RN Comprehensive Nursing Competency
Exam — Code: RN-CNC | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
Question 1
A client with septic shock has received 30 mL/kg of isotonic crystalloid. The blood
pressure remains 82/48 mmHg, and the MAP is 59 mmHg. Which intervention
should the nurse anticipate next?
A. Administer IV furosemide
B. Initiate a vasopressor infusion
C. Restrict additional IV fluids
D. Administer oral antihypertensive medication
Answer: Initiate a vasopressor infusion
,Rationale: Persistent hypotension after adequate initial fluid resuscitation in
septic shock requires vasopressor therapy, typically with norepinephrine as the
first-line agent, to restore adequate organ perfusion.
Question 2
A client receiving unfractionated heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ on day 7 of therapy. Which action is the priority?
A. Continue heparin and monitor platelets
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Transfuse platelets immediately
Answer: Stop heparin and notify the provider
Rationale: A platelet fall of more than 50% occurring 5–10 days after heparin
exposure strongly suggests heparin-induced thrombocytopenia (HIT), which
carries a high risk of thrombosis. Heparin should be discontinued and an
alternative anticoagulant anticipated.
Question 3
A client with acute pulmonary edema is severely dyspneic, coughing frothy pink
sputum, and has an oxygen saturation of 78%. Which action should the nurse take
first?
A. Place the client supine
B. Administer prescribed IV morphine
C. Position the client upright and administer oxygen
D. Encourage oral fluids
Answer: Position the client upright and administer oxygen
Rationale: Upright positioning improves lung expansion and reduces venous
return, while supplemental oxygen addresses severe hypoxemia. These
immediate measures take priority over medications.
,Question 4
A client with diabetic ketoacidosis has a serum potassium level of 3.0 mEq/L
before insulin therapy is started. Which intervention is most appropriate?
A. Start IV insulin immediately
B. Administer potassium replacement before insulin
C. Restrict potassium intake
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement before insulin
Rationale: Insulin drives potassium into cells and can produce life-threatening
hypokalemia. When potassium is below 3.3 mEq/L, potassium replacement is
required before insulin is initiated.
Question 5
A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 84%. Which action has the highest priority?
A. Encourage ambulation
B. Apply oxygen and rapidly assess for pulmonary embolism
C. Administer a sedative
D. Place the client in Trendelenburg position
Answer: Apply oxygen and rapidly assess for pulmonary embolism
Rationale: Sudden hypoxemia, pleuritic pain, and tachycardia following surgery
are classic warning signs of pulmonary embolism. Immediate oxygenation and
urgent evaluation are priorities.
Question 6
A client with an acute ischemic stroke develops worsening level of consciousness
and vomiting several hours after admission. Which complication should the nurse
suspect?
, A. Increased intracranial pressure
B. Hypoglycemia only
C. Peripheral neuropathy
D. Fluid volume deficit
Answer: Increased intracranial pressure
Rationale: Declining consciousness and vomiting after an acute stroke may
indicate cerebral edema and increased intracranial pressure, requiring
immediate neurologic reassessment.
Question 7
A client receiving warfarin has an INR of 6.8 and reports no bleeding. Which
intervention is most appropriate?
A. Administer the next warfarin dose
B. Hold warfarin and notify the provider
C. Administer protamine sulfate
D. Encourage foods high in vitamin K immediately
Answer: Hold warfarin and notify the provider
Rationale: An INR of 6.8 represents excessive anticoagulation and substantially
increases bleeding risk. Warfarin should be withheld and the provider notified
for further management.
Question 8
A client with chronic kidney disease has potassium 6.9 mEq/L and peaked T waves
on the ECG. Which prescribed medication should the nurse administer first?
A. Oral potassium chloride
B. IV calcium gluconate
C. Spironolactone
D. Lactated Ringer's solution
Answer: IV calcium gluconate
Exam — Code: RN-CNC | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
Question 1
A client with septic shock has received 30 mL/kg of isotonic crystalloid. The blood
pressure remains 82/48 mmHg, and the MAP is 59 mmHg. Which intervention
should the nurse anticipate next?
