RN Reentry-to-Practice Competency
Exam — Code: RN-RTP-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse returning to practice assesses a client with septic shock who has
received 30 mL/kg of crystalloid. The client remains hypotensive with a MAP of
58 mm Hg. Which intervention should the nurse anticipate?
A. Administer another rapid crystalloid bolus indefinitely
B. Initiate norepinephrine as prescribed
C. Administer IV furosemide
D. Place the client in a Trendelenburg position
Answer: B. Initiate norepinephrine as prescribed
Rationale: Norepinephrine is the preferred first-line vasopressor for persistent
hypotension after adequate initial fluid resuscitation in septic shock. The goal is
,generally to maintain a MAP of at least 65 mm Hg while continuing to evaluate
perfusion and the underlying infection.
2. A client with acute ischemic stroke suddenly develops worsening aphasia and
right-sided weakness 2 hours after symptom onset. Which action is the priority?
A. Administer aspirin immediately
B. Obtain a noncontrast CT of the head
C. Lower the blood pressure rapidly
D. Encourage oral fluids
Answer: B. Obtain a noncontrast CT of the head
Rationale: Brain imaging is required urgently to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy is considered. Rapid
neurologic assessment and imaging are critical because treatment eligibility is
time dependent.
3. A client receiving a continuous heparin infusion has a markedly elevated aPTT
and develops bleeding from the IV site. What is the nurse's priority?
A. Increase the infusion rate
B. Stop the heparin infusion and notify the provider
C. Administer aspirin
D. Encourage ambulation
Answer: B. Stop the heparin infusion and notify the provider
Rationale: Active bleeding with excessive anticoagulation requires immediate
interruption of heparin and prompt evaluation. Protamine sulfate may be
prescribed for significant heparin-associated bleeding.
,4. A client with heart failure suddenly develops severe dyspnea, pink frothy
sputum, crackles, and an oxygen saturation of 78%. Which intervention has the
highest priority?
A. Place the client supine
B. Apply oxygen and position the client upright
C. Encourage oral fluids
D. Administer a sedative
Answer: B. Apply oxygen and position the client upright
Rationale: The findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while supplemental oxygen addresses severe hypoxemia.
Additional therapy may include IV diuretics and vasodilators depending on the
client's blood pressure and clinical status.
5. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Continuous cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluids
Answer: A. IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can worsen hypokalemia.
When serum potassium is below approximately 3.3 mEq/L, potassium
replacement is generally initiated before insulin to reduce the risk of life-
threatening dysrhythmias.
6. A client with chronic obstructive pulmonary disease is receiving oxygen at 6
L/min by nasal cannula and becomes increasingly somnolent. Which assessment
is most important?
, A. Bowel sounds
B. Arterial blood gases
C. Peripheral pulses
D. Urine color
Answer: B. Arterial blood gases
Rationale: Increasing somnolence in a client with COPD receiving supplemental
oxygen can indicate worsening hypercapnia and respiratory acidosis. ABGs help
evaluate oxygenation, ventilation, and acid-base status.
7. A client with suspected pulmonary embolism develops sudden dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. Which intervention should the
nurse perform first?
A. Encourage ambulation
B. Administer supplemental oxygen
C. Place the client in a prone position
D. Restrict all fluids
Answer: B. Administer supplemental oxygen
Rationale: Airway and breathing take priority. Supplemental oxygen treats
hypoxemia while diagnostic evaluation and anticoagulation or other treatment
proceed.
8. A client taking warfarin has an INR of 6.8 but no active bleeding. Which action
is most appropriate?
A. Administer the next dose early
B. Hold warfarin and notify the provider
C. Give an additional dose of aspirin
D. Encourage foods high in potassium
Exam — Code: RN-RTP-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A nurse returning to practice assesses a client with septic shock who has
received 30 mL/kg of crystalloid. The client remains hypotensive with a MAP of
58 mm Hg. Which intervention should the nurse anticipate?
