A. A patient with acute decompensated heart failure presents with severe dyspnea, pink frothy sputum, and SpO₂ 78% on high-flow oxygen. BP is 190/100 mmHg. What is the priority nursing action?

B. A nurse hears a colleague making a negative joke about a patient’s mobility limitations. What is the most appropriate action?

C. A patient with an acute STEMI develops severe hypotension after receiving nitroglycerin. Jugular venous distention and clear lung sounds are noted. What is the priority nursing action?

D. A patient with end-stage renal disease becomes tearful when discussing dialysis. What is the most appropriate nursing action?

E. A patient with an acute myocardial infarction develops new-onset complete heart block with a ventricular rate of 30 bpm and hypotension. What is the priority nursing action?

F. A patient with a basilar skull fracture presents with clear nasal drainage, periorbital ecchymosis, and headache. What is the priority nursing intervention?

G. A patient with end-stage heart failure states, “I don’t want to continue aggressive treatments.” What should the nurse do first?

H. A patient post-CABG develops sudden hypotension, muffled heart sounds, and jugular venous distention. What is the immediate nursing action?

I. A patient with DKA is receiving IV insulin. Glucose is 180 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still open. What should the nurse do next?

J. A patient with a subarachnoid hemorrhage becomes acutely hypertensive and complains of severe headache and photophobia. What is the immediate nursing action?

K. A patient tells the nurse, “If my heart stops, I don’t want to be resuscitated.” What should the nurse do first?

L. A patient in septic shock is on norepinephrine at 30 mcg/min with a MAP of 54 mmHg. Cardiac output is normal, but SVR is critically low. What is the next nursing intervention?

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

N. A patient in septic shock has received 4 liters of crystalloids but remains hypotensive with a MAP of 56 mmHg. Cardiac index is 3.8 L/min/m², and SVR is low. What is the next step?

O. A trauma patient develops abdominal distension, hypotension, and oliguria after massive fluid resuscitation. Bladder pressure is 30 mmHg. What is the priority nursing action?

P. A patient with traumatic brain injury becomes unresponsive, with unequal pupils and bradycardia. ICP is 39 mmHg. What is the immediate action?

Q. A patient with severe ARDS on mechanical ventilation remains hypoxemic with SpO₂ 74% despite high PEEP, FiO₂ 100%, paralysis, and proning. Plateau pressures are stable at 28 cmH₂O. What is the next step?

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

S. A patient with acute inferior wall myocardial infarction develops severe hypotension and clear lung fields. The jugular veins are distended. What is the priority nursing intervention?

T. A patient in septic shock is on norepinephrine at 25 mcg/min and remains hypotensive with MAP of 55 mmHg. Cardiac output is normal, but SVR is critically low. What should the nurse do next?

U. A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Glucose is 160 mg/dL, potassium is 2.8 mEq/L, and the anion gap is still elevated. What is the priority intervention?

V. A patient with DKA is receiving IV insulin. Blood glucose is 160 mg/dL, potassium is 2.8 mEq/L, and the anion gap is still present. What is the appropriate nursing intervention?

W. A patient with severe ARDS is on mechanical ventilation with high PEEP and FiO₂ 100%. SpO₂ remains 74% despite paralysis and prone positioning. Plateau pressures are 29 cmH₂O. What is the next step?

X. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 170 mg/dL, potassium is 2.7 mEq/L, and the anion gap is still open. What is the immediate nursing intervention?

Y. A patient in septic shock is on norepinephrine at 30 mcg/min. MAP is 55 mmHg, cardiac output is 2.2 L/min/m², and lactate remains elevated. What should the nurse do next?

Z. A patient in septic shock is receiving norepinephrine but remains hypotensive with a MAP of 55 mmHg. Cardiac output is 2.1 L/min/m², and urine output is <10 mL/hr. What should the nurse do next?

AA. A patient with acute pulmonary edema is in severe respiratory distress. SpO₂ is 78% on high-flow oxygen, and pink frothy sputum is present. BP is 180/95 mmHg. What is the priority nursing action?

