A. A patient recovering from a stroke says, “I’m afraid I’ll never walk again.” What is the nurse’s best response?

B. A trauma patient with bilateral femur fractures develops hypoxemia, confusion, and petechial rash on the chest and upper arms. What is the priority nursing action?

C. A patient with heart failure says, “I feel anxious about being responsible for all this care at home.” What is the nurse’s best response?

D. A patient with decompensated cirrhosis is scheduled for large-volume paracentesis. What is the priority nursing action during the procedure?

E. A patient with chronic kidney disease develops muscle cramps, fatigue, and a potassium level of 2.6 mEq/L after aggressive diuresis. What should the nurse do first?

F. A patient with terminal illness says, “I want to stop treatment.” What should the nurse do first?

G. A patient with a pelvic fracture develops loss of sensation in the legs, urinary retention, and severe lower back pain. What is the priority nursing action?

H. A patient with decompensated cirrhosis has ascites and is scheduled for a large-volume paracentesis. What is the nurse’s priority during the procedure?

I. A patient with acute left ventricular failure develops pink frothy sputum, severe dyspnea, and crackles throughout both lungs. BP 85/50 mmHg. What is the priority nursing intervention?

J. A patient with multiple fractures from a motor vehicle crash develops sudden shortness of breath, confusion, and a petechial rash over the chest. SpO₂ is 82% on room air. What is the priority nursing action?

K. A patient with acute upper GI bleeding is vomiting bright red blood and becomes hypotensive and tachycardic. What is the priority nursing action?

L. A patient with decompensated liver cirrhosis presents with confusion, tremor, and an ammonia level of 210 µmol/L despite adherence to lactulose therapy. What is the next nursing action?

M. A patient with ischemic stroke is admitted 2 hours after symptom onset. CT shows no hemorrhage. BP is 178/98 mmHg. What is the priority nursing intervention?

N. A patient with dilated cardiomyopathy suddenly develops severe dyspnea, frothy pink sputum, and crackles in both lungs. BP is 80/50 mmHg. What is the priority nursing intervention?

O. A patient with cirrhosis is admitted with confusion, tremor, and ammonia 190 µmol/L. Despite lactulose therapy, symptoms persist. What is the next appropriate nursing intervention?

P. A patient with acute anterior myocardial infarction develops sudden shortness of breath, hypotension, and a new holosystolic murmur at the apex. What is the priority nursing action?

Q. A patient with poorly controlled type 1 diabetes becomes diaphoretic and confused during insulin therapy. Bedside glucose is 32 mg/dL, and IV access is available. What is the immediate nursing action?

R. A nurse overhears a colleague speaking disrespectfully to a patient with cognitive impairment. What is the most appropriate action?

S. A patient with dilated cardiomyopathy develops sudden dyspnea, frothy pink sputum, and crackles in both lungs. BP is 80/50 mmHg. What is the priority nursing intervention?

T. A patient with decompensated cirrhosis is scheduled for a large-volume paracentesis. Which pre-procedure nursing intervention is a priority?

U. A patient with traumatic brain injury develops new-onset bradycardia, hypertension, and irregular respirations. ICP is 40 mmHg. What is the immediate nursing intervention?

V. A patient with septic shock on norepinephrine has MAP 55 mmHg, mottled extremities, and low cardiac output by monitoring. What is the next nursing intervention?

W. A nurse observes a provider pressuring a patient to sign a consent form without proper explanation. What is the nurse’s priority action?

X. A patient says, “I don’t understand why I need to come back for more lab work.” What is the nurse’s best response?

Y. A patient says, “I don’t understand why I need to keep taking these medications even though I feel better.” What is the nurse’s best response?

Z. A patient with acute myocardial infarction develops severe hypotension, jugular venous distention, and muffled heart sounds. What is the priority nursing action?

AA. A patient with cirrhosis presents with hematemesis. After stabilization, the provider orders prophylaxis against rebleeding. What should the nurse anticipate?

AB. A patient with cirrhosis presents with confusion, asterixis, and ammonia 190 µmol/L despite lactulose therapy. Which additional intervention is appropriate?

AC. A patient with subarachnoid hemorrhage develops sudden severe headache, vomiting, and new pupillary dilation. What is the nurse’s priority action?

AD. A patient with traumatic brain injury develops unequal pupils and Cushing’s triad. ICP monitor shows 42 mmHg. What is the immediate nursing intervention?

AE. A patient with acute kidney injury due to sepsis develops metabolic acidosis (pH 7.20), hyperkalemia, and oliguria despite fluid resuscitation. What should the nurse anticipate?

AF. A patient asks, “Why do I need to keep using this incentive spirometer?” What is the nurse’s best response?

