RN Emergency Nursing Competency
Exam — Code: RN-ER-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A patient arrives in the emergency department after a high-speed motor vehicle
collision. The patient is restless, has a respiratory rate of 32/min, oxygen
saturation of 89%, and asymmetric chest expansion. Breath sounds are absent on
the left, and the trachea appears deviated to the right. Which intervention should
the nurse anticipate immediately?
A. Obtain a portable chest radiograph
B. Prepare for needle or finger thoracostomy
C. Administer IV furosemide
D. Place the patient in Trendelenburg position
Answer: B. Prepare for needle or finger thoracostomy
,Rationale: Tension pneumothorax is a clinical emergency. Severe respiratory
compromise with unilateral absent breath sounds and mediastinal shift requires
immediate decompression rather than waiting for imaging.
2.
A patient with suspected septic shock has received an initial crystalloid bolus but
remains hypotensive with a MAP of 58 mmHg. Which medication should the
nurse expect to administer next?
A. Dobutamine
B. Norepinephrine
C. Furosemide
D. Nitroglycerin
Answer: B. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for persistent
hypotension after adequate initial fluid resuscitation in septic shock.
3.
A patient presents with crushing substernal chest pain, diaphoresis, and ST-
segment elevation. Which action has the highest priority after immediate
assessment and cardiac monitoring?
A. Encourage ambulation
B. Administer aspirin if not contraindicated
C. Obtain a fasting lipid panel
D. Schedule an outpatient stress test
Answer: B. Administer aspirin if not contraindicated
Rationale: Early aspirin administration reduces platelet aggregation and
mortality in suspected acute coronary syndrome unless a contraindication such
as active major bleeding or true severe allergy exists.
4.
,A patient receiving alteplase for an acute ischemic stroke suddenly develops
severe headache, vomiting, and a rapid decline in level of consciousness. What is
the nurse's priority?
A. Continue the infusion and reassess in 30 minutes
B. Administer oral aspirin
C. Stop the thrombolytic therapy and notify the stroke team immediately
D. Lower the patient's head below heart level
Answer: C. Stop the thrombolytic therapy and notify the stroke team
immediately
Rationale: Sudden neurologic deterioration and severe headache during
thrombolysis suggest intracranial hemorrhage. The thrombolytic should be
stopped and emergency evaluation initiated.
5.
A patient with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L before
insulin therapy begins. Which action is most appropriate?
A. Start insulin immediately
B. Administer potassium replacement before insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: B. Administer potassium replacement before insulin
Rationale: Insulin shifts potassium intracellularly and can precipitate life-
threatening hypokalemia. When potassium is significantly low, replacement is
required before insulin is started.
6.
A patient with suspected opioid overdose has a respiratory rate of 6/min and
pinpoint pupils. Which intervention is the immediate priority?
, A. Obtain a urine toxicology screen
B. Initiate assisted ventilation and administer naloxone
C. Administer activated charcoal
D. Place the patient in a sitting position
Answer: B. Initiate assisted ventilation and administer naloxone
Rationale: Respiratory failure is the immediate threat. Airway support and
ventilation take priority while naloxone reverses opioid-induced respiratory
depression.
7.
A patient with an inferior STEMI develops hypotension, clear lung sounds, and
jugular venous distention. Which complication should the nurse suspect?
A. Left ventricular failure
B. Right ventricular infarction
C. Acute pulmonary edema
D. Cardiac tamponade from trauma
Answer: B. Right ventricular infarction
Rationale: Inferior myocardial infarction can involve the right ventricle.
Hypotension, elevated jugular venous pressure, and clear lungs are classic
findings.
8.
A trauma patient becomes increasingly hypotensive and tachycardic after a pelvic
fracture. The abdomen is soft, but the pelvis is unstable. Which intervention is
most appropriate?
