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RN Adult Health Competency Exam —
Code: RN-AH-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with acute decompensated heart failure develops severe dyspnea,
crackles throughout both lung fields, and an oxygen saturation of 82%
despite oxygen therapy. Which intervention should the nurse implement
first?
A. Administer IV furosemide
B. Place the client in high-Fowler's position
C. Obtain a 12-lead ECG
D. Restrict oral fluids
Answer: Place the client in high-Fowler's position.
,Rationale: Positioning upright decreases venous return and improves lung
expansion, providing immediate assistance with severe pulmonary congestion
while additional treatments are initiated.
2. A client with diabetic ketoacidosis is receiving IV regular insulin and isotonic
fluids. The serum potassium decreases from 5.6 mEq/L to 3.2 mEq/L. Which
action is most appropriate?
A. Increase the insulin infusion
B. Administer potassium replacement as prescribed
C. Discontinue all IV fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement as prescribed.
Rationale: Insulin drives potassium into cells, potentially causing dangerous
hypokalemia. Potassium must be replaced when levels fall, even though the
initial serum potassium may have been elevated.
3. A client with a traumatic head injury becomes increasingly restless and
develops a blood pressure of 178/58 mm Hg, pulse of 48/min, and irregular
respirations. Which complication should the nurse suspect?
A. Neurogenic shock
B. Increased intracranial pressure
C. Hypovolemic shock
D. Pulmonary embolism
Answer: Increased intracranial pressure.
Rationale: Hypertension with widened pulse pressure, bradycardia, and
irregular respirations represents Cushing's triad, a late sign of increased
intracranial pressure and impending neurologic deterioration.
4. A client receiving unfractionated heparin for a pulmonary embolism has a
platelet count that falls from 220,000/mm³ to 92,000/mm³. Which action is
the priority?
,A. Continue heparin and monitor the platelet count
B. Stop heparin and notify the provider
C. Administer vitamin K
D. Begin warfarin immediately
Answer: Stop heparin and notify the provider.
Rationale: A significant platelet decline during heparin therapy suggests
heparin-induced thrombocytopenia, a potentially life-threatening prothrombotic
disorder requiring immediate discontinuation of heparin.
5. A client with chronic obstructive pulmonary disease is receiving oxygen at 2
L/min by nasal cannula. The client becomes increasingly somnolent. Which
finding requires the most immediate evaluation?
A. Respiratory rate of 10/min
B. Productive cough
C. Oxygen saturation of 91%
D. Barrel-shaped chest
Answer: Respiratory rate of 10/min.
Rationale: New respiratory depression and somnolence may indicate worsening
hypercapnia and respiratory failure. Ventilation, rather than oxygen saturation
alone, must be assessed promptly.
6. A client with acute kidney injury has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which medication should the nurse anticipate
administering immediately?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide only
D. Oral potassium chloride
Answer: IV calcium gluconate.
, Rationale: IV calcium stabilizes the cardiac membrane and reduces the
immediate risk of fatal dysrhythmias in severe hyperkalemia with ECG changes.
It does not lower serum potassium but provides urgent cardiac protection.
7. A client with suspected bacterial meningitis is admitted to the emergency
department. Which infection-control measure is appropriate?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions only
D. Protective isolation
Answer: Droplet precautions.
Rationale: Bacterial meningitis caused by organisms such as Neisseria
meningitidis requires droplet precautions in addition to standard precautions,
particularly during the initial period of treatment.
8. A client with an acute myocardial infarction develops sudden pulmonary
edema. Which finding would indicate worsening left ventricular failure?
A. Distended neck veins
B. Crackles and pink frothy sputum
C. Peripheral cyanosis only
D. Increased bowel sounds
Answer: Crackles and pink frothy sputum.
Rationale: Pulmonary edema occurs when left ventricular failure causes blood to
back up into the pulmonary circulation, producing crackles, severe dyspnea, and
potentially pink frothy sputum.
9. A client taking digoxin has nausea, blurred or yellow vision, and an apical
pulse of 52/min. What should the nurse do?
A. Administer the medication with food
B. Hold digoxin and notify the provider
RN Adult Health Competency Exam —
Code: RN-AH-COMP | 100-Question
Advanced Practice Exam 2026 |
Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1. A client with acute decompensated heart failure develops severe dyspnea,
crackles throughout both lung fields, and an oxygen saturation of 82%
despite oxygen therapy. Which intervention should the nurse implement
first?
