A. A patient with septic shock remains hypotensive (MAP 50 mmHg) despite norepinephrine at maximum dose. Lactate is rising, urine output is <10 mL/hr. What should the nurse anticipate?

B. A patient with type 1 diabetes is found unresponsive with glucose of 28 mg/dL. IV access is unavailable. What is the immediate nursing action?

C. A patient with traumatic brain injury suddenly develops unilateral pupil dilation, hypertension, and bradycardia. ICP monitor shows 40 mmHg. What is the immediate nursing action?

D. During interdisciplinary rounds, a respiratory therapist raises a concern about ventilator settings, but the physician dismisses it. What should the nurse do?

E. A patient with pneumonia and sepsis remains hypotensive despite fluid resuscitation. Norepinephrine infusion is started, but MAP remains 52 mmHg. What is the next nursing intervention?

F. A patient with COPD says, “I’m afraid I won’t be able to manage at home alone.” What is the nurse’s best response?

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

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

I. A patient with type 1 diabetes presents with Kussmaul respirations, abdominal pain, and blood glucose 480 mg/dL. Labs: pH 7.20, HCO₃⁻ 12 mEq/L, positive ketones. What is the immediate nursing action?

J. A patient with Addison’s disease presents with severe hypotension, abdominal pain, sodium 120 mEq/L, and potassium 6.9 mEq/L. What is the nurse’s priority action?

K. A patient with anterior STEMI suddenly develops pulmonary edema, hypotension, and a new systolic murmur at the apex. What is the nurse’s immediate action?

L. A patient becomes tearful after hearing that their treatment is no longer effective. What is the most appropriate nursing action?

M. A patient with anterior STEMI suddenly develops acute shortness of breath, hypotension, and a new loud systolic murmur at the apex. What is the nurse’s immediate action?

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

O. A nurse receives a new assignment that includes four patients, one of whom requires immediate post-op monitoring. What is the nurse’s best initial step?

P. A nurse overhears a colleague mocking a patient’s religious beliefs. What is the most appropriate nursing action?

Q. A patient with decompensated cirrhosis and portal hypertension presents with hematemesis. Despite fluids and octreotide, bleeding continues. What is the next intervention?

R. A patient with Addison’s disease is admitted with severe hypotension, sodium 118 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing action?

S. A patient with terminal cancer says, “I don’t want any further treatment.” What should the nurse do first?

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

U. A nurse witnesses a provider starting a procedure without explaining it to the patient. What is the nurse’s priority action?

V. A patient with anterior STEMI suddenly develops new-onset pulmonary edema, hypotension, and a systolic murmur at the apex. What is the priority nursing action?

W. A patient with cirrhosis presents with hematemesis. Octreotide infusion is ongoing, but bleeding persists. What is the next nursing intervention?

X. A patient with Addison’s disease presents with severe hypotension, confusion, and sodium 124 mEq/L. What is the immediate nursing intervention?

Y. A patient with severe asthma exacerbation becomes silent on auscultation, with minimal chest movement and SpO₂ 82% despite oxygen. What is the priority nursing action?

Z. A patient with severe COPD exacerbation is receiving continuous nebulized bronchodilators. The patient becomes drowsy, with PaCO₂ 88 mmHg and PaO₂ 50 mmHg. What is the priority nursing action?

AA. A patient with multiple fractures develops sudden confusion, dyspnea, and a petechial rash on the chest. SpO₂ is 78% despite oxygen. What is the priority nursing action?

AB. A nurse observes a staff member ignoring a patient’s request for assistance. What is the best nursing action?

AC. A patient with a tibia fracture reports severe pain out of proportion to the injury, numbness, and pallor in the leg. Passive stretch worsens the pain. What is the priority nursing action?

AD. A patient with new-onset heart failure says, “I’m overwhelmed with all these changes.” What is the nurse’s best response?

AE. A patient with anterior STEMI develops sudden severe hypotension, crackles, and S3 gallop. What is the nurse’s priority intervention?

AF. A patient with end-stage kidney disease says, “I don’t want to continue dialysis.” What should the nurse do first?

AG. A patient with septic shock is on norepinephrine with improved MAP. However, lactate remains elevated and mottled extremities persist. Cardiac index is normal, but ScvO₂ is low. What is the next intervention?

AH. A patient with pneumonia is receiving oxygen by mask. ABG: pH 7.28, PaCO₂ 65 mmHg, PaO₂ 52 mmHg. The patient is lethargic. What is the priority nursing action?

AI. A patient says, “I don’t understand why I need so many lab tests after discharge.” What is the nurse’s best response?

