ. A patient with ischemic stroke develops right-sided weakness and expressive aphasia. CT shows no hemorrhage. What is the first-line secondary prevention therapy?

AK. A patient with acute kidney injury has potassium 6.8 mmol/L and ECG showing widened QRS complexes. Which medication should be given urgently to prevent fatal arrhythmias?

AL. A nurse feels distressed about providing treatment that conflicts with their ethical beliefs. What is the best step?

AM. A patient with acute pancreatitis develops hypocalcemia. Which clinical sign supports this finding?

AN. A patient with STEMI develops sustained ventricular tachycardia with hypotension. What is the immediate management?

AO. A nurse feels distressed about continuing aggressive care that does not align with the patient’s values. What is the best step?

AP. A patient with suspected gastrointestinal bleed has a positive fecal occult blood test but stable vital signs. What is the most appropriate next step?

AQ. A patient with peptic ulcer disease presents with hematemesis and hypotension. Which pharmacologic therapy is most appropriate?

AR. A patient with upper GI bleeding is stabilized after resuscitation. Which procedure is essential for diagnosis and management?

AS. A caregiver says, “I feel overwhelmed and don’t know how much longer I can continue.” What is the nurse’s best response?

AT. A patient with suspected upper GI bleeding has a hemoglobin of 6.9 g/dL and tachycardia. Which intervention is indicated?

AU. A patient with acute anaphylaxis (wheezing, hypotension, urticaria) is in the ED. Which treatment must be given first?

AV. A patient with suspected adrenal crisis presents with hypotension, hyponatremia, and hyperkalemia. What is the priority treatment?

AW. A nurse observes a colleague consistently arriving late and leaving tasks unfinished. What is the most appropriate response?

AX. A patient with ischemic stroke is not eligible for tPA. Which therapy reduces early recurrent stroke risk?

AY. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation. Which strategy is most important for improving survival?

AZ. A charge nurse must delegate tasks. Which assignment is appropriate for a nursing assistant?

BA. A patient with septic shock remains hypotensive despite fluids and norepinephrine. Which additional vasopressor is recommended next?

BB. A nurse observes a colleague skipping hand hygiene before entering a patient’s room. What is the most appropriate response?

BC. A patient with septic shock remains hypotensive despite fluids and norepinephrine. What additional therapy improves outcomes?

BD. A patient with acute decompensated heart failure presents with dyspnea, pulmonary rales, and edema. Which lab test best reflects fluid overload severity?

BE. A patient with acute decompensated heart failure presents with pulmonary edema. Which initial intervention is most appropriate?

BF. A patient with acute myocardial infarction suddenly develops pulseless ventricular tachycardia. What is the immediate priority intervention?

BG. A patient with severe pneumonia develops refractory hypoxemia despite high FiO₂. Chest X-ray shows bilateral infiltrates. What is the most likely condition?

BH. A patient with Addison’s disease is admitted for surgery. Which perioperative management is critical?

BI. A patient after traumatic brain injury has unequal pupils and a sudden drop in level of consciousness. What does this most likely indicate?

BJ. A nurse notices a coworker documenting an assessment that was never performed. What is the nurse’s best action?

BK. A patient with bacterial meningitis develops hypotension and tachycardia. What is the best immediate management?

BL. A patient with STEMI develops hypotension, muffled heart sounds, and jugular venous distension. What is the most likely complication?

BM. A patient with an acute COPD exacerbation is hypoxemic. What oxygen strategy is most appropriate to avoid CO₂ narcosis while correcting hypoxemia?

BN. A patient with unstable angina reports chest pain unrelieved by nitroglycerin. What is the next most appropriate intervention?

BO. A patient with acute coronary syndrome develops bradycardia and hypotension. Which medication should be avoided?

BP. A patient with suspected subarachnoid hemorrhage has a normal head CT. What is the next diagnostic step?

BQ. A patient with ulcerative colitis presents with fever, tachycardia, and severe abdominal distension. X-ray shows colonic dilation >6 cm. What is the likely diagnosis?

BR. A patient with atrial fibrillation develops rapid ventricular response causing hypotension. What is the most appropriate immediate treatment?

BS. A patient in septic shock has persistent hypotension despite fluid resuscitation and norepinephrine infusion. Which adjunctive therapy may be added?

BT. A charge nurse must delegate tasks. Which assignment is appropriate for a licensed practical nurse (LPN)?

BU. A patient develops new-onset atrial fibrillation with rapid ventricular response after cardiac surgery. Which drug is most appropriate for rate control?

BV. A patient with ischemic stroke arrives 2 hours after onset of symptoms. CT scan shows no hemorrhage. What is the appropriate intervention?

BW. A patient with severe acute pancreatitis develops increasing intra-abdominal pressure >25 mmHg with organ dysfunction. What is the most definitive treatment?

BX. During handoff, a nurse hears a colleague making sarcastic comments about a patient’s weight. What is the most appropriate response?

BY. In the ICU, which strategy has the strongest evidence to prevent and treat delirium?

BZ. During shift change, a nurse hears a colleague making disrespectful comments about a patient’s lifestyle choices. What is the most appropriate response?

CA. A patient with pulmonary embolism is started on heparin infusion. Which lab value should be closely monitored?

CB. A patient with ST-elevation myocardial infarction (STEMI) arrives 30 minutes after symptom onset. The hospital has PCI capability. What is the preferred reperfusion strategy?

CC. A patient with atrial fibrillation is started on warfarin therapy. Which lab value is monitored to determine therapeutic range?

CD. A patient with suspected acute aortic dissection presents with tearing chest pain and BP 190/110 mmHg. What is the most appropriate immediate pharmacologic step?

