RN Nurse Refresher Competency Exam
— Code: RN-NR-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse assesses a client 2 hours after abdominal surgery. The client is
restless, has a heart rate of 124/min, respiratory rate of 28/min, blood
pressure of 88/54 mm Hg, and cool clammy skin. Which action should the
nurse take first?
A. Administer the prescribed opioid
B. Place the client in a high-Fowler position
C. Assess the surgical dressing for bleeding
D. Increase oral fluid intake
Correct answer: Assess the surgical dressing for bleeding
,Rationale: The findings indicate possible hypovolemic shock. The nurse should
rapidly identify and address a potential source of blood loss while supporting
circulation and notifying the appropriate provider.
2. A client with heart failure receives IV furosemide. Which finding requires
the most immediate intervention?
A. Blood pressure 104/68 mm Hg
B. Potassium 2.7 mEq/L
C. Urine output 900 mL over 8 hours
D. Mild thirst
Correct answer: Potassium 2.7 mEq/L
Rationale: Severe hypokalemia can cause life-threatening ventricular
dysrhythmias, particularly in clients receiving diuretics. Potassium replacement
and cardiac monitoring may be required.
3. A client receiving a continuous heparin infusion develops sudden severe
headache, vomiting, and decreased level of consciousness. What is the
priority nursing action?
A. Stop the heparin infusion
B. Administer vitamin K
C. Encourage oral fluids
D. Place the client in Trendelenburg position
Correct answer: Stop the heparin infusion
Rationale: These findings may indicate intracranial hemorrhage. Heparin should
be stopped immediately and emergency evaluation initiated. Protamine sulfate,
rather than vitamin K, is the reversal agent for unfractionated heparin.
4. A client with COPD is receiving oxygen at 6 L/min by nasal cannula. The
client becomes increasingly somnolent. Which action is most appropriate?
A. Increase oxygen to 10 L/min
B. Assess respiratory status and oxygenation immediately
,C. Encourage the client to sleep
D. Administer a sedative
Correct answer: Assess respiratory status and oxygenation immediately
Rationale: Excessive oxygen administration in susceptible clients with chronic
CO₂ retention can worsen hypercapnia. Somnolence may indicate deteriorating
ventilation and requires immediate assessment.
5. A client with diabetes is unconscious, diaphoretic, and has a blood glucose
level of 38 mg/dL. Which intervention should the nurse anticipate?
A. Administer IV dextrose
B. Administer regular insulin
C. Provide a high-protein meal
D. Restrict carbohydrates
Correct answer: Administer IV dextrose
Rationale: An unconscious client cannot safely take oral carbohydrates. IV
dextrose is appropriate when IV access is available; glucagon is an alternative
when IV access is unavailable.
6. A client taking warfarin has an INR of 6.8 and reports black, tarry stools.
What is the priority action?
A. Administer the next scheduled dose
B. Hold warfarin and notify the provider immediately
C. Encourage foods high in vitamin K and discharge the client
D. Administer aspirin
Correct answer: Hold warfarin and notify the provider immediately
Rationale: A markedly elevated INR combined with melena indicates significant
bleeding risk or active bleeding. Warfarin should be withheld and urgent
evaluation initiated.
, 7. A client with suspected sepsis has a temperature of 39.2°C, heart rate of
132/min, blood pressure of 82/48 mm Hg, and lactate of 5.1 mmol/L.
Which intervention has the highest priority?
A. Delay treatment until blood cultures are finalized
B. Initiate rapid sepsis management, including prescribed IV fluids
C. Restrict fluids
D. Encourage ambulation
Correct answer: Initiate rapid sepsis management, including prescribed IV fluids
Rationale: Hypotension, elevated lactate, tachycardia, and infection suggest
septic shock. Early hemodynamic support, cultures, antibiotics, and source
control are critical.
8. A client with a tracheostomy suddenly develops respiratory distress and an
absent airflow through the tracheostomy tube. What should the nurse do
first?
A. Remove the tracheostomy ties
B. Assess for obstruction and suction the airway as indicated
C. Give oral fluids
D. Place the client flat
Correct answer: Assess for obstruction and suction the airway as indicated
Rationale: A mucus plug is a common cause of acute tracheostomy obstruction.
Airway assessment and suctioning should occur immediately while emergency
assistance is obtained if needed.
