A. A patient in septic shock is receiving fluids and norepinephrine. The MAP is 58 mmHg, lactate is 5 mmol/L, and urine output is 10 mL/hr. What is the next best step?

B. A patient with septic shock is receiving norepinephrine and fluids. Despite therapy, MAP is 55 mmHg, lactate is 7 mmol/L, and skin is mottled. What is the next intervention?

C. A patient with septic shock remains hypotensive after aggressive fluids and norepinephrine. The patient has cool extremities, weak pulses, and low urine output. What is the priority intervention?

D. A patient’s family requests detailed medical information, but the patient previously stated they do not want their health discussed with family. What should the nurse do?

E. A patient post-craniotomy develops sudden severe headache, hypertension, and bradycardia. ICP monitor shows a rapid rise in pressure. What should the nurse do first?

F. A patient with cirrhosis presents with hematemesis and hypotension. What is the immediate priority intervention?

G. A patient’s spouse says, “I feel overwhelmed by all of the home care responsibilities.” What is the nurse’s best response?

H. A patient on telemetry develops torsades de pointes. What is the immediate nursing action?

I. A nurse notices that a patient has not received prescribed pain medication due to a delayed order entry. What should the nurse do first?

J. A patient with COPD exacerbation is on BiPAP but now presents with increasing lethargy and PaCO₂ of 95 mmHg. What is the priority action?

K. A patient receiving tPA for an acute ischemic stroke suddenly develops new confusion and severe headache. What is the immediate priority?

L. A family member expresses anger about the perceived lack of updates regarding their loved one’s condition. What is the nurse’s best initial response?

M. A nurse observes a patient praying quietly before a procedure. What is the most appropriate action?

N. A patient in the ICU develops new-onset atrial fibrillation with rapid ventricular response and hypotension. What is the priority action?

O. A patient on mechanical ventilation for ARDS has plateau pressures rising above 30 cmH₂O. What is the priority nursing action?

P. A nurse is preparing to teach a patient newly diagnosed with atrial fibrillation about anticoagulant therapy. What is the best teaching strategy?

Q. A patient receiving tPA for an acute ischemic stroke suddenly develops new weakness in the right arm and slurred speech. What is the immediate action?

R. A patient on telemetry develops unstable ventricular tachycardia with a pulse of 50 mmHg and altered mental status. What is the immediate action?

S. A patient becomes tearful after learning they may need long-term dialysis. What is the most appropriate action for the nurse?

T. A patient in the ICU with septic shock develops oliguria, elevated creatinine, and hyperkalemia despite vasopressor therapy. What should the nurse do next?

U. A patient with severe sepsis is receiving broad-spectrum antibiotics and fluids. The nurse notes increasing mottling of the skin and a lactate of 8 mmol/L. What is the priority nursing intervention?

V. A patient with ARDS is sedated and on mechanical ventilation. Despite low tidal volume and high PEEP, SpO₂ remains 82%. What should the nurse anticipate?

W. A patient with diabetic ketoacidosis has a glucose of 180 mg/dL, an anion gap that is still open, and potassium of 4.0 mEq/L. What is the next step?

X. A patient with DKA is receiving IV insulin. Potassium level drops to 2.8 mEq/L. What is the immediate action?

Y. A patient with diabetic ketoacidosis is on IV insulin therapy. The anion gap is still open, and glucose has decreased to 180 mg/dL. What is the next step?

Z. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 180 mg/dL, and the anion gap is still elevated. What is the next step?

AA. A patient with COPD is receiving BiPAP for hypercapnic respiratory failure but becomes more lethargic and shows a PaCO₂ of 100 mmHg. What is the priority intervention?

AB. A nurse notices a colleague repeatedly failing to wash hands between patient encounters. What is the nurse’s priority action?

AC. A patient post-thyroidectomy suddenly develops inspiratory stridor and labored breathing. What is the immediate priority?

AD. A patient with a traumatic brain injury has ICP of 28 mmHg and is being ventilated. Which intervention should the nurse anticipate?

AE. A patient with septic shock is on norepinephrine and vasopressin. The MAP remains 55 mmHg, and lactate is 6 mmol/L. What is the next intervention?

AF. A patient with ARDS is mechanically ventilated. Oxygenation remains poor despite FiO₂ 100% and high PEEP. What should the nurse do next?

AG. A patient post-CABG develops sudden hypotension, jugular vein distention, and muffled heart sounds. What is the priority action?

