RN Return-to-Practice Exam — Code:
RN-RTP-EX | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A nurse returning to practice is caring for a client with acute pulmonary
edema who is severely dyspneic and coughing pink, frothy sputum. Which
action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler’s position
C. Obtain a sputum specimen
D. Administer a prescribed oral diuretic
Answer: Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning decreases venous return and improves lung
expansion, helping reduce the severity of pulmonary congestion and respiratory
distress. Oxygenation and airway support take priority over diagnostic or oral
interventions.
, 2. A client receiving a continuous heparin infusion develops a sudden severe
headache, confusion, and vomiting. Which action is the nurse’s priority?
A. Continue the infusion and reassess in 30 minutes
B. Administer the next scheduled dose of warfarin
C. Stop the heparin infusion and notify the provider immediately
D. Encourage the client to ambulate
Answer: Stop the heparin infusion and notify the provider immediately
Rationale: Severe headache, vomiting, and altered mental status may indicate
intracranial hemorrhage, a life-threatening complication of anticoagulation. The
infusion should be stopped and emergency evaluation initiated.
3. A client with diabetic ketoacidosis has a potassium level of 3.0 mEq/L and
requires an insulin infusion. Which intervention is most appropriate?
A. Start insulin immediately without replacement
B. Administer potassium replacement before initiating insulin
C. Restrict all intravenous fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement before initiating insulin
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When serum potassium is significantly low, potassium
replacement takes priority before insulin therapy.
4. A client with chronic obstructive pulmonary disease becomes increasingly
somnolent while receiving supplemental oxygen. Which assessment is most
important?
A. Bowel sounds
B. Serum glucose
C. Respiratory rate and level of consciousness
D. Pedal pulses
Answer: Respiratory rate and level of consciousness
,Rationale: Increasing somnolence in a client with COPD may indicate worsening
hypercapnia and respiratory failure. Respiratory status and neurologic changes
require immediate evaluation.
5. A client with suspected sepsis has a temperature of 39.4°C, blood pressure
of 82/48 mm Hg, heart rate of 128/min, and elevated lactate. Which
intervention should the nurse anticipate as a priority?
A. Delay fluids until culture results return
B. Initiate rapid intravenous fluid resuscitation
C. Restrict sodium intake
D. Encourage ambulation
Answer: Initiate rapid intravenous fluid resuscitation
Rationale: Hypotension and elevated lactate suggest impaired tissue perfusion
from septic shock. Rapid IV crystalloid administration is a key initial intervention
while cultures and antimicrobial therapy are addressed.
6. A client taking digoxin reports nausea, weakness, and seeing yellow-green
halos around lights. Which laboratory result is most important for the nurse
to review?
A. Serum potassium
B. Serum sodium
C. Hemoglobin
D. Platelet count
Answer: Serum potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity. The client’s
symptoms are also classic manifestations of digoxin toxicity, making electrolyte
assessment essential.
7. A nurse assesses a client 2 hours after receiving IV morphine. The client is
difficult to arouse and has respirations of 7/min. Which medication should
the nurse anticipate administering?
, A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Acetylcysteine
Answer: Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced
respiratory depression. Respiratory support and close monitoring are also
required.
8. A client with a new tracheostomy suddenly becomes restless, cyanotic, and
has absent airflow through the tracheostomy tube. What should the nurse
do first?
A. Give oral fluids
B. Remove the inner cannula and assess for obstruction
C. Place the client flat
D. Obtain a routine chest x-ray
Answer: Remove the inner cannula and assess for obstruction
Rationale: Sudden respiratory distress with absent airflow through a
tracheostomy suggests obstruction. The airway must be rapidly assessed and
cleared while emergency assistance is obtained.
9. A client with heart failure has gained 2.5 kg in 3 days. Which finding most
strongly supports fluid volume excess?
A. Dry mucous membranes
B. Flat neck veins
C. Bilateral crackles and dependent edema
D. Increased urine specific gravity
Answer: Bilateral crackles and dependent edema
RN-RTP-EX | 100-Question Advanced
Practice Exam 2026 | Questions &
Answers with Detailed Rationales |
Complete Exam Prep & Study Guide
1. A nurse returning to practice is caring for a client with acute pulmonary
edema who is severely dyspneic and coughing pink, frothy sputum. Which
action should the nurse take first?
