Adult Nursing

A 58-year-old with crushing chest pain arrives to the ED. What is the highest-priority initial nursing action?

A patient with acute pulmonary edema is dyspneic, SpO₂ 86% RA, pink frothy sputum. Best first nursing action?

A patient with a chest tube to water-seal has continuous bubbling in the water-seal chamber. What should you do?

A chest tube accidentally comes out. Priority immediate action?

A COPD patient on room air has SpO₂ 88% with mild distress. Target saturation?

Post-op patient suddenly develops pleuritic chest pain, dyspnea, tachycardia. First nursing action?

DKA is diagnosed. What is the priority initial therapy?

ECG shows tall peaked T waves in a patient with renal failure. Priority medication to stabilize myocardium?

SIADH is suspected after head injury: Na 122 mmol/L, low serum osmolality, concentrated urine. First-line management?

Central diabetes insipidus post-pituitary surgery: copious dilute urine, high serum Na. Nursing priority?

Suspected upper GI bleed with hypotension. Which immediate nursing action is best?

Acute pancreatitis with severe epigastric pain radiating to back. Initial nursing management?

A patient with suspected appendicitis reports sudden relief of pain followed by fever. Best response?

Post-op day 1 after abdominal surgery: low-grade fever, crackles, shallow breathing. Highest-yield nursing action?

New AKI with oliguria after dehydration. Which order do you anticipate?

CKD patient has hyperphosphatemia and low calcium. Key daily intervention?

Febrile neutropenia (ANC 300/µL) at 38.6°C. Nursing priority?

Septic shock with MAP 58 despite fluids. Highest-priority nursing action now?

Anaphylaxis after IV antibiotic starts. First medication?

Sudden unilateral facial droop and aphasia 45 minutes ago. Priority nursing step?

After stroke, before giving oral meds or food, what must be done?

PACU patient shivering and hypothermic. Best nursing intervention?

Adult burns ~40% TBSA, 80 kg. Using Parkland (4 mL/kg/%TBSA), how much fluid in first 8 hours?

Suspected compartment syndrome after tibial fracture cast. Priority action?

DVT prevention for post-op patient?

Community-acquired pneumonia; which nursing step should occur before first antibiotic dose if feasible?

ARDS on ventilator with refractory hypoxemia. Nurse anticipates which adjunct?

Suspected acute MI in triage. Which medication is most time-critical if not contraindicated?

Patient with chronic alcohol use has torsades de pointes risk due to low magnesium. Priority treatment?

C. difficile colitis with severe diarrhea after broad-spectrum antibiotics. Key nursing action?

Acute upper GI bleed with hematemesis; which lab is most urgent to review trend-wise?

Hyperthyroid crisis (thyroid storm): fever, tachycardia, agitation. First nursing priorities?

Heart failure patient on furosemide develops muscle cramps and PVCs. Likely electrolyte issue?

Post-op ileus with abdominal distention and nausea. Nursing priority?

COPD exacerbation ABG: pH 7.30, PaCO₂ 60 mmHg, HCO₃⁻ 28 mEq/L. Interpretation?

Acute PE confirmed; which position optimizes oxygenation immediately?

Cirrhosis with tense ascites and dyspnea. Best nursing intervention now?

NSTEMI on heparin infusion; which lab monitors anticoagulation?

New onset confusion, fever, neck stiffness in adult. Which isolation on arrival?

Patient with severe sepsis receives 30 mL/kg crystalloid. Next target to assess perfusion?

A patient with suspected STEMI arrives with chest pain 45 minutes onset. What is the immediate nursing priority?

A COPD patient on 2 L/min NC has rising PaCO₂ and somnolence. Best immediate action?

A patient with suspected pulmonary embolism suddenly becomes hypotensive and tachycardic. First nursing step?

DKA: glucose 520 mg/dL, K⁺ 5.4 mmol/L, pH 7.18. Nursing priority before insulin?

HHS vs DKA distinction most characteristic?

New rapid atrial fibrillation (HR 160) with hypotension and altered mentation. Priority nursing action?

A patient on warfarin has INR 8.2 without bleeding. Best nursing action per typical protocol?