A. Encourage oral fluids
B. Apply a pelvic binder
C. Place the patient in a high-Fowler position
D. Delay stabilization until CT imaging is completed
Exam — Code: RN-ER-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A patient arrives in the emergency department after a high-speed motor vehicle
collision. The patient is restless, has a respiratory rate of 32/min, oxygen
saturation of 89%, and asymmetric chest expansion. Breath sounds are absent on
the left, and the trachea appears deviated to the right. Which intervention should
the nurse anticipate immediately?
A. Obtain a portable chest radiograph
B. Prepare for needle or finger thoracostomy
C. Administer IV furosemide
D. Place the patient in Trendelenburg position
Answer: B. Prepare for needle or finger thoracostomy
,Rationale: Tension pneumothorax is a clinical emergency. Severe respiratory
compromise with unilateral absent breath sounds and mediastinal shift requires
immediate decompression rather than waiting for imaging.
2.
A patient with suspected septic shock has received an initial crystalloid bolus but
remains hypotensive with a MAP of 58 mmHg. Which medication should the
nurse expect to administer next?
A. Dobutamine
B. Norepinephrine
C. Furosemide
D. Nitroglycerin
Answer: B. Norepinephrine
Rationale: Norepinephrine is the preferred first-line vasopressor for persistent
hypotension after adequate initial fluid resuscitation in septic shock.
3.
A patient presents with crushing substernal chest pain, diaphoresis, and ST-
segment elevation. Which action has the highest priority after immediate
assessment and cardiac monitoring?
A. Encourage ambulation
B. Administer aspirin if not contraindicated
C. Obtain a fasting lipid panel
D. Schedule an outpatient stress test
Answer: B. Administer aspirin if not contraindicated
Rationale: Early aspirin administration reduces platelet aggregation and
mortality in suspected acute coronary syndrome unless a contraindication such
as active major bleeding or true severe allergy exists.
4.
,A patient receiving alteplase for an acute ischemic stroke suddenly develops
severe headache, vomiting, and a rapid decline in level of consciousness. What is
the nurse's priority?
A. Continue the infusion and reassess in 30 minutes
B. Administer oral aspirin
C. Stop the thrombolytic therapy and notify the stroke team immediately
D. Lower the patient's head below heart level
Answer: C. Stop the thrombolytic therapy and notify the stroke team
immediately
Rationale: Sudden neurologic deterioration and severe headache during
thrombolysis suggest intracranial hemorrhage. The thrombolytic should be
stopped and emergency evaluation initiated.
5.
A patient with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L before
insulin therapy begins. Which action is most appropriate?
A. Start insulin immediately
B. Administer potassium replacement before insulin
C. Administer sodium bicarbonate routinely
D. Restrict IV fluids
Answer: B. Administer potassium replacement before insulin
Rationale: Insulin shifts potassium intracellularly and can precipitate life-
threatening hypokalemia. When potassium is significantly low, replacement is
required before insulin is started.
6.
A patient with suspected opioid overdose has a respiratory rate of 6/min and
pinpoint pupils. Which intervention is the immediate priority?
, A. Obtain a urine toxicology screen
B. Initiate assisted ventilation and administer naloxone
C. Administer activated charcoal
D. Place the patient in a sitting position
Answer: B. Initiate assisted ventilation and administer naloxone
Rationale: Respiratory failure is the immediate threat. Airway support and
ventilation take priority while naloxone reverses opioid-induced respiratory
depression.
7.
A patient with an inferior STEMI develops hypotension, clear lung sounds, and
jugular venous distention. Which complication should the nurse suspect?
A. Left ventricular failure
B. Right ventricular infarction
C. Acute pulmonary edema
D. Cardiac tamponade from trauma
Answer: B. Right ventricular infarction
Rationale: Inferior myocardial infarction can involve the right ventricle.
Hypotension, elevated jugular venous pressure, and clear lungs are classic
findings.
8.
A trauma patient becomes increasingly hypotensive and tachycardic after a pelvic
fracture. The abdomen is soft, but the pelvis is unstable. Which intervention is
most appropriate?
A. Encourage oral fluids
B. Apply a pelvic binder
C. Place the patient in a high-Fowler position
D. Delay stabilization until CT imaging is completed