AG. A patient with decompensated cirrhosis is started on lactulose for encephalopathy. After treatment, the patient has 8 watery stools per day and develops hypokalemia. What is the nurse’s next action?

AH. A nurse witnesses a provider attempting to obtain consent for a procedure without explanation. What should the nurse do first?

AI. A patient with traumatic brain injury suddenly develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 38 mmHg. What is the immediate nursing action?

AJ. A patient with decompensated cirrhosis is scheduled for therapeutic paracentesis. The nurse notes a platelet count of 45,000/µL. What is the priority nursing intervention?

AK. A patient with decompensated cirrhosis and tense ascites undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and dizzy. What is the nurse’s next action?

AL. A patient with a femoral fracture reports severe pain unrelieved by opioids, pallor, and paresthesia in the limb. Passive stretch increases the pain. What is the priority nursing action?

AM. A patient with a pelvic fracture reports urinary retention, perineal numbness, and weakness in both legs. What is the priority nursing intervention?

AN. A patient with acute variceal bleeding is started on octreotide and IV fluids. The patient suddenly becomes hypotensive with HR 130 bpm and cool, clammy skin. What is the priority nursing action?

AO. A patient with cirrhosis and ascites undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and tachycardic. What is the nurse’s next action?

AP. A patient with severe pneumonia is on mechanical ventilation. Plateau pressures are rising, and SpO₂ is falling despite high PEEP. What should the nurse anticipate?

AQ. A patient with cirrhosis and large-volume ascites develops dyspnea and hypotension after paracentesis. What is the nurse’s immediate action?

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

AS. A patient’s caregiver says, “I feel exhausted and overwhelmed.” What is the nurse’s best response?

AT. A patient with ARDS is on mechanical ventilation: FiO₂ 80%, PEEP 15 cmH₂O. PaO₂ remains 50 mmHg, plateau pressures are rising. What should the nurse anticipate?

AU. A patient with severe COPD exacerbation is on high-flow oxygen. ABG results: pH 7.25, PaCO₂ 80 mmHg, PaO₂ 58 mmHg. The patient is drowsy and confused. What is the priority nursing action?

AV. A patient with poorly controlled type 2 diabetes develops polyuria, polydipsia, and glucose of 950 mg/dL. Serum osmolality is 340 mOsm/kg, no ketones are present. What is the immediate nursing action?

AW. A patient with severe ARDS on high PEEP develops hypotension and tracheal deviation. Breath sounds are absent on the right. What is the priority nursing intervention?

AX. A patient with severe acute pancreatitis develops hypotension, tachycardia, and abdominal distension. Ultrasound shows a large fluid collection in the peritoneal cavity. What is the priority nursing action?

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

AZ. A patient with septic shock remains hypotensive despite norepinephrine at high dose. MAP is 50 mmHg, lactate is rising, urine output is minimal. What should the nurse anticipate?

BA. A patient with acute kidney injury develops severe metabolic acidosis (pH 7.10), potassium of 7.0 mEq/L, and oliguria despite fluid resuscitation. What is the immediate nursing action?

BB. A patient on mechanical ventilation for ARDS develops worsening hypoxemia. The provider orders proning, but the patient becomes hypotensive. What should the nurse do first?

BC. A patient with acute mesenteric ischemia develops sudden severe abdominal pain out of proportion to physical findings, with lactic acidosis. What is the priority nursing action?

BD. A patient with known Addison’s disease presents with confusion, severe hypotension, and a potassium level of 6.5 mEq/L. What is the immediate nursing intervention?

BE. A patient newly diagnosed with hypertension says, “I don’t think I can change my lifestyle.” What is the nurse’s best response?

BF. A patient with type 1 diabetes who is NPO for surgery becomes diaphoretic, irritable, and confused. Bedside glucose is 40 mg/dL, and IV access is in place. What is the immediate nursing intervention?

BG. A patient with untreated hypothyroidism develops hypothermia, bradycardia, and decreased consciousness. What is the immediate nursing intervention?

BH. A patient with a traumatic brain injury suddenly becomes agitated, with dilated right pupil and hemiparesis on the left. ICP is 36 mmHg. What is the immediate nursing action?

BI. A patient with cirrhosis and ascites is undergoing repeated paracentesis. After the procedure, the patient becomes hypotensive and dizzy. What is the nurse’s immediate action?

BJ. A patient with sepsis develops MAP 50 mmHg despite fluids and norepinephrine infusion. ScvO₂ remains 50%. What should the nurse anticipate next?

BK. A patient with severe pancreatitis develops worsening abdominal pain, fever, and leukocytosis. CT imaging shows pancreatic necrosis. What is the priority nursing action?

BL. A patient with ARDS is on mechanical ventilation with FiO₂ 100%, PEEP 18 cmH₂O. PaO₂ remains 48 mmHg. What is the next nursing intervention?

