A 58-year-old male presents to the progressive care unit after cardiac catheterization for an NSTEMI. His troponin I was 4.2 ng/mL on admission. Which electrocardiographic finding is most consistent with NSTEMI rather than STEMI?

A patient with unstable angina is admitted to the progressive care unit. The nurse understands that the primary difference between unstable angina and NSTEMI is which of the following?

A 58-year-old patient with sepsis develops bilateral pulmonary infiltrates, a PaO2/FiO2 ratio of 180, and requires mechanical ventilation. PEEP is set at 6 cmH2O. Based on the Berlin Definition, how would this patient’s ARDS be classified?

A nurse is initiating lung-protective ventilation for a patient with severe ARDS. What tidal volume target is recommended to reduce ventilator-induced lung injury?

A 28-year-old with type 1 diabetes presents with nausea, vomiting, and abdominal pain. Blood glucose is 420 mg/dL, pH 7.22, bicarbonate 12 mEq/L, and serum ketones are large. Which finding is most consistent with the diagnosis of diabetic ketoacidosis?

A nurse is caring for a patient receiving IV insulin infusion for DKA. The blood glucose drops from 280 mg/dL to 200 mg/dL. Which action is the priority at this time?

A progressive care nurse reviews labs for a 68-year-old woman admitted with fatigue and dyspnea on exertion. Hemoglobin is 7.2 g/dL, MCV 72 fL, serum ferritin 6 ng/mL, and TIBC is elevated. Which type of anemia do these findings most strongly indicate?

A 54-year-old man with stage IV colon cancer on chemotherapy has a hemoglobin of 7.8 g/dL and reports dizziness with ambulation. His cardiologist has documented stable coronary artery disease with a recent EF of 50 percent. He is hemodynamically stable. Which trigger most appropriately guides the decision to transfuse packed red blood cells in this patient?

A 68-year-old patient in the progressive care unit develops sudden confusion and agitation at 2200. She was alert and oriented this morning. Which assessment finding most strongly suggests delirium rather than dementia?

A nurse is assessing a 74-year-old man 18 hours after elective hip replacement. He is pulling at his IV line, speaking to people who are not present, and alternating between agitation and somnolence. His oxygen saturation is 94 percent on 2 L per minute nasal cannula and a bladder scan shows 550 mL of retained urine. Which intervention should the nurse prioritize first?

A patient with a small bowel obstruction has a nasogastric tube to low intermittent suction outputting 1,200 mL over 8 hours. Which electrolyte and acid-base disturbance is the nurse most likely to find on the next laboratory draw?

A patient returns to the progressive care unit after abdominal surgery. On postoperative day 3, the patient has hypoactive bowel sounds, mild abdominal distension, and has not yet passed flatus, but has no fever, no severe pain, and stable vital signs. Which intervention should the nurse anticipate first?

A 58-year-old patient develops oliguria after receiving IV contrast for a CT scan. Serum creatinine rises from 1.0 mg/dL to 1.6 mg/dL within 48 hours. Which classification of acute kidney injury does this presentation represent?

A critically ill patient develops AKI with a urine sodium of 62 mEq/L, urine osmolality of 290 mOsm/kg, and a fractional excretion of sodium (FeNa) of 3.2%. These findings are most consistent with which etiology?

A 42-year-old male is admitted to the progressive care unit following open reduction and internal fixation of a tibial shaft fracture. Six hours postoperatively, he reports pain rated 9/10 that is unrelieved by IV morphine. Assessment reveals the right lower leg is tense, the foot is pale, and passive dorsiflexion of the toes produces severe pain. Which action should the nurse take first?

A progressive care nurse is monitoring a 55-year-old woman with a crush injury to her right forearm. Compartment pressures are measured and the diastolic blood pressure is 78 mmHg. Which compartment pressure reading is the threshold that warrants immediate surgical consultation for fasciotomy?

A critically ill patient with terminal cancer has a valid do-not-resuscitate (DNR) order. The patient experiences a sudden cardiac arrest. Which action by the nurse is most appropriate?

A 78-year-old patient with end-stage COPD is receiving comfort-focused care. The family asks the nurse why morphine is being given when the patient has not complained of pain. Which response by the nurse is most accurate?

A progressive care nurse is caring for a 58-year-old man admitted overnight after an acute myocardial infarction. He is visibly tense, repeatedly asking when he can go home, and states, ‘I feel like something terrible is about to happen.’ His vital signs are HR 108, BP 148/90, RR 20, SpO2 97 percent on 2 L nasal cannula. Which intervention is the highest priority at this time?

A 66-year-old woman with COPD is admitted during an acute exacerbation. Despite bronchodilators and supplemental oxygen bringing her SpO2 to 94 percent, she remains extremely distressed, gripping the bed rails and stating, ‘I cannot breathe, I am dying.’ The team has verified her oxygenation is adequate. What is the most appropriate next step for her persistent anxiety?

A patient with end-stage heart failure who retains decision-making capacity tells the nurse she wants to stop all aggressive treatments and transition to comfort-focused care, but her adult children insist the team “do everything.” What is the nurse’s primary advocacy role in this situation?

A progressive care nurse overhears a colleague using derogatory language to ridicule a patient who has a high body mass index, while no patient or family member is present. Which action best reflects moral agency?

During a handoff, a progressive care nurse states: ‘Based on the heart rate staying between 110 and 130 despite the metoprolol I gave at 1400, I think this patient’s atrial fibrillation is not yet rate-controlled and may need a different agent.’ Which element of the SBAR framework is the nurse demonstrating with this statement?

During a bedside shift report, the oncoming progressive care nurse notices the outgoing nurse does not mention the patient’s current code status or advance directive. What is the most appropriate action?