RN Clinical Competency Assessment —
Code: RN-CCA | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A postoperative client develops sudden dyspnea, pleuritic chest pain, HR
128/min, RR 32/min, and oxygen saturation of 86%. Which action should
the RN take first?
A. Obtain a 12-lead ECG
B. Apply supplemental oxygen
C. Encourage coughing and deep breathing
D. Administer prescribed IV morphine
Answer: Apply supplemental oxygen
Rationale: The client has signs of acute hypoxemia and possible pulmonary
embolism. Supporting oxygenation is the immediate priority while activating
further emergency evaluation and treatment.
, 2. A client with septic shock remains hypotensive after receiving an
appropriate crystalloid bolus. Which medication would the RN anticipate
administering first to support blood pressure?
A. Furosemide
B. Norepinephrine
C. Metoprolol
D. Nitroglycerin
Answer: Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension
associated with septic shock after adequate fluid resuscitation.
3. A client receiving a continuous unfractionated heparin infusion has an aPTT
significantly above the therapeutic range and develops bleeding from the
gums. What is the priority nursing action?
A. Increase the infusion rate
B. Hold the heparin infusion
C. Administer aspirin
D. Encourage increased oral fluid intake
Answer: Hold the heparin infusion
Rationale: Excessive anticoagulation with active bleeding requires immediate
interruption of heparin and prompt provider notification for further
management.
4. A client with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L
before insulin therapy is started. Which intervention is most appropriate?
A. Start the insulin infusion immediately
B. Administer potassium replacement before insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: Administer potassium replacement before insulin
,Rationale: Insulin shifts potassium intracellularly and can cause life-threatening
hypokalemia. When potassium is severely low, potassium must be replaced
before insulin is initiated.
5. A client with acute ischemic stroke suddenly becomes more lethargic 2
hours after receiving thrombolytic therapy. Which assessment is the
priority?
A. Bowel sounds
B. Neurologic status and signs of intracranial bleeding
C. Peripheral pulses
D. Urinary output
Answer: Neurologic status and signs of intracranial bleeding
Rationale: Sudden neurologic deterioration after thrombolytic therapy may
indicate intracranial hemorrhage, a life-threatening complication requiring
immediate evaluation.
6. A client with severe asthma has increasing respiratory distress and
suddenly develops markedly diminished breath sounds. How should the RN
interpret this finding?
A. The client is improving
B. Bronchodilator therapy is no longer necessary
C. Severe airflow obstruction may be worsening
D. Anxiety is resolving
Answer: Severe airflow obstruction may be worsening
Rationale: A nearly silent chest in severe asthma can indicate critically reduced
airflow and impending respiratory failure rather than improvement.
7. A client receiving IV potassium chloride reports severe burning at the IV
site. What should the RN do first?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
, C. Apply a heating pad and continue the infusion
D. Flush rapidly with saline
Answer: Stop the infusion and assess the IV site
Rationale: IV potassium is highly irritating and extravasation or infiltration can
cause significant tissue injury. The infusion should be stopped and the site
assessed immediately.
8. A client with heart failure has crackles, severe dyspnea, pink frothy sputum,
and oxygen saturation of 82%. Which intervention has the highest priority?
A. Place the client supine
B. Position the client upright and provide oxygen
C. Encourage oral fluids
D. Administer a sedative
Answer: Position the client upright and provide oxygen
Rationale: These findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while oxygen supports severe hypoxemia.
9. A client receiving digoxin has nausea, visual disturbances, and an apical
pulse of 48/min. What should the RN do?
A. Administer the medication
B. Hold digoxin and notify the provider
C. Give an additional dose
D. Administer a beta blocker
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia and visual or gastrointestinal disturbances are classic
manifestations of possible digoxin toxicity.
10.A client with a central venous catheter suddenly develops dyspnea and
chest pain during catheter manipulation. Which complication should the RN
suspect?
Code: RN-CCA | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A postoperative client develops sudden dyspnea, pleuritic chest pain, HR
128/min, RR 32/min, and oxygen saturation of 86%. Which action should
the RN take first?
