ASA 114 Advanced Anesthesiology Practice ACTUAL
PRACTICE EXAM V2 2026/2027 | Verified Questions and
Answers | Distinct Clinical Scenarios from V1 | For
Specialized Certification & Board Review | Grade A
Target | Pass Guaranteed
SECTION I. Clinical Judgment & Decision-Making (1–20)
1. You are the night-shift RN receiving a 68-year-old post-op AAA repair patient from PACU.
VS: BP 88/52, HR 112, RR 24, SpO₂ 94% on 2 L NC, urine output 20 mL/hr for the last 2 h.
The patient is restless and reports “severe” abdominal pain (9/10) despite morphine 10
mg IV 45 min ago. What is your first action?
A. Administer the next ordered dose of morphine.
B. Increase the nasal cannula to 4 L/min.
C. Perform a focused abdominal and graft site assessment.
D. Call the surgeon to request a CT angiogram.
Correct Answer: C
Rationale: Restlessness + hypotension + severe pain are cues of possible graft
leak/hemorrhage. Before treating pain or escalating oxygen, the RN must gather
additional objective data (assessment) to differentiate causes and determine urgency.
2. Which cue best supports an inference of potential sepsis in a 78-year-old NH resident
with Alzheimer’s?
A. “Feels warm to touch” reported by CNA.
B. Temperature 38.9 °C (102 °F), WBC 16 000.
C. Patient pulling at IV line.
D. New-onset confusion since this morning.
Correct Answer: B
Rationale: Objective abnormal data (fever + leukocytosis) allows inference of systemic
inflammatory response; warmth is a subjective cue, confusion is nonspecific without
supporting data.
3. Using the ABC priority framework, which patient requires immediate RN intervention?
A. Chest-tube insertion site with intermittent bubbling in water-seal chamber.
B. Post-thyroidectomy patient whose trach ties are damp with serosanguinous drainage.
, C. Newly admitted CHF patient with bilateral 2+ pitting edema.
D. S/P appendectomy refusing PO pain med due to nausea.
Correct Answer: B
Rationale: Airway—potential airway compromise from post-op bleeding/hematoma
takes precedence.
4. You have four med-surg patients. Which task is most appropriate to delegate to the
certified UAP?
A. Check PEG tube residual before intermittent feeding.
B. Record intake & output at the end of shift.
C. Perform blood glucose check for a symptomatic diabetic.
D. Reinforce teaching on incentive spirometry.
Correct Answer: B
Rationale: Standard, unchanging task within UAP scope; glucose check, assessment, and
teaching require licensed personnel.
5. A patient with DKA’s arterial blood gas shows pH 7.22, HCO₃ 14, PaCO₂ 32, K 3.2 mEq/L.
The provider orders an insulin gtt and 40 mEq KCl IV. What is the priority nursing action?
A. Start the insulin gtt immediately.
B. Verify the pharmacy sent a concentrated KCl vial.
C. Ensure patent second IV line for KCl using infusion pump.
D. Call the provider to question the KCl order.
Correct Answer: C
Rationale: Hypokalemia must be corrected to prevent lethal dysrhythmias once insulin
drives K⁺ intracellularly; safe high-alert medication administration is imperative.
6. During a rapid response, the team leader asks you to “draw a rainbow, place an 18-gauge
IV, and hang LR wide open.” You have never started an 18-gauge on an unstable patient.
Best response?
A. Attempt the IV but ask another nurse to watch you.
B. Say, “I am not comfortable; I will draw labs while you start the line.”
C. Ask the UAP to find the most experienced IV nurse.
D. Insert a 20-gauge instead because it is easier.
Correct Answer: B
Rationale: Advocacy for patient safety and honest self-assessment prevent delay and
harm; offers alternative within your scope.
7. A mother on postpartum day 1 tells you, “I’m exhausted; the baby cried all night. Maybe
I’m not cut out for this.” Your initial statement employs which component of clinical
judgment?
, A. Analysis
B. Cue recognition
C. Planning
D. Evaluation
Correct Answer: B
Rationale: The nurse first recognizes a cue that may indicate mood alteration or risk for
impaired attachment before further analysis.
8. Which statement best differentiates a nursing diagnosis from a medical diagnosis?
A. It identifies the disease the provider treats.
B. It focuses on client’s response to health conditions.
C. It predicts prognosis.
D. It requires physician approval.
Correct Answer: B
Rationale: Nursing diagnoses address human responses, guiding independent
interventions.
9. The charge nurse assigns you a new admit from ED with rule-out CVA, NIHSS 8, last
known normal 90 min ago. What additional information is most critical to determine
acceptability of assignment?