AJ. A patient with advanced renal failure develops K⁺ 7.0 mEq/L, ECG showing wide QRS, and muscle weakness. What is the priority nursing intervention?

AK. A patient with ARDS is on mechanical ventilation with FiO₂ 100% and PEEP 18 cmH₂O. PaO₂ remains 46 mmHg. What should the nurse anticipate?

AL. A patient with severe pancreatitis develops fever, hypotension, and leukocytosis. CT shows necrosis. What is the priority nursing intervention?

AM. A caregiver says, “I feel like I can’t keep up with my partner’s care.” What is the nurse’s best response?

AN. A nurse overhears a physician dismissing a patient’s concerns about pain. What is the most appropriate action?

AO. A patient with acute kidney injury due to sepsis develops K⁺ 7.2 mEq/L, wide QRS complexes, and peaked T waves on ECG. What is the priority nursing action?

AP. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 120 mEq/L, and potassium 6.8 mEq/L. What is the immediate nursing action?

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

AR. A patient with severe hypothyroidism is admitted with hypothermia, bradycardia, and altered mental status. What is the priority nursing action?

AS. A patient with Addison’s disease presents with confusion, sodium 118 mEq/L, potassium 6.8 mEq/L, and severe hypotension. What is the nurse’s immediate action?

AT. A patient with subdural hematoma develops sudden anisocoria (unequal pupils), bradycardia, and hypertension. ICP is 36 mmHg. What is the nurse’s immediate action?

AU. A patient with type 1 diabetes is found unresponsive, glucose 35 mg/dL, IV access unavailable. What is the immediate nursing action?

AV. A patient with decompensated cirrhosis undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and dizzy. What is the next nursing intervention?

AW. A patient with an acute MI suddenly develops hypotension, clear lungs, and jugular venous distension. What is the nurse’s immediate intervention?

AX. A patient with myxedema coma presents with hypothermia, bradycardia, and confusion. What is the nurse’s immediate action?

AY. A trauma patient with multiple fractures suddenly develops confusion, dyspnea, and a petechial rash on the chest. SpO₂ is 80% despite oxygen. What is the priority nursing action?

AZ. A patient recovering from surgery says, “I feel anxious about going home so soon.” What is the nurse’s best response?

BA. A patient with a femur fracture reports severe pain unrelieved by opioids, pallor, and paresthesia. Pain increases with passive movement. What is the priority nursing action?

BB. A patient with a femur fracture develops sudden confusion, dyspnea, and a petechial rash on the chest. SpO₂ is 78% despite oxygen. What is the nurse’s immediate action?

BC. A patient with septic shock remains hypotensive (MAP 50 mmHg) despite norepinephrine. Lactate is rising, urine output is minimal, and cardiac index is low. What should the nurse anticipate?

BD. A patient with septic shock is receiving norepinephrine. Despite improved MAP, lactate remains elevated and mottled extremities persist. Cardiac index is normal, but ScvO₂ is low. What is the next intervention?

BE. A patient with cirrhosis presents with hematemesis and hypotension. Octreotide is infusing, but bleeding persists. What is the next intervention?

BF. A patient with an inferior MI develops bradycardia at 28 bpm, hypotension, and dizziness. Atropine has no effect. What is the nurse’s immediate action?

BG. A patient with septic shock has received 30 mL/kg IV fluids. MAP remains 50 mmHg despite norepinephrine infusion. Cardiac index is low, and ScvO₂ is 45%. What should the nurse anticipate?

BH. A patient with cirrhosis and portal hypertension develops hematemesis and hypotension. Octreotide infusion is ongoing, but bleeding persists. What is the next intervention?

BI. A patient with septic shock is on norepinephrine with MAP improved to 65 mmHg. However, lactate remains elevated and mottled extremities persist. Cardiac index is normal, but ScvO₂ is low. What is the next nursing intervention?

BJ. A patient with decompensated cirrhosis is receiving lactulose but continues to have confusion and asterixis. Ammonia is 185 µmol/L. What is the next nursing action?

BK. A patient with severe pneumonia is on high-flow oxygen. ABG: pH 7.23, PaCO₂ 68 mmHg, PaO₂ 48 mmHg. The patient is increasingly somnolent. What is the priority nursing action?

BL. A patient’s spouse says, “I don’t think I can keep caring for my partner at home.” What is the nurse’s best response?

BM. A patient with decompensated cirrhosis and massive ascites develops shortness of breath and hypotension after paracentesis. What is the next nursing intervention?