Severe sepsis after pneumonia; lactate 5.2 mmol/L. Initial fluid bolus?

Overt upper GI bleed with hematemesis. Which order should the nurse implement first?

Acute pancreatitis pain radiating to back; amylase/lipase elevated. Priority nursing interventions?

Post-op day 2 with temperature 38.2°C and crackles. Nursing priority?

CKD with pruritus and hyperphosphatemia. What medication timing is essential?

New neuro deficit 30 minutes ago—aphasia and hemiparesis. Nursing priority?

Community-acquired pneumonia starting IV antibiotics. What should be done before first dose if feasible?

Chest tube to water-seal shows continuous bubbling in the water-seal chamber. Nursing action?

Chest tube dislodged at bedside. First step?

Patient with decompensated heart failure has crackles and 4+ edema. Priority assessment?

Hyperkalemia (K⁺ 7.0 mmol/L) with peaked T waves. Immediate stabilization?

Possible adrenal crisis: hypotension, hyponatremia, hyperkalemia. Nursing priority?

Patient with GI bleed on warfarin and hypotension. Best product to anticipate besides RBCs?

Acute stroke with BP 210/115, no tPA planned yet. What is appropriate BP goal initially?

Status asthmaticus with silent chest and fatigue. Priority nursing action?

Febrile neutropenia ANC 200/µL. Which room/precaution is appropriate?

Suspected spinal cord compression in cancer patient: new leg weakness, urinary retention. First nursing action?

AKI with K⁺ 6.8 and EKG changes despite medical therapy. Anticipated treatment?

Suspected meningococcal meningitis in ED. First infection-control step?

Decompensated cirrhosis with confusion and asterixis. Which medication is expected?

Torsades de pointes on monitor. What is first-line medication?

Suspected perforated peptic ulcer: sudden severe pain, rigid abdomen. Nursing priority?

Anaphylaxis after contrast: stridor, hypotension. Immediate drug and route?

Patient with DVT started on heparin infusion. Which lab guides titration?

Acute decompensated HF with pink frothy sputum. Positioning?

Hyperthyroidism with thyroid storm risk. Which symptom cluster alerts the nurse?

Acute cholecystitis classic sign?

Alcohol withdrawal 12 hours after last drink: tremors, anxiety, tachycardia. Anticipated medication?

Acute kidney injury with fluid overload and crackles. Which order to question?

New-onset confusion and pinpoint pupils after unknown ingestion. Anticipated reversal?

Heat stroke: temp 41°C, altered mental status. Priority nursing action?

Hypoglycemia in NPO patient on insulin: diaphoretic, confused, BG 2.4 mmol/L (43 mg/dL). First intervention?

Acute gout flare in CKD stage 4. Which medication is most appropriate?

A 72-year-old with new-onset atrial fibrillation is hemodynamically stable (BP 128/78). What is the initial priority?

In chronic SIADH with Na 118 mmol/L, what is the safe maximum sodium correction within 24 hours?

A patient with cirrhosis and confusion has ammonia elevation. Which nursing intervention is key?

A 66-year-old with COPD exacerbation has ABG: pH 7.28, PaCO₂ 58, HCO₃⁻ 26. Interpretation?

A 45-year-old with suspected bacterial meningitis arrives. What infection control is needed immediately?

A 58-year-old with chest pain has ST elevation in II, III, aVF. Which complication needs close monitoring?

A dialysis patient arrives with K⁺ 7.1 mmol/L and wide QRS. First medication to stabilize the myocardium?

A 64-year-old with sepsis after UTI has MAP 58 after 30 mL/kg fluids. Next step?

A 70-year-old with CHF on furosemide develops cramps and frequent PVCs. Likely electrolyte issue?

A 55-year-old with severe RUQ pain and positive Murphy sign likely has what condition?

A 62-year-old with hematemesis is hypotensive. Which initial action is best?

A 49-year-old with DKA: glucose 520 mg/dL, K⁺ 5.4 mmol/L. First therapy?

A 67-year-old with pneumonia is starting antibiotics. What should be done first if feasible?

A 72-year-old post-op day 1 has shallow breaths and crackles. Highest-yield nursing action?