AB. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, and paralysis. SpO₂ is 76% and plateau pressures are 30 cmH₂O. What is the next intervention?

AC. A patient with septic shock is on norepinephrine but remains hypotensive with MAP of 55 mmHg. Cardiac output is 2.5 L/min/m², and lactate remains elevated at 7 mmol/L. What is the next step?

AD. A patient with a subarachnoid hemorrhage develops acute hypertension, severe headache, and nausea. What is the immediate nursing action?

AE. A patient in septic shock is on norepinephrine at 25 mcg/min but remains hypotensive with MAP of 55 mmHg. Cardiac index is 2.2 L/min/m², and lactate is 7 mmol/L. What is the next intervention?

AF. A patient with severe ARDS is on high PEEP and FiO₂ 100%, with paralysis and prone positioning already initiated. SpO₂ remains 74%, and plateau pressures are 28 cmH₂O. What should the nurse anticipate?

AG. A patient with diabetic ketoacidosis is receiving IV insulin. Glucose is 160 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still present. What should the nurse do next?

AH. A patient with septic shock is receiving norepinephrine at 30 mcg/min. MAP remains at 54 mmHg, cardiac output is 3.0 L/min/m², and lactate is rising. What is the next step?

AI. A patient with diabetic ketoacidosis is on an insulin drip. Blood glucose is 180 mg/dL, potassium is 3.2 mEq/L, and the anion gap is still open. What is the next nursing intervention?

AJ. A nurse overhears a staff member making fun of a patient’s limited English skills. What is the most appropriate action?

AK. A patient in septic shock remains hypotensive despite norepinephrine and vasopressin infusions. Cardiac output is 1.9 L/min/m², and urine output is minimal. What is the next step?

AL. A patient with ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, and prone positioning. Plateau pressures are stable at 30 cmH₂O. What is the next intervention?

AM. A patient with severe COPD exacerbation is on BiPAP. ABG shows pH 7.18, PaCO₂ 80 mmHg, and worsening lethargy. What is the priority nursing intervention?

AN. A patient with severe ARDS is on mechanical ventilation with high PEEP and FiO₂ 100%. SpO₂ remains 75%, and plateau pressures are 28 cmH₂O despite paralysis and proning. What is the next step?

AO. A patient with cardiogenic shock presents with hypotension, cool extremities, and oliguria. Pulmonary artery catheter shows a cardiac index of 1.5 L/min/m² and wedge pressure of 28 mmHg. What is the priority intervention?

AP. A patient with diabetic ketoacidosis is receiving IV insulin. Glucose is 160 mg/dL, potassium is 2.7 mEq/L, and the anion gap is still present. What should the nurse do first?

AQ. A patient with traumatic brain injury suddenly becomes unresponsive with bradycardia and hypertension. ICP monitoring shows a pressure of 38 mmHg. What is the immediate nursing intervention?

AR. A patient with acute coronary syndrome develops ventricular fibrillation. What is the immediate nursing action?

AS. A patient post-craniotomy develops sudden hypertension, bradycardia, and irregular respirations. ICP is 38 mmHg. What is the immediate nursing action?

AT. A patient with DKA is on an insulin drip. Glucose is 180 mg/dL, potassium is 3.3 mEq/L, and the anion gap remains elevated. What should the nurse do next?

AU. A patient with acute pulmonary embolism presents with hypotension, tachycardia, and SpO₂ of 78% despite high-flow oxygen. What is the immediate nursing action?

AV. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and proning. Plateau pressures are stable at 28 cmH₂O. What is the next step?

AW. A patient with an acute inferior wall myocardial infarction develops symptomatic bradycardia with a heart rate of 30 bpm and hypotension. What is the immediate nursing intervention?

AX. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and prone positioning. Plateau pressures remain stable at 28 cmH₂O. What is the next appropriate step?