AH. A patient with ARDS is receiving low tidal volume ventilation. Plateau pressures remain above 30 cmH₂O. What is the priority nursing intervention?

AI. A patient with ARDS is on mechanical ventilation with high PEEP and FiO₂. Plateau pressures are above 30 cmH₂O. What is the priority nursing action?

AJ. During a stressful code, a nurse observes a colleague becoming verbally aggressive toward another staff member. What is the most appropriate nursing action?

AK. A patient with ARDS is ventilated with low tidal volume settings. Plateau pressures remain high despite optimized sedation. What is the priority action?

AL. A patient in septic shock remains hypotensive despite adequate fluids and norepinephrine. MAP is 55 mmHg, lactate is 6 mmol/L, and SvO₂ is low. What is the next intervention?

AM. A patient with diabetic ketoacidosis is on an insulin drip. Potassium level is 2.9 mEq/L. What is the priority action?

AN. A patient with septic shock remains hypotensive after fluids and norepinephrine. MAP is 55 mmHg, and urine output is minimal. What is the priority intervention?

AO. A patient requests not to be awakened for routine nighttime vital signs unless necessary. What should the nurse do?

AP. A patient with septic shock remains hypotensive after aggressive fluid resuscitation and norepinephrine infusion. MAP is 56 mmHg, and lactate is increasing. What is the next best intervention?

AQ. A nurse finds a patient crying after receiving a new diagnosis. What is the most appropriate action?

AR. A patient with a traumatic brain injury shows ICP of 28 mmHg, sluggish pupils, and hypertension with bradycardia. What is the priority nursing action?

AS. A patient post-CABG develops sudden chest pain, hypotension, and muffled heart sounds. What is the priority nursing action?

AT. A patient post-thyroidectomy develops inspiratory stridor and cyanosis. What is the immediate priority intervention?

AU. A patient with ARDS remains hypoxemic despite FiO₂ 100% and PEEP 15 cmH₂O. Plateau pressures are stable at 28 cmH₂O. What is the best nursing action?

AV. A patient receiving tPA for an acute ischemic stroke develops new-onset slurred speech and right-sided weakness during the infusion. What is the priority action?

AW. A patient on mechanical ventilation for ARDS has plateau pressures >30 cmH₂O. What is the best nursing intervention?

AX. A patient with a traumatic brain injury has ICP of 28 mmHg and a Glasgow Coma Scale score of 7. What is the priority intervention?

AY. A nurse is educating a patient with hypertension about lifestyle modifications. Which teaching strategy is most effective?

AZ. A patient receiving tPA for an acute ischemic stroke suddenly becomes unresponsive, with a rapid decline in Glasgow Coma Scale. What is the immediate action?

BA. A patient post-stroke is on enteral feeding. During administration, the patient starts coughing and desaturates to 88%. What is the priority nursing action?

BB. A patient with diabetic ketoacidosis is on IV insulin. Potassium is 3.0 mEq/L, and glucose is 190 mg/dL. What is the priority nursing action?

BC. A nurse overhears another staff member making jokes about a patient’s weight. What is the most appropriate response?

BD. A patient with diabetic ketoacidosis has a glucose level of 160 mg/dL, but the anion gap remains elevated. What is the next step?

BE. A patient with acute pancreatitis develops severe abdominal distention, hypotension, and low urine output. Bladder pressure is 26 mmHg. What is the priority intervention?

BF. A patient with ARDS is receiving mechanical ventilation with high FiO₂ and PEEP. Plateau pressures remain elevated, and oxygenation is poor. What is the priority nursing action?

BG. A patient with a traumatic brain injury presents with ICP of 28 mmHg and decreasing level of consciousness. What is the immediate nursing action?

BH. A patient receiving tPA for acute ischemic stroke suddenly becomes unresponsive with unequal pupils. What is the immediate nursing action?

BI. A patient receiving tPA for an ischemic stroke suddenly develops severe headache, hypertension, and decreased consciousness. What is the immediate nursing intervention?

BJ. A patient with ARDS is on mechanical ventilation. Despite optimal settings and sedation, SpO₂ is 80% and PaO₂ is 45 mmHg. What is the next nursing intervention?

BK. During a team huddle, a nurse notices that one colleague consistently interrupts others. What is the most appropriate nursing action?

