Introduction
Scenario setup A client with asthma reports worsening wheeze and chest tightness after a viral illness. RR 30/min, HR 110/min, SpO₂ 90% on RA. You observe suprasternal retractions and inability to complete sentences. This suggests moderate-to-severe bronchospasm with hypoxemia. RPN responsibilities center on assessment, timely collaboration, and safe administration of ordered therapies. Traps: delaying notification, minimizing retractions, or independent medication changes. This case-study format is intentional: boards reward trajectory thinking—what changed, what is unstable, and what you do next for the role named in the stem. For REx-PN (Canada), read the assignment line before you eliminate answers. Slow read: re-scan the stem for vitals trends, oxygen settings, allergies, and time since onset—case items often hide the decisive clue in a single line. On the exam, writers often pair stable-sounding options with unstable data—notice the mismatch before you commit. If the stem names a license or role, reread that line; are classic trap answers even when the clinical topic is familiar. Run a : breathing work and oxygenation, perfusion and end organs, neuro baseline, likely infection sources, and...