AY. A patient with acute inferior wall myocardial infarction develops complete heart block with a ventricular rate of 28 bpm and hypotension. What is the priority nursing action?

AZ. A patient with diabetic ketoacidosis (DKA) is receiving IV insulin. Glucose is 150 mg/dL, potassium is 3.1 mEq/L, and the anion gap is closing. What should the nurse do next?

BA. A patient with traumatic brain injury suddenly becomes bradycardic, hypertensive, and has irregular respirations. ICP monitor reads 38 mmHg. What is the priority nursing action?

BB. A nurse witnesses a provider obtaining consent without explaining the risks and benefits of a procedure. What should the nurse do first?

BC. A patient with severe hypocalcemia develops laryngospasm and tetany. What is the immediate nursing intervention?

BD. A patient with acute intracerebral hemorrhage presents with BP of 220/120 mmHg, confusion, and unequal pupils. What is the immediate nursing intervention?

BE. A patient’s spouse says, “I don’t think I can handle all the care my husband will need at home.” What is the nurse’s best response?

BF. A patient with septic shock remains hypotensive after aggressive fluids and norepinephrine at 25 mcg/min. Cardiac index is adequate, but SVR remains critically low. What is the next step?

BG. A patient with severe ARDS remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and prone positioning. Plateau pressures remain stable at 28 cmH₂O. What is the next step?

BH. A nurse observes a provider rushing a patient to sign a consent form without explanation. What should the nurse do first?

BI. A nurse hears a colleague making a negative comment about a patient’s appearance. What is the most appropriate response?

BJ. A patient with traumatic brain injury becomes suddenly unresponsive, with unequal pupils and hypertension. ICP monitor reads 38 mmHg. What is the next intervention?

BK. A patient with severe ARDS is on mechanical ventilation with high PEEP, FiO₂ 100%, and paralysis. SpO₂ remains 74% despite proning. Plateau pressures are stable at 28 cmH₂O. What is the next nursing action?

BL. A patient in septic shock is on norepinephrine but remains hypotensive with MAP of 55 mmHg. Cardiac output is normal, but SVR is critically low. What is the next intervention?

BM. A patient with DKA is on an insulin drip. Blood glucose is 170 mg/dL, potassium is 3.0 mEq/L, and the anion gap is still open. What is the appropriate intervention?

BN. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite maximal ventilatory support, including high PEEP, FiO₂ 100%, paralysis, and prone positioning. Plateau pressure is stable at 28 cmH₂O. What is the next nursing action?

BO. A patient with acute coronary syndrome suddenly becomes unresponsive with a monitor showing ventricular fibrillation. What is the priority nursing action?

BP. A patient on mechanical ventilation suddenly develops hypotension, tachycardia, and absent breath sounds on the left. The trachea is deviated to the right. What is the immediate nursing action?

BQ. A patient with acute decompensated heart failure presents with severe dyspnea, orthopnea, and crackles in all lung fields. BP is 185/100 mmHg, and SpO₂ is 82% despite high-flow oxygen. What is the priority nursing action?

BR. A patient in septic shock is receiving norepinephrine but remains hypotensive with a MAP of 55 mmHg. Cardiac output is normal, and SVR is critically low. What is the next step?

BS. A patient with traumatic brain injury develops bradycardia, irregular respirations, and hypertension. ICP monitor shows pressures of 37 mmHg. What is the priority nursing action?

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

BU. A patient post-trauma develops abdominal distension, hypotension, and oliguria. Bladder pressure is 28 mmHg. What is the next nursing action?

BV. A patient with septic shock is receiving norepinephrine and remains hypotensive with MAP of 55 mmHg. Cardiac output is low, and urine output is less than 15 mL/hr. What is the next intervention?

BW. A patient with DKA is on an insulin drip. Blood glucose is 150 mg/dL, potassium is 2.9 mEq/L, and the anion gap is still elevated. What should the nurse do first?

BX. A patient post-thyroidectomy reports difficulty breathing and a tight sensation in the neck. Stridor is audible, and SpO₂ is 82% on oxygen. What is the immediate nursing action?