BM. A patient with STEMI develops sudden hypotension, clear lungs, and jugular venous distension. What is the priority nursing intervention?

BN. A patient with severe acute pancreatitis develops fever, hypotension, and new-onset leukocytosis. Blood cultures are positive for gram-negative rods. What is the priority nursing intervention?

BO. A patient with decompensated cirrhosis has ascites and is scheduled for paracentesis. Pre-procedure labs: INR 2.6, platelets 40,000/µL. What is the nurse’s priority action?

BP. A patient with a subarachnoid hemorrhage reports sudden worsening headache, decreased level of consciousness, and pupillary asymmetry. What is the priority nursing action?

BQ. A patient with type 1 diabetes on insulin therapy is found unresponsive with blood glucose of 28 mg/dL. IV access is not available. What is the immediate nursing action?

BR. A patient with acute ischemic stroke is admitted with sudden right-sided weakness, facial droop, and slurred speech. Last known well: 1 hour ago. What is the priority nursing action?

BS. A patient with type 2 diabetes presents with confusion, dehydration, and a blood glucose level of 780 mg/dL. Serum osmolality is 350 mOsm/kg, and no significant ketones are present. What is the priority nursing action?

BT. A patient recovering from surgery says, “I’m scared I won’t be able to manage when I get home.” What is the nurse’s best response?

BU. A patient with acute kidney injury due to rhabdomyolysis develops hyperkalemia, oliguria, and rising creatinine. Despite IV fluids, urine output remains minimal. What should the nurse anticipate?

BV. A patient with septic shock remains hypotensive despite fluids and norepinephrine. ScvO₂ is 48%, lactate is rising, and urine output is <10 mL/hr. What should the nurse anticipate?

BW. A patient with decompensated cirrhosis develops hematemesis and hypotension. Octreotide infusion is ongoing, but the patient becomes increasingly unstable. What is the priority nursing action?

BX. A patient with advanced cirrhosis develops worsening confusion, tremor, and elevated ammonia levels despite standard lactulose dosing. What is the next appropriate nursing action?

BY. A patient with decompensated cirrhosis is scheduled for paracentesis. Platelet count is 30,000/µL and INR 2.4. What is the nurse’s priority action?

BZ. A patient with septic shock remains hypotensive despite 30 mL/kg fluid resuscitation. Norepinephrine infusion is started, but MAP is still 50 mmHg. What is the next intervention?

CA. A patient with advanced liver failure presents with hypotension, confusion, and a serum sodium of 118 mEq/L. What is the priority nursing intervention?

CB. A nurse overhears a colleague making a mocking comment about a patient’s accent. What is the most appropriate nursing action?

CC. A patient with advanced chronic kidney disease reports muscle weakness, tingling, and prolonged QT intervals on ECG. Labs show calcium 6.7 mg/dL. What is the immediate nursing intervention?

CD. A patient with a tibia fracture develops intense pain unrelieved by opioids, pallor, and decreased sensation in the affected leg. What is the priority nursing action?

CE. A patient with acute gastrointestinal bleeding receives multiple transfusions. Hours later, the patient develops hypocalcemia with muscle twitching and a prolonged QT interval on ECG. What is the priority nursing action?

CF. A patient with multiple long-bone fractures develops severe leg pain unrelieved by opioids, tense swelling, and diminished pulses. What is the priority nursing intervention?

CG. A patient with cirrhosis and portal hypertension develops hematemesis and hypotension. Despite transfusions, blood pressure remains low. What is the next nursing intervention?

CH. A patient with acute kidney injury develops oliguria, hyperkalemia, and metabolic acidosis. The patient is also hypotensive and not tolerating intermittent hemodialysis. What should the nurse anticipate?

CI. A patient becomes tearful after hearing that their condition is not improving. What is the most appropriate nursing action?

CJ. A patient on peritoneal dialysis reports abdominal pain, fever, and cloudy effluent. What is the nurse’s first intervention?

CK. A patient’s spouse says, “I don’t think I can keep up with all this caregiving.” What is the nurse’s best response?

CL. A patient with an acute inferior wall MI develops complete heart block and HR 30 bpm. The patient is hypotensive and dizzy. What is the priority nursing intervention?

CM. A patient recovering from a crush injury develops tea-colored urine, elevated creatine kinase, and hyperkalemia. What is the priority nursing action?

CN. A patient with cirrhosis presents with hematemesis, hypotension, and tachycardia. After stabilization with fluids, octreotide infusion is started. The patient suddenly becomes more hypotensive and tachycardic. What is the next nursing action?

CO. A nurse observes a staff member skipping safety checks before medication administration. What is the best action?

CP. A patient with acute upper GI bleeding develops hypotension, tachycardia, and altered mental status despite receiving fluids. What is the immediate nursing intervention?

