RN Comprehensive Clinical Knowledge
Exam — Code: RN-CK-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with septic shock has received 30 mL/kg of crystalloid. The blood
pressure remains 82/46 mm Hg, and the MAP is 58 mm Hg. Which
intervention should the nurse anticipate next?
A. Administer IV furosemide
B. Initiate norepinephrine infusion
C. Administer oral antihypertensive medication
D. Restrict all IV fluids
Answer: B. Initiate norepinephrine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor therapy. Norepinephrine is the preferred first-line
,vasopressor because it increases vascular tone and supports the MAP without
producing excessive tachycardia.
2. A client with acute pulmonary edema is receiving oxygen and IV
nitroglycerin. Which assessment finding requires the most immediate
intervention?
A. BP 104/68 mm Hg
B. Respiratory rate 32/min with pink frothy sputum
C. Heart rate 108/min
D. Bilateral crackles extending to the mid-lung fields
Answer: B. Respiratory rate 32/min with pink frothy sputum
Rationale: Pink frothy sputum and severe tachypnea indicate worsening
pulmonary edema and impaired gas exchange. Airway and oxygenation take
priority, and the client may require noninvasive or invasive ventilatory support.
3. A client receiving unfractionated heparin for a pulmonary embolism has a
platelet count that decreases from 220,000/mm³ to 96,000/mm³. Which
action is most appropriate?
A. Increase the heparin infusion
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Continue treatment because the platelet count remains above 50,000/mm³
Answer: C. Stop heparin and notify the provider
Rationale: A platelet fall of more than 50% during heparin therapy strongly
suggests heparin-induced thrombocytopenia (HIT). Heparin should be
discontinued immediately, and an alternative non-heparin anticoagulant is
generally required.
4. A client with diabetic ketoacidosis has a potassium level of 3.0 mEq/L
before insulin therapy begins. Which prescription should the nurse
question?
,A. IV regular insulin infusion
B. Continuous cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluid administration
Answer: A. IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can produce life-threatening
hypokalemia. When serum potassium is below 3.3 mEq/L, potassium
replacement is initiated before insulin therapy.
5. A client with acute ischemic stroke suddenly develops decreased level of
consciousness and projectile vomiting several hours after admission. Which
complication should the nurse suspect?
A. Hypoglycemia
B. Increased intracranial pressure
C. Neurogenic bladder
D. Peripheral neuropathy
Answer: B. Increased intracranial pressure
Rationale: A declining level of consciousness with projectile vomiting after
stroke may indicate cerebral edema and increased intracranial pressure.
Immediate neurologic reassessment and escalation of care are required.
6. A client with chronic kidney disease has potassium 6.8 mEq/L and peaked T
waves on ECG. Which prescription should the nurse implement first?
A. Oral sodium-restricted diet
B. IV calcium gluconate
C. Oral potassium-binding resin
D. Fluid restriction
Answer: B. IV calcium gluconate
, Rationale: Severe hyperkalemia with ECG changes is an immediate cardiac
emergency. IV calcium stabilizes the myocardial membrane and reduces the risk
of fatal dysrhythmias while other therapies lower serum potassium.
7. A client receiving digoxin reports nausea and seeing yellow halos around
lights. The apical pulse is 48/min. What should the nurse do?
A. Administer the medication with food
B. Give the next dose early
C. Hold digoxin and notify the provider
D. Encourage increased potassium intake immediately
Answer: C. Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings of digoxin toxicity. The medication should be withheld and the
client evaluated for serum digoxin and electrolyte abnormalities.
8. A client with a traumatic brain injury has BP 178/58 mm Hg, HR 48/min,
and irregular respirations. Which finding is most concerning?
A. Widened pulse pressure
B. Bradycardia
C. Irregular respirations
D. The combination of these findings
Answer: D. The combination of these findings
Rationale: Hypertension with widened pulse pressure, bradycardia, and
abnormal respirations constitutes Cushing's triad, a late and ominous sign of
increased intracranial pressure and possible brain herniation.
9. A client with heart failure taking spironolactone asks which food should be
limited.