A. Administer IV furosemide
B. Place the client in high-Fowler's position
C. Obtain a 12-lead ECG
D. Restrict oral fluids
Answer: Place the client in high-Fowler's position.
,Rationale: Positioning upright decreases venous return and improves lung
expansion, providing immediate assistance with severe pulmonary congestion
while additional treatments are initiated.
2. A client with diabetic ketoacidosis is receiving IV regular insulin and isotonic
fluids. The serum potassium decreases from 5.6 mEq/L to 3.2 mEq/L. Which
action is most appropriate?
A. Increase the insulin infusion
B. Administer potassium replacement as prescribed
C. Discontinue all IV fluids
D. Administer sodium bicarbonate routinely
Answer: Administer potassium replacement as prescribed.
Rationale: Insulin drives potassium into cells, potentially causing dangerous
hypokalemia. Potassium must be replaced when levels fall, even though the
initial serum potassium may have been elevated.
3. A client with a traumatic head injury becomes increasingly restless and
develops a blood pressure of 178/58 mm Hg, pulse of 48/min, and irregular
respirations. Which complication should the nurse suspect?
A. Neurogenic shock
B. Increased intracranial pressure
C. Hypovolemic shock
D. Pulmonary embolism
Answer: Increased intracranial pressure.
Rationale: Hypertension with widened pulse pressure, bradycardia, and
irregular respirations represents Cushing's triad, a late sign of increased
intracranial pressure and impending neurologic deterioration.
4. A client receiving unfractionated heparin for a pulmonary embolism has a
platelet count that falls from 220,000/mm³ to 92,000/mm³. Which action is
the priority?
,A. Continue heparin and monitor the platelet count
B. Stop heparin and notify the provider
C. Administer vitamin K
D. Begin warfarin immediately
Answer: Stop heparin and notify the provider.
Rationale: A significant platelet decline during heparin therapy suggests
heparin-induced thrombocytopenia, a potentially life-threatening prothrombotic
disorder requiring immediate discontinuation of heparin.
5. A client with chronic obstructive pulmonary disease is receiving oxygen at 2
L/min by nasal cannula. The client becomes increasingly somnolent. Which
finding requires the most immediate evaluation?
A. Respiratory rate of 10/min
B. Productive cough
C. Oxygen saturation of 91%
D. Barrel-shaped chest
Answer: Respiratory rate of 10/min.
Rationale: New respiratory depression and somnolence may indicate worsening
hypercapnia and respiratory failure. Ventilation, rather than oxygen saturation
alone, must be assessed promptly.
6. A client with acute kidney injury has a potassium level of 6.8 mEq/L and
peaked T waves on the ECG. Which medication should the nurse anticipate
administering immediately?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide only
D. Oral potassium chloride
Answer: IV calcium gluconate.
, Rationale: IV calcium stabilizes the cardiac membrane and reduces the
immediate risk of fatal dysrhythmias in severe hyperkalemia with ECG changes.
It does not lower serum potassium but provides urgent cardiac protection.
7. A client with suspected bacterial meningitis is admitted to the emergency
department. Which infection-control measure is appropriate?
A. Airborne precautions
B. Droplet precautions
C. Contact precautions only
D. Protective isolation
Answer: Droplet precautions.
Rationale: Bacterial meningitis caused by organisms such as Neisseria
meningitidis requires droplet precautions in addition to standard precautions,
particularly during the initial period of treatment.
8. A client with an acute myocardial infarction develops sudden pulmonary
edema. Which finding would indicate worsening left ventricular failure?
A. Distended neck veins
B. Crackles and pink frothy sputum
C. Peripheral cyanosis only
D. Increased bowel sounds
Answer: Crackles and pink frothy sputum.
Rationale: Pulmonary edema occurs when left ventricular failure causes blood to
back up into the pulmonary circulation, producing crackles, severe dyspnea, and
potentially pink frothy sputum.
9. A client taking digoxin has nausea, blurred or yellow vision, and an apical
pulse of 52/min. What should the nurse do?
A. Administer the medication with food
B. Hold digoxin and notify the provider