BY. A patient with severe ARDS on mechanical ventilation remains hypoxemic with SpO₂ 72% despite high PEEP, FiO₂ 100%, paralysis, and prone positioning. What is the next step?

BZ. A patient’s daughter says, “I’m afraid I can’t provide the care my father needs at home.” What is the nurse’s best response?

CA. A patient with septic shock has received 4 liters of crystalloids and is on norepinephrine at 25 mcg/min. MAP remains 54 mmHg, cardiac output is 2.0 L/min/m², and urine output is <10 mL/hr. What is the next step?

CB. A patient on CRRT shows increasing transmembrane pressures and reduced ultrafiltrate output, accompanied by machine alarms. What should the nurse do first?

CC. A patient with acute inferior wall MI develops symptomatic bradycardia with hypotension and dizziness. What is the priority nursing action?

CD. A patient recovering from a myocardial infarction says, “I’ll never be able to go back to normal.” What is the nurse’s best response?

CE. A patient in septic shock is on norepinephrine at 25 mcg/min and has MAP of 54 mmHg despite adequate fluids. Cardiac output is low at 2.0 L/min/m², and lactate is rising. What is the next step?

CF. A patient says, “I’m confused about why I’m taking so many medications.” What is the nurse’s best action?

CG. A patient with traumatic brain injury suddenly becomes bradycardic, hypertensive, and unresponsive. ICP monitor shows a pressure of 38 mmHg. What is the immediate nursing action?

CH. A patient with septic shock is on norepinephrine at 25 mcg/min. MAP is 55 mmHg, cardiac output is low, and lactate is rising. What should the nurse do next?

CI. A patient with DKA is on an insulin infusion. Blood glucose is 150 mg/dL, potassium is 3.2 mEq/L, and the anion gap is still elevated. What is the appropriate nursing action?

CJ. A patient with severe bradycardia (heart rate 28 bpm) presents with hypotension, cool extremities, and altered mental status. What is the priority nursing intervention?

CK. A patient post-craniotomy becomes unresponsive with unequal pupils, bradycardia, and hypertension. ICP is 39 mmHg. What is the priority nursing intervention?

CL. A patient with acute decompensated heart failure presents with severe dyspnea, pulmonary crackles, and BP of 180/100 mmHg. SpO₂ is 80% on a non-rebreather mask. What is the priority nursing action?

CM. A patient with myxedema coma presents with hypotension, bradycardia, and hypothermia. What is the priority nursing intervention?

CN. A patient with traumatic brain injury develops bradycardia, irregular respirations, and unequal pupils. ICP monitor shows a reading of 39 mmHg. What is the priority nursing action?

CO. A patient recently diagnosed with heart failure begins crying while discussing lifestyle changes. What is the most appropriate nursing action?

CP. A patient with advanced cancer states that they no longer want chemotherapy. What should the nurse do first?

CQ. During handoff, a nurse notices that a colleague omits critical safety information about a patient. What is the best nursing action?

CR. A patient in septic shock is receiving norepinephrine at 30 mcg/min with a MAP of 55 mmHg. Cardiac output is 2.0 L/min/m², and lactate is 8 mmol/L. What is the next intervention?

CS. A patient with acute pancreatitis develops hypocalcemia with muscle twitching and a prolonged QT interval on ECG. What is the appropriate intervention?

CT. A patient with severe ARDS on mechanical ventilation has plateau pressures of 30 cmH₂O and FiO₂ 100%. Despite proning and paralysis, SpO₂ is 74%. What is the next step?

CU. A patient says, “I feel hopeless about my illness.” What is the nurse’s best response?

CV. A patient with traumatic brain injury exhibits bradycardia, hypertension, and irregular respirations. ICP is 38 mmHg. What is the immediate nursing action?

CW. A patient with heart failure says, “I’m scared I won’t be able to handle this at home.” What is the nurse’s best response?