A. Apples
B. White rice
Exam — Code: RN-CK-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with septic shock has received 30 mL/kg of crystalloid. The blood
pressure remains 82/46 mm Hg, and the MAP is 58 mm Hg. Which
intervention should the nurse anticipate next?
A. Administer IV furosemide
B. Initiate norepinephrine infusion
C. Administer oral antihypertensive medication
D. Restrict all IV fluids
Answer: B. Initiate norepinephrine infusion
Rationale: Persistent hypotension after adequate fluid resuscitation in septic
shock requires vasopressor therapy. Norepinephrine is the preferred first-line
,vasopressor because it increases vascular tone and supports the MAP without
producing excessive tachycardia.
2. A client with acute pulmonary edema is receiving oxygen and IV
nitroglycerin. Which assessment finding requires the most immediate
intervention?
A. BP 104/68 mm Hg
B. Respiratory rate 32/min with pink frothy sputum
C. Heart rate 108/min
D. Bilateral crackles extending to the mid-lung fields
Answer: B. Respiratory rate 32/min with pink frothy sputum
Rationale: Pink frothy sputum and severe tachypnea indicate worsening
pulmonary edema and impaired gas exchange. Airway and oxygenation take
priority, and the client may require noninvasive or invasive ventilatory support.
3. A client receiving unfractionated heparin for a pulmonary embolism has a
platelet count that decreases from 220,000/mm³ to 96,000/mm³. Which
action is most appropriate?
A. Increase the heparin infusion
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Continue treatment because the platelet count remains above 50,000/mm³
Answer: C. Stop heparin and notify the provider
Rationale: A platelet fall of more than 50% during heparin therapy strongly
suggests heparin-induced thrombocytopenia (HIT). Heparin should be
discontinued immediately, and an alternative non-heparin anticoagulant is
generally required.
4. A client with diabetic ketoacidosis has a potassium level of 3.0 mEq/L
before insulin therapy begins. Which prescription should the nurse
question?
,A. IV regular insulin infusion
B. Continuous cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluid administration
Answer: A. IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can produce life-threatening
hypokalemia. When serum potassium is below 3.3 mEq/L, potassium
replacement is initiated before insulin therapy.
5. A client with acute ischemic stroke suddenly develops decreased level of
consciousness and projectile vomiting several hours after admission. Which
complication should the nurse suspect?
A. Hypoglycemia
B. Increased intracranial pressure
C. Neurogenic bladder
D. Peripheral neuropathy
Answer: B. Increased intracranial pressure
Rationale: A declining level of consciousness with projectile vomiting after
stroke may indicate cerebral edema and increased intracranial pressure.
Immediate neurologic reassessment and escalation of care are required.
6. A client with chronic kidney disease has potassium 6.8 mEq/L and peaked T
waves on ECG. Which prescription should the nurse implement first?
A. Oral sodium-restricted diet
B. IV calcium gluconate
C. Oral potassium-binding resin
D. Fluid restriction
Answer: B. IV calcium gluconate
, Rationale: Severe hyperkalemia with ECG changes is an immediate cardiac
emergency. IV calcium stabilizes the myocardial membrane and reduces the risk
of fatal dysrhythmias while other therapies lower serum potassium.
7. A client receiving digoxin reports nausea and seeing yellow halos around
lights. The apical pulse is 48/min. What should the nurse do?
A. Administer the medication with food
B. Give the next dose early
C. Hold digoxin and notify the provider
D. Encourage increased potassium intake immediately
Answer: C. Hold digoxin and notify the provider
Rationale: Bradycardia, gastrointestinal symptoms, and visual disturbances are
classic findings of digoxin toxicity. The medication should be withheld and the
client evaluated for serum digoxin and electrolyte abnormalities.
8. A client with a traumatic brain injury has BP 178/58 mm Hg, HR 48/min,
and irregular respirations. Which finding is most concerning?
A. Widened pulse pressure
B. Bradycardia
C. Irregular respirations
D. The combination of these findings
Answer: D. The combination of these findings
Rationale: Hypertension with widened pulse pressure, bradycardia, and
abnormal respirations constitutes Cushing's triad, a late and ominous sign of
increased intracranial pressure and possible brain herniation.
9. A client with heart failure taking spironolactone asks which food should be
limited.
A. Apples
B. White rice
