Advanced Nursing Practice &
Clinical Decision-Making
Examination 2026/2027
**Examination Description:** This examination focuses on advanced clinical reasoning, prioritization,
and evidence-based interventions across the lifespan. It integrates complex concepts from medical-
surgical nursing, critical care, pharmacology, mental health, and community health to prepare nursing
students for dynamic healthcare environments.
---
**Question 1**
,The nurse is caring for a client admitted with suspected meningitis. Which assessment finding is the
priority for immediate nursing intervention?
A. Complaints of a severe headache
B. Nuchal rigidity and photophobia
C. Temperature of 103.2°F (39.6°C)
D. Decreased level of consciousness
💫RATIONALE✔️✔️: A decreased level of consciousness is the most concerning finding as it indicates
increased intracranial pressure and potential cerebral edema, which can lead to herniation and death.
While fever, headache, and nuchal rigidity are classic signs of meningitis, changes in LOC represent a
deterioration in neurological status requiring immediate intervention.
💫ANSWER✔️✔️: D. Decreased level of consciousness
---
**Question 2**
A client with chronic kidney disease (CKD) has a potassium level of 6.5 mEq/L. Which intervention should
the nurse anticipate being prescribed?
A. Oral potassium supplements
B. Kayexalate (sodium polystyrene sulfonate)
C. Potassium-sparing diuretics
D. High-potassium diet
,💫RATIONALE✔️✔️: Kayexalate is a cation-exchange resin that binds potassium in the
gastrointestinal tract, promoting its excretion in the stool. This is a primary treatment for hyperkalemia
in clients with CKD. The other options would further elevate potassium levels.
💫ANSWER✔️✔️: B. Kayexalate (sodium polystyrene sulfonate)
---
**Question 3**
The nurse is providing discharge teaching to a client with a new diagnosis of heart failure. Which
statement indicates the client understands fluid restriction guidelines?
A. "I should limit my fluid intake to 3000 mL per day."
B. "I can drink as much fluid as I want as long as I take my diuretics."
C. "I should measure all liquids I drink and keep a daily log."
D. "Ice chips and popsicles don't count as fluid intake."
💫RATIONALE✔️✔️: Accurate measurement of all fluid intake, including liquids, ice chips, and
popsicles, is essential for clients on fluid restrictions. The typical restriction is 1500-2000 mL/day, not
3000 mL. Keeping a log promotes adherence and helps the healthcare provider adjust treatments.
💫ANSWER✔️✔️: C. "I should measure all liquids I drink and keep a daily log."
---
**Question 4**
, The nurse is assessing a client who has been diagnosed with bipolar disorder and is currently in a
depressive episode. Which of the following is a priority nursing diagnosis?
A. Risk for injury related to suicidal ideation
B. Imbalanced nutrition: less than body requirements
C. Chronic low self-esteem
D. Social isolation
💫RATIONALE✔️✔️: Safety is always the highest priority. Clients experiencing a depressive episode in
bipolar disorder are at significant risk for suicide. The nurse must first assess for suicidal ideation, plan,
or intent before addressing other concerns.
💫ANSWER✔️✔️: A. Risk for injury related to suicidal ideation
---
**Question 5**
A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client with
diabetes mellitus. Which action is correct?
A. Draw up the NPH insulin first, then the regular insulin.
B. Draw up the regular insulin first, then the NPH insulin.
C. Draw up each insulin in separate syringes.
D. Mix the insulins in a sterile medication cup before drawing up.
Clinical Decision-Making
Examination 2026/2027
**Examination Description:** This examination focuses on advanced clinical reasoning, prioritization,
and evidence-based interventions across the lifespan. It integrates complex concepts from medical-
surgical nursing, critical care, pharmacology, mental health, and community health to prepare nursing
students for dynamic healthcare environments.
---
**Question 1**
,The nurse is caring for a client admitted with suspected meningitis. Which assessment finding is the
priority for immediate nursing intervention?
A. Complaints of a severe headache
B. Nuchal rigidity and photophobia
C. Temperature of 103.2°F (39.6°C)
D. Decreased level of consciousness
💫RATIONALE✔️✔️: A decreased level of consciousness is the most concerning finding as it indicates
increased intracranial pressure and potential cerebral edema, which can lead to herniation and death.
While fever, headache, and nuchal rigidity are classic signs of meningitis, changes in LOC represent a
deterioration in neurological status requiring immediate intervention.
💫ANSWER✔️✔️: D. Decreased level of consciousness
---
**Question 2**
A client with chronic kidney disease (CKD) has a potassium level of 6.5 mEq/L. Which intervention should
the nurse anticipate being prescribed?
A. Oral potassium supplements
B. Kayexalate (sodium polystyrene sulfonate)
C. Potassium-sparing diuretics
D. High-potassium diet
,💫RATIONALE✔️✔️: Kayexalate is a cation-exchange resin that binds potassium in the
gastrointestinal tract, promoting its excretion in the stool. This is a primary treatment for hyperkalemia
in clients with CKD. The other options would further elevate potassium levels.
💫ANSWER✔️✔️: B. Kayexalate (sodium polystyrene sulfonate)
---
**Question 3**
The nurse is providing discharge teaching to a client with a new diagnosis of heart failure. Which
statement indicates the client understands fluid restriction guidelines?
A. "I should limit my fluid intake to 3000 mL per day."
B. "I can drink as much fluid as I want as long as I take my diuretics."
C. "I should measure all liquids I drink and keep a daily log."
D. "Ice chips and popsicles don't count as fluid intake."
💫RATIONALE✔️✔️: Accurate measurement of all fluid intake, including liquids, ice chips, and
popsicles, is essential for clients on fluid restrictions. The typical restriction is 1500-2000 mL/day, not
3000 mL. Keeping a log promotes adherence and helps the healthcare provider adjust treatments.
💫ANSWER✔️✔️: C. "I should measure all liquids I drink and keep a daily log."
---
**Question 4**
, The nurse is assessing a client who has been diagnosed with bipolar disorder and is currently in a
depressive episode. Which of the following is a priority nursing diagnosis?
A. Risk for injury related to suicidal ideation
B. Imbalanced nutrition: less than body requirements
C. Chronic low self-esteem
D. Social isolation
💫RATIONALE✔️✔️: Safety is always the highest priority. Clients experiencing a depressive episode in
bipolar disorder are at significant risk for suicide. The nurse must first assess for suicidal ideation, plan,
or intent before addressing other concerns.
💫ANSWER✔️✔️: A. Risk for injury related to suicidal ideation
---
**Question 5**
A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client with
diabetes mellitus. Which action is correct?
A. Draw up the NPH insulin first, then the regular insulin.
B. Draw up the regular insulin first, then the NPH insulin.
C. Draw up each insulin in separate syringes.
D. Mix the insulins in a sterile medication cup before drawing up.