A. Whether tissue plasminogen activator (tPA) is pending.
B. If family is at bedside.
C. If CT showed hemorrhage.
D. Patient’s insurance status.
Correct Answer: A
Rationale: tPA requires intensive 1:1 monitoring for 24 h; determines acuity and staffing
need.
10. When using the IPSO (Intake, Prioritization, Staffing, Outcomes) model for shift
organization, the “Intake” step primarily involves:
A. Delegating tasks to LPN/UAP.
B. Gathering data on all assigned patients.
C. Communicating with providers.
D. Documenting outcomes.
Correct Answer: B
Rationale: Intake = data collection phase of clinical judgment.
11. A 5-year-old with asthma is receiving albuterol nebulizer q4h. After the treatment, HR
rises from 110 to 148 bpm. What is the priority action?
A. Hold next scheduled dose and call respiratory therapy.
, B. Document expected side effect and continue per order.
C. Call the provider to lower the dosage.
D. Apply oxygen at 2 L via NC.
Correct Answer: B
Rationale: Tachycardia is a common, non-life-threatening adverse effect; no evidence of
toxicity; holding therapy could worsen bronchospasm.
12. The surgeon writes, “Ambulate patient 100 ft TID.” While assisting, the patient says, “I
feel dizzy” and begins to fall. You lower him to the floor. After ensuring no injury, your
next action is:
A. Complete an incident report.
B. Obtain orthostatic vital signs.
C. Notify the provider.
D. Document fall risk score change.
Correct Answer: B
Rationale: Assess to identify etiology (hypotension, arrhythmia) before intervening
further.
13. Which finding in a patient 4 h post-percutaneous coronary intervention (PCI) via right
radial access warrants immediate notification of the provider?
A. 2-cm ecchymosis at sheath site.
B. Capillary refill 4 s, loss of pulse ox waveform on right index.
C. Patient reports mild chest “fullness.”
D. BP 138/78, HR 76.
Correct Answer: B
Rationale: Signs of arterial occlusion—limb-threatening emergency.
14. A patient with cirrhosis and ascites has new-onset asterixis. This is best classified as
which type of cue?
A. Secondary subjective
B. Secondary objective
C. Primary subjective
D. Primary objective
Correct Answer: D
Rationale: Observable, measurable data directly obtained by RN.
15. Which order is priority for a patient with active upper GI bleed and hemoglobin 6.8
g/dL?
A. Type & crossmatch 2 units PRBC.
B. Insert 18-gauge IV saline lock.
PRACTICE EXAM V2 2026/2027 | Verified Questions and
Answers | Distinct Clinical Scenarios from V1 | For
Specialized Certification & Board Review | Grade A
Target | Pass Guaranteed
SECTION I. Clinical Judgment & Decision-Making (1–20)
1. You are the night-shift RN receiving a 68-year-old post-op AAA repair patient from PACU.
VS: BP 88/52, HR 112, RR 24, SpO₂ 94% on 2 L NC, urine output 20 mL/hr for the last 2 h.
The patient is restless and reports “severe” abdominal pain (9/10) despite morphine 10
mg IV 45 min ago. What is your first action?
A. Administer the next ordered dose of morphine.
B. Increase the nasal cannula to 4 L/min.
C. Perform a focused abdominal and graft site assessment.
D. Call the surgeon to request a CT angiogram.
Correct Answer: C
Rationale: Restlessness + hypotension + severe pain are cues of possible graft
leak/hemorrhage. Before treating pain or escalating oxygen, the RN must gather
additional objective data (assessment) to differentiate causes and determine urgency.
2. Which cue best supports an inference of potential sepsis in a 78-year-old NH resident
with Alzheimer’s?
A. “Feels warm to touch” reported by CNA.
B. Temperature 38.9 °C (102 °F), WBC 16 000.
C. Patient pulling at IV line.
D. New-onset confusion since this morning.
Correct Answer: B
Rationale: Objective abnormal data (fever + leukocytosis) allows inference of systemic
inflammatory response; warmth is a subjective cue, confusion is nonspecific without
supporting data.
3. Using the ABC priority framework, which patient requires immediate RN intervention?
A. Chest-tube insertion site with intermittent bubbling in water-seal chamber.
B. Post-thyroidectomy patient whose trach ties are damp with serosanguinous drainage.
, C. Newly admitted CHF patient with bilateral 2+ pitting edema.
D. S/P appendectomy refusing PO pain med due to nausea.
Correct Answer: B
Rationale: Airway—potential airway compromise from post-op bleeding/hematoma
takes precedence.
4. You have four med-surg patients. Which task is most appropriate to delegate to the
certified UAP?
A. Check PEG tube residual before intermittent feeding.
B. Record intake & output at the end of shift.
C. Perform blood glucose check for a symptomatic diabetic.
D. Reinforce teaching on incentive spirometry.
Correct Answer: B
Rationale: Standard, unchanging task within UAP scope; glucose check, assessment, and
teaching require licensed personnel.
