RN Clinical Judgment & Prioritization
Competency Exam — Code: RN-CJ-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. The RN receives handoff on four clients. Which client should the RN assess
first?
A. A client with heart failure who has 2+ bilateral ankle edema
B. A client with COPD whose oxygen saturation is 91% on prescribed oxygen
C. A client 6 hours after thyroidectomy who develops inspiratory stridor
D. A client with diabetes whose blood glucose is 68 mg/dL and is awake
Answer: The client 6 hours after thyroidectomy who develops inspiratory stridor
Rationale: Inspiratory stridor after thyroid surgery indicates possible airway
obstruction from edema or hematoma and requires immediate intervention.
Airway threats take priority over the other findings.
, 2. A client with sepsis has received IV fluids and antibiotics. The blood
pressure remains 82/48 mm Hg, urine output is 15 mL/hr, and lactate is
increasing. What is the priority nursing action?
A. Place the client in a high-Fowler position
B. Notify the provider and prepare for vasopressor therapy
C. Restrict fluids to prevent pulmonary edema
D. Administer an oral antipyretic
Answer: Notify the provider and prepare for vasopressor therapy
Rationale: Persistent hypotension and worsening tissue perfusion despite fluid
resuscitation suggest septic shock. Vasopressor support may be required to
restore adequate mean arterial pressure and organ perfusion.
3. A client with acute ischemic stroke suddenly becomes drowsy and develops
unequal pupils. What should the RN do first?
A. Reassess the client's Glasgow Coma Scale in 30 minutes
B. Administer the prescribed oral antiplatelet medication
C. Activate urgent neurologic evaluation and assess the airway
D. Place the client in Trendelenburg position
Answer: Activate urgent neurologic evaluation and assess the airway
Rationale: Acute deterioration in level of consciousness with anisocoria may
indicate increased intracranial pressure or cerebral herniation. Immediate
neurologic and airway assessment is essential.
4. Four clients require reassessment. Which finding requires immediate
intervention?
A. Potassium 3.3 mEq/L in a client receiving diuretics
B. Respiratory rate 8/min in a client receiving IV opioid medication
C. Temperature 38.2°C in a client with pneumonia
D. Hemoglobin 9.2 g/dL after orthopedic surgery
Answer: Respiratory rate 8/min in a client receiving IV opioid medication
,Rationale: Significant opioid-induced respiratory depression can rapidly progress
to respiratory arrest. Airway and breathing take priority.
5. A client with diabetic ketoacidosis has a potassium level of 2.8 mEq/L
before insulin therapy is started. Which action is most appropriate?
A. Start the insulin infusion immediately
B. Administer potassium replacement as prescribed before insulin
C. Restrict IV fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement as prescribed before insulin
Rationale: Insulin shifts potassium intracellularly and can worsen severe
hypokalemia, increasing the risk of life-threatening dysrhythmias.
6. A client receiving a blood transfusion develops fever, chills, flank pain, and
hypotension. What is the priority action?
A. Slow the transfusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen and continue the transfusion
D. Flush the blood tubing with additional blood
Answer: Stop the transfusion immediately
Rationale: These findings suggest an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately to prevent further exposure.
7. A client with chest pain has ST-segment elevation on the ECG and
diaphoresis. Which intervention has the highest priority?
A. Obtain a routine lipid panel
B. Prepare the client for urgent reperfusion therapy
C. Encourage ambulation
D. Schedule a routine echocardiogram
Answer: Prepare the client for urgent reperfusion therapy
, Rationale: ST-segment elevation with ischemic symptoms indicates an acute
coronary occlusion requiring rapid reperfusion to minimize myocardial injury.
8. A postoperative client becomes restless, tachycardic, and hypotensive. The
surgical dressing is saturated with blood. What should the RN do first?
A. Reinforce the dressing and assess the client's circulation
B. Document the amount of drainage at the end of the shift
C. Administer the scheduled analgesic
D. Encourage oral fluids
Answer: Reinforce the dressing and assess the client's circulation
Rationale: The findings suggest postoperative hemorrhage and possible
hypovolemic shock. Immediate assessment and control of bleeding are
priorities.
9. A client with asthma has received repeated bronchodilator treatments but
remains unable to speak in complete sentences and has minimal air
movement. What does the RN recognize?
A. Expected improvement
B. Impending respiratory failure
C. Mild anxiety
D. Medication intolerance only
Answer: Impending respiratory failure
Rationale: Minimal air movement, inability to speak normally, and persistent
distress indicate severe airway obstruction and possible respiratory failure.
10.Which client should the RN see first?
A. A client with chronic kidney disease and a creatinine of 3.1 mg/dL
B. A client with atrial fibrillation and a heart rate of 138/min with hypotension
C. A client with osteoarthritis reporting pain of 7/10
D. A client with stable cirrhosis and mild ascites
Competency Exam — Code: RN-CJ-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. The RN receives handoff on four clients. Which client should the RN assess
first?
