REx-PN Prep 2026–2027: Medical-Surgical,
Pharmacology & Fundamentals Practice
Exam Complete Test Prep Practice
Questions With Answers & Detailed
Rationales |clinical Judgment &Safety |A+
Rated
1. A client with pneumonia has a temperature of 39.2°C (102.6°F),
respiratory rate of 30/min, and oxygen saturation of 88% on room
air. Which action should the practical nurse take first?
A. Encourage oral fluids
B. Administer the prescribed antipyretic
C. Apply oxygen as prescribed
D. Obtain a sputum specimen
Answer: C. Apply oxygen as prescribed
The oxygen saturation of 88% indicates hypoxemia. Supporting
oxygenation takes priority over fever management, hydration, or
specimen collection.
2. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen. Which finding requires the most immediate
attention?
A. Oxygen saturation of 90%
B. Productive cough with clear sputum
C. New confusion and increasing drowsiness
D. Respiratory rate of 20/min
,Answer: C. New confusion and increasing drowsiness
Acute mental-status changes may indicate worsening hypoxemia or
carbon dioxide retention and require prompt assessment.
3. A client with heart failure reports increasing shortness of breath
and has bilateral crackles. Which assessment finding is most
concerning?
A. Heart rate of 92/min
B. Blood pressure of 138/84 mmHg
C. Oxygen saturation of 86%
D. Mild ankle edema
Answer: C. Oxygen saturation of 86%
Severe hypoxemia indicates impaired oxygenation and requires
immediate intervention.
4. Which finding is most characteristic of left-sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles
Left-sided heart failure causes pulmonary congestion, commonly
producing dyspnea and crackles.
5. A client taking furosemide should be monitored most closely for
which electrolyte imbalance?
,A. Hypercalcemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hypokalemia
Furosemide is a loop diuretic that increases urinary potassium loss.
6. A client with diabetes mellitus becomes shaky, sweaty, and
confused. What should the nurse do first?
A. Administer long-acting insulin
B. Check the blood glucose level
C. Encourage exercise
D. Restrict oral intake
Answer: B. Check the blood glucose level
The symptoms strongly suggest hypoglycemia. Blood glucose should
be assessed promptly, followed by appropriate treatment.
7. A conscious client has a blood glucose level of 2.8 mmol/L (50
mg/dL). Which intervention is appropriate?
A. Give approximately 15 g of rapid-acting carbohydrate
B. Administer scheduled insulin
C. Encourage the client to sleep
D. Give a high-protein meal only
Answer: A. Give approximately 15 g of rapid-acting carbohydrate
Conscious clients who can safely swallow should receive rapid-acting
carbohydrate for symptomatic hypoglycemia.
, 8. Which finding is most consistent with diabetic ketoacidosis (DKA)?
A. Bradycardia and hypothermia
B. Kussmaul respirations and fruity breath
C. Severe hypertension and edema
D. Decreased respiratory rate and shallow breathing
Answer: B. Kussmaul respirations and fruity breath
DKA causes metabolic acidosis, leading to deep, rapid respirations
and acetone-like breath.
9. A client with DKA is receiving IV insulin. Which laboratory value
requires close monitoring?
A. Serum potassium
B. Serum calcium only
C. Hemoglobin
D. Platelet count
Answer: A. Serum potassium
Insulin shifts potassium into cells, potentially causing dangerous
hypokalemia during DKA treatment.
10. Which instruction is appropriate for a client with diabetes
regarding foot care?
A. Walk barefoot indoors to strengthen the feet
B. Soak the feet in hot water daily
C. Inspect the feet every day
D. Cut corns with a razor
Answer: C. Inspect the feet every day
Daily inspection helps identify injuries early, especially when
peripheral neuropathy reduces sensation.
Pharmacology & Fundamentals Practice
Exam Complete Test Prep Practice
Questions With Answers & Detailed
Rationales |clinical Judgment &Safety |A+
Rated
1. A client with pneumonia has a temperature of 39.2°C (102.6°F),
respiratory rate of 30/min, and oxygen saturation of 88% on room
air. Which action should the practical nurse take first?
A. Encourage oral fluids
B. Administer the prescribed antipyretic
C. Apply oxygen as prescribed
D. Obtain a sputum specimen
Answer: C. Apply oxygen as prescribed
The oxygen saturation of 88% indicates hypoxemia. Supporting
oxygenation takes priority over fever management, hydration, or
specimen collection.
2. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen. Which finding requires the most immediate
attention?
A. Oxygen saturation of 90%
B. Productive cough with clear sputum
C. New confusion and increasing drowsiness
D. Respiratory rate of 20/min
,Answer: C. New confusion and increasing drowsiness
Acute mental-status changes may indicate worsening hypoxemia or
carbon dioxide retention and require prompt assessment.
3. A client with heart failure reports increasing shortness of breath
and has bilateral crackles. Which assessment finding is most
concerning?
A. Heart rate of 92/min
B. Blood pressure of 138/84 mmHg
C. Oxygen saturation of 86%
D. Mild ankle edema
Answer: C. Oxygen saturation of 86%
Severe hypoxemia indicates impaired oxygenation and requires
immediate intervention.
4. Which finding is most characteristic of left-sided heart failure?
A. Ascites
B. Jugular venous distention
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles
Left-sided heart failure causes pulmonary congestion, commonly
producing dyspnea and crackles.
5. A client taking furosemide should be monitored most closely for
which electrolyte imbalance?
,A. Hypercalcemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B. Hypokalemia
Furosemide is a loop diuretic that increases urinary potassium loss.
6. A client with diabetes mellitus becomes shaky, sweaty, and
confused. What should the nurse do first?
A. Administer long-acting insulin
B. Check the blood glucose level
C. Encourage exercise
D. Restrict oral intake
Answer: B. Check the blood glucose level
The symptoms strongly suggest hypoglycemia. Blood glucose should
be assessed promptly, followed by appropriate treatment.
7. A conscious client has a blood glucose level of 2.8 mmol/L (50
mg/dL). Which intervention is appropriate?
A. Give approximately 15 g of rapid-acting carbohydrate
B. Administer scheduled insulin
C. Encourage the client to sleep
D. Give a high-protein meal only
Answer: A. Give approximately 15 g of rapid-acting carbohydrate
Conscious clients who can safely swallow should receive rapid-acting
carbohydrate for symptomatic hypoglycemia.
, 8. Which finding is most consistent with diabetic ketoacidosis (DKA)?
A. Bradycardia and hypothermia
B. Kussmaul respirations and fruity breath
C. Severe hypertension and edema
D. Decreased respiratory rate and shallow breathing
Answer: B. Kussmaul respirations and fruity breath
DKA causes metabolic acidosis, leading to deep, rapid respirations
and acetone-like breath.
9. A client with DKA is receiving IV insulin. Which laboratory value
requires close monitoring?
A. Serum potassium
B. Serum calcium only
C. Hemoglobin
D. Platelet count
Answer: A. Serum potassium
Insulin shifts potassium into cells, potentially causing dangerous
hypokalemia during DKA treatment.
10. Which instruction is appropriate for a client with diabetes
regarding foot care?
A. Walk barefoot indoors to strengthen the feet
B. Soak the feet in hot water daily
C. Inspect the feet every day
D. Cut corns with a razor
Answer: C. Inspect the feet every day
Daily inspection helps identify injuries early, especially when
peripheral neuropathy reduces sensation.