A. Encourage oral fluids
B. Place the client in high-Fowler’s position
C. Obtain a sputum specimen
D. Administer a prescribed oral diuretic
Answer: Place the client in high-Fowler’s position
Rationale: High-Fowler’s positioning decreases venous return and improves lung
expansion, helping reduce the severity of pulmonary congestion and respiratory
distress. Oxygenation and airway support take priority over diagnostic or oral
interventions.
, 2. A client receiving a continuous heparin infusion develops a sudden severe
headache, confusion, and vomiting. Which action is the nurse’s priority?
A. Continue the infusion and reassess in 30 minutes
B. Administer the next scheduled dose of warfarin
C. Stop the heparin infusion and notify the provider immediately
D. Encourage the client to ambulate
Answer: Stop the heparin infusion and notify the provider immediately
Rationale: Severe headache, vomiting, and altered mental status may indicate
intracranial hemorrhage, a life-threatening complication of anticoagulation. The
infusion should be stopped and emergency evaluation initiated.
3. A client with diabetic ketoacidosis has a potassium level of 3.0 mEq/L and
requires an insulin infusion. Which intervention is most appropriate?
A. Start insulin immediately without replacement
B. Administer potassium replacement before initiating insulin
C. Restrict all intravenous fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement before initiating insulin
Rationale: Insulin shifts potassium into cells and can cause life-threatening
hypokalemia. When serum potassium is significantly low, potassium
replacement takes priority before insulin therapy.
4. A client with chronic obstructive pulmonary disease becomes increasingly
somnolent while receiving supplemental oxygen. Which assessment is most
important?
A. Bowel sounds
B. Serum glucose
C. Respiratory rate and level of consciousness
D. Pedal pulses
Answer: Respiratory rate and level of consciousness
,Rationale: Increasing somnolence in a client with COPD may indicate worsening
hypercapnia and respiratory failure. Respiratory status and neurologic changes
require immediate evaluation.
5. A client with suspected sepsis has a temperature of 39.4°C, blood pressure
of 82/48 mm Hg, heart rate of 128/min, and elevated lactate. Which
intervention should the nurse anticipate as a priority?
A. Delay fluids until culture results return
B. Initiate rapid intravenous fluid resuscitation
C. Restrict sodium intake
D. Encourage ambulation
Answer: Initiate rapid intravenous fluid resuscitation
Rationale: Hypotension and elevated lactate suggest impaired tissue perfusion
from septic shock. Rapid IV crystalloid administration is a key initial intervention
while cultures and antimicrobial therapy are addressed.
6. A client taking digoxin reports nausea, weakness, and seeing yellow-green
halos around lights. Which laboratory result is most important for the nurse
to review?
A. Serum potassium
B. Serum sodium
C. Hemoglobin
D. Platelet count
Answer: Serum potassium
Rationale: Hypokalemia increases the risk of digoxin toxicity. The client’s
symptoms are also classic manifestations of digoxin toxicity, making electrolyte
assessment essential.
7. A nurse assesses a client 2 hours after receiving IV morphine. The client is
difficult to arouse and has respirations of 7/min. Which medication should
the nurse anticipate administering?
, A. Flumazenil
B. Naloxone
C. Protamine sulfate
D. Acetylcysteine
Answer: Naloxone
Rationale: Naloxone is an opioid antagonist used to reverse opioid-induced
respiratory depression. Respiratory support and close monitoring are also
required.
8. A client with a new tracheostomy suddenly becomes restless, cyanotic, and
has absent airflow through the tracheostomy tube. What should the nurse
do first?
A. Give oral fluids
B. Remove the inner cannula and assess for obstruction
C. Place the client flat
D. Obtain a routine chest x-ray
Answer: Remove the inner cannula and assess for obstruction
Rationale: Sudden respiratory distress with absent airflow through a
tracheostomy suggests obstruction. The airway must be rapidly assessed and
cleared while emergency assistance is obtained.
9. A client with heart failure has gained 2.5 kg in 3 days. Which finding most
strongly supports fluid volume excess?
A. Dry mucous membranes
B. Flat neck veins
C. Bilateral crackles and dependent edema
D. Increased urine specific gravity
Answer: Bilateral crackles and dependent edema