9. A client with acute kidney injury has a potassium level of 6.9 mEq/L and
peaked T waves on ECG. Which medication should the nurse anticipate
administering first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral potassium chloride
— Code: RN-NR-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse assesses a client 2 hours after abdominal surgery. The client is
restless, has a heart rate of 124/min, respiratory rate of 28/min, blood
pressure of 88/54 mm Hg, and cool clammy skin. Which action should the
nurse take first?
A. Administer the prescribed opioid
B. Place the client in a high-Fowler position
C. Assess the surgical dressing for bleeding
D. Increase oral fluid intake
Correct answer: Assess the surgical dressing for bleeding
,Rationale: The findings indicate possible hypovolemic shock. The nurse should
rapidly identify and address a potential source of blood loss while supporting
circulation and notifying the appropriate provider.
2. A client with heart failure receives IV furosemide. Which finding requires
the most immediate intervention?
A. Blood pressure 104/68 mm Hg
B. Potassium 2.7 mEq/L
C. Urine output 900 mL over 8 hours
D. Mild thirst
Correct answer: Potassium 2.7 mEq/L
Rationale: Severe hypokalemia can cause life-threatening ventricular
dysrhythmias, particularly in clients receiving diuretics. Potassium replacement
and cardiac monitoring may be required.
3. A client receiving a continuous heparin infusion develops sudden severe
headache, vomiting, and decreased level of consciousness. What is the
priority nursing action?
A. Stop the heparin infusion
B. Administer vitamin K
C. Encourage oral fluids
D. Place the client in Trendelenburg position
Correct answer: Stop the heparin infusion
Rationale: These findings may indicate intracranial hemorrhage. Heparin should
be stopped immediately and emergency evaluation initiated. Protamine sulfate,
rather than vitamin K, is the reversal agent for unfractionated heparin.
4. A client with COPD is receiving oxygen at 6 L/min by nasal cannula. The
client becomes increasingly somnolent. Which action is most appropriate?
A. Increase oxygen to 10 L/min
B. Assess respiratory status and oxygenation immediately
,C. Encourage the client to sleep
D. Administer a sedative
Correct answer: Assess respiratory status and oxygenation immediately
Rationale: Excessive oxygen administration in susceptible clients with chronic
CO₂ retention can worsen hypercapnia. Somnolence may indicate deteriorating
ventilation and requires immediate assessment.
5. A client with diabetes is unconscious, diaphoretic, and has a blood glucose
level of 38 mg/dL. Which intervention should the nurse anticipate?
A. Administer IV dextrose
B. Administer regular insulin
C. Provide a high-protein meal
D. Restrict carbohydrates
Correct answer: Administer IV dextrose
Rationale: An unconscious client cannot safely take oral carbohydrates. IV
dextrose is appropriate when IV access is available; glucagon is an alternative
when IV access is unavailable.
6. A client taking warfarin has an INR of 6.8 and reports black, tarry stools.
What is the priority action?
A. Administer the next scheduled dose
B. Hold warfarin and notify the provider immediately
C. Encourage foods high in vitamin K and discharge the client
D. Administer aspirin
Correct answer: Hold warfarin and notify the provider immediately
Rationale: A markedly elevated INR combined with melena indicates significant
bleeding risk or active bleeding. Warfarin should be withheld and urgent
evaluation initiated.
, 7. A client with suspected sepsis has a temperature of 39.2°C, heart rate of
132/min, blood pressure of 82/48 mm Hg, and lactate of 5.1 mmol/L.
Which intervention has the highest priority?
A. Delay treatment until blood cultures are finalized
B. Initiate rapid sepsis management, including prescribed IV fluids
C. Restrict fluids
D. Encourage ambulation
Correct answer: Initiate rapid sepsis management, including prescribed IV fluids
Rationale: Hypotension, elevated lactate, tachycardia, and infection suggest
septic shock. Early hemodynamic support, cultures, antibiotics, and source
control are critical.
8. A client with a tracheostomy suddenly develops respiratory distress and an
absent airflow through the tracheostomy tube. What should the nurse do
first?
A. Remove the tracheostomy ties
B. Assess for obstruction and suction the airway as indicated
C. Give oral fluids
D. Place the client flat
Correct answer: Assess for obstruction and suction the airway as indicated
Rationale: A mucus plug is a common cause of acute tracheostomy obstruction.
Airway assessment and suctioning should occur immediately while emergency
assistance is obtained if needed.
9. A client with acute kidney injury has a potassium level of 6.9 mEq/L and
peaked T waves on ECG. Which medication should the nurse anticipate
administering first to stabilize the myocardium?
A. IV calcium gluconate
B. Oral potassium chloride
