RN Fundamentals Competency Exam —
Code: RN-FUND-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A postoperative client suddenly develops dyspnea, tachycardia, pleuritic
chest pain, and an oxygen saturation of 86% on room air. Which action
should the nurse take first?
A. Obtain a prescription for a CT pulmonary angiogram
B. Encourage the client to ambulate
C. Apply oxygen and assess respiratory status
D. Administer the prescribed opioid
Answer: C. Apply oxygen and assess respiratory status
Rationale: Hypoxemia and acute respiratory compromise take priority under the
ABC framework. Oxygen should be applied while the nurse rapidly assesses the
,client's airway, breathing, circulation, and need for emergency intervention.
Diagnostic testing and other interventions should not delay stabilization.*
2. A nurse is preparing to administer medication through a nasogastric tube.
Which action is most appropriate before administration?
A. Mix all medications together
B. Verify tube placement according to agency policy
C. Add medication directly to the enteral feeding
D. Crush enteric-coated tablets
Answer: B. Verify tube placement according to agency policy
Rationale: Correct tube placement should be confirmed before medication
administration to reduce the risk of pulmonary aspiration or ineffective
delivery. Medications should generally be administered separately, and enteric-
coated or extended-release formulations should not be crushed.
3. A client with dysphagia following a stroke is prescribed oral medications.
Which finding requires the nurse to intervene immediately?
A. The client requests water with medication
B. The client has a wet, gurgling voice after swallowing
C. The client prefers medication in applesauce
D. The client takes medications slowly
Answer: B. The client has a wet, gurgling voice after swallowing
Rationale: A wet or gurgling voice after swallowing may indicate aspiration or
impaired airway protection. The nurse should stop oral intake and initiate
appropriate aspiration precautions and further evaluation.
4. A client receiving IV potassium chloride reports burning at the infusion site.
The nurse observes swelling and coolness around the catheter. What is the
priority action?
A. Slow the infusion
B. Apply pressure over the catheter
,C. Stop the infusion and assess the IV site
D. Flush the catheter with normal saline
Answer: C. Stop the infusion and assess the IV site
Rationale: Pain, swelling, and coolness suggest IV infiltration. Potassium is
particularly irritating to tissue, so the infusion must be stopped promptly to
prevent further tissue injury.
5. A client with a central venous catheter suddenly develops shortness of
breath and chest pain during catheter manipulation. Which complication
should the nurse suspect?
A. Fluid overload
B. Air embolism
C. Hypoglycemia
D. Pulmonary edema
Answer: B. Air embolism
Rationale: Sudden respiratory distress and chest pain associated with central-
line manipulation can indicate an air embolism. The nurse should immediately
stop the source of air entry, position the client according to emergency protocol,
administer oxygen, and notify the appropriate provider or rapid response team.
6. A nurse is caring for an older adult who is confused and repeatedly
attempts to get out of bed. Which intervention is best initially?
A. Apply wrist restraints
B. Administer a sedative
C. Identify and address reversible causes of confusion
D. Keep the client isolated in the room
Answer: C. Identify and address reversible causes of confusion
Rationale: Acute confusion may result from hypoxia, infection, medications,
dehydration, metabolic abnormalities, pain, or urinary retention. The nurse
, should first assess and correct reversible causes while implementing the least
restrictive safety measures.
7. A client is at high risk for falls. Which intervention is most appropriate?
A. Keep all four side rails raised
B. Place the call light within reach
C. Keep the room completely dark at night
D. Encourage the client to walk independently
Answer: B. Place the call light within reach
Rationale: Keeping the call light accessible promotes assistance before the client
attempts to ambulate. Four side rails may constitute a restraint and should not
routinely be used as a fall-prevention measure.
8. A nurse discovers that a client received another client's medication. What
should the nurse do first?
A. Complete an incident report
B. Notify the pharmacy
C. Assess the client for adverse effects
D. Document the error in the medical record
Answer: C. Assess the client for adverse effects
Rationale: The immediate priority after a medication error is client safety. The
nurse should assess the client, determine potential effects, notify the
appropriate provider and pharmacy according to policy, and complete required
reporting and documentation.
9. Which assessment finding is most concerning in a client receiving opioid
analgesia?
