RNSG 2539 – Advanced Nursing Skills Exam 2
(2025–2026 Study Guide) Focus: Complex
patient care, fluid/electrolyte balance,
perioperative concepts, and advanced clinical
practice.
Complex Patient Care & Advanced Clinical Practice
1. A patient with septic shock is on a norepinephrine drip. The nurse's primary
assessment for effectiveness should focus on:
a) Urine output
b) Heart rate
c) ✓ Mean Arterial Pressure (MAP)
d) Respiratory rate
2. When managing a patient on a ventilator, the nurse should prioritize which
intervention to prevent Ventilator-Associated Pneumonia (VAP)?
a) Suctioning every 2 hours
b) ✓ Maintaining head-of-bed at 30-45 degrees
c) Using a heated humidifier
d) Sedating the patient to prevent self-extubation
3. A patient with acute respiratory distress syndrome (ARDS) is placed in the prone
position. The main physiological goal of this intervention is to:
a) Improve cardiac output
b) ✓ Improve oxygenation by recruiting dorsal lung alveoli
c) Facilitate suctioning
d) Reduce patient anxiety
4. The nurse is caring for a patient with a traumatic brain injury whose intracranial
pressure (ICP) is rising. A priority nursing action is to:
a) Cluster all nursing care to promote rest
b) ✓ Elevate the head of the bed 30 degrees and maintain neck alignment
c) Administer a bolus of hypotonic IV fluid
d) Encourage the patient to cough and deep breathe vigorously
,5. When titrating an insulin drip for a patient in diabetic ketoacidosis (DKA), the nurse
should monitor which laboratory value most closely to avoid complications?
a) Blood glucose
b) ✓ Serum potassium
c) Serum sodium
d) Arterial pH
6. A patient with a left-sided chest tube has continuous bubbling in the water seal
chamber. The nurse should:
a) This is a normal finding
b) ✓ Clamp the tube and call the physician immediately
c) Assess the system for an air leak
d) Increase the suction pressure
7. The Glasgow Coma Scale (GCS) assesses which three components?
a) Pulse, Blood Pressure, Respiration
b) ✓ Eye opening, Verbal response, Motor response
c) Orientation, Memory, Cognition
d) Pupil reaction, Limb strength, Sensation
8. A patient with a pulmonary artery catheter (Swan-Ganz) has a pulmonary artery
wedge pressure (PAWP) of 2 mm Hg. This finding is most consistent with:
a) Left-sided heart failure
b) ✓ Hypovolemia
c) Hypervolemia
d) Right-sided heart failure
9. The "Triple Aim" of healthcare includes all EXCEPT:
a) Improving the patient experience of care
b) Improving the health of populations
c) ✓ Reducing physician workload
d) Reducing the per capita cost of healthcare
10. A nurse is preparing to administer blood products. The most critical action to ensure
patient safety is:
a) Checking the blood product with another RN at the patient's bedside
b) ✓ Verifying the patient's identity using two unique identifiers against the blood
product tag
c) Priming the IV tubing with 0.9% Normal Saline
d) Obtaining a signed consent from the patient
, Fluid and Electrolyte Balance
11. A patient with heart failure is receiving furosemide (Lasix). The nurse should be most
concerned about which electrolyte imbalance?
a) Hypernatremia
b) ✓ Hypokalemia
c) Hypercalcemia
d) Hypermagnesemia
12. Clinical manifestations of hypervolemia include:
a) Flat neck veins, dry mucous membranes
b) ✓ Bounding pulses, jugular venous distension (JVD), crackles in lungs
c) Thready pulses, decreased skin turgor
d) Muscle weakness, lethargy
13. The primary laboratory value used to assess fluid status is:
a) Blood Urea Nitrogen (BUN)
b) ✓ Serum sodium
c) Serum osmolality
d) Hematocrit
14. A patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) will exhibit:
a) ✓ Dilute hyponatremia and concentrated urine
b) Concentrated hyponatremia and dilute urine
c) Hypernatremia and polyuria
d) Hyperkalemia and oliguria
15. A patient's arterial blood gas shows: pH 7.50, PaCO2 48, HCO3 38. This is interpreted
as:
a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic acidosis
d) ✓ Metabolic alkalosis
16. The most appropriate IV fluid for a patient with hypovolemic shock is:
a) 0.45% Sodium Chloride (1/2 NS)
b) ✓ 0.9% Sodium Chloride (Normal Saline)
c) 5% Dextrose in Water (D5W)
d) Lactated Ringer's (LR)
(2025–2026 Study Guide) Focus: Complex
patient care, fluid/electrolyte balance,
perioperative concepts, and advanced clinical
practice.