A 60-year-old with suspected PE becomes acutely hypoxemic. Best initial position?

A patient with chronic alcohol use has prolonged QT and torsades. First-line drug?

A 48-year-old with thyroid storm presents with fever and severe tachycardia. Nursing priorities?

A 63-year-old with suspected spinal cord compression reports new weakness and urinary retention. Action?

A chest tube on water seal shows continuous bubbling in the water-seal chamber. Next step?

A 58-year-old with NSTEMI on UF heparin needs lab monitoring. Which test guides titration?

A 76-year-old with suspected stroke 40 minutes ago arrives. Nursing priority?

A 59-year-old with DVT is on heparin infusion. The nurse should avoid which action?

A 65-year-old with COPD has target SpO₂ range of 88–92%. Why?

A 72-year-old with AKI from dehydration is oliguric. Anticipated order?

A 50-year-old with perforated peptic ulcer is suspected. Priority nursing management?

A 69-year-old septic patient has lactate 5.5 mmol/L. What best indicates improving perfusion?

A 62-year-old with cirrhosis and tense ascites is dyspneic. Helpful immediate action?

A 56-year-old post-op ileus has distention and nausea. Nursing priority?

A 58-year-old on warfarin has INR 8.2 without bleeding. Nursing action?

A 35-year-old with anaphylaxis after antibiotic dose has stridor and hypotension. First drug?

A 72-year-old with CHF is started on furosemide. What daily nursing measurement is most useful?

A 66-year-old with HHS has severe dehydration and glucose 980 mg/dL. Distinguishing feature vs DKA?

A 59-year-old with suspected compartment syndrome after cast placement reports pain out of proportion. What to do?

A 68-year-old with GI bleed on warfarin is hypotensive. Besides PRBCs, what product may be needed?

A 71-year-old post-op has DVT risk. Best nursing prevention bundle?

A 52-year-old with pancreatitis asks for food. What diet order is expected initially?

A 64-year-old with pneumonia develops sepsis. What initial fluid is recommended?

A 70-year-old with COPD has chronic CO₂ retention and somnolence at SpO₂ 100% on NRB. What to do?

A 58-year-old with upper GI bleed needs transfusion. Which endpoint best indicates adequate resuscitation?

A 61-year-old with severe asthma has “silent chest” and fatigue despite bronchodilators. Nursing action?

In suspected ACS, which finding is a contraindication to giving sublingual nitroglycerin?

A patient with symptomatic Mobitz II heart block (HR 34, hypotension). Best immediate step?

A patient has severe symptomatic hyponatremia (Na 112) with seizures. Initial therapy?

DKA with K⁺ 2.8 mmol/L is diagnosed. What precedes insulin?

COPD exacerbation with hypercapnic acidosis (pH 7.28, PaCO₂ 60). Best ventilatory support?

Massive hematemesis in cirrhosis suggests variceal bleed. Priority bundle?

Acute pancreatitis patient develops perioral tingling and carpal spasm with BP cuff. What sign?

Using CURB-65 for pneumonia severity, which score suggests admission?

Fresh tracheostomy (<7 days) becomes dislodged. Safe immediate action?

Hot, swollen monoarthritis with fever. Best diagnostic step first?

Hyperkalemia needs serum K⁺ lowering (after cardiac stabilization). Best rapid measure?

Candidate for IV alteplase in ischemic stroke has BP 198/112. Next step?

New DVT is suspected in a swollen, tender calf. Key nursing precaution?

Acute ischemic stroke on arrival. Optimal head positioning?

Suspected Guillain–Barré with rising weakness. What bedside measure predicts need for intubation?

Tension pneumothorax signs appear (hypotension, tracheal shift). Immediate nursing action?

Adult partial-thickness burns ~25% TBSA, 70 kg. Parkland first 8-hour volume?

ABG: pH 7.28, PaCO₂ 30, HCO₃⁻ 14. Interpretation?

Clostridioides difficile isolation requires which cleaning approach?

Severe epistaxis after trauma with suspected facial fractures. First step?

Heart failure self-care teaching includes which key restriction?

ACE inhibitor is started; K⁺ rises to 5.9 mmol/L. Nursing action?