5. A patient with DKA’s arterial blood gas shows pH 7.22, HCO₃ 14, PaCO₂ 32, K 3.2 mEq/L.
The provider orders an insulin gtt and 40 mEq KCl IV. What is the priority nursing action?
A. Start the insulin gtt immediately.
B. Verify the pharmacy sent a concentrated KCl vial.
C. Ensure patent second IV line for KCl using infusion pump.
D. Call the provider to question the KCl order.
Correct Answer: C
Rationale: Hypokalemia must be corrected to prevent lethal dysrhythmias once insulin
drives K⁺ intracellularly; safe high-alert medication administration is imperative.
6. During a rapid response, the team leader asks you to “draw a rainbow, place an 18-gauge
IV, and hang LR wide open.” You have never started an 18-gauge on an unstable patient.
Best response?
A. Attempt the IV but ask another nurse to watch you.
B. Say, “I am not comfortable; I will draw labs while you start the line.”
C. Ask the UAP to find the most experienced IV nurse.
D. Insert a 20-gauge instead because it is easier.
Correct Answer: B
Rationale: Advocacy for patient safety and honest self-assessment prevent delay and
harm; offers alternative within your scope.
7. A mother on postpartum day 1 tells you, “I’m exhausted; the baby cried all night. Maybe
I’m not cut out for this.” Your initial statement employs which component of clinical
judgment?
, A. Analysis
B. Cue recognition
C. Planning
D. Evaluation
Correct Answer: B
Rationale: The nurse first recognizes a cue that may indicate mood alteration or risk for
impaired attachment before further analysis.
8. Which statement best differentiates a nursing diagnosis from a medical diagnosis?
A. It identifies the disease the provider treats.
B. It focuses on client’s response to health conditions.
C. It predicts prognosis.
D. It requires physician approval.
Correct Answer: B
Rationale: Nursing diagnoses address human responses, guiding independent
interventions.
9. The charge nurse assigns you a new admit from ED with rule-out CVA, NIHSS 8, last
known normal 90 min ago. What additional information is most critical to determine
acceptability of assignment?
A. Whether tissue plasminogen activator (tPA) is pending.
B. If family is at bedside.
C. If CT showed hemorrhage.
D. Patient’s insurance status.
Correct Answer: A
Rationale: tPA requires intensive 1:1 monitoring for 24 h; determines acuity and staffing
need.
10. When using the IPSO (Intake, Prioritization, Staffing, Outcomes) model for shift
organization, the “Intake” step primarily involves:
A. Delegating tasks to LPN/UAP.
B. Gathering data on all assigned patients.
C. Communicating with providers.
D. Documenting outcomes.
Correct Answer: B
Rationale: Intake = data collection phase of clinical judgment.
11. A 5-year-old with asthma is receiving albuterol nebulizer q4h. After the treatment, HR
rises from 110 to 148 bpm. What is the priority action?
A. Hold next scheduled dose and call respiratory therapy.
, B. Document expected side effect and continue per order.
C. Call the provider to lower the dosage.
D. Apply oxygen at 2 L via NC.
Correct Answer: B
Rationale: Tachycardia is a common, non-life-threatening adverse effect; no evidence of
toxicity; holding therapy could worsen bronchospasm.
12. The surgeon writes, “Ambulate patient 100 ft TID.” While assisting, the patient says, “I
feel dizzy” and begins to fall. You lower him to the floor. After ensuring no injury, your
next action is:
A. Complete an incident report.
B. Obtain orthostatic vital signs.
C. Notify the provider.
D. Document fall risk score change.
Correct Answer: B
Rationale: Assess to identify etiology (hypotension, arrhythmia) before intervening
further.
13. Which finding in a patient 4 h post-percutaneous coronary intervention (PCI) via right
radial access warrants immediate notification of the provider?
A. 2-cm ecchymosis at sheath site.
B. Capillary refill 4 s, loss of pulse ox waveform on right index.
C. Patient reports mild chest “fullness.”
D. BP 138/78, HR 76.
Correct Answer: B
Rationale: Signs of arterial occlusion—limb-threatening emergency.
14. A patient with cirrhosis and ascites has new-onset asterixis. This is best classified as
which type of cue?
A. Secondary subjective
B. Secondary objective
C. Primary subjective
D. Primary objective
Correct Answer: D
Rationale: Observable, measurable data directly obtained by RN.
15. Which order is priority for a patient with active upper GI bleed and hemoglobin 6.8
g/dL?
A. Type & crossmatch 2 units PRBC.
B. Insert 18-gauge IV saline lock.
