A 62-year-old with hepatitis C cirrhosis develops progressive sleep–wake reversal and difficulty concentrating after missing several doses of lactulose. Exam: disoriented to date, mild icterus, flapping tremor. Vitals: BP 114/70, HR 90, RR 18, SpO₂ 98% RA. Morning labs: serum ammonia 98 µmol/L (elevated), total bilirubin 3.9 mg/dL, albumin 2.8 g/dL, sodium 131 mEq/L, glucose 118 mg/dL. Which abnormality most directly accounts for the current neurologic findings?

A newly admitted adult’s 12-lead ECG is reviewed. Which measured interval requires prompt follow-up?

A 56-year-old male with a history of cirrhosis presents to the emergency department with confusion, jaundice, and abdominal swelling. The client receives lactulose and diuretics. Which findings would NOT be expected if hepatic encephalopathy and decompensation were ongoing? Select all that apply.

A 26-year-old with systemic lupus erythematosus reports 2 weeks of worsening fatigue, morning joint stiffness, and new swelling in both ankles and around the eyes. She notes her urine has looked “foamy.” Vitals: BP 152/92, HR 96, RR 18, afebrile. Which potential complication is the nurse most concerned about?

A patient with RA says, “I’ll wait on methotrexate until the pain gets worse.” What is the nurse’s best response?

A client is 7 days post–orthotopic liver transplant and is taking tacrolimus and high-dose corticosteroids. Which finding is most important for the nurse to report to the provider?

A 55-year-old patient in urgent care reports 2 days of progressive abdominal pain and anorexia. Vitals: T 38.0°C (100.4°F), HR 96, BP 132/76, RR 16. Labs: WBC 13,200/µL. The patient denies vomiting. Which assessment finding would the nurse expect with uncomplicated diverticulitis? Which assessment finding is most consistent with this diagnosis?

A patient is admitted with an acute exacerbation of inflammatory bowel disease (IBD) with frequent loose stools and abdominal cramping. Which nursing action is most appropriate to include in the plan of care?

You are the charge nurse on a 32-bed surgical unit during evening rounds. Several bedside nurses on your unit call with new patient changes. For which situations should you direct the bedside nurse to activate the Rapid Response Team immediately, before routine provider notification? Select all that apply.

A 76-year-old with nonvalvular atrial fibrillation presents with palpitations. Vitals: BP 132/76, HR 124 and irregular, RR 18, SpO2 98% room air. The plan includes preventing thromboembolism and controlling ventricular rate. Drag each medication into its correct therapeutic category.