Complex Patient Care & Advanced Clinical Practice
1. A patient with septic shock is on a norepinephrine drip. The nurse's primary
assessment for effectiveness should focus on:
a) Urine output
b) Heart rate
c) ✓ Mean Arterial Pressure (MAP)
d) Respiratory rate
2. When managing a patient on a ventilator, the nurse should prioritize which
intervention to prevent Ventilator-Associated Pneumonia (VAP)?
a) Suctioning every 2 hours
b) ✓ Maintaining head-of-bed at 30-45 degrees
c) Using a heated humidifier
d) Sedating the patient to prevent self-extubation
3. A patient with acute respiratory distress syndrome (ARDS) is placed in the prone
position. The main physiological goal of this intervention is to:
a) Improve cardiac output
b) ✓ Improve oxygenation by recruiting dorsal lung alveoli
c) Facilitate suctioning
d) Reduce patient anxiety
4. The nurse is caring for a patient with a traumatic brain injury whose intracranial
pressure (ICP) is rising. A priority nursing action is to:
a) Cluster all nursing care to promote rest
b) ✓ Elevate the head of the bed 30 degrees and maintain neck alignment
c) Administer a bolus of hypotonic IV fluid
d) Encourage the patient to cough and deep breathe vigorously
,5. When titrating an insulin drip for a patient in diabetic ketoacidosis (DKA), the nurse
should monitor which laboratory value most closely to avoid complications?
a) Blood glucose
b) ✓ Serum potassium
c) Serum sodium
d) Arterial pH
6. A patient with a left-sided chest tube has continuous bubbling in the water seal
chamber. The nurse should:
a) This is a normal finding
b) ✓ Clamp the tube and call the physician immediately
c) Assess the system for an air leak
d) Increase the suction pressure
7. The Glasgow Coma Scale (GCS) assesses which three components?
a) Pulse, Blood Pressure, Respiration
b) ✓ Eye opening, Verbal response, Motor response
c) Orientation, Memory, Cognition
d) Pupil reaction, Limb strength, Sensation
8. A patient with a pulmonary artery catheter (Swan-Ganz) has a pulmonary artery
wedge pressure (PAWP) of 2 mm Hg. This finding is most consistent with:
a) Left-sided heart failure
b) ✓ Hypovolemia
c) Hypervolemia
d) Right-sided heart failure
9. The "Triple Aim" of healthcare includes all EXCEPT:
a) Improving the patient experience of care
b) Improving the health of populations
c) ✓ Reducing physician workload
d) Reducing the per capita cost of healthcare
10. A nurse is preparing to administer blood products. The most critical action to ensure
patient safety is:
a) Checking the blood product with another RN at the patient's bedside
b) ✓ Verifying the patient's identity using two unique identifiers against the blood
product tag
c) Priming the IV tubing with 0.9% Normal Saline
d) Obtaining a signed consent from the patient
, Fluid and Electrolyte Balance
11. A patient with heart failure is receiving furosemide (Lasix). The nurse should be most
concerned about which electrolyte imbalance?
a) Hypernatremia
b) ✓ Hypokalemia
c) Hypercalcemia
d) Hypermagnesemia
12. Clinical manifestations of hypervolemia include:
a) Flat neck veins, dry mucous membranes
b) ✓ Bounding pulses, jugular venous distension (JVD), crackles in lungs
c) Thready pulses, decreased skin turgor
d) Muscle weakness, lethargy
13. The primary laboratory value used to assess fluid status is:
a) Blood Urea Nitrogen (BUN)
b) ✓ Serum sodium
c) Serum osmolality
d) Hematocrit
14. A patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) will exhibit:
a) ✓ Dilute hyponatremia and concentrated urine
b) Concentrated hyponatremia and dilute urine
c) Hypernatremia and polyuria
d) Hyperkalemia and oliguria
15. A patient's arterial blood gas shows: pH 7.50, PaCO2 48, HCO3 38. This is interpreted
as:
a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic acidosis
d) ✓ Metabolic alkalosis
16. The most appropriate IV fluid for a patient with hypovolemic shock is:
a) 0.45% Sodium Chloride (1/2 NS)
b) ✓ 0.9% Sodium Chloride (Normal Saline)
c) 5% Dextrose in Water (D5W)
d) Lactated Ringer's (LR)