Chest tube to water-seal suddenly stops tidaling. First check?

Suspected PE with absolute anticoagulation contraindication (active intracranial bleed). Likely plan?

Patient with HHS is profoundly dehydrated and lethargic. Nursing priority?

Anion gap calculation: Na 140, Cl 100, HCO₃⁻ 18. What is the gap?

Suspected meningococcal meningitis in triage. First infection-control step?

Snakebite to lower leg shortly after hiking. Prehospital/ED nursing measure?

Acute angle-closure glaucoma suspicion (severe eye pain, halos). Nursing priority?

NSTEMI patient on heparin develops platelets 55,000 with thrombosis. Concern?

End-stage COPD with CO₂ narcosis becomes very somnolent. Immediate step?

Large ischemic stroke, now NPO. What prevents aspiration pneumonia?

Septic shock persists after fluids; norepinephrine started. What MAP target?

Chronic liver disease with coagulopathy needs paracentesis. Pre-procedure check?

Patient with suspected cauda equina (saddle anesthesia, urinary retention). Nursing priority?

Hospitalized diabetic on basal-bolus regimen is NPO for procedure. Best insulin plan?

Atrial flutter with rapid ventricular response; patient stable. First medication class?

Rhabdomyolysis after crush injury: dark urine, CK >20,000. Priority fluid?

Clotting reversal for life-threatening bleeding on warfarin. Expected meds?

Patient with COPD and pneumonia is confused with PaO₂ 52 mmHg on room air. First nursing action?

A 64-year-old with severe sepsis remains hypotensive after 30 mL/kg crystalloids. Best next step?

Patient with ACS has aspirin allergy (anaphylaxis). Antiplatelet alternative to give now?

COPD exacerbation: pH 7.25, PaCO₂ 68, somnolent. Best immediate support?

Upper GI bleed on arrival: HR 122, BP 86/52, cool clammy skin. Priority nursing action?

New-onset AFib, stable. Which lab abnormality can precipitate it and should be checked?

Chronic liver disease with hematemesis. Which prophylaxis lowers infection and mortality?

DKA therapy started. Potassium now 3.1 mmol/L before insulin infusion. What to do?

Patient with PE on heparin develops platelets 48,000 with new clot. Likely diagnosis?

Severe community-acquired pneumonia: when are corticosteroids appropriate?

Status epilepticus (ongoing >5 min). First-line medication?

Suspected aortic dissection with tearing chest/back pain and unequal BPs. Initial nursing priority?

Acute ischemic stroke candidate for tPA. Required door-to-needle window typically?

Hyperosmolar hyperglycemic state (HHS) key distinguishing feature vs DKA?

TIA symptoms resolved. Highest-priority education to reduce early stroke risk?

Hyponatremia due to SIADH. Core nursing fluid order to anticipate?

Patient with septic shock starts norepinephrine. Central-line extravasation suspected. Antidote?

Rapid regular wide-complex tachycardia, unstable (hypotensive). Immediate step?

Acute diverticulitis with localized LLQ pain, afebrile, no peritonitis. Nursing diet plan initially?

Tumor lysis syndrome after chemotherapy: K⁺ 6.2, uric acid high, Cr rising. Priority nursing action?

Post-thyroidectomy patient develops stridor and voice changes. Priority?

Cirrhosis with ascites on spironolactone develops K⁺ 6.0 mmol/L. Nursing action?

Acute gout flare with CKD stage 4. Best analgesic strategy?

Mechanical valve on warfarin with GI bleed. Reversal strategy now?

Community MRSA skin abscess with systemic signs. Initial nursing intervention?

Myasthenic crisis: worsening weakness, respiratory distress. Nursing priority?

Alcohol withdrawal 24 hours after last drink: tremor, agitation, tachycardia. First-line?

New DVT on heparin develops sudden pleuritic chest pain and dyspnea. First nursing action?

Acute pancreatitis: which lab trend best reflects severity/complications?

Torsades de pointes seen on monitor with syncope. First medication?

Post-op patient with sudden dyspnea and pleuritic pain: suspected PE. What diagnostic test is typical first-line in stable patients?