A. Obtain a 12-lead ECG
B. Apply supplemental oxygen
C. Encourage coughing and deep breathing
D. Administer prescribed IV morphine
Answer: Apply supplemental oxygen
Rationale: The client has signs of acute hypoxemia and possible pulmonary
embolism. Supporting oxygenation is the immediate priority while activating
further emergency evaluation and treatment.
, 2. A client with septic shock remains hypotensive after receiving an
appropriate crystalloid bolus. Which medication would the RN anticipate
administering first to support blood pressure?
A. Furosemide
B. Norepinephrine
C. Metoprolol
D. Nitroglycerin
Answer: Norepinephrine
Rationale: Norepinephrine is a first-line vasopressor for persistent hypotension
associated with septic shock after adequate fluid resuscitation.
3. A client receiving a continuous unfractionated heparin infusion has an aPTT
significantly above the therapeutic range and develops bleeding from the
gums. What is the priority nursing action?
A. Increase the infusion rate
B. Hold the heparin infusion
C. Administer aspirin
D. Encourage increased oral fluid intake
Answer: Hold the heparin infusion
Rationale: Excessive anticoagulation with active bleeding requires immediate
interruption of heparin and prompt provider notification for further
management.
4. A client with diabetic ketoacidosis has a serum potassium of 2.8 mEq/L
before insulin therapy is started. Which intervention is most appropriate?
A. Start the insulin infusion immediately
B. Administer potassium replacement before insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: Administer potassium replacement before insulin
,Rationale: Insulin shifts potassium intracellularly and can cause life-threatening
hypokalemia. When potassium is severely low, potassium must be replaced
before insulin is initiated.
5. A client with acute ischemic stroke suddenly becomes more lethargic 2
hours after receiving thrombolytic therapy. Which assessment is the
priority?
A. Bowel sounds
B. Neurologic status and signs of intracranial bleeding
C. Peripheral pulses
D. Urinary output
Answer: Neurologic status and signs of intracranial bleeding
Rationale: Sudden neurologic deterioration after thrombolytic therapy may
indicate intracranial hemorrhage, a life-threatening complication requiring
immediate evaluation.
6. A client with severe asthma has increasing respiratory distress and
suddenly develops markedly diminished breath sounds. How should the RN
interpret this finding?
A. The client is improving
B. Bronchodilator therapy is no longer necessary
C. Severe airflow obstruction may be worsening
D. Anxiety is resolving
Answer: Severe airflow obstruction may be worsening
Rationale: A nearly silent chest in severe asthma can indicate critically reduced
airflow and impending respiratory failure rather than improvement.
7. A client receiving IV potassium chloride reports severe burning at the IV
site. What should the RN do first?
A. Increase the infusion rate
B. Stop the infusion and assess the IV site
, C. Apply a heating pad and continue the infusion
D. Flush rapidly with saline
Answer: Stop the infusion and assess the IV site
Rationale: IV potassium is highly irritating and extravasation or infiltration can
cause significant tissue injury. The infusion should be stopped and the site
assessed immediately.
8. A client with heart failure has crackles, severe dyspnea, pink frothy sputum,
and oxygen saturation of 82%. Which intervention has the highest priority?
A. Place the client supine
B. Position the client upright and provide oxygen
C. Encourage oral fluids
D. Administer a sedative
Answer: Position the client upright and provide oxygen
Rationale: These findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while oxygen supports severe hypoxemia.
9. A client receiving digoxin has nausea, visual disturbances, and an apical
pulse of 48/min. What should the RN do?
A. Administer the medication
B. Hold digoxin and notify the provider
C. Give an additional dose
D. Administer a beta blocker
Answer: Hold digoxin and notify the provider
Rationale: Bradycardia and visual or gastrointestinal disturbances are classic
manifestations of possible digoxin toxicity.
10.A client with a central venous catheter suddenly develops dyspnea and
chest pain during catheter manipulation. Which complication should the RN
suspect?
