ADVANCED MEDICAL-SURGICAL
NURSING COMPETENCY EXAM
QUESTIONS AND ANSWERS
1. A client with a history of heart failure is prescribed digoxin. During the assessment, the
nurse notes the client reports seeing yellow halos around lights and has a heart rate of 48
beats per minute. Which action should the nurse take first?
A. Administer the next dose of digoxin as scheduled.
B. Hold the medication and notify the healthcare provider.
C. Document the findings as expected side effects.
D. Encourage the client to increase dietary potassium intake.
Answer: B
Conceptual Explanation: Visual changes such as yellow halos and significant bradycardia
are classic signs of digoxin toxicity. The medication must be held, and the provider must be
notified to assess serum levels.
2. A client is admitted with an acute exacerbation of Chronic Obstructive Pulmonary Disease
(COPD). The arterial blood gas (ABG) results show: pH 7.30, PaCO2 58 mmHg, and HCO3 26
mEq/L. How should the nurse interpret these results?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: A low pH (below 7.35) indicates acidosis, and an elevated PaCO2
(above 45 mmHg) indicates a respiratory cause. The normal bicarbonate level suggests the
body has not yet compensated.
3. The nurse is caring for a client who is 24 hours post-operative following a total hip
arthroplasty. Which assessment finding requires immediate intervention?
A. Pain level of 4 on a scale of 0 to 10.
B. Decreased range of motion in the affected hip.
C. Serosanguinous drainage on the surgical dressing.
D. Sudden onset of shortness of breath and chest pain.
Answer: D
Conceptual Explanation: Sudden respiratory distress and chest pain following orthopedic
surgery are highly suggestive of a pulmonary embolism, which is a life-threatening
complication requiring immediate action.
, 4. A client with Type 1 Diabetes Mellitus presents to the emergency department with a blood
glucose of 600 mg/dL and fruity-smelling breath. Which intravenous fluid should the nurse
anticipate administering first?
A. 0.9% Sodium Chloride
B. 5% Dextrose in 0.45% Sodium Chloride
C. 3% Sodium Chloride
D. 5% Dextrose in Water
Answer: A
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is rehydrating the
intravascular space. 0.9% Sodium Chloride (Isotonic) is the fluid of choice for initial
resuscitation.
5. Which clinical manifestation should the nurse expect to find in a client diagnosed with
Cushing’s Syndrome?
A. Trunkal obesity and a buffalo hump.
B. Hyperpigmentation of the skin.
C. Weight loss and hypotension.
D. Increased muscle mass in the extremities.
Answer: A
NURSING COMPETENCY EXAM
QUESTIONS AND ANSWERS
1. A client with a history of heart failure is prescribed digoxin. During the assessment, the
nurse notes the client reports seeing yellow halos around lights and has a heart rate of 48
beats per minute. Which action should the nurse take first?
A. Administer the next dose of digoxin as scheduled.
B. Hold the medication and notify the healthcare provider.
C. Document the findings as expected side effects.
D. Encourage the client to increase dietary potassium intake.
Answer: B
Conceptual Explanation: Visual changes such as yellow halos and significant bradycardia
are classic signs of digoxin toxicity. The medication must be held, and the provider must be
notified to assess serum levels.
2. A client is admitted with an acute exacerbation of Chronic Obstructive Pulmonary Disease
(COPD). The arterial blood gas (ABG) results show: pH 7.30, PaCO2 58 mmHg, and HCO3 26
mEq/L. How should the nurse interpret these results?
A. Metabolic Acidosis
,B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: A low pH (below 7.35) indicates acidosis, and an elevated PaCO2
(above 45 mmHg) indicates a respiratory cause. The normal bicarbonate level suggests the
body has not yet compensated.
3. The nurse is caring for a client who is 24 hours post-operative following a total hip
arthroplasty. Which assessment finding requires immediate intervention?
A. Pain level of 4 on a scale of 0 to 10.
B. Decreased range of motion in the affected hip.
C. Serosanguinous drainage on the surgical dressing.
D. Sudden onset of shortness of breath and chest pain.
Answer: D
Conceptual Explanation: Sudden respiratory distress and chest pain following orthopedic
surgery are highly suggestive of a pulmonary embolism, which is a life-threatening
complication requiring immediate action.
, 4. A client with Type 1 Diabetes Mellitus presents to the emergency department with a blood
glucose of 600 mg/dL and fruity-smelling breath. Which intravenous fluid should the nurse
anticipate administering first?
A. 0.9% Sodium Chloride
B. 5% Dextrose in 0.45% Sodium Chloride
C. 3% Sodium Chloride
D. 5% Dextrose in Water
Answer: A
Conceptual Explanation: In Diabetic Ketoacidosis (DKA), the priority is rehydrating the
intravascular space. 0.9% Sodium Chloride (Isotonic) is the fluid of choice for initial
resuscitation.
5. Which clinical manifestation should the nurse expect to find in a client diagnosed with
Cushing’s Syndrome?
A. Trunkal obesity and a buffalo hump.
B. Hyperpigmentation of the skin.
C. Weight loss and hypotension.
D. Increased muscle mass in the extremities.
Answer: A
