RN Medication Administration
Competency Exam — Code: RN-MED-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1.
A nurse is preparing to administer digoxin to an older adult with heart failure. The
patient's apical pulse is 54/min, potassium is 3.1 mEq/L, and the patient reports
nausea and seeing yellow halos. What is the nurse's priority action?
A. Administer the medication with food
B. Recheck the pulse in 30 minutes
C. Withhold digoxin and notify the provider
D. Administer potassium after giving digoxin
Answer: Withhold digoxin and notify the provider
Rationale: Bradycardia, hypokalemia, nausea, and visual disturbances are
concerning for digoxin toxicity. The medication should be withheld and the
provider notified promptly.
,2.
A patient receiving IV vancomycin develops flushing, erythema of the face and
neck, and pruritus during the infusion. The blood pressure is stable. Which action
is most appropriate?
A. Increase the infusion rate
B. Administer the next dose immediately
C. Stop or slow the infusion and notify the provider; assess the patient
D. Permanently discontinue all antibiotics
Answer: Stop or slow the infusion and notify the provider; assess the patient
Rationale: Rapid vancomycin infusion can cause an infusion reaction commonly
called vancomycin infusion reaction. Slowing or stopping the infusion and
assessing the patient are appropriate.
3.
A patient taking warfarin has an INR of 5.8 without active bleeding. Which
intervention should the nurse anticipate?
A. Administer the scheduled warfarin dose
B. Hold warfarin and notify the provider for further management
C. Administer protamine sulfate
D. Encourage increased vitamin K intake immediately
Answer: Hold warfarin and notify the provider for further management
Rationale: An INR of 5.8 represents excessive anticoagulation. Warfarin should
generally be held while the provider determines whether additional treatment,
such as vitamin K, is indicated. Protamine reverses heparin, not warfarin.
4.
A patient receiving heparin has a platelet count that has fallen from 220,000/mm³
to 92,000/mm³ several days after therapy began. What should the nurse suspect?
,A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Heparin-induced thrombocytopenia
D. Vitamin K deficiency
Answer: Heparin-induced thrombocytopenia
Rationale: A substantial platelet decline after exposure to heparin is highly
concerning for HIT, a potentially life-threatening prothrombotic condition.
Heparin should be stopped and the provider notified immediately.
5.
A patient receiving IV potassium chloride has a prescription for potassium
chloride 40 mEq IV push. What should the nurse do?
A. Administer it slowly over 10 minutes
B. Dilute it in 5 mL of sterile water
C. Question the prescription because potassium chloride must never be
administered IV push
D. Administer it through a central line by IV push
Answer: Question the prescription because potassium chloride must never be
administered IV push
Rationale: Concentrated potassium chloride can cause fatal cardiac
dysrhythmias if administered by IV push. It must be appropriately diluted and
infused using controlled administration.
6.
A patient prescribed lisinopril develops facial swelling, tongue swelling, and
difficulty breathing. What is the priority action?
A. Give the next dose with food
B. Place the patient flat
C. Treat this as a medical emergency and initiate airway/emergency
, management
D. Document the reaction as an expected adverse effect
Answer: Treat this as a medical emergency and initiate airway/emergency
management
Rationale: Angioedema associated with an ACE inhibitor can rapidly
compromise the airway and requires immediate emergency intervention.
7.
A nurse is administering IV morphine to a postoperative patient whose
respiratory rate is 8/min and who is difficult to arouse. What should the nurse do
first?
A. Administer another dose for pain
B. Hold morphine and immediately assess and support respirations
C. Place the patient in Trendelenburg position
D. Encourage oral fluids
Answer: Hold morphine and immediately assess and support respirations
Rationale: Severe respiratory depression is a potentially life-threatening opioid
adverse effect. The opioid should be withheld while airway and breathing are
immediately assessed and supported.
8.
A patient receiving insulin glargine asks whether it can be mixed in the same
syringe with regular insulin. Which response is correct?
A. “Yes, as long as glargine is drawn up first.”
B. “Yes, if both medications are prescribed for the same time.”
C. “No. Insulin glargine should not be mixed with other insulins.”
D. “Only mix it with NPH insulin.”
Answer: “No. Insulin glargine should not be mixed with other insulins.”
Competency Exam — Code: RN-MED-
COMP | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1.