A. Administer IV furosemide
B. Initiate a vasopressor infusion
C. Restrict additional IV fluids
D. Administer oral antihypertensive medication
Answer: Initiate a vasopressor infusion
,Rationale: Persistent hypotension after adequate initial fluid resuscitation in
septic shock requires vasopressor therapy, typically with norepinephrine as the
first-line agent, to restore adequate organ perfusion.
Question 2
A client receiving unfractionated heparin develops a platelet count decrease from
220,000/mm³ to 92,000/mm³ on day 7 of therapy. Which action is the priority?
A. Continue heparin and monitor platelets
B. Administer vitamin K
C. Stop heparin and notify the provider
D. Transfuse platelets immediately
Answer: Stop heparin and notify the provider
Rationale: A platelet fall of more than 50% occurring 5–10 days after heparin
exposure strongly suggests heparin-induced thrombocytopenia (HIT), which
carries a high risk of thrombosis. Heparin should be discontinued and an
alternative anticoagulant anticipated.
Question 3
A client with acute pulmonary edema is severely dyspneic, coughing frothy pink
sputum, and has an oxygen saturation of 78%. Which action should the nurse take
first?
A. Place the client supine
B. Administer prescribed IV morphine
C. Position the client upright and administer oxygen
D. Encourage oral fluids
Answer: Position the client upright and administer oxygen
Rationale: Upright positioning improves lung expansion and reduces venous
return, while supplemental oxygen addresses severe hypoxemia. These
immediate measures take priority over medications.
,Question 4
A client with diabetic ketoacidosis has a serum potassium level of 3.0 mEq/L
before insulin therapy is started. Which intervention is most appropriate?
A. Start IV insulin immediately
B. Administer potassium replacement before insulin
C. Restrict potassium intake
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement before insulin
Rationale: Insulin drives potassium into cells and can produce life-threatening
hypokalemia. When potassium is below 3.3 mEq/L, potassium replacement is
required before insulin is initiated.
Question 5
A postoperative client suddenly develops dyspnea, pleuritic chest pain,
tachycardia, and oxygen saturation of 84%. Which action has the highest priority?
A. Encourage ambulation
B. Apply oxygen and rapidly assess for pulmonary embolism
C. Administer a sedative
D. Place the client in Trendelenburg position
Answer: Apply oxygen and rapidly assess for pulmonary embolism
Rationale: Sudden hypoxemia, pleuritic pain, and tachycardia following surgery
are classic warning signs of pulmonary embolism. Immediate oxygenation and
urgent evaluation are priorities.
Question 6
A client with an acute ischemic stroke develops worsening level of consciousness
and vomiting several hours after admission. Which complication should the nurse
suspect?
, A. Increased intracranial pressure
B. Hypoglycemia only
C. Peripheral neuropathy
D. Fluid volume deficit
Answer: Increased intracranial pressure
Rationale: Declining consciousness and vomiting after an acute stroke may
indicate cerebral edema and increased intracranial pressure, requiring
immediate neurologic reassessment.
Question 7
A client receiving warfarin has an INR of 6.8 and reports no bleeding. Which
intervention is most appropriate?
A. Administer the next warfarin dose
B. Hold warfarin and notify the provider
C. Administer protamine sulfate
D. Encourage foods high in vitamin K immediately
Answer: Hold warfarin and notify the provider
Rationale: An INR of 6.8 represents excessive anticoagulation and substantially
increases bleeding risk. Warfarin should be withheld and the provider notified
for further management.
Question 8
A client with chronic kidney disease has potassium 6.9 mEq/L and peaked T waves
on the ECG. Which prescribed medication should the nurse administer first?
A. Oral potassium chloride
B. IV calcium gluconate
C. Spironolactone
D. Lactated Ringer's solution
Answer: IV calcium gluconate