BL. A patient on mechanical ventilation for ARDS has plateau pressures above 30 cmH₂O despite low tidal volumes. What should the nurse anticipate next?

BM. A patient with ARDS on mechanical ventilation remains hypoxemic despite FiO₂ 100%, PEEP 15, and prone positioning. What is the next step?

BN. A patient with diabetic ketoacidosis is on an insulin infusion. The glucose is 190 mg/dL, and the anion gap remains elevated. What is the next step?

BO. A nurse is caring for a patient who identifies with a different religion. The patient asks if their spiritual leader can visit. What is the most appropriate response?

BP. A patient in septic shock is receiving high doses of norepinephrine. The MAP remains 55 mmHg, and capillary refill is delayed. What is the next intervention?

BQ. A patient with septic shock is receiving fluids and norepinephrine. Despite this, the patient’s lactate remains high, and the extremities are cool and mottled. What is the next step?

BR. A patient with septic shock is on norepinephrine and fluids. Lactate levels remain elevated, and urine output is decreasing. What is the next step?

BS. A patient receiving a massive blood transfusion develops tingling around the mouth and muscle twitching. What is the priority action?

BT. A patient post-craniotomy suddenly develops severe headache, projectile vomiting, and a rapid rise in ICP. What is the priority intervention?

BU. A patient with ARDS is on mechanical ventilation with high FiO₂ and PEEP. Oxygenation is still poor, and plateau pressures are above 30 cmH₂O. What is the priority nursing intervention?

BV. A patient with a traumatic brain injury presents with ICP of 30 mmHg and decreased cerebral perfusion pressure. What is the immediate nursing action?

BW. A patient with a traumatic brain injury has ICP of 32 mmHg and bradycardia with widening pulse pressure. What is the immediate priority intervention?

BX. A patient tells the nurse, “I feel anxious about going home with oxygen therapy.” What is the best nursing response?

BY. A patient with a new tracheostomy becomes visibly anxious when trying to communicate. What is the nurse’s best intervention?

BZ. A patient with ARDS on mechanical ventilation remains hypoxemic despite maximal PEEP and FiO₂. What is the next recommended intervention?

CA. A patient with ARDS on mechanical ventilation remains hypoxemic despite high PEEP and FiO₂ 100%. What is the next intervention?

CB. A nurse witnesses a provider failing to obtain informed consent before a procedure. What should the nurse do first?

CC. A patient with septic shock is on norepinephrine. Despite fluids and vasopressor support, MAP remains 54 mmHg, and urine output is 8 mL/hr. What is the next intervention?

CD. A patient with diabetic ketoacidosis is receiving IV insulin. Glucose is 180 mg/dL, but the anion gap remains elevated. What is the priority nursing action?

CE. A patient with diabetic ketoacidosis is on an insulin infusion. The glucose is 160 mg/dL, the anion gap is still open, and potassium is stable. What is the next step?

CF. A patient with traumatic brain injury presents with ICP of 28 mmHg, bradycardia, and hypertension. What is the immediate priority?

CG. A patient asks for information about advance directives. What is the nurse’s best response?

CH. A patient with ARDS is mechanically ventilated. Despite FiO₂ 100% and PEEP 15 cmH₂O, PaO₂ remains 48 mmHg. What is the next step?

CI. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 170 mg/dL, but the anion gap is still open. Potassium is 3.8 mEq/L. What is the next step?

CJ. A patient states, “I don’t understand why I need to take so many medications.” What is the nurse’s best action?

CK. A patient with diabetic ketoacidosis is on IV insulin. Glucose is 170 mg/dL, but the anion gap remains open. Potassium is 3.5 mEq/L. What is the next step?

CL. A patient with diabetic ketoacidosis is on an insulin drip. Glucose is 165 mg/dL, and the anion gap is still elevated. What is the next step?

CM. A patient recovering from surgery expresses concern about returning home alone. Which action by the nurse best supports safe discharge?

CN. A nurse is discharging a patient who expresses uncertainty about managing complex wound care at home. What is the best nursing action?

CO. A patient with ARDS remains hypoxemic despite FiO₂ 100%, PEEP 15 cmH₂O, and sedation. What should the nurse anticipate next?

CP. A patient with open fractures following a motor vehicle accident develops severe pain, pallor, and decreased pulses in the affected limb. What is the priority action?

CQ. A patient receiving tPA for an acute ischemic stroke develops sudden severe headache and vomiting. What is the priority nursing action?