CX. A patient with septic shock is receiving norepinephrine at 25 mcg/min and has a MAP of 54 mmHg. Cardiac output is 2.1 L/min/m², and lactate remains elevated. What is the next step?

CY. A nurse overhears a colleague speaking disrespectfully to a patient with dementia. What is the most appropriate nursing action?

CZ. A patient with traumatic brain injury develops bradycardia, irregular respirations, and hypertension. ICP monitoring shows a pressure of 36 mmHg. What is the next nursing action?

DA. A patient with diabetic ketoacidosis is on insulin infusion. Glucose is 160 mg/dL, potassium is 3.0 mEq/L, and the anion gap remains elevated. What should the nurse do?

DB. A patient with traumatic brain injury has ICP of 38 mmHg and exhibits bradycardia, hypertension, and unequal pupils. What is the immediate nursing action?

DC. A patient on mechanical ventilation for severe ARDS has plateau pressures of 28 cmH₂O and FiO₂ of 100%. Despite paralysis and prone positioning, SpO₂ remains 74%. What is the next appropriate intervention?

DD. A patient post-thyroidectomy develops sudden inspiratory stridor, dyspnea, and cyanosis. What is the priority nursing action?

DE. A patient with acute coronary syndrome develops hypotension, cool extremities, and altered mental status. The cardiac index is 1.6 L/min/m², and pulmonary artery wedge pressure is 28 mmHg. What is the priority intervention?

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

DG. A patient post-craniotomy suddenly develops unequal pupils, bradycardia, and hypertension. ICP monitoring shows a reading of 38 mmHg. What is the priority nursing action?

DH. A patient with traumatic brain injury suddenly becomes unresponsive. ICP monitor reads 39 mmHg. Pupils are unequal, and the patient is bradycardic and hypertensive. What is the next intervention?

DI. A patient in septic shock is on norepinephrine at 25 mcg/min but remains hypotensive with MAP of 55 mmHg. Cardiac output is adequate, but SVR is critically low. What is the next nursing action?

DJ. A patient in the ICU develops sudden hypotension, distended neck veins, and muffled heart sounds. What is the immediate nursing action?

DK. A patient with DKA is receiving IV insulin. Glucose is 180 mg/dL, potassium is 2.8 mEq/L, and the anion gap is not yet closed. What should the nurse do next?

DL. A patient with traumatic brain injury becomes unresponsive with unequal pupils and bradycardia. ICP monitor shows 36 mmHg. What is the priority nursing intervention?

DM. A patient recovering from pneumonia says, “I’m worried I’ll get sick again.” What is the nurse’s best response?

DN. A patient presents with severe hypocalcemia after multiple blood transfusions. They exhibit tetany, tingling around the mouth, and a prolonged QT interval. What is the immediate action?

DO. A patient with limited health literacy says, “These instructions are too complicated.” What is the nurse’s best response?

DP. A patient with septic shock is receiving norepinephrine at 25 mcg/min but remains hypotensive with a MAP of 55 mmHg. Cardiac output is 2.5 L/min/m², and lactate remains elevated. What should the nurse do next?

DQ. During multidisciplinary rounds, a nurse notices that a colleague dismisses another team member’s input. What is the best nursing action?

DR. A patient with DKA is receiving insulin therapy. Blood glucose is 160 mg/dL, potassium is 3.1 mEq/L, and the anion gap remains elevated. What should the nurse do?

DS. A patient with DKA is on an insulin drip. Glucose is 170 mg/dL, potassium is 3.0 mEq/L, and the anion gap is not yet closed. What should the nurse do first?

DT. A patient with acute decompensated heart failure is on IV diuretics. Suddenly, the patient develops hypotension, weak pulses, and a narrow QRS tachycardia. What is the immediate nursing intervention?

DU. A patient with severe ARDS on mechanical ventilation remains hypoxemic despite high PEEP, FiO₂ 100%, paralysis, and proning. Plateau pressure is stable at 28 cmH₂O. What is the next step?