BN. A trauma patient with femur fracture reports severe leg pain unrelieved by opioids, with pallor and decreased sensation. Passive stretch worsens the pain. What is the priority nursing intervention?

BO. A patient with septic shock remains hypotensive despite fluids and norepinephrine. MAP is 50 mmHg, cardiac index is low, ScvO₂ is 44%. What is the appropriate nursing intervention?

BP. A patient preparing for discharge after a stroke says, “I’m worried I won’t be able to handle things at home.” What is the nurse’s best response?

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

BR. A patient with chronic kidney disease develops K⁺ 6.9 mEq/L, muscle weakness, and peaked T waves on ECG. What is the immediate nursing action?

BS. A patient with Addison’s disease develops severe hypotension, hyponatremia, and hyperkalemia after missing steroid doses. What is the immediate nursing action?

BT. A patient with cirrhosis and ascites undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and tachycardic. What is the next nursing intervention?

BU. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP is 39 mmHg. What is the nurse’s immediate action?

BV. A patient with septic shock has received 30 mL/kg IV fluids. MAP is 48 mmHg despite norepinephrine infusion. Urine output is <15 mL/hr, lactate is rising. What is the next nursing intervention?

BW. A patient with cirrhosis undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and tachycardic. What is the next nursing action?

BX. A patient with ARDS is on mechanical ventilation: FiO₂ 100%, PEEP 18 cmH₂O. PaO₂ remains 48 mmHg, plateau pressures are stable. What is the next appropriate nursing intervention?

BY. A patient with subarachnoid hemorrhage becomes acutely confused, hypertensive, and develops pupillary changes. What is the immediate nursing intervention?

BZ. A patient with decompensated cirrhosis develops confusion, tremors, and ammonia 185 µmol/L despite lactulose therapy. What should the nurse anticipate next?

CA. A patient with end-stage renal disease develops chest pain, dyspnea, and a pericardial friction rub. Potassium is 7.0 mEq/L. What should the nurse anticipate?

CB. A trauma patient with multiple long-bone fractures develops sudden dyspnea, confusion, and a petechial rash on the chest. SpO₂ is 80% despite oxygen. What is the nurse’s priority action?

CC. A patient with myxedema coma presents with hypothermia, bradycardia, and confusion. What is the nurse’s priority intervention?

CD. A patient with an inferior MI develops bradycardia at 28 bpm, hypotension, and dizziness. Atropine has no effect. What is the nurse’s next action?

CE. A patient asks, “Why do I need to keep wearing this sling?” What is the nurse’s best response?

CF. A patient with pneumonia is on high-flow oxygen. ABG: pH 7.28, PaCO₂ 68 mmHg, PaO₂ 48 mmHg. The patient is increasingly somnolent. What is the priority nursing action?

CG. A patient with acute kidney injury develops K⁺ 7.3 mEq/L, wide QRS complexes, and muscle weakness. IV calcium gluconate has already been given. What is the next intervention?

CH. A patient with anterior STEMI suddenly develops hypotension, pulmonary edema, and a new harsh systolic murmur at the left sternal border. What is the priority nursing action?

CI. A patient with cirrhosis is receiving lactulose but remains confused with ammonia 185 µmol/L. What is the next nursing intervention?

CJ. A patient with traumatic brain injury develops sudden bradycardia, hypertension, and irregular respirations. ICP is 42 mmHg. What is the immediate nursing action?

CK. A patient with severe asthma exacerbation is receiving continuous nebulized bronchodilators. The patient becomes increasingly drowsy, with PaCO₂ 78 mmHg. What is the priority nursing intervention?

CL. A patient becomes tearful when discussing the burden their illness places on family. What is the most appropriate nursing action?

CM. A patient with an anterior STEMI develops sudden chest pain, hypotension, and a new loud systolic murmur at the left sternal border. What is the nurse’s priority action?

CN. A patient with traumatic brain injury develops bradycardia, hypertension, and irregular respirations. ICP monitor shows 40 mmHg. What is the priority nursing action?

CO. A patient with cirrhosis undergoes large-volume paracentesis. Shortly after, the patient becomes hypotensive and dizzy. What is the next nursing action?

CP. A patient with chronic kidney disease develops pericardial friction rub, dyspnea, and rising BUN/creatinine. What should the nurse anticipate?

CQ. A patient with traumatic brain injury develops unequal pupils, hypertension, and bradycardia. ICP is 38 mmHg. What is the nurse’s immediate action?

CR. A patient with septic shock is on norepinephrine. MAP is 65 mmHg, but mottled extremities and elevated lactate persist. Cardiac index is normal, ScvO₂ is low. What is the next intervention?