A nurse is preparing to administer digoxin to an older adult with heart failure. The
patient's apical pulse is 54/min, potassium is 3.1 mEq/L, and the patient reports
nausea and seeing yellow halos. What is the nurse's priority action?
A. Administer the medication with food
B. Recheck the pulse in 30 minutes
C. Withhold digoxin and notify the provider
D. Administer potassium after giving digoxin
Answer: Withhold digoxin and notify the provider
Rationale: Bradycardia, hypokalemia, nausea, and visual disturbances are
concerning for digoxin toxicity. The medication should be withheld and the
provider notified promptly.
,2.
A patient receiving IV vancomycin develops flushing, erythema of the face and
neck, and pruritus during the infusion. The blood pressure is stable. Which action
is most appropriate?
A. Increase the infusion rate
B. Administer the next dose immediately
C. Stop or slow the infusion and notify the provider; assess the patient
D. Permanently discontinue all antibiotics
Answer: Stop or slow the infusion and notify the provider; assess the patient
Rationale: Rapid vancomycin infusion can cause an infusion reaction commonly
called vancomycin infusion reaction. Slowing or stopping the infusion and
assessing the patient are appropriate.
3.
A patient taking warfarin has an INR of 5.8 without active bleeding. Which
intervention should the nurse anticipate?
A. Administer the scheduled warfarin dose
B. Hold warfarin and notify the provider for further management
C. Administer protamine sulfate
D. Encourage increased vitamin K intake immediately
Answer: Hold warfarin and notify the provider for further management
Rationale: An INR of 5.8 represents excessive anticoagulation. Warfarin should
generally be held while the provider determines whether additional treatment,
such as vitamin K, is indicated. Protamine reverses heparin, not warfarin.
4.
A patient receiving heparin has a platelet count that has fallen from 220,000/mm³
to 92,000/mm³ several days after therapy began. What should the nurse suspect?
,A. Disseminated intravascular coagulation
B. Iron-deficiency anemia
C. Heparin-induced thrombocytopenia
D. Vitamin K deficiency
Answer: Heparin-induced thrombocytopenia
Rationale: A substantial platelet decline after exposure to heparin is highly
concerning for HIT, a potentially life-threatening prothrombotic condition.
Heparin should be stopped and the provider notified immediately.
5.
A patient receiving IV potassium chloride has a prescription for potassium
chloride 40 mEq IV push. What should the nurse do?
A. Administer it slowly over 10 minutes
B. Dilute it in 5 mL of sterile water
C. Question the prescription because potassium chloride must never be
administered IV push
D. Administer it through a central line by IV push
Answer: Question the prescription because potassium chloride must never be
administered IV push
Rationale: Concentrated potassium chloride can cause fatal cardiac
dysrhythmias if administered by IV push. It must be appropriately diluted and
infused using controlled administration.
6.
A patient prescribed lisinopril develops facial swelling, tongue swelling, and
difficulty breathing. What is the priority action?
A. Give the next dose with food
B. Place the patient flat
C. Treat this as a medical emergency and initiate airway/emergency
, management
D. Document the reaction as an expected adverse effect
Answer: Treat this as a medical emergency and initiate airway/emergency
management
Rationale: Angioedema associated with an ACE inhibitor can rapidly
compromise the airway and requires immediate emergency intervention.
7.
A nurse is administering IV morphine to a postoperative patient whose
respiratory rate is 8/min and who is difficult to arouse. What should the nurse do
first?
A. Administer another dose for pain
B. Hold morphine and immediately assess and support respirations
C. Place the patient in Trendelenburg position
D. Encourage oral fluids
Answer: Hold morphine and immediately assess and support respirations
Rationale: Severe respiratory depression is a potentially life-threatening opioid
adverse effect. The opioid should be withheld while airway and breathing are
immediately assessed and supported.
8.
A patient receiving insulin glargine asks whether it can be mixed in the same
syringe with regular insulin. Which response is correct?
A. “Yes, as long as glargine is drawn up first.”
B. “Yes, if both medications are prescribed for the same time.”
C. “No. Insulin glargine should not be mixed with other insulins.”
D. “Only mix it with NPH insulin.”
Answer: “No. Insulin glargine should not be mixed with other insulins.”