CE. A high-risk patient is scheduled for contrast-enhanced CT. The best-proven strategy to prevent contrast-associated acute kidney injury is:

CF. A patient in septic shock on norepinephrine develops rising lactate levels and mottled skin. Which additional therapy may improve tissue perfusion?

CG. A mechanically ventilated patient acutely develops hypotension, tracheal deviation, and absent breath sounds on the right. What is the next action?

CH. A patient with community-acquired pneumonia is admitted with PaO₂ of 52 mmHg on room air. What is the initial management priority?

CI. A patient with advanced liver disease says, “I don’t want CPR if my heart stops.” What is the nurse’s best action?

CJ. A patient develops massive hemoptysis with airway compromise. What is the priority intervention?

CK. A nurse discovers that a patient’s allergy was not documented in the chart and the patient nearly received the allergen. What is the nurse’s best action?

CL. A patient with upper GI bleeding has hematemesis and hypotension. Which diagnostic procedure is the gold standard to identify and treat the bleeding source?

CM. A patient with diabetic ketoacidosis presents with potassium 3.1 mmol/L. What is the next best step before starting insulin?

CN. A patient with acute myocardial infarction develops hypotension, clear lungs, and elevated jugular venous pressure. Which complication is most likely?

CO. A patient with acute pulmonary embolism is hypotensive and hypoxemic. What is the recommended immediate therapy?

CP. A patient with end-stage illness says, “I do not want any further life-prolonging treatments.” What is the nurse’s best action?

CQ. A patient with COPD exacerbation is on high-flow oxygen. ABG shows pH 7.28, PaCO₂ 72 mmHg. What is the best next step?

CR. A patient with chronic kidney disease presents with hyperkalemia (K⁺ 6.5 mmol/L) and peaked T waves on ECG. What is the immediate priority intervention?

CS. A patient with ARDS is on mechanical ventilation. Which ventilator strategy improves survival?

CT. A nurse notices a colleague not using gloves while drawing blood. What is the most appropriate action?

CU. A patient with diabetic ketoacidosis (DKA) is admitted. Which intervention should be initiated first?

CV. A patient with acute pancreatitis presents with severe epigastric pain and hypotension. Which lab finding would most strongly support this diagnosis?

CW. A patient with Guillain-Barré syndrome develops progressive weakness and difficulty clearing secretions. Which intervention is most urgent?

CX. A patient with diabetic ketoacidosis presents with potassium 5.9 mmol/L before insulin infusion is started. What is the best management?

CY. A patient with suspected bowel perforation presents with severe abdominal pain, rigidity, and free air under the diaphragm on X-ray. What is the priority intervention?

CZ. A provider begins preparing to place a central line without verifying informed consent. What is the priority nursing action?

DA. A patient with myxedema coma presents with hypothermia, bradycardia, and hypotension. What is the most appropriate immediate therapy?

DB. A patient with acute ischemic stroke has blood pressure of 210/115 mmHg but is not a candidate for thrombolytic therapy. What is the best management?

DC. A patient with severe asthma is receiving continuous nebulized albuterol. The nurse notices tremors and a serum potassium of 2.9 mmol/L. What caused this electrolyte disturbance?

DD. A patient with spinal cord injury at C4 suddenly develops severe hypertension, bradycardia, and profuse sweating above the injury level. What condition is this?

DE. A patient with traumatic brain injury is receiving mannitol. Which finding requires immediate intervention?

DF. A patient in septic shock has a central venous oxygen saturation (ScvO₂) of 55% despite adequate fluids and norepinephrine. What is the next best step?

DG. A patient with COPD is admitted for acute exacerbation. ABG shows pH 7.36, PaCO₂ 58 mmHg, HCO₃⁻ 32 mEq/L. How should this be interpreted?

DH. A trauma patient develops flail chest with paradoxical chest wall movement. Which intervention is most likely required?

DI. A patient with Guillain–Barré syndrome is admitted to the ICU. Which therapy improves outcomes by hastening recovery?

DJ. A postoperative patient develops sudden calf pain, swelling, and warmth. Which diagnostic test is most appropriate to confirm the suspected condition?

DK. A patient with sepsis develops progressive hypotension despite fluids and vasopressors. Lactate remains elevated. What is the most likely underlying cause?

DL. A patient with suspected acute adrenal insufficiency presents with profound hypotension unresponsive to fluids. What is the priority treatment?

DM. A patient with severe asthma exacerbation has silent chest on auscultation and confusion. What is the next best step?

DN. A patient with suspected meningitis presents with fever, neck stiffness, and photophobia. Which intervention is most appropriate before lumbar puncture?

DO. A patient with diabetic ketoacidosis is receiving IV insulin infusion. Potassium level is 3.1 mmol/L. What is the priority action?

DP. A patient with suspected small bowel obstruction presents with abdominal distension, vomiting, and high-pitched bowel sounds. Which diagnostic imaging is most appropriate?

DQ. A patient with severe COPD exacerbation is on BiPAP but becomes increasingly somnolent with PaCO₂ 85 mmHg. What is the next step?

DR. A patient post–subarachnoid hemorrhage suddenly develops acute confusion and significantly increased urine output. Which complication is most likely?

DS. A patient with pneumonia is on antibiotics but develops progressive hypoxemia and bilateral crackles. Chest X-ray shows diffuse infiltrates. Which condition is suspected?

DT. A patient with acute renal failure has severe hyperkalemia (K⁺ 7.2 mmol/L, ECG: peaked T waves). After stabilizing the myocardium with IV calcium, what is the next therapy to rapidly lower serum potassium?