A. Respiratory rate of 8/min
B. Pain rating of 5/10
C. Mild nausea
D. Blood pressure of 138/82 mm Hg
Code: RN-FUND-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A postoperative client suddenly develops dyspnea, tachycardia, pleuritic
chest pain, and an oxygen saturation of 86% on room air. Which action
should the nurse take first?
A. Obtain a prescription for a CT pulmonary angiogram
B. Encourage the client to ambulate
C. Apply oxygen and assess respiratory status
D. Administer the prescribed opioid
Answer: C. Apply oxygen and assess respiratory status
Rationale: Hypoxemia and acute respiratory compromise take priority under the
ABC framework. Oxygen should be applied while the nurse rapidly assesses the
,client's airway, breathing, circulation, and need for emergency intervention.
Diagnostic testing and other interventions should not delay stabilization.*
2. A nurse is preparing to administer medication through a nasogastric tube.
Which action is most appropriate before administration?
A. Mix all medications together
B. Verify tube placement according to agency policy
C. Add medication directly to the enteral feeding
D. Crush enteric-coated tablets
Answer: B. Verify tube placement according to agency policy
Rationale: Correct tube placement should be confirmed before medication
administration to reduce the risk of pulmonary aspiration or ineffective
delivery. Medications should generally be administered separately, and enteric-
coated or extended-release formulations should not be crushed.
3. A client with dysphagia following a stroke is prescribed oral medications.
Which finding requires the nurse to intervene immediately?
A. The client requests water with medication
B. The client has a wet, gurgling voice after swallowing
C. The client prefers medication in applesauce
D. The client takes medications slowly
Answer: B. The client has a wet, gurgling voice after swallowing
Rationale: A wet or gurgling voice after swallowing may indicate aspiration or
impaired airway protection. The nurse should stop oral intake and initiate
appropriate aspiration precautions and further evaluation.
4. A client receiving IV potassium chloride reports burning at the infusion site.
The nurse observes swelling and coolness around the catheter. What is the
priority action?
A. Slow the infusion
B. Apply pressure over the catheter
,C. Stop the infusion and assess the IV site
D. Flush the catheter with normal saline
Answer: C. Stop the infusion and assess the IV site
Rationale: Pain, swelling, and coolness suggest IV infiltration. Potassium is
particularly irritating to tissue, so the infusion must be stopped promptly to
prevent further tissue injury.
5. A client with a central venous catheter suddenly develops shortness of
breath and chest pain during catheter manipulation. Which complication
should the nurse suspect?
A. Fluid overload
B. Air embolism
C. Hypoglycemia
D. Pulmonary edema
Answer: B. Air embolism
Rationale: Sudden respiratory distress and chest pain associated with central-
line manipulation can indicate an air embolism. The nurse should immediately
stop the source of air entry, position the client according to emergency protocol,
administer oxygen, and notify the appropriate provider or rapid response team.
6. A nurse is caring for an older adult who is confused and repeatedly
attempts to get out of bed. Which intervention is best initially?
A. Apply wrist restraints
B. Administer a sedative
C. Identify and address reversible causes of confusion
D. Keep the client isolated in the room
Answer: C. Identify and address reversible causes of confusion
Rationale: Acute confusion may result from hypoxia, infection, medications,
dehydration, metabolic abnormalities, pain, or urinary retention. The nurse
, should first assess and correct reversible causes while implementing the least
restrictive safety measures.
7. A client is at high risk for falls. Which intervention is most appropriate?
A. Keep all four side rails raised
B. Place the call light within reach
C. Keep the room completely dark at night
D. Encourage the client to walk independently
Answer: B. Place the call light within reach
Rationale: Keeping the call light accessible promotes assistance before the client
attempts to ambulate. Four side rails may constitute a restraint and should not
routinely be used as a fall-prevention measure.
8. A nurse discovers that a client received another client's medication. What
should the nurse do first?
A. Complete an incident report
B. Notify the pharmacy
C. Assess the client for adverse effects
D. Document the error in the medical record
Answer: C. Assess the client for adverse effects
Rationale: The immediate priority after a medication error is client safety. The
nurse should assess the client, determine potential effects, notify the
appropriate provider and pharmacy according to policy, and complete required
reporting and documentation.
9. Which assessment finding is most concerning in a client receiving opioid
analgesia?
A. Respiratory rate of 8/min
B. Pain rating of 5/10
C. Mild nausea
D. Blood pressure of 138/82 mm Hg