A. Administer another rapid crystalloid bolus indefinitely
B. Initiate norepinephrine as prescribed
C. Administer IV furosemide
D. Place the client in a Trendelenburg position
Answer: B. Initiate norepinephrine as prescribed
Rationale: Norepinephrine is the preferred first-line vasopressor for persistent
hypotension after adequate initial fluid resuscitation in septic shock. The goal is
,generally to maintain a MAP of at least 65 mm Hg while continuing to evaluate
perfusion and the underlying infection.
2. A client with acute ischemic stroke suddenly develops worsening aphasia and
right-sided weakness 2 hours after symptom onset. Which action is the priority?
A. Administer aspirin immediately
B. Obtain a noncontrast CT of the head
C. Lower the blood pressure rapidly
D. Encourage oral fluids
Answer: B. Obtain a noncontrast CT of the head
Rationale: Brain imaging is required urgently to distinguish ischemic stroke from
intracranial hemorrhage before thrombolytic therapy is considered. Rapid
neurologic assessment and imaging are critical because treatment eligibility is
time dependent.
3. A client receiving a continuous heparin infusion has a markedly elevated aPTT
and develops bleeding from the IV site. What is the nurse's priority?
A. Increase the infusion rate
B. Stop the heparin infusion and notify the provider
C. Administer aspirin
D. Encourage ambulation
Answer: B. Stop the heparin infusion and notify the provider
Rationale: Active bleeding with excessive anticoagulation requires immediate
interruption of heparin and prompt evaluation. Protamine sulfate may be
prescribed for significant heparin-associated bleeding.
,4. A client with heart failure suddenly develops severe dyspnea, pink frothy
sputum, crackles, and an oxygen saturation of 78%. Which intervention has the
highest priority?
A. Place the client supine
B. Apply oxygen and position the client upright
C. Encourage oral fluids
D. Administer a sedative
Answer: B. Apply oxygen and position the client upright
Rationale: The findings indicate acute pulmonary edema. Upright positioning
improves ventilation, while supplemental oxygen addresses severe hypoxemia.
Additional therapy may include IV diuretics and vasodilators depending on the
client's blood pressure and clinical status.
5. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L.
Which prescription should the nurse question?
A. IV regular insulin infusion
B. Continuous cardiac monitoring
C. IV potassium replacement
D. Isotonic IV fluids
Answer: A. IV regular insulin infusion
Rationale: Insulin drives potassium into cells and can worsen hypokalemia.
When serum potassium is below approximately 3.3 mEq/L, potassium
replacement is generally initiated before insulin to reduce the risk of life-
threatening dysrhythmias.
6. A client with chronic obstructive pulmonary disease is receiving oxygen at 6
L/min by nasal cannula and becomes increasingly somnolent. Which assessment
is most important?
, A. Bowel sounds
B. Arterial blood gases
C. Peripheral pulses
D. Urine color
Answer: B. Arterial blood gases
Rationale: Increasing somnolence in a client with COPD receiving supplemental
oxygen can indicate worsening hypercapnia and respiratory acidosis. ABGs help
evaluate oxygenation, ventilation, and acid-base status.
7. A client with suspected pulmonary embolism develops sudden dyspnea,
pleuritic chest pain, tachycardia, and hypoxemia. Which intervention should the
nurse perform first?
A. Encourage ambulation
B. Administer supplemental oxygen
C. Place the client in a prone position
D. Restrict all fluids
Answer: B. Administer supplemental oxygen
Rationale: Airway and breathing take priority. Supplemental oxygen treats
hypoxemia while diagnostic evaluation and anticoagulation or other treatment
proceed.
8. A client taking warfarin has an INR of 6.8 but no active bleeding. Which action
is most appropriate?
A. Administer the next dose early
B. Hold warfarin and notify the provider
C. Give an additional dose of aspirin
D. Encourage foods high in potassium