CS. A patient with pneumonia is receiving high-flow oxygen. ABG: pH 7.25, PaCO₂ 70 mmHg, PaO₂ 50 mmHg. The patient is increasingly somnolent. What is the next nursing intervention?

CT. A patient with severe COPD exacerbation is receiving high-flow oxygen. ABG: pH 7.22, PaCO₂ 82 mmHg, PaO₂ 48 mmHg. The patient is lethargic. What is the priority nursing intervention?

CU. During a rapid response event, a nurse notices a colleague skipping critical steps in the resuscitation protocol. What is the nurse’s best action?

CV. A patient with a subarachnoid hemorrhage develops sudden severe headache, vomiting, and new pupillary dilation. What is the immediate nursing action?

CW. A patient with subarachnoid hemorrhage suddenly develops new-onset confusion, pupillary dilation, and hypertension. What is the priority nursing action?

CX. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 120 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing action?

CY. A patient with end-stage renal disease develops dyspnea, chest pain, and a pericardial friction rub. Potassium is 6.8 mEq/L. What should the nurse anticipate?

CZ. A patient with type 1 diabetes presents with confusion, diaphoresis, and a glucose of 42 mg/dL. IV access is not available. What is the immediate nursing action?

DA. A patient with acute kidney injury has potassium 7.1 mEq/L, peaked T waves, and muscle weakness. IV calcium gluconate has already been administered. What is the next nursing intervention?

DB. A patient with acute kidney injury develops confusion, pericardial rub, BUN 95 mg/dL, creatinine 7.2 mg/dL. What should the nurse anticipate?

DC. A patient with Addison’s disease presents with confusion, severe hypotension, sodium 118 mEq/L, and potassium 6.9 mEq/L. What is the immediate nursing action?

DD. A patient with subarachnoid hemorrhage develops sudden severe headache, hypertension, and unequal pupils. What is the nurse’s immediate intervention?

DE. A patient with Addison’s disease develops severe hypotension, abdominal pain, and K⁺ 6.5 mEq/L. What is the immediate nursing intervention?

DF. A patient with a femur fracture develops severe leg pain unrelieved by opioids, pallor, and paresthesia. Passive stretch increases the pain. What is the nurse’s priority intervention?

DG. A patient with septic shock has received fluids and norepinephrine. MAP is 60 mmHg, but lactate remains high and urine output is <10 mL/hr. Cardiac index is low. What should the nurse anticipate?

DH. A nurse observes a staff member rushing a patient through medication teaching without confirming understanding. What is the best action?

DI. A patient with end-stage renal disease reports chest pain and dyspnea. Pericardial friction rub is noted, and potassium is 6.8 mEq/L. What should the nurse anticipate?

DJ. A patient with end-stage renal disease on dialysis develops pericardial friction rub, chest pain, and hypotension. What should the nurse anticipate?

DK. A nurse overhears a colleague making fun of a patient’s dietary restrictions. What is the most appropriate nursing action?

DL. A patient with COPD suddenly develops unilateral chest pain, absent breath sounds on the right, and SpO₂ 78%. What is the priority nursing action?

DM. A nurse discovers a medication error after administering the wrong dose. What is the priority nursing action?

DN. A patient with an inferior wall MI develops bradycardia, hypotension, and dizziness. ECG shows complete heart block. What is the nurse’s priority intervention?

DO. A patient with pneumonia and sepsis has received fluids and norepinephrine. MAP is now 60 mmHg, but lactate remains elevated and mottled extremities persist. Cardiac index is low. What should the nurse anticipate?

DP. A trauma patient with a tibia fracture develops severe pain unrelieved by opioids, pallor, and paresthesia in the limb. Passive stretch worsens the pain. What is the priority nursing action?

DQ. A patient with Addison’s disease is admitted with severe hypotension, sodium 118 mEq/L, and potassium 6.7 mEq/L. What is the priority nursing action?

DR. A patient with severe pneumonia develops refractory hypoxemia despite high FiO₂ and PEEP. Plateau pressures remain within safe limits. What should the nurse anticipate?

DS. A patient with cirrhosis is receiving lactulose but remains confused with ammonia 190 µmol/L. What is the next appropriate nursing action?

DT. A patient with ARDS is on mechanical ventilation with FiO₂ 90% and PEEP 16 cmH₂O. PaO₂ remains 48 mmHg. Plateau pressures are safe. What should the nurse anticipate?

DU. A patient with a subarachnoid hemorrhage suddenly becomes confused, hypertensive, and develops unequal pupils. What is the nurse’s priority action?