A. A client with heart failure who has 2+ bilateral ankle edema
B. A client with COPD whose oxygen saturation is 91% on prescribed oxygen
C. A client 6 hours after thyroidectomy who develops inspiratory stridor
D. A client with diabetes whose blood glucose is 68 mg/dL and is awake
Answer: The client 6 hours after thyroidectomy who develops inspiratory stridor
Rationale: Inspiratory stridor after thyroid surgery indicates possible airway
obstruction from edema or hematoma and requires immediate intervention.
Airway threats take priority over the other findings.
, 2. A client with sepsis has received IV fluids and antibiotics. The blood
pressure remains 82/48 mm Hg, urine output is 15 mL/hr, and lactate is
increasing. What is the priority nursing action?
A. Place the client in a high-Fowler position
B. Notify the provider and prepare for vasopressor therapy
C. Restrict fluids to prevent pulmonary edema
D. Administer an oral antipyretic
Answer: Notify the provider and prepare for vasopressor therapy
Rationale: Persistent hypotension and worsening tissue perfusion despite fluid
resuscitation suggest septic shock. Vasopressor support may be required to
restore adequate mean arterial pressure and organ perfusion.
3. A client with acute ischemic stroke suddenly becomes drowsy and develops
unequal pupils. What should the RN do first?
A. Reassess the client's Glasgow Coma Scale in 30 minutes
B. Administer the prescribed oral antiplatelet medication
C. Activate urgent neurologic evaluation and assess the airway
D. Place the client in Trendelenburg position
Answer: Activate urgent neurologic evaluation and assess the airway
Rationale: Acute deterioration in level of consciousness with anisocoria may
indicate increased intracranial pressure or cerebral herniation. Immediate
neurologic and airway assessment is essential.
4. Four clients require reassessment. Which finding requires immediate
intervention?
A. Potassium 3.3 mEq/L in a client receiving diuretics
B. Respiratory rate 8/min in a client receiving IV opioid medication
C. Temperature 38.2°C in a client with pneumonia
D. Hemoglobin 9.2 g/dL after orthopedic surgery
Answer: Respiratory rate 8/min in a client receiving IV opioid medication
,Rationale: Significant opioid-induced respiratory depression can rapidly progress
to respiratory arrest. Airway and breathing take priority.
5. A client with diabetic ketoacidosis has a potassium level of 2.8 mEq/L
before insulin therapy is started. Which action is most appropriate?
A. Start the insulin infusion immediately
B. Administer potassium replacement as prescribed before insulin
C. Restrict IV fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement as prescribed before insulin
Rationale: Insulin shifts potassium intracellularly and can worsen severe
hypokalemia, increasing the risk of life-threatening dysrhythmias.
6. A client receiving a blood transfusion develops fever, chills, flank pain, and
hypotension. What is the priority action?
A. Slow the transfusion rate
B. Stop the transfusion immediately
C. Administer acetaminophen and continue the transfusion
D. Flush the blood tubing with additional blood
Answer: Stop the transfusion immediately
Rationale: These findings suggest an acute hemolytic transfusion reaction. The
transfusion must be stopped immediately to prevent further exposure.
7. A client with chest pain has ST-segment elevation on the ECG and
diaphoresis. Which intervention has the highest priority?
A. Obtain a routine lipid panel
B. Prepare the client for urgent reperfusion therapy
C. Encourage ambulation
D. Schedule a routine echocardiogram
Answer: Prepare the client for urgent reperfusion therapy
, Rationale: ST-segment elevation with ischemic symptoms indicates an acute
coronary occlusion requiring rapid reperfusion to minimize myocardial injury.
8. A postoperative client becomes restless, tachycardic, and hypotensive. The
surgical dressing is saturated with blood. What should the RN do first?
A. Reinforce the dressing and assess the client's circulation
B. Document the amount of drainage at the end of the shift
C. Administer the scheduled analgesic
D. Encourage oral fluids
Answer: Reinforce the dressing and assess the client's circulation
Rationale: The findings suggest postoperative hemorrhage and possible
hypovolemic shock. Immediate assessment and control of bleeding are
priorities.
9. A client with asthma has received repeated bronchodilator treatments but
remains unable to speak in complete sentences and has minimal air
movement. What does the RN recognize?
A. Expected improvement
B. Impending respiratory failure
C. Mild anxiety
D. Medication intolerance only
Answer: Impending respiratory failure
Rationale: Minimal air movement, inability to speak normally, and persistent
distress indicate severe airway obstruction and possible respiratory failure.
10.Which client should the RN see first?
A. A client with chronic kidney disease and a creatinine of 3.1 mg/dL
B. A client with atrial fibrillation and a heart rate of 138/min with hypotension
C. A client with osteoarthritis reporting pain of 7/10
D. A client with stable cirrhosis and mild ascites