CQ. A patient with pneumonia develops worsening hypoxemia despite high-flow oxygen. ABG: pH 7.28, PaCO₂ 55 mmHg, PaO₂ 52 mmHg. What is the next nursing intervention?

CR. A trauma patient with a tibia fracture reports severe pain unrelieved by opioids, paresthesia, and diminished pulses. What is the nurse’s immediate action?

CS. A patient with acute kidney injury from nephrotoxic medications develops rising creatinine, hyperkalemia, and oliguria. What is the next nursing step?

CT. A patient with untreated Graves’ disease presents with agitation, profuse sweating, fever of 105°F (40.5°C), and tachycardia of 190 bpm. What is the priority nursing intervention?

CU. A patient with septic shock has received fluids and norepinephrine. MAP remains 48 mmHg, cardiac index is low, and ScvO₂ is 45%. What should the nurse anticipate?

CV. A patient with STEMI suddenly develops pulseless ventricular tachycardia. What is the nurse’s immediate action?

CW. A patient with poorly controlled type 1 diabetes is found unresponsive, with glucose of 30 mg/dL and seizure activity. IV access is available. What is the immediate nursing action?

CX. A patient with untreated hypothyroidism is admitted with hypothermia, bradycardia, and altered mental status. Which is the immediate nursing action?

CY. A nurse sees a provider asking a patient to sign a consent form without explaining the procedure. What should the nurse do first?

CZ. A nurse notices a staff member failing to answer a patient’s repeated call light. What is the best action?

DA. A patient with a crush injury reports increasing pain in the leg, paresthesia, and pallor. Pedal pulses are diminished, and passive stretch worsens the pain. What is the priority nursing action?

DB. A patient with severe asthma exacerbation is receiving continuous nebulized bronchodilators. The patient suddenly becomes quiet with minimal air movement and SpO₂ 82% despite oxygen. What is the immediate nursing action?

DC. A patient’s spouse says, “I feel guilty and exhausted caring for my partner at home.” What is the nurse’s best response?

DD. A patient in septic shock is receiving norepinephrine at 0.3 mcg/kg/min. MAP is 52 mmHg, lactate is rising, urine output <15 mL/hr. What is the next appropriate intervention?

DE. A patient with acute kidney injury has BUN 90 mg/dL, creatinine 6.8 mg/dL, confusion, and pericardial rub. What should the nurse anticipate?

DF. A patient with severe pneumonia is receiving high-flow oxygen. ABG: pH 7.30, PaCO₂ 60 mmHg, PaO₂ 50 mmHg. The patient is somnolent. What is the immediate nursing action?

DG. A patient with advanced chronic kidney disease develops lethargy, asterixis, and pericardial friction rub. Potassium is 6.9 mEq/L. What should the nurse anticipate?

DH. A patient with an inferior wall myocardial infarction develops bradycardia and hypotension. What is the nurse’s immediate action?

DI. A patient with a femoral shaft fracture develops swelling, pain out of proportion to the injury, and paresthesia in the leg. Passive stretch increases the pain. What is the immediate nursing action?

DJ. A patient with advanced renal failure presents with periorbital edema, dyspnea, and crackles in both lungs. BP is 180/95 mmHg, and urine output is minimal. What should the nurse anticipate?

DK. A patient with septic shock on norepinephrine develops worsening acidosis, mottled extremities, and urine output <10 mL/hr. MAP remains 48 mmHg. What should the nurse anticipate?

DL. A patient asks, “Why do I need to wear this sling even when I’m resting?” What is the nurse’s best response?

DM. A patient with poorly controlled Graves’ disease presents with extreme irritability, tachycardia, and temperature of 104°F (40°C). What is the immediate nursing action?

DN. A patient with terminal illness states, “I want to stop all treatments.” What should the nurse do first?

DO. A patient with type 2 diabetes presents with confusion, dry mucous membranes, and glucose of 980 mg/dL. Serum osmolality is 340 mOsm/kg, and ketones are absent. What is the priority nursing action?

DP. A patient becomes tearful after hearing that their condition is terminal. What is the most appropriate nursing action?

DQ. A patient with multiple fractures develops swelling, severe pain unrelieved by opioids, and pallor in the affected extremity. What is the next nursing action?

DR. A patient with acute liver failure is at risk for cerebral edema. Which intervention is the priority?

DS. A patient with cirrhosis is admitted with confusion, asterixis, and ammonia 175 µmol/L. Lactulose has been ineffective. What is the next appropriate nursing intervention?

DT. A patient with fulminant hepatic failure develops sudden confusion, asterixis, and cerebral edema on CT. What is the priority nursing action?

DU. A patient becomes tearful after being told their disease is progressing despite treatment. What is the most appropriate nursing action?