CR. A patient in septic shock is receiving norepinephrine at the maximum dose, but MAP remains at 55 mmHg. Lactate is elevated, and urine output is 10 mL/hr. What is the priority intervention?

CS. A patient receiving tPA for an acute ischemic stroke develops sudden neurological deterioration and vomiting. What is the immediate nursing intervention?

CT. A patient with septic shock is receiving norepinephrine and vasopressin. Despite therapy, MAP is 55 mmHg and urine output is <15 mL/hr. What is the next step?

CU. A patient receiving tPA for ischemic stroke develops sudden confusion and new-onset headache. What is the priority nursing action?

CV. A patient with a traumatic brain injury has ICP of 32 mmHg and a Glasgow Coma Scale score of 6. What is the priority nursing action?

CW. A patient with a traumatic brain injury has ICP 28 mmHg and is coughing during suctioning. What should the nurse do first?

CX. A patient post-thyroidectomy suddenly develops stridor and difficulty breathing. What is the immediate priority?

CY. A patient with septic shock develops oliguria and rising creatinine despite adequate fluid resuscitation and vasopressors. What is the next nursing action?

CZ. A patient with diabetic ketoacidosis is improving on IV insulin. The glucose is 180 mg/dL, but the anion gap remains elevated. What is the next action?

DA. A patient suddenly develops chest pain, dyspnea, and tachycardia. Oxygen saturation drops to 84% on room air. What is the priority nursing action?

DB. A patient with acute liver failure develops confusion, asterixis, and an ammonia level of 120 mcg/dL. What is the priority nursing intervention?

DC. A patient with septic shock is on norepinephrine and vasopressin. The MAP remains 55 mmHg, and the cardiac index is low. What is the priority action?

DD. A patient on telemetry develops unstable ventricular tachycardia with hypotension and altered mental status. What is the immediate nursing action?

DE. A nurse recognizes that a patient with depression is reluctant to attend physical therapy sessions. What is the nurse’s best action?

DF. A patient with a traumatic brain injury presents with ICP of 30 mmHg and bradycardia, along with irregular respirations. What is the priority intervention?

DG. A patient with acute upper GI bleeding is hypotensive and tachycardic. Two large-bore IV lines are in place. What is the next priority intervention?

DH. A patient with septic shock remains hypotensive despite fluids, norepinephrine, and vasopressin. The cardiac index is low. What is the next step?

DI. A patient with diabetic ketoacidosis is receiving IV insulin. The glucose is 160 mg/dL, but the anion gap has not yet closed. What should the nurse do?

DJ. A patient with septic shock is receiving norepinephrine and fluids. The MAP remains 55 mmHg, and lactate is 5.5 mmol/L. What is the next nursing intervention?

DK. A patient with diabetic ketoacidosis is improving on IV insulin. The glucose is 180 mg/dL, but the anion gap remains open. What is the next step?

DL. A patient in septic shock is on high-dose norepinephrine and vasopressin. MAP remains 55 mmHg, and urine output is 8 mL/hr. What is the next best step?

DM. A patient receiving tPA for an ischemic stroke suddenly develops a severe headache and decreased level of consciousness. What is the priority intervention?

DN. A patient with COPD exacerbation is on BiPAP but becomes increasingly lethargic. ABG shows pH 7.18, PaCO₂ 95 mmHg, and PaO₂ 52 mmHg. What is the priority action?

DO. A patient with septic shock remains hypotensive after 3 liters of crystalloid fluids and norepinephrine at the maximum dose. Cardiac output is low. What is the next step?

DP. A patient post-traumatic brain injury presents with ICP of 30 mmHg and cerebral perfusion pressure of 50 mmHg. What is the priority intervention?

DQ. A family member expresses frustration, saying, “No one tells us what is going on with my father.” What is the nurse’s best response?

DR. A patient with multiple traumatic injuries presents with hypotension, tachycardia, and cool, clammy skin. FAST exam is positive for intra-abdominal bleeding. What is the priority nursing intervention?

DS. A patient with acute inferior myocardial infarction becomes hypotensive after receiving sublingual nitroglycerin. What is the priority action?

DT. A patient’s daughter expresses concern, saying, “I don’t think I can take care of my mother at home.” What is the nurse’s best response?

DU. A patient with ARDS is sedated and mechanically ventilated. Plateau pressures are rising, and lung compliance is worsening. What is the best nursing intervention?